Single Source Self-Funding:

Requesting a Quote

Required Information

The following 5 categories are required for a Single Source Self-Funding quote.

Better information from you means better quotes back to you. We recognize getting information on fully-insured clients can be difficult. Talk with us if you don’t have some of the information, especially the claims reporting. We will work out an approach with you.

Download the checklist to help in gathering the needed information.

1. Client Information

  • Legal name
  • Address
  • Nature of business and SIC

2. Census

  • Sex
  • Date of Birth
  • Home Zip Code
  • Coverage status (such as Single or Family)

3. Claims reporting

  • Most recent year-to-date and previous year reporting package. Ideally this will include:
    • Loss ratio (claims and admin versus premium paid)
    • Top provider listing:
      • Provider tax-ID
      • Provider name
      • Total billed and paid charges by provider
    • Breakdown of claims spend by major categories
    • Rx utilization metrics (mail use, Retail 90 use, generic utilization)
  • Month by Month Claims Paid Report
    • Up to 36 months of data if possible
    • List the month, the amount of claims paid for the group in that month, and the total number of covered employees for that month.
  • Shock or Catastrophic Claims Information
    • Up to 36 months of data if possible
    • List any individual who has had a serious diagnosis, and/or who has had claims paid over a set dollar amount
    • Include amount paid for each year, the diagnosis, and the current condition/prognosis.

4. Plan Benefit Information

  • A copy  of the plan certificate and SBC for each plan offered

5. Rate History

  • Current rates
  • Prior two years rate history
  • Upcoming renewal rates (if available)

If you’d prefer to send the required information through email, contact us at SingleSource@the-alliance.org.

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