Quotation Request

Thank You for your interest in purchasing seCUREme!

Each seCUREme product will require your Broker to request a quotation. Each quotation request must be submitted with the defined information as per the products below.

seCUREme CATASTROPHIC COVERAGE

For Individuals or groups of 1-4.

• Rates are fixed and based on Single, Couple or Family status
• Rates are guaranteed for12 months from Policy Date.
• Renewal rates will be based on the performance of the seCUREme Catastrophic Coverage pool.

Please submit the following:

1. Application for Quotation – seCUREme  Castastrophic Coverage
2. For Individuals who have had individual stand-alone coverage through an Insurance Company, please submit most recent proof of coverage such as a billing statement, to accommodate Grandfathering.
3. For Individuals or groups of 1-4 who have been covered through a Group Benefit Plan, please submit Name of Past Employer, Insurance Carrier and Group Policy Number to accommodate Grandfathering.
4. For Individuals or groups of 1-4 who have been covered through a Group Benefit Plan, please submit a copy of your current benefit coverage or group benefit booklet to accommodate Grandfathering.

When all your information has been compiled and your Application for Quotation completed, please forward to: [email protected]

We will have your quotation back to you within 48 hours of receipt!

seCUREme STOP LOSS INSURANCE

For Groups of 5 employees or more

• Rates are Grouped and start at a Base Rate.
• Rates may fluctuate due to experience submitted.
• Rates are guaranteed for 12 months.
• Renewals will be based on Individual Group Experience as well as the overall performance of the seCUREme  Stop Loss Insurance pool.

Please submit the following:

1. Application for Quotation – seCUREme Group Stop Loss Insurance
2. Current Employee Census
3. For companies who are currently fully insured through an Insurance Carrier, EP3 statements are required for the previous two (2) benefit years.
4. For companies who are currently fully insured through an Insurance Carrier, Extended Health and Dental claims experience for the previous two (2) benefit years.
5. Copy of current Benefit Plan design inclusive of Stop Loss parameters.
6. For companies who are currently Self-Insured through a Third Party Administrator, Stop Loss Experience for the previous two (2) benefit years.
7. For companies who are currently Self-Insured through a Third Party Administrator, Extended Health and Dental experience for the previous two (2) benefit years.
8. Copy of current Benefit Plan design inclusive of Stop Loss parameters.

When all your information has been compiled and your Application for Quotation completed, please forward to: [email protected]

We will have your quotation back to you as soon as possible!

seCUREme STOP LOSS INSURANCE – PRESCRIPTION DRUGS ONLY

For Groups of 5 employees or more

• Rates are Grouped and start at a Base Rate.
• Rates may fluctuate due to experience submitted.
• Rates are guaranteed for 12 months.
• Renewals will be based on Individual Group Experience as well as the overall performance of the seCUREme  Stop Loss Insurance pool.

Please submit the following:

1. Application for Quotation – seCUREme  Group Stop Loss Insurance
2. Current Employee Census
3. For companies who are currently fully insured through an Insurance Carrier, EP3 statements are required for the previous two (2) benefit years.
4. For companies who are currently fully insured through an Insurance Carrier, Extended Health claims experience for the previous two (2) benefit years.
5. Copy of current Benefit Plan design inclusive of Stop Loss parameters.
6. For companies who are currently Self-Insured through a Third Party Administrator, Stop Loss Experience for the previous two (2) benefit years.
7. For companies who are currently Self-Insured through a Third Party Administrator, Extended Health experience for the previous two (2) benefit years.
8. Copy of current Benefit Plan design inclusive of Stop Loss parameters.

When all your information has been compiled and your Application for Quotation completed, please forward to: [email protected]

We will have your quotation back to you as soon as possible!