WANT TO REQUEST A QUOTE?

A complete and current census including the following information: 

Gender
Date of Birth
Does your plan cover retirees?
Level of coverage (Emp Only, Emp+Sp, Emp+Ch, Family)
Zip Code

Additional Data Needed if already Self-Funded or Level-Funded:

Current & Renewal Rates (specific and aggregate) and funding factor

3-year History

3-Years of Aggregate/Specific Reports
Schedule of Medical Benefits
Schedule of Prescription Drug Benefits
All claimants who have reached $10,000 or are expected to
Anyone on a Transplant waiting list
Any members who are disabled (including spouses)

Additional Data Needed if already Fully Insured:

Current & Renewal Rates

Schedule of Benefits for Medical/Prescriptions

Any known high claimants

Statement of Health

For a copy of the Health Statement, please contact Brittany Martin at brittany@dbainc.org