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Customize Proposal - 2nd Quarter 2007
Group Name:
Prepared By:
TRADITIONAL PLANS
Carrier
Plans
Tier(s)
Atlantis
HMO 25/40A
HMO 20A
HMO 25/40
HMO 20
HMO 25/40 Plus
HMO 20 Plus
POS 25/40 2000A
POS 20/2000
POS 25/40 2000
POS 20/1000
POS 25/40 1000 Plus
POS 20/500
GHI
CS EPO 40/2000
CS EPO 40/2000A
CS EPO 40/1000C
CS EPO 40/1000A
CS EPO 40/1000B
CS EPO 40/1000
CS EPO 30/2000A
CS EPO 30/2000
CS EPO 30/1000A
CS EPO 30/1000B
CS EPO 30/1000
CS EPO 30/500A
CS EPO 30/500
CS PPO 30/1000
CS PPO 30/1000A
EPO 20A
EPO 25/500
EPO 30/500
EPO 40/1000
PPO 25/3000
PPO 30/1000
PPO 25/1000
Renewals Only
EPO 30/2000 (For Renewals Only)
EPO 30/1000 (For Renewals Only)
EPO 30/1000A (For Renewals Only)
EPO 30/500 (For Renewals Only)
EPO 30/500A (For Renewals Only)
PPO 30/2000 (For Renewals Only)
EPO 30/1000B (For Renewals Only)
EPO 30/1000C (For Renewals Only)
EPO 30/750 (For Renewals Only)
EPO 30/750 Plus (For Renewals Only)
EPO 30A (For Renewals Only)
EPO 30 (For Renewals Only)
EPO 20 (For Renewals Only)
EPO 15 (For Renewals Only)
HIP
EPO Smart Start
EPO Super Value
EPO 30/45 2000 Select
EPO 20/1000 Select
PPO 15 IN 1000
PPO 30/45 3000 Select
PPO 30/1000 Select
HMO Super Value
HMO 25/40A
HMO Value
HMO 20
HMO 5
HMO 15
HMO 10
POS 20
HIP
with Vytra Premium
EPO 30/45 2000 Select
PPO 30/45 3000 Select
PPO 30/1000 Select
Direct Access HMO 20
Direct Access HMO 15
Direct Access HMO 10
POS 20/1000
POS 15/500
POS 10/250
MDNY
HMO 20A
HMO 20B
HMO 20
HMO 25A
HMO 25
HMO 15
HMO 10
POS 20
POS 10
CONSUMER DRIVEN PLANS
Atlantis
POS 20/2000 HRA Option #1
POS 20/2000 HRA Option #2
POS 20/2000 HRA Option #3
POS 20/2000 HRA Option #4
GHI
HSA High Deductible EPO Option #1
HSA High Deductible EPO Option #2
HSA High Deductible EPO Option #3
HSA High Deductible EPO Option #4
HSA High Deductible PPO Option #1
HSA High Deductible PPO Option #2
HSA High Deductible PPO Option #3
HSA High Deductible PPO Option #4
Perfect Health
PPO HSA PLAN 22G
PPO HSA PLAN 22P
PPO HSA PLAN 29G
PPO HSA PLAN 30P
Select All
 
# Employees
Monthly Employer Contribution
EE Only:
EE + Spouse /EE + One:
EE + Child(ren):
Family:
 
Select Pay Period:  Percentage Contributions:
 
Proposal
Rate Sheet
Proposal & Rate Sheet
Show Money Funded into HSA: yes    no

 
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