Required Information for Self-Funded Proposal

• Renewal or Effective Date
• Copy of Current Plan Document(s)/Amendments or SBC.
• Employee Census/Current Census

              - Name, Age or DOB, Sex, Zip Code, Coverage Status
                (active, waiving or in waiting period, (Employee, employee/spouse,
                employee/child or family coverage)

• Multiple Plans: Census must be broken down by plan coverage.
• Minimum two years of claims data

              - Month by month by Coverage (Medical & Rx)

• Top claimants in excess of $25,000 paid claims under two year of history.  A diagnosis with a prognosis is critical.
• Most current 50% stop-loss report and previous contract year's final 50% stop-loss report.
• Current stop-loss contract rates and renewal rates.
• Network Being Utilized.

Standard turnaround time for a complete proposal by SecureOne, which will include the stop-loss carriers, is ten (10) working days.

SecureOne stop-loss carriers have a minimum AM Best rating of A- or higher.