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GASB 74 / 75 Valuations
Quote Information Request
For each Valuation required (i.e., Annual Required Contribution Development)
*Entity's Name (Employer, Union, Fund)
*Contact First Name
*Contact Last Name
*Contact Email Address
*Contact Phone Number
*Which fiscal years will be covered by the valuation we propose to prepare?
Participant Data
Number of Covered Employees
Number of Covered Retirees
*Type of Insured Arrangement:
Please Select Type of Insurance Arrangement
Self Insured Arrangement (Employer pays health claims directly)
Fully Insured Arrangement (Employer pays premium to insurance company)
Benefits Provided (check all that apply)
Medical
RX
Pre - Medicare Eligible Retiree
Pre - Medicare Eligible Retiree
Post - Medicare Eligible Retiree
Post - Medicare Eligible Retiree
Pre - Medicare Eligible Spouse
Pre - Medicare Eligible Spouse
Post - Medicare Eligible Spouse
Post - Medicare Eligible Spouse
Dental
Vision
Pre - Medicare Eligible Retiree
Pre - Medicare Eligible Retiree
Post - Medicare Eligible Retiree
Post - Medicare Eligible Retiree
Pre - Medicare Eligible Spouse
Pre - Medicare Eligible Spouse
Post - Medicare Eligible Spouse
Post - Medicare Eligible Spouse
Life
Pre - Medicare Eligible Retiree
Post - Medicare Eligible Retiree
*Required Information
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