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HomeMy WebLinkAboutHM Life Insurance 1ft! Stop Loss Proposal for City of Oshkosh LfFE INSl.'lMNCE COMPANY Carrier: HM Life Insurance Company. . Effective Date: Sales Representative: TPA: Broker: 1/1/2008 Gerald Brennan. Chicago Sales Office Prairie States HCSC Lives . RENEWALI ICURRENT rS~p.ECIF(C ._-'''~''--'-- I ISpecific Deductible (per Covered Person) j Lifetime Maximum Specific Benefit i Covered Benefits iSpecific Premium. ~Single Rate iSingle + 1 Rate I Family Rate I , I Estimated Contract Specific Premium ! ~ i iContract Basis L<29.!!Lry)J.~~~n ---....._,-~-----......- 183 179 254 616 $75.000 . $75,000 $1,925,000 $1,925,000 Medical, Rx Medical, Rx $41.77 '$50.12 $70.12 $83.56 $102.00 $117.99 $553,241 '$649,184 12/15 12/15 5.0% 5.0% Medical. Rx Medical, Rx $1;000.000 $1,000,000 $633.07 $655.42 $1,139.52 $1,179.75 $1,740.93 '. $1,802.40 $9,144.265 $9,467,121 $9.144,265 $9,467,121 125% 125% 12/15 12/15 $0.00 $4.22 $6 $31,144 5.0% 5.0% $553,241 . $680,328 I 'AGGReGATE Covered Benefits !Policy Year Maximum IAggregate Factors. !Single Medical. Rx Factor 183 1Single + 1 Medical, Rx Factor 179 I Family Medical. Rx Factor 254 fEstimated Contract Attachment Point 616 i . jcontract Minimum Attachment Point (100%) !Aggregate Corridor I Contract Basis iAggregate Premium ,Composite Rate . .615 jEstimated Contract Aggregate Premium 615 ! . iCoJ:Tlmission L_..~__,- TOTAL COMBINED CONTRACT PREMIUM . This proposal ;s not complete unless accompanied by the Basis pf Offer noted in the neXt page. * The proposal includes Advanced Specific Funding. . This quote includes a Separate Specifi.c Deductible for Tammy Runlow at $150,000. OPTION 11 OPTION 21 '----l $80,000 $90,000 $1,920,000 $1,910,000 Medical, Ri< Medical, Rx $43.97 $38.211. $73.47 $64.051 $105.41 $93.09/ $575.661 $50512~71 12/15 12/~ 5.0% 5.0% , Medical. Rx Medical, Rxl $1,000,000 $1,000,0001 $660.66 $669.841 . $1,189.19 $1,205.701 $1,816.82 $1,842.051 $9.542.857' $9,675.381 i , $9.542.857 $9,675,381 I I , 125% 125%1 12/15 12/151 . $4.25 $4.31 $31,365 $31,808 , I 5.0% 5,0%1 I $607,026 $537,035 11/14/200703:47 PM