What do we need to quote?  That depends.
If you are moving your client from fully insured to self insured, we would hope to receive the following:
  • Census of Current Eligible Population.
  • Two Years of Enrollment History – Month by Month.
  • Two or three years of renewal history.
  • Current benefits summaries.
  • Large Claim information, if possible.
  • Any insight into any large claimants you may be aware of.
If your client or prospect is currently self funded, that changes things significantly.  In such a situation, at a minimum we would require:
  • Census
  • Copy of current SPD
  • Copy of current plan design
  • High Dollar Claimants – Over 20k for last 2 plan years
  • Month by Month Total Claims for last 2 or 3 plan years
  • Month by Month Total Rx Claims for last 2 or 3 plan years
If possible, since we are data nerds, we would also request:
  • Network Utilization by Plan Year
  • EE vs. Dep. Claims by
  • EE vs. Dep Claims by division by plan by month
  • Network Utilization By Plan year
  • PPO Savings By Plan year
  • Specific Services (by division/plan if necessary)
  • Information on Lab/X-ray in a separate email
Don’t be overwhelmed!  We are often presented with situations where have to work with what we have.  If you are concerned you may not have everything we list above, please just give us a call to chat about it.