Corporate Benefits Solution, LLC About Us

Corporate Benefits Solution, LLC

Online Quote - Group That Is Currently Self-Funded

Bid Specifications

Company Legal Name:
Total Number of Eligible Employees:
Total Number of Enrolled Employees:
Street Address:
City:
State:

Zipcode:

Nature of Business:
Date Quote Needed:
Anniversary / Renewal Date:
Proposed Effective date:

Current Vendors, Rates and Factors

Current Stop Loss Carrier:

Current and Requested Specific Deductibles:
1. $
2. $
3. $

Current Rates:
Specific Contact:
Aggregate Contact:

Specific Coverages: (Check all that apply)
Include Medical RX
Aggregate Coverages: (Check all that apply)
Include Medical RX Dental Vision STD etc.

Optional Coverage

Specific Advance included?
Yes No

Aggregate Accommodation Included?
Yes No

Any Lasers Included?
Yes No
If Yes, provide detail on medical condition.

Current Specific Premium Rates:
Single/Family:
Single Family
3-Tier:
EE EE + 1 EF
4-Tier:
EE EC ES EF
Current Aggregated Premium Rates:
Single/Family:
Single Family
3-Tier:
EE EE + 1 EF
4-Tier:
EE EC ES EF
Current Aggregate Factors:
Single/Family:
Single Family
3-Tier:
EE EE + 1 EF
4-Tier:
EE EC ES EF
Renewal Rates and Factors as soon as available:
Yes No

Current 50% Specific Report for Current year and two prior plan years:

Current Aggregate report including month-to-month claims, enrollment for the current year and two prior plan years:

Current Large Claimants (or claimants having a diagnosis that could lead to a large claim)

Current case management report including diagnosis/Prognosis Information:

Broker Info

Quoting Broker:
Broker of Record:
What level of Commissions are Included in Current Rates:
Producer Commissions Requirements:

Census

Provide Current Census in Microsoft Excel or Word Format:
• Date of Birth
• Gender
• Dependent Elections (EE, EE+SP, EE+CH, EE+FAM)
• Multiple Plans (Please include identifier)
• Multiple Locations (Please include location identifier)
• Zip Codes