• Group
  • Networks/Repricing
  • Stop Loss
  • Employee Benefit Plans
  • Attachments & Notes
  • Submit
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Groups

To obtain quotes, carriers and MGUs require basic information about the group (also known as the plan sponsor). Required information includes the group name and industry classification code.

Upload the group's census
About uploading a census

A census is required for all quote requests. The uploaded census must follow the required format.

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Policy dates and deadlines
Policy Effective Date
The start date of the benefit plan.
Policy Termination Date
The end date of the benefit plan.
Final Proposals Due
Indicates when final proposals are due to your organization.

Please choose from the following networks or repricing:

Requested Stop Loss Plan Designs
Change Stop Loss Options
Prescription Drug Coverage Options
Specific Includes Rx Coverage? - Yes
Aggregate Includes Rx Coverage? - Yes
Plan Name Spec Deductible Spec Contract Aggregating Spec Deductible Agg Contract Agg Corridor Commission
35k: 12-12 $35,000 12/12 $0 12/12 1.20 0.00%
35k: 12-18 $35,000 12/18 $0 12/18 1.20 0.00%
40k: 12-12 $40,000 12/12 $0 12/12 1.20 0.00%
40k: 12-18 $40,000 12/18 $0 12/18 1.20 0.00%
45k: 12-12 $45,000 12/12 $0 12/12 1.20 0.00%
45k: 12-18 $45,000 12/18 $0 12/18 1.20 0.00%
50k: 12-12 $50,000 12/12 $0 12/12 1.20 0.00%
50k: 12-18 $50,000 12/18 $0 12/18 1.20 0.00%
55k: 12-12 $55,000 12/12 $0 12/12 1.20 0.00%
55k: 12-18 $55,000 12/18 $0 12/18 1.20 0.00%
60k: 12-12 $60,000 12/12 $0 12/12 1.20 0.00%
60k: 12-18 $60,000 12/18 $0 12/18 1.20 0.00%
65k: 12-12 $65,000 12/12 $0 12/12 1.20 0.00%
65k: 12-18 $65,000 12/18 $0 12/18 1.20 0.00%
75k: 12-12 $75,000 12/12 $0 12/12 1.20 0.00%
75k: 12-18 $75,000 12/18 $0 12/18 1.20 0.00%
Requested Employee Benefit Plans
Plan Name Deductible Coinsurance OOP Maximum OOP Includes
Deductible?		 Rx Copay
(Generic)		 Rx Copay
(Formulary)		 Rx Copay
(Non-Formulary)		 Rx Covers
Specialty?		 Rx Copay
(Specialty)
Plan 1 In: $250
Out: $500		 In: 80%
Out: 60%		 In: $2,000
Out: $4,000		 In: Yes
Out: Yes		 $0 $25 $50 Yes $200
Plan 2 In: $500
Out: $1,000		 In: 80%
Out: 60%		 In: $3,000
Out: $6,000		 In: Yes
Out: Yes		 $0 $25 $50 Yes $200
Plan 3 In: $1,500
Out: $3,000		 In: 80%
Out: 60%		 In: $3,500
Out: $7,000		 In: Yes
Out: Yes		 $0 $25 $50 Yes $200
Plan 4 In: $2,000
Out: $4,000		 In: 80%
Out: 60%		 In: $5,000
Out: $10,000		 In: Yes
Out: Yes		 $0 $35 $70 Yes $300
Plan 5 In: $3,500
Out: $7,000		 In: 80%
Out: 60%		 In: $5,000
Out: $10,000		 In: Yes
Out: Yes		 $0 $0 $0 Yes $300
Plan 6 In: $5,000
Out: $10,000		 In: 70%
Out: 50%		 In: $6,000
Out: $12,000		 In: Yes
Out: Yes		 $0 $0 $0 Yes $300
Plan 7 In: $0
Out: $2,000		 In: 100%
Out: 75%		 In: $5,000
Out: $5,000		 In: Yes
Out: Yes		 $10 $25 $50 Yes $200
Attachments Upload any attachment such as claims experience (if available), case management history or anything else.
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Quote Request Notes Add any notes regarding the quote request below to provide the quote request recipient with additional information.
Quote Request Recipients
You will receive instant quotes from our partners for the PPOs or repricing listed below.
Quoting Partner Networks or Repricing
Prodigy Health Insurance logo Prodigy Health Insurance
  • First Choice Health Plans of Mississippi
Fees
The fees listed below will be added to the proposal.
Fee Type Amount
TPA, PPO, PBM, Service Providers PEPM This fee is editable
Broker Fee PEPM This fee is editable