Instructions for Obtaining a Quote for Groups of 6 or more eligible employees
Information Requirements:

HMO/POS/PPO 6-50 Eligible Employees

1. Account name, address, phone number and ZIP code
2. Type of Business
3. Employee Census Date
   • Total # of employees
   • Total # of employees eligible for benefits
   • Total # of employees participating in Health Benefits
   • For each employee include age, coverage status and zip code
4. Rate and Carrier History, including upcoming renewal rates
5. Current Plan of Benefits and any historic plan changes

HMO/POS/PPO 51- 99 Eligible Employees

1. Account name, address, phone number and ZIP code
2. Type of Business
3. Employee Census Date
   • Total # of employees
   • Total # of employees eligible for benefits
   • Total # of employees participating in Health Benefits
   • For each employee include age and gender, coverage status and zip code
4. Rate and Carrier History, including upcoming renewal rates
5. Current Plan of Benefits and any historic plan changes

HMO/POS/PPO 100 Plus Eligible Employees

1. Account name, address, phone number and ZIP code
2. Type of Business
   • Employee Census Date
   • Total # of employees
   • Total # of employees eligible for benefits
   • Total # of employees participating in Health Benefits
   • For each employee include age and gender, coverage status and zip code
3. Rate and Carrier History, including upcoming renewal rates
4. Current Plan of Benefits and any historic plan changes
5. Most recent 24 months of claims experience
6. Shock Claims greater than $10,000 for Most Recent 24 months of claims experience
7. Average number of lives for most recent 24 months of claims experience

HNE Underwriting Department reserves the right to request additional information on any group. The guidelines here do not constitute a guarantee of coverage to any group.