.REQUEST FOR PROPOSAL​

CHECKLIST

INFORMATION REQUIRED

 

Company Name __________________________________________________________

City__________________________, State__________

Zip Code____________

 

Nature of Business____________________________________________

Current bill for each Line of Coverage.___________________________

Benefit Booklet or Schedule of Benefits for each Line of Coverage.________________

Most recent renewal letter/renewal date for Line of Coverage._____________________

 

Employee Census Data (see Employee Census Form). Please included employee resident zip codes for out of state employees ______________

The key  Employee monthly contribution amounts by Line of Coverage (explain):­­­­___________________________________________________

Optional - List of physicians employees currently utilize form or at least

decision makers_________________________________________________________________________________________________________REQUEST FOR PROPOSALREQUEST FOR PROPOSAL

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