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ACCG Insurance

Data Required for Medical Quote

Required Item Sample Sources
  • Plan design (Prior year and current)
  • Booklets/SPDs
  • Benefit summaries or SBCs
  • Annual enrollment guides
  • Renewal
  • Rates (Prior year, current, renewal)
  • Most recent bill (current rates)
  • Current year renewal package (current and renewal rates)
  • Prior year final/accepted renewal (prior year)
  • COBRA packet (current rates)
  • Contributions
  • Annual enrollment/new hire guide
  • 24 months of claims, enrollment and premium reported monthly
  • Carrier report from online system
  • Billing/invoice report from carrier system (enrollment and premium only)
  • Renewal package
  • 24 months of large claimant (over $25K) information with the following details:
    • Member gender
    • Member age/dob
    • Diagnosis
    • Member type (EE, spouse, child)
    • Separation of medical/rx claim amounts
  • Carrier report from online system
  • Renewal package
  • Payroll system
  • Carrier system (enrollment report/census)
  • Self insured only: Current and renewal stop loss terms (i.e. rates, levels, term, lasers)
  • Stop loss renewal
  • Stop loss policy
  • Self insured only: Current and renewal administrative terms (i.e. fees, services)
  • Administrative fee renewal
  • Administrative agreement

Contacts:

Ben Pittarelli, Health Program and Insurance Marketing Director, at (404) 522-5022 or bpittarelli@accg.org
Joe Dan Thompson, Marketing and Field Service Representative, at (404) 522-5022 or jthompson@accg.org

ACCG Insurance Programs Partners


Contact ACCG Claims
TEL: 404.614.2553 | 877.421.6298
FAX: 678.225.4240 | 888.221.4079
WORKERS COMP: ahixon@accg.org
IRMA: ldjomeni@accg.org