PUP-AF Employees 100-150

• No Individual Health Questionnaires
• Complete Proposal Request Form
• Census with the following minimum information for all enrolling members (including dependents):
  • ​First Name
  • Last Name
  • Date of Birth
  • Full Address
  • Coverage Tier (EE, ES, EC, or EF)
  • Noted if they are enrolling, waiving or in waiting period.
  • Date of Hire 
  • Noted if employee (or dependents) are on COBRA or in the COBRA waiting period.
• Current SBC or benefit summary for all plans the group currently offers.
• Current / Renewal Rates
• Claims Experience
  • ​Current year based upon effective date, not a rolling 12 months.
  • Previous years complete claims experience, based upon effective date, not a rolling 12 months.
  • Current individual claimants, in excess of $25,000, with diagnosis.
  • Previous year individual claimants, in excess of $25,000, with diagnosis.
  • Minimum required participation is 40% of all eligible full-time employees.
  • Employers must contribute a minimum of 40% of the employee cost.
  • Compensation is a minimum of $40 PEPM; lower or higher levels must be requested in writing.​

Once all required information is received, please allow 5-7 business days for proposal outcome.​

• Possible Proposal Outcomes
  • ​Preliminary Firm Rates
    • ​A final enrollment census, with most recent wage & tax statement, will determine final rate outcome.
    • Should five (5) or more additional members be added from the original census submitted, the group will be reevaluated within our database underwriting. Upon completion of the updated underwriting, a final outcome will be determined.
  • Declination