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We value you as a broker and request that you send the following information for a Self-Funded Quote.  Please click our contact link  and select our Marketing Department should you have any further questions.

A complete, up-to-date census including:





Zip Code/location – if there are multiple locations.

Current and renewal rates (specific and aggregate) and factors.

3 Year Carrier History (Monthly Aggregate Report if available).

PPO or Non-PPO. If PPO, do you have preference?

Schedule of Benefits. Note any anticipated plan changes.

ALL large claims, from $10,000 or lower if expected to be a major claim. Include diagnosis and prognosis. List anyone who is on the transplant waiting list, or being evaluated for a transplant.

Is there a Drug Card? If so, who is the plan with and what is the co-pay?

Upon receipt of this information, we will review and obtain quote for your account.

If you have any questions, please contact our office. Thank you for this opportunity to be of service to you and your employees.

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