1. Claims experience by month for the last three (3) years including:

   1. Employee enrollment by month

   2. Large claim information, including current status of claims.  If currently self funded, information is needed on any claims exceeding 50% of the specific deductible.  The information should include the following:

                           i.      Participant status (i.e., employee, dependent)

                          ii.      Total dollar amount of claim

                         iii.      Date claim was incurred

                         iv.      Diagnosis of illness or injury

                          v.      Current status of claim

2. Copy of benefit booklets corresponding to the claim years provided

3. Current census including:

   1. Birth date

   2. Sex

   3. Coverage status (i.e., single, family)

   4. Group life amounts

   5. Salaries and job titles, if STD or LTD benefits are to be quoted

4. Information on the stop loss carrier, TPA, PPO and any other vendors connected with the group including:

   1. Name of vendor

   2. Individual and aggregate stop loss information

   3. Rates charged by the various vendors

The information requested here in Item 4 can be found in the renewal contract from the most recent policy year

5.  Information on employer/employee contribution levels