FULLY INSURED GROUPS

Instructions

For groups that are fully insured, EHIM would like to have the following information to quote our services:

 

1. Census, Please include:
   
   1. Family Status (Single, Two-Person,  Family, Family Continuation)
   2. Birthdate or Age
   3. Gender
2. Current/Renewal Rx Benefit Level or Co-Pay
   
   1. Current/Renewal Rx Carrier
   2. Current/Renewal Rx Rates
   3. Renewal Date
   4. Case Characteristic Factor (CCF) if group has BCBS of MI or BCN
   5. Type of Business
   6. Location/Address of Business

If a census is not available, a premium statement may provide enough information.  A rate sheet and/or renewal information may be provided in lieu of #2 listed above.

SELF-FUNDED GROUPS


Instructions

For groups that are experience rated or self funded, EHIM would like to have the following information when a quote is requested:

1. Census, Please include:
   
   1. Family Status (Single, Two-Person,  Family, Family Continuation)
   2. Birthdate or Age
   3. Gender
2. Claim Run (At least one month of data or more is helpful)
   
   1. Date of Service
   2. Quantity
   3. Days Supply
   4. NDC Code
   5. Drug Name
   6. Brand/Generic Indicator
   7. Retail/Mail Order Indicator
   8. Ingredient Cost
   9. Dispensing Fee
   10. Copay
   11. Administration Fee
   12. Plan Cost

If a claim run is not available, EHIM can provide an analysis which shows potential savings based on the following information:

1. Experience rates (if applicable)
2. Claims Experience
3. Brand vs. Generic Breakdown
4. Number of Claims Processed
5. Total Dollars Spent
6. Therapeutic Class Report
7. Top 100 Drugs by Cost
8. Top 100 Drugs by Number of Scripts dispensed
9. Copay Structure (include retail and mail order)
10. Plan Design Information (benefit levels, exclusions, limitations, formulary,etc.)

In order to expedite your request, an electronic format of claims data is helpful.  For more information, please contact us.