HealthMAPS®

2016 Order Form (Please check all products ordered)

Product Additional
Base Health Rating Products Price(*) Cost
Medical Rating Manual and Software $33,400
— includes Detail Census Entry/Import feature, Rx Card, & State Mandated Benefits manual
Dental Rating Manual and Software 17,250
— includes Detail Census Entry/Import feature
Medical and Dental Rating Manuals and Software 44,550
— also includes Group Life Insurance component
Add Medical Simulation Software to Medical Purchase $2,550
Medical Simulation Software 6,250
State Mandated Benefits Manual 8,100
Stop Loss Products
Specific Stop Loss Manual and Software $22,250
— includes Detail Census Entry/Import feature, and Quoting System/Group Life Insurance component
Would you like the early release version? Yes___ No___
Aggregate Stop Loss Manual and Software 18,600
–includes medical claim costs for common medical plans and Detail Census Entry/Import feature
Specific and Aggregate Stop Loss Manuals and Software 35,450
Add Advanced Medical Rating Manual and Software $15,150
Add Rx Card Rating Manual and Software 5,050
Add Medical Simulation Software 3,700
Add Dental Rating Manual and Software
Basic 4,450
Advanced 12,150
*Discounts for prior purchases of same product; 33% if purchased within last 2 years; 20% if purchased prior to year 2014.

To request information about other Towers Watson products, please check one or more of the following boxes:
Stop Loss Survey Dental Rate and Experience Surveys

To request information about Third-Party products, please check one or more of the following boxes:
Stop Loss Administrative Systems PPO Discounts/Medicare Data/ACA Rating Tool

Contact Person
Name of Company
Address
City, State, ZIP Code
Phone & Fax Number
E-mail address
Please visit our Web site at www.towerswatson.com/healthmaps for product information.
Towers Watson, 101 South Hanley Road, St. Louis, MO 63105
Telephone: 314/719-5777, Fax: 314/719-5853
Email: hmaps@towerswatson.com