Employer Stop Loss

The following information is requested and can be mailed, faxed, or e-mailed to iiSi

Please contact your designated Marketing Office or Representative

  • 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

Quote Submission

Quote submissions should be sent to quotes@iisinet.com. If you wish to submit a request for quote via e-mail, please download and use the MS Excel workbook below.

  1. Sheet 1 gives an example of how to enter census data.

  2. Sheet 2 is the actual area where the data is filled in.

Census Template

  • The file should be in Excel 4.0 (or higher) format.

  • Simply fill out the template above and send it to your assigned underwriter at IISI.

  • Please contact our San Francisco office for the appropriate email address.

  • Include the completed template as an attachment and send.

  • If you wish you may also attach your own spreadsheet or database with correct census information and send.