Medical Stop Loss Producer Follow-up Report

Producer / Producer Contact / Prospect

First line is the producer name and address. Second line is your contact for the producer. Additional lines are prospects for that producer.

Effective

Policy effective date.

Revised

Revised date.

Status

Submission status.

Underwriter

Policy underwriter.

Marketing Rep

Marketing representative for the prospect.

TPA

Third-party administrator for the prospect.

Census

Census count for the prospect.

Specific Deductible

Policy specific deductible.

Total Premium

Total policy premium.