WHAT TO SUBMIT FOR A SELF-FUNDED HEALTH PLAN QUOTE
► Excluding participants' names, a group census including each employee’s gender, date of birth, residential zip code and coverage (single/family status).
► Group premium and claims experience for a period of 2-3 years.
► A copy of the Summary of Benefits coverages.
► Specifications may be filled in the form or sent to Kevin Gannon (716-427-7745) at firstname.lastname@example.org.