If sending in a request for quotation (or RFQ) for the SummaCare Chamber HBP, you need to complete the SummaCare Chamber HBP Census. This completed census should be emailed to email@example.com.
NOTE: FormFire won't process your RFQ if sent on a different census.
Instruction for Completing Census File
- Enter all Employees' names with their associated Sex (M or F) , Age, Member Type and Contract Type. (Enter "Child" in any children's Sex field)
- After each Employee, add a row for each related Spouse and each Child and provide the associated data.
- Enter the Group Name, Effective Date and the Group County in cells B3, B4 and B5.
Data Entry Rules
Member Type values may include:
Contract Type values only need to be added to the Employee lines and may include:
NOTE: FormFire will process your RFQ and provide rates directly to you within 24 hours.
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