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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
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