1. Employee Group Waiver Plan (“EGWP”)
Request for Proposal
Pre-Qualifying Questions for Target Entity
(Corporation, Non-Profit, Government Entity or Union)
1. Are you providing post retiree medical benefits? Yes/No
2. Are you providing port retiree prescription drug benefits? Yes/No
3. If the answers to #1 and #2 above are “yes” is the post retiree Yes/No
benefit plan self funded?
4. Is the plan year of the post retiree benefit plan a calendar Yes/No
year?
5. Are there more than 500 retirees (including spouses) receiving Yes/No
benefits under the post retiree plan or plans?
The best prospect will answer yes to all of the questions above. However, the most important questions are 1,
2 and 5.
If the target company answers “yes” to at least questions 2 and 5 the following information is required to
provide a proposal:
1. Legal name of company and address of the home/corporate office. Please include a key contact for
this proposal along with requisite contact information.
2. Tax identification number.
3. If the company has multiple locations, please provide a zip code breakdown and describe the nature of
each business unit with an accompanying SIC code.
4. For the Group Medical Plan (or if more than one Plan for each Plan): Age/Gender Band Report. This
Report indicates the type of coverage for the covered group (individual/family). If the Band Report is
not available please provide a complete census which would include: type of coverage; gender; zip
code and age/date of birth. Please also clearly identify any retirees; indicating if they are receiving
coverage and whether Medicare is primary or secondary. Also include retiree eligibility requirements.
5. A copy of the self-funded plan document(s) and/or Summary Plan Description(s), name(s) of the
current Third Party Administrator for these plans, and name(s) of current or proposed PPO networks or
HMOs. Include any proposed plan design changes.
6. Please indicate if specific coverage currently includes post retiree (age 65) prescription drugs. If “yes”
please include relevant plan documents and historical claims data.
7. Please indicate any parameters for this proposal: effective date; deductibles; contract types; maximum
coverages and/or deadlines.
1 RFP April 2011. Prepared in conjunction with Advisors LLC. For Agent Use Only.