Plan Comparison Spreadsheet Request - Midwest Insurance Brokerage Services Inc

Broker Name*
First Last
Broker Email*
Group Name*
New or Renewal Group?*
- New Group
- Renewal Group
Effective Date*
MM slash DD slash YYYY
Select a Rating Method*
- Age Banded Rates
- Composite Rates
- Provide Age Banded & Composite Rates

Select a Blue Cross Blue Shield Medical Plan(s) to Compare

Carrier	Plan Type	Network	Deductible	Coinsurance

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Select a Humana Medical Plan(s) to Compare

Carrier	Plan Type	Deductible	Coinsurance

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Select a BCBS IL Dental Plan(s) to Compare

Carrier	Deductible	Annual Max	Preventive/Basic/Major Services	Ortho Max

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Select a Humana Dental Plan(s) to Compare

Carrier	Deductible	Annual Max	Preventative/Basic/Major Services	Ortho Max

Click the PLUS Sign to Add Row