Please print and complete the following RFP checklist so that we can provide you and your client with a Best-in-Class RFP Response.

Request for Proposal (RFP) Checklist

Client Name___________________________________________________________________
Broker/Consultant______________________________________________________________
Address______________________________________________________________________
Phone_________________________
Due Date__________________
Delivery address of RFP_________________________________________________________
____________________________________________________________________________
Number of copies needed Client____________Broker/Consultant___________
Services requested: Health, Dental, Flex, Vision, Prescription, Stop Loss, Other ______________
Requested effective date __________________ Number of lives_____________________
Please include the following

Health
Copy of Enrollment Plan Booklet
Census of Current Enrollment
Premium History (2-3 years plus current year)
Record of Historical Loss Data (2-3 years)
Current Large Claims Data (over $10,000)

Dental
Copy of Current Dental Plan Booklet
Census of Current Enrollment
Premium History (1 year plus current year)
Dental Claim History (1 year plus current year)

RX
Census
Co-Pay
Multi-Vendor
Claims Data

Geo access needed?_______Standard or Specialized? Is data available for specialized report?______
Plan design requested?______________ Comparison to other Plans?___________________