Interested in obtaining a proposal from us?  Here’s what we need to get started:

• Company name and principal location (City, state, zip)
• Address of other locations and number of covered employees at each
• Nature of business (industry type, SIC code)
• Copy of current plan of benefits, and any desired changes
• Current census information, including gender, age or date of birth, and type of coverage (single, family, etc.)
• Current carrier name (and prior carrier information, if less than three years with current carrier)
• Premium rate history and claims history, if known
• Details on any large claims (over $10,000), past or present, including total amounts paid, diagnosis and prognosis, by individual
• Requested effective date
• If currently self-funded, please provide copies of schedule of benefits page(s) from in-force stop-loss insurance contract

Mail, fax or e-mail the information to:

Attn:  Curtis Donley
Donley Benefits Consulting, Inc.
4653 Statesmen Drive
Indianapolis, IN  46250

FAX:  (317) 849-3436

e-mail:  cdonley@donleybenefits.com

Questions?  Call toll-free:  (800) 382-5220

______________________________________________________________________________

4653 Statesmen Drive, Indianapolis, IN 46250
317-849-3282 * 800-382-5220 * Fax 317-849-3436

______________________________________________________________________________