<p> Rogers Benefit Group Large Group Quoting Requirements</p><p>Group Name & REC’D DATE Full Street Address of group HQ If not provided, the earliest effective date available will be Effective Date Requested quoted. Specific Nature of Business or All carriers require this information for quoting. SIC 50% (51-499 lives) required by Florida Blue Employer Contribution 50% (25-250 lives) required by Cigna 50% (51-299 lives) required by Humana Maximum waiting period allowed is 90 days from date Benefit Waiting Period of hire.</p><p>Carriers to be Quoted</p><p>A signed GMQ is required PRIOR to obtaining a quote Group Medical Questionnaire from the carrier. </p><p>Include gender, date of birth, date of hire, coverage Census election (include waiver reasons), current plan election and residence zip code. Excel spreadsheet required. Average Payroll Calculator – To include full-time, part- Average Payroll Calculation time and seasonal employee count for all commonly from Prior Year owned companies from PRIOR CALENDAR YEAR. Must include the summary page reflecting the premium Most Recent Prior Carrier paid to date. Will need if sold. Billing Copy of Current Carrier Plan Required by all carriers (detailed plan summary). Design If current rates for ALL dep categories are listed on the Current Carrier Rates prior carrier billing this is not necessary.</p><p>Current Carrier Renewal Rates Underwritten rates can not be provided without a renewal.</p><p>Claims Experience/History required for 100+ enrolled groups</p><p>Please list the number of years covered with each carrier. If 5 Year Carrier History less than 5 years, please list carriers prior to the current.</p><p>Will affect rating so we must have this prior to quoting for Commission Level Requested all carriers. 1% RBG fee must be built in for all Florida Blue large group requests.</p><p>Incumbent Agent? </p><p>Large Group Participation Requirement (rate load will apply if 50% is not attained): BCBS: 50% overall participation Cigna: 50% overall participation (regardless of waiver reason) Humana: 50% overall participation (regardless of waiver reason) *Benefit specific coverage (i.e. cancer only) are not valid waivers.</p><p>RBG can provide large group quotes for: Florida Blue: 51 covered – 499 eligible medical lives commercial / 299 governmental Cigna: 25-250 covered medical lives Humana: 51-300 covered medical lives</p>