New Sales Opportunities for Mid-Market Groups

New sales opportunities in the Optima Health Mid-Market segment

Effective immediately for new sales opportunities in the Optima Health Mid-Market segment, you can now use a GRx census to obtain underwritten quotes if the current carrier does not provide claims and premiums paid information for a group being quoted. As a reminder, the Optima Health Mid-Market segment covers groups with 51 or more total employees up to 150 or fewer eligible employees. The list of items needed to ensure the most accurate underwritten quote are:

The list of items needed to assure the most accurate underwritten quote are:

  • Census
  • Claims and premiums for past 24 months
  • Large claimant information for past 24 months
  • Medical and Rx plan(s) requested
  • Renewal exhibits
  • Rate history
  • Employer Group Health Questionnaire
  • Employer contribution and waiting period
  • Accumulator (Contract or Calendar)

If the current carrier does not provide claims and premiums paid information for the past 24 months, you may submit a six data-point census so that GRx can be used as a component to underwrite. The GRx census must include the following information for all members:

  • First name
  • Last name
  • Home zip code
  • Date of birth
  • Gender
  • Employee or dependent (using “1” for employee and “0” for dependent)

Note: All fields must be submitted for the employee and all dependents

We look forward to our continued success together. Please contact your Optima Health representative if you have any questions.