ESL QUOTE
CENSUS TEMPLATE
SUBMIT A QUOTE
VIA EMAIL

 

 
   

The following information is requested and can be mailed, faxed, or e-mailed to IISI.
Contact the Employer Stop Loss Marketing Office in San Francisco for more information.

  • Name, address, location, and industry of group
  • Effective date requested and due date
  • Description of current plan and proposed plan, if different
  • Requested Specific deductible and current Specific deductible
  • Requested claim basis for Specific and Aggregate
  • Complete census, indicating any retirees, COBRAs, and HMO participants
  • Employer Contribution
  • Details of any individuals exceeding 50% of the requested Specific during the past 12 months
  • Details of any disabilities, illnesses or claims expected to exceed 50% of the Specific during the next plan year
  • Experience: rates, claims and enrollments for the current and prior two policy years
  • Commission requirements