insurance quote for global power group - adobe reader

8/3/2019 Insurance Quote for GLOBAL POWER GROUP - Adobe Reader

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Group InsuranceProposal

Cov r g

Prepared for

GLOBAL POWER GROUP

These rates were quoted for the proposed

effective date of January 1, 2012 . If another

ef fec t ive date is se lec ted or you are

requesting an effective date more than 30

days in advance please confirm the rates

quoted.

Presented By

SNAPP & ASSOC INS SVC

CAROLYN LOUIE

(619) 908-3100

License No. 0E00422

QUOT-O-MATIC 658360 November 3, 2011


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GLOBAL POWER GROUP

Quote 658360 November 3, 2011

We have endeavored to provide you with an accurate proposal based on the information collected from sources that are considered reliable including, without limitation, rate information

provided by carriers. We have not verified nor can we guarantee the accuracy, timeliness or completeness of such information. This proposal is provided on an "AS-IS" basis. The rates

quoted are the carriers standard risk rates, unless otherwise stated. We assume no liability for rate differences and ask that you advise your client not to cancel their prior coverage until

final rating information and underwriting approval have been received from the carrier. This proposal is a summary of plan benefits: for complete details refer to the master contract,

benefit booklet, or similar document.

All Rights Reserved. No portion of this material may be reproduced in any form or by any electronic or mechanical systems, without permission from the publisher.

Quote Report

COMPANY BROKER (Code: )

GLOBAL POWER GROUP CAROLYN LOUIE

LAKESIDE, CA 92040 SNAPP & ASSOC INS SVC

SAN DIEGO COUNTY 438 CAMINO DEL RIO SOUTH STE 112

SAN DIEGO, CA 92108

Phone: (619) 908-3100

Fax: (619) 908-3110

Quote Information

RAF Specials Requested ? Yes

Current or Renewing Carrier Kaiser Permanente

Other Carrier within the last 12 months

Current RAF 0.95

Renewal RAF 0.95

Renewal Date 01/01/2012

RAF Specials this Group qualifies for:

Aetna: 0.90 Anthem Blue Cross: 0.90

Blue Shield: 0.90 Blue Shield Simplesync: 0.90

HSA California: 0.90 Seechange Health: 0.90

Sharp: 0.90 Unitedhealthcare: 0.90

Benefit Type Quoted Medical,Dental,Life,Vision,Riders

Nature of Business PLUMBING & HYDRONIC SUPPLIES

SIC Code 5074

Multiple Locations NO

Out of State Employees NO

Full Time 31

Part Time 0

COBRA 0Employees Paid

By CommissionAs Independent Contractors

NONO

Percent of Insurance Cost Paid by EmployerEmployeeDependents

100%0%

Expected Dental Participation 75%

Number of Complete Years of Prior Dental 0

Requested Effective Date: January 1, 2012

Quo por


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GLOBAL POWER GROUP


Census Page

The Average Age of all 31 employees is 43 (excludes COBRA Employees). COBRA employees are included in the rates. However, the employer is not responsible for this amount. Employee zip code unknown. Employer zip code used for rating.

NAMELIFE

ONLY SEX DOB AGE

SPOUSE/PARTNER

DOB

SPOUSE/PARTNER

AGE

NUMBEROF ELIGIBLECHILDREN COBRA

AMOUNTOF LIFE

INSURANCE ZIP CODE

1. Gabriel Ayala NO MALE 06/15/82 29 06/15/82 29 2 NO MINIMUM 91901

2. Salvador Ceballos NO MALE 06/15/67 44 06/15/67 44 2 NO MINIMUM 91914

3. Gabriel Chavez NO MALE 07/15/77 34 -- -- 2 NO MINIMUM 92020

4. Robert Coombes NO MALE 07/15/69 42 -- -- 2 NO MINIMUM 92065

5. Erwin Dennis (92251) NO MALE 06/15/71 40 06/15/71 40 2 NO MINIMUM 92040

6. Henry Freow II NO MALE 06/15/62 49 06/15/62 49 2 NO MINIMUM 92114

7. Michael Galceran NO MALE 07/15/72 39 -- -- 0 NO MINIMUM 91010

8. James Harris NO MALE 06/15/73 38 06/15/73 38 2 NO MINIMUM 92154

9. Ramon Hernandez NO MALE 06/15/67 44 -- -- 0 NO MINIMUM 92105

10. Dennis Hill NO MALE 06/15/54 57 -- -- 0 NO MINIMUM 92071

11. Myrna Holmes NO FEMALE 07/15/72 39 -- -- 0 NO MINIMUM 91977

12. Terrance Hurley NO MALE 06/15/80 31 06/15/80 31 0 NO MINIMUM 9193513. Dante Jerig NO MALE 07/15/81 30 07/15/81 30 2 NO MINIMUM 92020

14. Douglas Knight NO MALE 07/15/64 47 07/15/64 47 2 NO MINIMUM 92234

15. Michael Kunkel NO MALE 07/15/57 54 07/15/57 54 0 NO MINIMUM 92867

16. Gerry LaFargue NO MALE 06/15/56 55 -- -- 0 NO MINIMUM 92019

17. Tai Le NO MALE 06/15/75 36 06/15/75 36 0 NO MINIMUM 92115

18. Terry Mammen NO MALE 06/15/50 61 06/15/50 61 2 NO MINIMUM 92064

19. David Marcos NO MALE 06/15/59 52 -- -- 0 NO MINIMUM 92105

20. Anthony Martorana NO MALE 06/15/39 72 -- -- 0 NO MINIMUM 92071

21. Jamie Mellinger NO MALE 07/15/76 35 -- -- 0 NO MINIMUM 92071

22. Anthony Monroig NO MALE 06/15/85 26 -- -- 0 NO MINIMUM 91942

23. Donald Patterson NO MALE 07/15/67 44 07/15/67 44 0 NO MINIMUM 92346

24. Daniel Pearson NO MALE 07/15/89 22 07/15/89 22 0 NO MINIMUM 92020

25. Brian Pena NO MALE 06/15/69 42 -- -- 2 NO MINIMUM 91730

26. Robert Petraglia NO MALE 06/15/53 58 06/15/53 58 0 NO MINIMUM 92029

27. Santos Ramos NO MALE 07/15/60 51 -- -- 0 NO MINIMUM 92404

28. Maria Rivas NO FEMALE 07/15/77 34 -- -- 2 NO MINIMUM 92124

29. David Santos NO MALE 07/15/59 52 -- -- 0 NO MINIMUM 92103

30. Steven Waltman NO MALE 06/15/51 60 06/15/51 60 0 NO MINIMUM 92071

roup Cnsus


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GLOBAL POWER GROUP


Census Page

The Average Age of all 31 employees is 43 (excludes COBRA Employees). COBRA employees are included in the rates. However, the employer is not responsible for this amount.

NAMELIFE

ONLY SEX DOB AGE

SPOUSE/PARTNER

DOB

SPOUSE/PARTNER

AGE

NUMBEROF ELIGIBLECHILDREN COBRA

AMOUNTOF LIFE

INSURANCE ZIP CODE

31. Justin Yancovich NO MALE 06/15/78 33 06/15/78 33 2 NO MINIMUM 92020


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This comparison is for illustrative purposes only. Please refer to plan brochures for complete benefit and rate information. Rates assume Employees Age 65 and over have Medic This RAF is the renewal RAF for this carrier. RAF specials and rules have been applied.

GLOBAL POWER GROUP

Quote 658360

Detailed Benefits & Rate Comparison with Census

J HIJPlan Name HMO $30/$1,500 GOLD VALUE $1500 DED/40/40

Network HMO HMO

Deductible

Individual $1,500 $1,500Family $3,000 $3,000

Maximum Out of Pocket

Individual $3,500 $4,000

Family $7,000 $8,000

Lifetime Maximum NO MAXIMUM NO MAXIMUM

Outpatient Services

Doctor Office Copay DED WAIVED-$30 COPAY $40 COPAY

Preventive Care DED WAIVED-100% DED WAIVED-100%

Physical Therapy $30 COPAY $40 COPAY

Lab X-Ray $10/$50 SOME SVCS 100%

Outpatient Surgery $250 COPAY DED-60%

Inpatient Services

Hospitalization $500 PER DAY DED-60%

Inpatient Physician Fee INCL W/HOSPITAL SVCS 100%

Emergency Room $100 COPAY $150 COPAYAmbulance $75 COPAY $150 COPAY

Non-Severe Mental Health/Substance Abuse

Mental - Inpatient $500/DAY-MAX 30/YR NOT COVERED

Mental - Outpatient $30-MAX 20 VISITS/YR $40-MAX 20 VISITS/YR

Chemical - Inpatient $500/DAY-DETOX ONLY NOT COVERED

Chemical - Outpatient $30 COPAY $150 COPAY-DETOX

Durable Medical Equipment NOT COVERED 50%-MAX $2,000/YR

Prescription Drugs

Formulary Generic Copay $10 $20

Formulary Brand Copay $30 $150 Rx DED + $35

Non-Formulary Copay NOT COVERED $150 Rx DED + $70

Separate RX Deductible NONE NONE

Formulary Brand RX Deductible NONE $150

Cost Comparison KAISER PERMANENTE SHARP

Risk Adjustment Factor 0.95 0.90

Premium

Average Employee Premium 305.44 283.00

Employee Total 9,468.65 8,773.04

Dependent Total 7,619.00 8,218.16

Total Monthly Group Premium 17,087.65 16,991.20

Sn p sh D il n f i n d C omp r ison


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This comparison is for illustrative purposes only. Please refer to plan brochures for complete benefit and rate information. Rates assume Employees Age 65 and over have Medic This RAF is the renewal RAF for this carrier. RAF specials and rules have been applied.

GLOBAL POWER GROUP

Quote 658360

Detailed Benefits & Rate Comparison with Census

PQR PQRPlan Name HMO COINSURANCE 70% AVN HMO $40/$50

Network HMO DED NETWORK HMO VALUE NETWORK

Deductible

Individual NONE NONEFamily

Maximum Out of Pocket

Individual $3,500 $3,500

Family $7,000 $7,000

Lifetime Maximum NO MAXIMUM NO MAXIMUM

Outpatient Services

Doctor Office Copay $40/$50 SPECIALIST $40/$50 SPECIALIST

Preventive Care 100% 100%

Physical Therapy $50-MAX 20 VISITS/YR $50-MAX 20 VISITS/YR

Lab X-Ray $40 COPAY $40 COPAY

Outpatient Surgery 70% $400 COPAY

Inpatient Services

Hospitalization 70% $800/DAY-1ST 3 DAYS

Inpatient Physician Fee INCL W/HOSPITAL SVCS INCL W/HOSPITAL SVCS

Emergency Room $200 COPAY $100 COPAYAmbulance 70% $100 COPAY

Non-Severe Mental Health/Substance Abuse

Mental - Inpatient NOT COVERED NOT COVERED

Mental - Outpatient $50-MAX 20 VISITS/YR $50-MAX 20 VISITS/YR

Chemical - Inpatient 70%-DETOX ONLY $800/DAY-1ST 3 DAYS

Chemical - Outpatient $50 COPAY-DETOX ONLY $50 COPAY-DETOX

Durable Medical Equipment 50%-MAX $2,000/YR 50%-MAX $2,000/YR

Prescription Drugs

Formulary Generic Copay $20 $20

Formulary Brand Copay $40 $40

Non-Formulary Copay $60 $60

Separate RX Deductible NONE NONE

Formulary Brand RX Deductible NONE NONE

Cost Comparison AETNA AETNA

Risk Adjustment Factor 0.90 0.90

Premium

Average Employee Premium 311.55 373.16

Employee Total 9,658.00 11,568.00

Dependent Total 9,177.00 10,982.00

Total Monthly Group Premium 18,835.00 22,550.00


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Medical Section - 9

GLOBAL POWER GROUP

Quote 658360 Plan 138102 November 3, 2011

Premiums

Area 5 Rate Grid0.95 RAF (Additional amounts for dependents are shown in each category)

Family deductible has embedded individual ded. Indiv must only meet own ded before receiving benefits. Ded applies to all services unless noted.

Out-of-Pocket Maximum includes deductible.

Please refer to the Evidence of Coverage for more information, most DME is not covered.

Rates assume Employees Age 65 and over have Medicare. Medicare rates are based on employee info only & subject to final review. Dependent

Medicare status may cause rates to change. Rates dont include optional riders.

This RAF is the renewal RAF for this carrier.

Medical Benefits and Premiums

JHMO $30/$1,500Benefits HMOGeneral

Deductible - Individual/Family $1,500/$3,000

Max Out of Pocket - Individual/Family $3,500/$7,000

Lifetime Benefit Maximum NO MAXIMUMPhysician Services:

Doctor Office Visit DED WAIVED-$30 COPAY

Preventive Care DED WAIVED-100%

Physical/Occupational Therapy $30 COPAY

Lab & X-Ray Outpatient $10/$50 SOME SVCS

Durable Medical Equipment NOT COVERED

Chiropractic OPTIONAL RIDER AVAIL

Hospital Services:

Inpatient Hospital Services $500 PER DAY

Inpatient Physician Fee INCL W/HOSPITAL SVCS

Outpatient Surgery $250 COPAY

Emergency Room $100 COPAY

Ambulance $75 COPAY

Non Severe Mental Health:

Outpatient $30-MAX 20 VISITS/YRInpatient $500/DAY-MAX 30/YR

Chemical Dependency:

Outpatient $30 COPAY

Inpatient $500/DAY-DETOX ONLY

Prescription Drugs:

PharmacyKAISER PERMANENTE

Formulary Generic Copay $10

Formulary Brand Copay $30

Non Formulary Copay NOT COVERED

Brand Name Deductible NONE

Separate Deductible NONE

Rx Annual Maximum Benefits NO MAXIMUM

Mail Order Prescriptions AVAILABLE

Employees Dependents Subtotal Addtnl. for COBRA Grand Total

RAF 0.95 Standard Total Premium $ 9,469 $ 7,619 $ 17,088 $ 0 $ 17,088

Note: This group may qualify for a 0.95 RAF. The final RAF is decided during the Underwriting Process by the Carrier.

Age Employee Additional for Spouse Additional for Child(ren) Additional for Family

0-29 $ 171.95 $ 299.25 $ 217.55 $ 396.15

30-39 $ 203.30 $ 340.10 $ 207.10 $ 433.20

40-49 $ 275.50 $ 285.95 $ 154.85 $ 437.95

50-54 $ 367.65 $ 395.20 $ 135.85 $ 476.90

55-59 $ 456.00 $ 492.10 $ 134.90 $ 583.30

60-64 $ 584.25 $ 585.20 $ 137.75 $ 709.6565-99 $ 708.70 $ 908.20 $ 132.05 $ 987.05

ADEA 65-99 $ 708.70 $ 908.20 $ 132.05 $ 987.05

HMO$30/$1,500 - Benefits/Premiums


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Medical Section - 10

GLOBAL POWER GROUP


Premiums




RAF specials and rules have been applied.


HIJ GOLD VALUE $1500 DED/40/40Benefits HMOGeneral




Doctor Office Visit $40 COPAY



Lab & X-Ray Outpatient 100%

Durable Medical Equipment 50%-MAX $2,000/YR


Hospital Services:

Inpatient Hospital Services DED-60%

Inpatient Physician Fee 100%

Outpatient Surgery DED-60%


Ambulance $150 COPAY


Outpatient $40-MAX 20 VISITS/YRInpatient NOT COVERED


Outpatient $150 COPAY-DETOX

Inpatient NOT COVERED

Prescription Drugs:

PharmacyPARTICIPATING


Formulary Brand Copay $150 Rx DED + $35

Non Formulary Copay $150 Rx DED + $70

Brand Name Deductible $150



Mail Order Prescriptions 2X COPAY-90 DAYS


RAF 0.90 Best Total Premium $ 8,773 $ 8,218 $ 16,991 $ 0 $ 16,991

RAF 0.90 Maximum Total Premium $ 8,773 $ 8,218 $ 16,991 $ 0 $ 16,991



0-29 $ 174.18 $ 262.96 $ 255.32 $ 501.21

30-39 $ 203.00 $ 297.89 $ 264.37 $ 521.96

40-49 $ 250.04 $ 297.17 $ 237.03 $ 512.87

50-54 $ 317.14 $ 335.85 $ 205.75 $ 564.27

55-59 $ 398.62 $ 433.21 $ 198.96 $ 604.01

60-64 $ 511.90 $ 490.29 $ 164.00 $ 681.53

65-99 $ 731.96 $ 636.33 $ 216.79 $ 811.67

ADEA 65-99 $ 731.96 $ 636.33 $ 216.79 $ 811.67

GOLD VALUE$1500 DED/40/40- Benefits/Premiums


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GLOBAL POWER GROUP


Premiums






HIJ GOLD VALUE $1000 DED/30/40Benefits HMOGeneral




Doctor Office Visit $30/$40 SPECIALIST



Lab & X-Ray Outpatient 100%



Hospital Services:

Inpatient Hospital Services DED-70%

Inpatient Physician Fee 100%

Outpatient Surgery DED-70%







Inpatient NOT COVERED

Prescription Drugs:



Formulary Brand Copay $150 Rx DED + $35

Non Formulary Copay $150 Rx DED + $70

Brand Name Deductible $150



Mail Order Prescriptions 2X COPAY-90 DAYS






0-29 $ 186.55 $ 281.69 $ 273.51 $ 536.91

30-39 $ 217.43 $ 319.11 $ 283.19 $ 559.13

40-49 $ 267.82 $ 318.33 $ 253.92 $ 549.39

50-54 $ 339.71 $ 359.77 $ 220.40 $ 604.47

55-59 $ 426.98 $ 464.06 $ 213.13 $ 647.04

60-64 $ 548.33 $ 525.22 $ 175.69 $ 730.09

65-99 $ 784.07 $ 681.64 $ 232.23 $ 869.48

ADEA 65-99 $ 784.07 $ 681.64 $ 232.23 $ 869.48

O LD V AL U 1 0 00 D D 0 4 0 n f i s r m i u ms


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GLOBAL POWER GROUP


Premiums


First copay shown is for Non-Specialist office visits. Second copay is for Specialist office visits.





PQR HMO COINSURANCE 70%Benefits HMO DED NETWORKGeneral

Deductible - Individual/Family NONE




Preventive Care 100%

Physical/Occupational Therapy $50-MAX 20 VISITS/YR

Lab & X-Ray Outpatient $40 COPAY


Chiropractic $15-MAX 20 VISITS/YR

Hospital Services:

Inpatient Hospital Services 70%


Outpatient Surgery 70%


Ambulance 70%




Outpatient $50 COPAY-DETOX ONLY

Inpatient 70%-DETOX ONLY

Prescription Drugs:




Non Formulary Copay $60










0-29 $ 183.00 $ 304.00 $ 329.00 $ 551.00

30-39 $ 219.00 $ 366.00 $ 317.00 $ 597.00

40-49 $ 280.00 $ 329.00 $ 292.00 $ 560.00

50-54 $ 359.00 $ 373.00 $ 262.00 $ 628.00

55-59 $ 441.00 $ 495.00 $ 253.00 $ 586.00

60-64 $ 573.00 $ 505.00 $ 182.00 $ 639.00

65-99 $ 569.00 $ 568.00 $ 213.00 $ 781.00

ADEA 65-99 $ 774.00 $ 742.00 $ 213.00 $ 913.00

HMO COINSURANCE70% -Benefits/Premiums


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GLOBAL POWER GROUP


Premiums







PQR AVN HMO $40/$50Benefits HMO VALUE NETWORKGeneral










Hospital Services:

Inpatient Hospital Services $800/DAY-1ST 3 DAYS









Inpatient $800/DAY-1ST 3 DAYS

Prescription Drugs:














0-29 $ 219.00 $ 364.00 $ 394.00 $ 660.00

30-39 $ 263.00 $ 437.00 $ 379.00 $ 714.00

40-49 $ 335.00 $ 394.00 $ 350.00 $ 671.00

50-54 $ 429.00 $ 447.00 $ 315.00 $ 752.00

55-59 $ 528.00 $ 592.00 $ 303.00 $ 702.00

60-64 $ 687.00 $ 603.00 $ 217.00 $ 764.00

65-99 $ 681.00 $ 681.00 $ 255.00 $ 936.00

ADEA 65-99 $ 927.00 $ 889.00 $ 255.00 $ 1,093.00

A VN M O 4 0 0 n f i s r m i u ms


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GLOBAL POWER GROUP


Premiums







PQR AVN HMO $30/$40Benefits HMO VALUE NETWORKGeneral










Hospital Services:

Inpatient Hospital Services $600/DAY-1ST 3 DAYS









Inpatient $600/DAY-1ST 3 DAYS

Prescription Drugs:














0-29 $ 231.00 $ 385.00 $ 416.00 $ 697.00

30-39 $ 277.00 $ 462.00 $ 401.00 $ 755.00

40-49 $ 354.00 $ 416.00 $ 370.00 $ 709.00

50-54 $ 454.00 $ 472.00 $ 332.00 $ 794.00

55-59 $ 558.00 $ 626.00 $ 320.00 $ 742.00

60-64 $ 725.00 $ 638.00 $ 230.00 $ 808.00

65-99 $ 719.00 $ 720.00 $ 270.00 $ 989.00

ADEA 65-99 $ 979.00 $ 939.00 $ 270.00 $ 1,155.00

AVN MO 0 4 0 n f is r miums

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