QUOTE REQUIREMENTS

In order to process your request for a quote rapidly and accurately, please forward the following at your earliest convenience:

For Specific Excess:

1.	Name of Account; include city, state and zip code to site group.
2.	Contact person, phone number and email address.
3.	Our minimum is $25,000 Specific deductible with 50 employees covered under the plan(s) to be quoted.
4.	Age/Gender band report which shows type of coverage (individual/family). If a band report is not available, complete census showing age/date of birth, gender, individual/family coverage selection in electronic format.
5.	Please include the zip code breakdown if you have multiple locations and describe nature of business (SIC Code).
6.	Large loss reports which show current contract year and previous contract year claims in excess of 50% of the specific deductible including to/from paid dates and diagnosis/prognosis.
7.	A copy of the self-funded plan document(s) or plan summary(s) of benefits, name of current TPA, and name(s) of current networks (PPO or HMO).
8.	Current stop loss rates, deductible level, contract type (i.e., 12/12, 12/15, 15/12, PAID, etc.), current carrier and any contract limitations or exclusions.
9.	If specific coverage is to include other products (dental, vision, prescription drugs), please note that and include relevant plan documents and that historical claims data.
10.	State quote requirements, effective date, requested deductibles, contract types, maximum liability and quote deadline.

For Aggregate Excess:

1.	Loss corridor you want quoted (i.e., 120%, 125%, etc.).
2.	Type of Contract you want (i.e., 12/12, 12/15, 15/12, PAID, etc.).
3.	Monthly paid claims and enrollment for the current and prior contract years.
4.	Current aggregate attachment factors, contract type (i.e., 12/12, 12/15, 15/12, PAID, etc.) and premium rate.
5.	If coverage is for additional products (dental, vision, prescription drugs), please note that and include that historical claims data as well.