Quoting Best Practices and Tips

Sometimes a few basic missteps can lead to inaccurate quoting results. Below are common items that should be looked at to troubleshoot a quote discrepancy. These apply when comparing two proposals against each other, as well as when comparing a proposal against a carrier renewal.

Effective Dates

Rates may change from one month to the next. It’s also possible the renewal date was miscommunicated when the quote was originally requested.

Company Zip Code

Zip code information may have changed or been miscommunicated. Some zip codes are also split between 2 counties; ensure the same county is used for rating. For example, the carrier may be using Ventura county (region 12), while the quoting system shows Los Angeles county (region 16) in the Group Information..

For Blue Shield, rates are based on the principal business address. This is the location most of the employees work, and may not be the same as the primary business address.

Employee Zip Codes

Plan availability is determined by employee zip code. If one proposal/renewal is showing a rate and the other is not, make sure they are both using the same zip code. If different, one zip code could be ineligible for the network.

Employee Birthdates

Accurate DOBs on all members and dependents is critical since each age has its own rate. If you have an employee-only entry that is under 18 or over 100 then rates will not generate. If your proposals/renewals are a month apart, understand rates will also change if the member experiences a birthday within that timeframe. For example, the member’s birthdate is 7/5/76; a quote run for July effective date will have different rates than a quote run for August effective date, even though the carrier did not have a change in rates, because the member moves from a 39 yr old rate to a 40 yr old rate.

Employee Dependent Status

Changes in dependent status, including the DOBs for dependents and whether they are included for coverage, can affect the rates shown.

SIC Code (ancillary)

Remember to check the excluded plans list if your carrier selection does not appear. While SIC does not affect medical plans, some ancillary carriers do still apply factors and even exclude certain industries from eligibility.

Plan Selection 

If your member is not rated for a plan, please check the selection boxes to make sure that member was chosen to be quoted for that coverage and/or plan type. Below are examples of members who would be excluded from coverages.

Remember to utilize the Excluded Plans list during the plan selection process.

User Interface (BFX/Benefix)

If your member is not rated for a plan you will be able to see that reflected in the user interface in Step 3 & Step 4.