If you would like to submit a quote or census online, please do
by e-mailing it to email@example.com.
You may also fax it to Scott Perry at 763-425-1677 or mail it to:
VeraSource Excess Risk, Ltd.
8525 Edinbrook Crossing, Suite 108
Brooklyn Park, MN 55443
- Complete Census: (minimum 100 covered lives): Including year of birth, gender, covered dependents. Please designate those under COBRA and any retirees.
- Plan Information: Current and
proposed benefit plans.
- Managed Care Information: Current
and proposed networks.
- Third Party Administrator
- Paid Claims and Enrollment Information: Month-by-month for one year minimum, and for three years, if possible.
- Shock Claims Information: Include dollar amount, diagnosis, prognosis and large case management notes, if available.
- Detailed Description of Business:
Include SIC Code, if possible.
- Current Rates, Aggregate Factors, and Type
of Contract (e.g., 15/12)
- Specific Deductible Information:
Current and proposed specific deductible amounts as well as detailed information on any lasered individuals currently on the plan.
- Locations: City, state, zip
code and number of employees at each location.