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The Premium Saver by MikeJenny


The Premium Saver

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									                    The Premium Saver - Request for Quote
          Watch the Premium Saver video
    1. Fill out all Blue hig hlig hted sectio ns below.
             a. When considering the “best” Alterna te Plan, look for a plan design that reduces the Major Medical renewal
                 rate by 28% to 40% and/or a plan that yields $100 or more savings for the Employee Only premium.
    2. Email this document (along with a copy of the medical plan summaries) to your contact person at MWG Marketing
        or to           fax 601-709-2875
    3. For more information call 1-877-800-1397 Alison Loper @ MWG Marketing
Employer Name:                                                                                      Telephone:

Employer Address:

Employer City:                                                          State:                      Zip Code:

Nature of business                                                      SIC Code:                   Effective Date:

Agent Name:                                         Email:                                          Telephone:

Employer’s Objective
Describe what the employer wants to accomplish using the Premium Saver.

                        Current Plan                                                       Alternate Plan
Medical Carrier                                                    Medical Carrier
Deductible Amount                          $                       Deductible Amount                     $
Co-Insurance                                                  %    Co-Insurance                                                 %
Co-Insurance Out of Pocket                 $                       Co-Insurance Out of Pocket            $
Is the deducti ble i ncluded in the                                Is the deducti ble i ncluded in the
co-insurance out of pocket? y/n                                    co-insurance out of pocket? y/n
Doctor Co Pays                             $                       Doctor Co Pays                        $
Drug Co Pays                               $                       Drug Co Pays                          $
Drug Deductible Amount                     $                       Drug Deductible Amount                $
Renewal Date                                                       Renewal Date
Notes                                                              Notes

                                      # of
                                                    Current Plan         Renewal            Alternate Plan
         Coverage                  Employees                                                                          Savings
                                                     Premium             Premium               Premium
Employee                                        $                   $                       $                   $
Employee and Spouse                             $                   $                       $                   $
Employee and Child(ren)                         $                   $                       $                   $
Family                                          $                   $                       $                   $
                        Premium Saver Plan Design (please enter the plan design you want quoted)
Deductible Amount (Per Person)
Deductible Type (Calendar Year or Plan Year)
Co-Insurance %

          PS Request for Quote 5-18-2010
Co-Insurance $ Amount (Excludes Deductible)
Benefit Amount
Commission %
Prior Plan Deductible Credit Rider and Allied Service Rider are included with all quotes.
*** The Allied Service Rider premium is non-commissionable (approximately 5% to 15% of the premium)

        PS Request for Quote 5-18-2010

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