Quotes and Additional Information

Requirements for a Quote:

In order to obtain a quote, please email or fax (602.680.5743) the following requirements to the attention of Ashley Peyton:

I. Employer Application. Download.

II. Prior Insurance Carrier Invoice

III. Wage and Tax: most current quarter

IV. Completed Medical Questionnaires: ONLY for groups of < 10. Download

V. Documented Curriculum: ONLY required if not a charter school (link is acceptable)

VI. Census: in excel format

1. Name

2. Date of Birth

3. Gender

4. Job Title

5. Zip code

6. Enrollment (use the following codes)

a. EE: Employee Only

b. ES: Employee + Spouse

c. EC: Employee + Child(ren)

d. EF: Employee + Family)

7. Eligibility

a. Active

b. Retired

c. Part Time

d. COBRA

Additional Details:

1. Plan Year: 8/1/08 – 8/1/09

2. Policy numbers:

a. Issued within seven business days of enrollment submittal

b. Each can hold one medical and two dental plans. If the school chooses to offer more than one medical and all three dental plans, there could be up to four policy numbers.

3. ID Cards:

a. JPET Acronym will precede each school’s name

b. Released the same day as the policy number

c. Please allow 10-14 business days for production and delivery

d. Temporary ID cards are available on www.myuhc.com within 48 hours with the following information:

i. Social Security Number

ii. Date of Birth

iii. Policy Number

4. Pharmacy Benefits: available within 48 hours of policy number issuance

a. H9 Plan Benefits: Download Benefit Summary.

5. Employer Contributions: required at 75% for all employees

6. Enrollment Additions, Changes, Terminations, COBRA and Billing Information can be found by clicking here.

Necessary Submittal Documents:

1. Letter of Intent: 1 per group. Download.

2. Signed Trust: 1 per group. Request a copy.

3. Employer Enrollment Application: 1 per group. Download.

4. Employee Enrollment Application: each eligible employee. Download.

5. Employee Coverage Worksheet: each eligible employee. Request a copy.

6. Binder Check: Send to - PMB 125, 23425 N 39th Drive, Suite 104, Glendale, AZ 85310