Data Needed if currently Fully Insured without claim data (Small Group Market)

  • Member Level Census REQUIRED, and to include (must have these elements, no middle initials or suffix):
    • First Name
    • Last Name
    • Gender (M/F)
    • Date of Birth (MM/DD/YYYY)
    • Zip Code (5 digit)
    • State (XX)
    • 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)
    • Plan Election (if more than one plan must be included)
    • Retiree Indicator (Y/N)
  • 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, please send in Schedule of Benefits and note any requested future plan changes

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