Data Needed: If currently level funded or have claim data available

Level Funded or Fully Insured (Monthly Claims Data Available)

  • Member Level Census to include (must have these elements):
    • First Name
    • Last Name
    • SSN (required for groups with 5-15 employees, optional for groups with 16+ employees)
    • Gender (M/F)
    • Dat of Birth (MM/DD/YYYY)
    • Home Address Including Zip Code (5 digit)
    • Subscriber Relationship (Subscriber, Spouse, Child, Legal Dependent)
    • Tier Election (EE Only, EE+Spouse, EE+Child(ren, Family, Waived, Waiting Period, Not Eligible, Refusing Coverage)
    • COBRA Indicator (Y/N)
    • State (XX)
    • Plan Election 
    • Retiree Indicator (if applicable)

  • Renewal Year + 2 Prior Year Rates (must include a copy of the Carrier renewal proposal for each year)
  • Current and Renewal Year Plan Design Details (including any requested future changes) - Schedule of Benefits is preferred

  • Claims data to include:
    • Minimum 12 months of Monthly Medical/Rx Claims Data, by Plan Year
    • Monthly Enrollment Data that matches up with medical/Rx data, by Plan Year
    • Large claims data, including diagnosis information, that coincides with the monthly data (should cover same time periods as monthly data)


Enter the information above into the form below and send your data contents as specified by group size to CAM@varipro.com