All POMCO solutions are fully customized.  To begin the process, the following is necessary to develop a quote for benefits administration services:

 

For stop loss quotes and financial analysis:

  • Census for all employees – Excel spreadsheet
    Include:  name, date of birth, gender, tier (single/family), plan classification, status (active, waiver, retiree, COBRA, part-time), zip code
  • Copy of current summary plan description
  • Premium history – current year and two years prior
  • Claims experience – current year and two years prior bi-monthly
  • Current large claims data – over $20,000
    Include:  dates of care, patients’ gender, patients’ age, diagnosis, prognosis, premium and claims data for prescription drug program – current year and two years prior

For disruption (disruptions not required to quote):

  • Provider list – Excel spreadsheet
    Include:  nine digit tax ID, name, address, city, state, zip, total paid or total services

For GEO access reports (GEOs not required to quote):

  • Census zip list – Excel spreadsheet
    Include:  full five digit zip code, count of enrollees by zip, and access standards e.g. PCP 2 in 10
  • Copy of current plan and requested plan
  • Request experience and large claim information (preferred by not required)