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Help Us Complete Required RXDC Reporting for 2025
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1.
Please provide the following information about your company and plan.
(Required.)
Company name
Group number (i.e. SM11111E)
Contact name
Contact email
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2.
Please enter the required employee and employer contributions for your plan in 2025 as a percentage of total plan costs. Please round your answers so that they total 100%.
Note: While this survey supports prescription drug reporting, the federal requirement includes total medical plan premiums. Please use overall plan contributions, not prescription-only costs.
(Required.)
Required employee contribution for plan as a percentage of total plan costs
Required employer contribution for plan as a percentage of total plan costs
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3.
Please provide the following information.
(Required.)
Employer Identification Number (EIN)
3-digit health plan number reported on IRS Form 5500 (Enter N/A if not applicable.)
