ORDER NO. 29994 2007 EMPLOYEE IIEALTH BENEFITS PROGRAM BIDS Came to be heard this the 23rd day of October, 2006, with a motion made by Commissioner Letz, seconded by Commissioners Williams/Nicholson. The Court unanimously approved by vote of 4-0-0 to: Accept all bids submitted, and turn them over to the Human Resources Department for review and coordination with our consultant, Mr. Looney: I. GPA-Group & Pension Administrators, Inc., including TPA Administration and Stop-Loss Proposals, consisting of a total of 3 binders. 2. Box from Wallace & Associates, indicating that it is primarily Declination Letters where, Wallace submitted to 3rd parties and they declined. 3. UnitcdI-Iealthcare, 3 binders. 4. Fiserv Health, submitted through Wallace and Associates, 3 binders. 5. A copy of the request for proposals that was advertised, and some notes from Mr. Wallace, indicating submissions, with references to TD for "turn down", and indications of things that might be received, or no communication received. ~~ ~9 ~9 . 13 COMMISSIONERS' COURT AGENDA REOUEST PLEASE FURNISH ONE ORIGINAL AND TEN COPIES OF THIS MADE BY: Pat Tinley OFFICE: County MEETING DATE: October 23, 2006 TIME PREFERRED: SUBJECT: Receive and take appropriate action on bids or proposals received for 2007 Employee Health Benefits Program. EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON) NAME OF PERSON ADDRESSING THE COURT: County Judge ESTIMATED LENGTH OF PRESENTATION: IF PERSONNEL MATTER -NAME OF EMPLOYEE: Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter 551 and 552, Government Code, is as follows: Meeting scheduled for Mondays: THIS REQUEST RECEIVED BY: THIS REQUEST RECEIVED ON: 5:00 P.M. previous Tuesday. All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been prepared for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be appreciated and contribute towards your request being addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners' Court. ~.~~ ~~ Kerr County Proposal Notice Kerr County is accepting proposals for their Group Medical Claims Administration, Specific and Aggregate Stop Loss Insurance, Health Reimbursement, Arrangement Administration, Group Term Life Insurance and Accidental Death and Dismemberment Insurance. Specifications will be released at 10:00 AM Monday, September 25, 2006, and be obtained at the Kerr County Court House, 700 Main St. Kerrville. Texas 78028. The proposal closing will be 11:00 AM October 2Q, 2006. Please run in the following paper: September 23, 2006 October 4, 2006 ~~~ - i~~ 9~~0/~ ~ ''' 1.1' ~,/~ PARS 800.540.6369 l~QS~ c~~ ~ K~~~ ~o~ ~~ ~~ i f~ ~~~~' ~Q~~.e nt~..0 Page 1 of 1 Kerr County JudgelCommissioners' Court From: "Gary Looney" To: "Pat Tinley" ; "Kathy Mitchell" Sent: Wednesday, September 20, 2006 9:24 AM Subject: Medical Plan RFP Notice Kathy, Would you provide the following wording to the Clerk to be placed in this Sunday's Paper and once again in a 10 day period. Any additional date is OK as long as it is within 10 days. I will provide you with a complete RFP file via email and send you about 5 CD's with all the files. I hope to get all this to you by late this afternoon or tomorrow noon latest. Gary "Ken County Proposal Notice Ken County is accepting proposals for their Group Medical Claims Administration, Specific and Aggregate Stop Loss insurance, Health Reimbursement Arrangement Administration, Group Term Life Insurance and Accidental Death and Dismemberment Insurance. Specifications will be released at 10:00 AM Monday September 25, 2006, and may be obtained at the Kerr County Court House, 700 Main Kerrville, Texas 78028. The proposal closing will be 11:00 AM October 20, 2006." ~Q~~~ - Gary Looney REec Senior Vice President ALAMO INSURANCE GROUP. INC. 3201 Cherry Ridge Drive, Suite D405 San Antonio. Texas 78230 210.930.6665 Ext. 236 voice 210.930.1838 fax Confidentiality Notice: Protected Health Informatior /~-~`-~`/V i,71~ ~ ~~~1'~r c~.~m-e ~(i~1~j ~Y ~G~-'r ~,,~ 1 ~-zee-O(, Protected Health Information (PH) is personal and sensitive Individually-identil health care. It is being faxed/emailed to you after appropriate authorization from t do not require authorization. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Re- disclosure without authorization or as permitted by law is prohibited. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to penalties described in federal and state law. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed. If you are not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any disclosure, copying or distribution of this information is strictly prohibited. Please notify the sender immediately to arrange for the return or desUuction of these misdirected documents. 9/20/2006 ~. ~' Advantages of a Nationwide Network UnitedHealthcare offers access to health and well-being services through a single national network. Our network consists of over 470,000 physicians and other care professionals at 630,000 locations in all 50 states, as well as more than 4,500 hospitals and 60,000 pharmacies. Nearly 94 percent of the addressable commercial insurance population has access to our national network* This means it's easy for you and your employees to find a nearby physician or hospital. While our network is national in scope, it is our local health plans that have the greatest impact on customers. Increasing the number of local physicians and hospitals - in addition to our open access policy that allows visits to a specialist without areferral -means enrollees have more choices close to home. We have a defined and growing presence in the communities we serve. Our network consists of more than: • 470,000 physicians and other health care professionals • 630,000 physician locations in all 50 states • 4,500 hospitals • 60,000 pharmacies *Addressable population defined as living within 30 miles of a primary physician and a hospital Managing Costs through Strategic Relationships With a base of 21 million enrolled individuals, UnitedHealthcare negotiates significant discounts with physicians and hospitals choosing to participate in our network in exchange for bringing them a volume of patients. By selecting care from a network physician or facility, enrollees pay lower out-of-pocket costs and employers gain more consistency around the cost of care. The result is savings in health care costs for you and your employees. Because physicians and facilities outside our network set their own pricing for services, the result is usually higher billed charges and out-of-pocket costs for enrollees. In most cases, the cost for visiting an in-network physician will be considerably lower than going to one outside the network. Network and non-network cost comparison example' 'Based on 110% of Medicare. 'This amount does not apply to the OuC-of-Pocket Maximum. ฉ Other cost saving measures Maximum Non-Network Reimbursement Program (MNRP) UnitedHealthcare's out-of-network reimbursement policy pays non-network physicians a maximum amount based on the payment methodology established 6y Medicare. It does not apply to emergency care or services coordinated in advance by UnitedHealthcare. This fixed maximum reduces the impact of escalating non-network fee schedules on cost trend and encourages more physicians and hospitals to join the UnitedHealthcare network. The resulting savings for enrollees can be up to 50 percent off billed charges. Facility Fee Negotiation In some cases, UnitedHealthcare will negotiate pricing with non-network facilities to reduce the cost to enrollees for using services there. The average savings resulting from our negotiation with facilities ranges between 15 and 27 percent. Shared Savings Program Another way we improve access and contain costs, especially in rural and remote areas, is through our Shared Savings Program. In less populated areas, UnitedHealthcare may contract with a third party vendor to negotiate discounts on services received from non-network physicians. We currently offer this discount through more than 233,000 non-network physicians. The average savings is 30 percent on physician costs and 19 percent on facility costs. 'These examples represent average billed charges for these service categories. They are not intended to 6e an exact calculation of claim payment end individual financial responsihility that may resph from the services you receive. The amounts will vary depending on the services received, the specific benefit plan capay and/or coinsurance design and changes [o Medicare reimbursement methodology. Recognizing and Promoting Quality UnitedHealthcare has developed a comprehensive, evidence-based approach to advancing quality and efficiency among our network physicians and facilities. This approach helps to improve the quality of care, reduce care variation, lower costs, and encourage enrollees to understand the cost of their care. Evidence-based medicine To improve consistent clinical outcomes and reduce inefficient delivery of care, UnitedHealthcare encourages our network physicians and hospitals to practice evidence-based medicine by: • Offering Clinical Evidence- a compilation of thousands of recent research studies Facilitating peer-to-peer consultations among physicians and encouraging them to share data ' and best practices • Providing physicians with relevant data regarding their clinical performance compared to nationally accepted, evidence-based practices UnitedHealth Premiums"' designation program The UnitedHealth Premium designation program is designed to provide information to consumers regarding physician quality and efficiency that can help them make more informed health care decisions. The program also provides our contracted physicians with information that supports their practice of consistent evidence-based and efficient medical care. Physician evaluations and designations are provided across the continuum of care -from adult primary care for common and chronic conditions such as asthma and diabetes, to more complex cardiac, orthopedic and cancer conditions. These conditions account for a large percentage of the health care expenses for our member population. In-network physicians treating these conditions are evaluated for performance based on quality and efficiency benchmarks. A physician's UnitedHealthcare claims data and practice patterns are compared to those of their peers in the same specialty and same market. Criteria are based on evidence-based medicine, expert physician guidance and national clinical standards. Making It Easy to Administer Health Care Multi-site We make it easy to offer health insurance to employees who don't work at your primary worksite. Our multi-site capability simplifies the administration of health care benefits by letting employers offer one product, one rate, one contract, one administration system, and one network to employees working in different states and regions. One Network Our single national network offers your employees convenient and broad access to high quality health and wellness services, affordable care and smooth claims processing. Consistent Products Flexibility with multi-site means you can choose from: • Standard Enterprise Choice Plus and Preferred Portfolio plans • Dual Option plans that let employees in different locations choose between the same two plans at the same rates under a single contract • Managed plans, consumer-driven plans, PPOs One Contract and Rate Because a single contract is written at the base location (wherever there is the majority of employees), your administration will be simple: • Pay one rate at with one monthly invoice • Budgetforcostwithease • Eliminate uneven employee contributions Physician Web site UnitedHealthcare's secure Web site for network physicians, facilities and other health care professionals uses the latest in Internet technology to reduce the time spent on administrative processes. Physicians and health care professionals can use the site to: • Check patient eligibility and copay amounts • Submit claims for reimbursement • Submit in-patient admissions and outpatient surgery notifications to activate our Care Coordinations"" programs R g 3F ~. . t. b „err ~~} ~ ~i.~ I[:y ~ j ,~ S ,~` y__ A rs~ ~ l,ti i .. s ,', _ t s. . 4~ w I !>r: 6 s '~' ~i"j^ ~'d a ei* x a ' 1 ~' ^~~~ 'r . r . ~ ~ pi_ t. .. .. 5 ' ~ . .. ' f~ _ ~ ~ ~, ~~.. ~. N ~ v M k xJy. ,.ir u. a _ ~`f,o,E '~.4. y c r i ~u~3..;'.'.;i1i.~ "S~~d~:o`5:,~,'ti.*y4+a~:''l"-`'f~.~~~?:^~^. ~.y^.:. 'ir.a y yy~ ~ f ~YR%. t'Khv ~'!NN.'.i ~i.?'x nN...l Y.u_fi u~ ~~ rv F k+ 4 t Dear Valued Customer, Here is your UnitedHealth Wellness"' employer toolkit, which explains our portfolio of wellness programs and services through UnitedHealthcare. The UnitedHealth Wellness employer toolkit contains the following: 1. A folder to help keep everything in one place for you. 2. A multi-page brochure and possible optional sell sheetls) that explain the portfolio and all its various components. 3. Samples of a poster, flyer and paycheck stuffier for use to promote UnitedHealth Wellness to your employees. 4. A compact disc that features a 30-second UnitedHealth Wellness promotional FLASH clip, athree-minute demo, two PowerPoint presentations (an overview on UnitedHealth Wellness with script in Notes section, and an overview on the Communication Resource Center via Employer eServicess"') and electronic files of the poster, flyer and paycheck stuffier for you to print and hand out to your employees, if you desire. We hope you are as excited as we are about this value-added service for you and your employees. If you have any questions, please contact your UnitedHealthcare representative. Sincerely, UnitedHealthcare UnitedHealth Wellness is a collection of programs and services offered to UnitedHealthcare enrollees to help them stay healthy. It is not an insurance product but is offered to existing enrollees of certain products underwritten or provided by United Healthcare Insurance Company or its affiliates to encourage their participation in wellness programs. Health care professional availability for certain services may be dependent on licensure, scope of practice restrictions or other requirements in the state. Therefore, some services may not be included in some programs due to state regulations. Some UnitedHealth Wellness programs and services may not be included in all medical plans or for all customers and individuals. It just makes sense: M96411 7N6 C92006 Untied HeatthCare Services, Inc. Feel Good. Be Healthy. Live WeII:M Health and wellness at the workplace The price of health care coverage continues to skyrocket - up 54 percent in just the past five years.' Employers are beginning to realize that they need to address the underlying causes of these cost increases in new and innovative ways. For instance, we now know that modifiable health behaviors, such as obesity, lack of exercise, smoking and stress, account for between 50 to 70 percent of all diseases in the United States.' Employers know that sick or unhealthy employees are bad for business. Aside from the sheer cost to a company's bottom line through increased health care expenses, additional issues include employee absenteeism lor, "presentisim"j, productivity, morale and retention. Plainly, it's no longer enough to look simply at plan design or contribu- tion levels to maintain plan affordability. Instead, questions about the health and wellness of the workplace population -and how to positively affect employees -must take its place near the top of the executive strategic agenda. What to do UnitedHealthcare is prepared to deliver thoughtful, comprehensive assistance. Whether your employees want to eat right, exercise more, stop smoking or just relax, our UnitedHealth Wellnesse"" portfolio of pro- grams and services provides a wide range of resources and tools to help them stay healthy. We hope you will take advantage of this support, which automatically comes with your UnitedHealthcare membership at no additional cost to you. (Ask about our available additional cus- tomized wellness programs, tool 1. Henry J, Kaiser Family Foundation, Employer Health Bene/its.'20W Annual Survey, September 2004 2. Whitmer, et al., Journal o/Occupational and Environmental Medicine, 2003 3. A.H. Miller, et al., "Adherence to Heart Healthy Behaviais in a Sample of the U 5 Population," Preventing Chronic Disease, April. 2005. 4. American Journal of Health Promotion, 2003 5. Rand Cnrnnraiinn eindv X009 Take the neXt step with UnitedHealth Wellness Even though the advantages of prevention and wellness education seem obvious, only about 30 percent of employers have any sort of workplace health promotion program in place.' This is especially unfortunate because employers may find ready and willing allies among their employee population. Consider just a couple of points: • More than 92 percent of Americans want to be more informed health consumers.e • More than 85 percent of Americans want to improve their health, fitness and the overall balance in their lives' Here is a golden opportunity for you to make a positive impact on your workplace health and well-being. Now is the time to leverage employee awareness and motivation to make positive changes by taking advantage of our coordinated wellness tools and services through UnitedHealth Wellness. Read on for a complete description of the programs and services available through UnitedHealth Wellness. 7 Kenneth E. Thorpe, Health Affairs, "The Hire in Health Care Costs and What To Do About It" November/December, 2005 Let UnitedHealth Wellness help you and your employees achieve your wellness goals Here's how We make it easy for you and your employees to access a wide portfolio of UnitedHealth Wellness programs and services. Depending on the specific program you need, we offer services through a separate UnitedHealth Wellness Web site, UnitedHealthWellness.com, through our main consumer Web portal, myuhc.comฎ, plus employer-specific services available through our dedicated customer Web site, EmployereServices.com. Researchers have a robust understanding of the process people go through to change their personal behavior. Briefly, we progress through a series of stages where we gradually move toward change by thinking about the problem, making preparations to change, taking action to change and then maintaining our new behavior.'ฐ That's why the UnitedHealth Wellness portfolio has multiple dimensions intended to assist people in various stages -whether it's thinking, preparing, acting or maintaining. Just look at all the ways we support your employees so that they can start living healthier lives. They can do the following: • Think about their health status by taking one of our personal health assessments/surveys. • Think some more with tips and trivia from our wellness quizzes and games. • Prepare and read upon health topics in our vast libraries of health and wellness articles. • Act by choosing from several health improvement tools to begin their healthy journey. • Act efficiently with discounts on thousands of wellness products and services. • Maintain new behaviors with personal journaling and other wellness tools. With so many resources and tools to choose from within UnitedHealth Wellness, everyone is sure to find something that will work best for their needs. UnitedHealthWellness.com The Total Well-Being Program (administered by myRenewells"") For convenience and a comprehensive approach, you just can't beat the Total Well-Being Program. It organizes tools and resources around the five key areas of total well-being: physical, intellectual, social, spiritual and emotional. The Total Well-Being Program cultivates a holistic approach to wellness. If someone is troubled by relationship issues or stress, for example; it will be very difficult to sustain a healthy approach to diet and exercise. By visiting the Total Well-Being Program through UnitedHealthWellness.com, members will discover a wealth of self-guided tools and resources to help them bring their lives into better balance. On UnitedHealthWellness.com, you'll find our most comprehensive one-stop-shopping wellness experience. The Health Value Program (administered by UnitedHealth Alliess"") Our Health Value Program provides typical savings of 70-50 percent on certain health care services that are not covered by your medical, dental or vision plan. Your employees can save on the following services: • Complementary Care/Alternative Medicine -chiropractic care, acupuncture, massage therapy and natural medicine. • Cosmetic Dentistry- a wide range of cosmetic dentistry services, including teeth whitening. • Laser Eye Vision Correction - LASIK, Custom LASIK and other procedures. • Hearing Services -hearing tests and devices. Long-Term Care Services -adult day care, assisted living, durable medical equipment, homemaker and personal care services, respite programs, skilled nursing facilities and hospice services. Your employees will find UnitedHealthWellness.com to be a great resource in launching their new, healthier lifestyles, no matter what the stage -whether it's thinking, preparing, acting or maintaining. myuhc.comฐ Start thinking about better health with the online Health Assessment and Personalized Report To help your employees assess their overall state of health, the Health Assessment features an online questionnaire. Once completed, they receive immediate and confidential results from an online personalized report, as well as suggestions for improving their health. Take action with Health Improvement Tools After taking the Health Assessment, your employees can choose from a variety of online personal guides and programs to help them develop skills to improve their health and well-being. Topics include back fitness, blood pressure, cholesterol, fitness, nutrition, smoking cessation, stress relief, weight loss and management, and more (see next page for more details). Think and prepare on using information from our Libraries of Health Articles and Tools Through our vast libraries of health articles and tools, your employees will find quizzes, calculators and charts; as well as information on a wide range of health and wellness topics that include addiction, family, fitness and nutrition, healthy aging, healthy pregnancy, preventive medicine, relationships and more. Personal Action Guides and Healthy Living Programs Your employees can build skills at their own pace with the following online personal action guides and six-week healthy living programs. Personal Action Guides These guides are used in helping employees set and follow SMART goals (Specific, Measurable, Achievable, Rewarding and Trackable). • Back Fitness- provides steps to learn about posture, lifting correctly and handling pain. • Blood Pressure -gives tips on knowing risk factors, eating healthy and dealing with blood pressure medications. • Cholesterol -helps with understanding cholesterol numbers, making good food choices and working with HCP. • Fitness-features advice on becoming more active in a daily routine, building a fitness plan and gaining flexibility. • Nutrition -provides information on the food pyramid, vitamins and minerals, power food and how to read labels properly. • Stop Smoking -helps in learning about triggers, planning to quit, and finding the support needed to quit smoking for good. • Stress -gives tools to help know stressors, take action againstthem and relieve stress in life. • Weight- provides information on a healthy weight, making healthier choices and how emotions and habits affect a person's lifestyle. Healthy Living Programs The core elements of the six-week online healthy living programs feature diet recommendations, exercise plans and other tools that promote better health and well-being. All of the programs are based on sound medical and behavioral research. • Easy Start- perfect for beginners who want to get healthier but don't know where to begin. • Weight Loss -the basics of weight loss and nutrition with a personalized meal plan for steady weight loss. • Get in Shape -personal fitness plans and menus. • Smoke-Free -tools and trackers to identify and conquer barriers to quitting, incorporate healthy lifestyle changes into a daily routine, and understand how to become smoke-free. • Stress Relief -nutrition and fitness strategies to fight stress, and techniques to help ward off daily stressors. • Healthy Aging -personalized meal plans and fitness recommendations, plus the latest • Healthier Diet- information on how making simple substitutions can improve your diet and give you along-range plan for eating better. • Disease-Fighting -three separate programs about good nutrition and fitness as the foundation of disease prevention: Cancer- Fighting, Diabetes-Fighting and Healthy Heart. • Custom -design your own plan with interactive tools, including personalized meal plans, access to fitness trackers and self-assessments. • Your Healthy Living Program -weekly features customized to personal interest and health concerns if any program was completed, with a quick review of personal Progress Tracker and access to personal meal plan. science-backed advice on nutrition, supplements, wellness and fitness. Again, both the personal action guides and healthy living programs are found on myuhc.com after taking the Health Assessment. Healthy-Pregnancy.com Getting on the right track with our Healthy Pregnancy Program The Healthy Pregnancy Program offers personal support through all stages of pregnancy and delivery. It features pregnancy assessment via phone, identification of pregnancy risk factors, 24-hour, toll-free access to experienced nurses, and customized maternity education materials. EmployereServices.com Health and wellness tools for the workplace The Communication Resource Center (CRC) through Employer eServicesฎgives you the tools to communicate with employees about valuable UnitedHealthcare programs and services, as well as ฉ health and wellness topics. Using the CRC is easy. Just log on to EmployereServices.com and click the Communication Resource Center link. The Health & Wellness section contains informative articles on health and wellness topics that offer advice on how to take action. There are even useful guides for creating a wellness program, sponsoring a health fair, building a customized newsletter and more. The Communication Tools section allows you to plan your communications and integrate resources into powerful educational campaigns for your employees. Other Wellness Programs and Services Depending on your selected health care benefit offerings, you may have access to other special wellness programs and services from UnitedHealthcare. These could include one or more of the following: • 24-Hour Helplines -24-hour toll-free helplines feature registered nurses and/or master's level counselors. We also have audio messages on more than 1,000 health topics. Ask about our available on-site training options and seminars covering nearly 100 wellness and work/life topics. • Personal Health Coaching -available now for clients who choose our Definitys"" Health Reimbursement Account and Health Savings Account products. Combines elements of the helpline service together with customized member outreach. Workplace Wellness Program -customized workplace health management program that can be accessed from your Intranet site or via myuhc.com, containing a health assessment survey, lifestyle intervention programs and coaching, and a participation incentive program. (Note: This program is available for employers with 750 or more adult participants.) • Preventive Care Reminders -recommended preventive care and screenings, including mammograms, diabetic eye exams, pediatric immunizations and more. Mental Health Programs -offers support for family and relationship issues, work-related concerns, financial and legal needs, stress and other personal concerns. • Self-Care Books and Newsletters -.promoting healthy living and providing credible information on common injuries, illnesses and conditions. For mdse information on the above wellness programs apd ervices, ask your broker ar UnitedHealthcare. rapresentative. y ~.lnitedHealthcare Health Group Company UnitedHealth Wellness= Resources and tools to help you stay healthy. • Gauge your health status by taking one of our personal health assessments/surveys. • Choose from several online health improvement programs and tools to begin your healthy journey. • Receive discounts of 5-60% on thousands of wellness products like smoking cessation aids, weight management programs, fitness gear, nutritional foods and supplements, and more. • Save 10-50% on certain health care services not covered by your medical, dental or vision plans, such as complementary care/alternative medicine, cosmetic dentistry, laser eye vision correction, hearing services and long-term care services. • Keep track of your progress with personal journaling and other wellness tools. • Learn healthy tips and trivia with our wellness quizzes and games. • Read up on several health topics in our vast libraries of health and wellness articles. Feel good. Be healthy. Live wells"' ~a~ ITni~edHealthcareฐ. .III AUnnedHealN Group Company Features of UnitedHealth Wellness: • Health Assessments/ Surveys • Health Improvement Tools • Wellness Product and Service Discounts • Personal Journaling and Tracking • Health Quizzes/Games • Health Articles/Library ,. t.~.- ._.,. .. .... Resources and tools to help you stay healthy. Whether you want to eat right, exercise more, stop smoking or just relax, our UnitedHealth Wellness"" portfolio of programs and services provides a wide range of resources and tools to help you stay healthy. We hope you will take advantage of this support, which was designed to be at your fingertips every day. Just look at the various ways you can start achieving your goals to a healthier lifestyle: • Gauge your health status by taking one of our personal health assessmerns/surveys. • Choose from several health improvement tools to begin your healthy journey. • Receive discounts on thousands of wellness products and services. • Keep track of your progress with personal journaling and other wellness tools. • Learn healthy tips and trivia with our wellness quizzes and games. • Read up on several health topics in our vast libraries of health and wellness articles. With so many resources and tools to choose from within UnitedHealth Wellness, you're sure to find something that will work best for you and your needs. But first you must register on UnitedHealthWellness.com. You will need your Subscriber ID/Group Number from your UnitedHealthcare medicallD card. Visit ~ ,~ _ ~~ It just makes sense: Access our comprehensive portfolio of UnitedHealth Wellness programs every day Here is our comprehensive portfolio of UnitedHealth Wellness programs and services, grouped under their corresponding Web sites. Make sure to check them out and use them often to your health's advantage once you've enrolled with UnitedHealthcare: Total Well-Being Program Focused on subjects like exercise and fitness, diet and nutrition, and personal development, the Total Well-Being Program (administered by myRenewells"") organizes information that relates to the five areas of total well-being: Physical, Intellectual, Social, Spiritual and Emotional. Through the program's Marketplace, you can save 5-fi0% on thousands of wellness products and services like fitness equipment, weight management programs, smoking cessation aids, and nutritional foods and supplements. Health Value Program The Health Value Program (administered by UnitedHealth Alliese"") provides typical savings of 10 to 50 percent on certain health care services not covered by your medical, dental or vision plan. It features complementary care/alternative medicine (chiropractic, acupuncture and massage therapy), cosmetic dentistry, laser eye vision correction, hearing services, long-term care services and more. Health Assessment and Personalized Report To help assess your overall state of health, the Health Assessment features an online questionnaire. Once completed, you receive immediate and confidential results from an online personalized report, as well as suggestions for improving your health. Health Improvement Tools and Programs After taking the Health Assessment, you can choose from a variety of online personal "Take Action" guides UnitedHealthcare AUnitedHealth Group Company 100 fitfi3 706 n 2006 United Healthcare Servicev, Inc to help you develop skills to improve your health and well-being. Guide topics include back fitness, blood pressure, cholesterol, fitness, nutrition, stop smoking, stress and weight. In addition, you can enroll in an online six-week Healthy Living Program. Choose from a variety of programs focused on helping you make lifestyle changes around weight loss, personal fitness, stress relief, nutrition, smoking cessation and more. Libraries of Health Articles and Tools Through our vast libraries of health articles and tools, you'll find quizzes, calculators and charts; as well as information on a wide range of health and wellness topics that include addiction, family, fitness and nutrition, healthy aging, healthy pregnancy, preventive medicine, relationships and more. Healthy Pregnancy Program The Healthy Pregnancy Program offers personal support through all stages of pregnancy and delivery. It features pregnancy assessment via phone, identification of pregnancy risk factors, 24-hour toll- free access to experienced nurses, and customized maternity education materials. Other Wellness Programs and Services Depending on your employer's selected health care benefit offerings, you may have access to other special wellness programs and services from UnitedHealthcare. If you have questions about UnitedHealth Wellness after enrolling with UnitedHealthcare, call our Customer Care toll-free phone number at 1-888-848-WELL (1-888-848-9355) from 8 a.m. to 8 p.m. Central Time, Monday through Friday. Or simply register at UnitedHealthWellness.com once you receive your medical ID card. UnitedHealth Wellness is a collection of programs antl services offered to UnitedHealthcare enrullees to help them stay healthy It is not an insurance product but is offered to existing enrollees of certain piaducts underwntten or provided by Unted Healthcare Insurance Company or its affiliates to encourage their participation in wellness programs Health care professional availability for certain services may be dependent on licensure, scope of practice restrictions or other requirements in the state. Therefore, some services may not be included in some programs tlue to state regulations. Same UnitedHealth Wellness programs and services may not be included in all medical plans or for all customers antl individuals. The HeatlhY Pregnancy Program follows national practice standards from the Institute far Clinical Systems Improvement. Insurance coverage is provided by ar through'. United Healthcare Insurance Company. .,q UnitedHealthcare CIA AUnnetlH~M Gioip Company ' h, '' `~e { Y u ~ Z~~~~ ~j .• ~ g p 9 g j ibj ~ P t ~Y ~~~~tiifa SFE. ฃ~ 3 i ` 5 }} S i'f~~~rp .$. Yfi ~'~ ~p SS~k~ey~:~.*, ~ _ ~ ~ ~ • I ~: • ~• ~ • ~ a} gg p~ry , $ { ~yf4 }.~g5 T g~~$~~-~~pE}~p PS 1~ ;S ^~ ~ w 1- a F P ฐ C` e a .g ข gg S~~#ip~p~yg{~S • ~ Y4 AP~63,ฐk'~SY'4~4k~"&'E73 ,N~?.~C~i~5 ~~ ~ f .~ yf f ~pF 7~d '@s~~~'~5d ~fix~ i ~P F i -I x r .~ ss' 4 ~~ '' P.f~.,...7 VISIt 3 a . . t ~~:; ~ ~ ,~ ~ ~ ~ ~, v ea f Access our comprehensive portfolio of UnitedHealth Wellness programs every day. Total Well-Being Program The Total Well-Being Program ladministered by myRenewell`") organizes information around physical, intellectual, social, spiritual and emotional health. You also can save 5- 6o%on products like fitness equipment, smoking cessation aids and more. Health Value Program The Health Value Program ladministered by UnitedHealth Allies'") provides typical savings of 78 to 50 percent on certain 1W-6164 ]/e6 m3Wfi United HeatlhCere Services, Inc. health care services not covered by your medical, dental or vision plan. It features complementary care, cosmetic dentistry, laser vision correction, hearing services, and long-term care services. Health Assessment and Personal Report To help assess your overall health, the Health Assessment is an online questionnaire. You receive immediate and confidential results from an online personal report, and suggestions for improving your health. Health Improvement Tools and Progrems After taking the Health Assessment, you can choose from a variety of online personal guides to help you improve your health. In addition, you can enroll in .~ online six-week Healthy Living Programs focused on weight loss, fitness, stress relief, smoking cessation and more. Lihraries of Health Articles and Tools Through our vast lihraries of health articles and tools, you'll find quizzes, calculators and charts; and information on health and wellness topics that include addiction, family, fitness and nutrition, relationships and more. .;naR.., ..,:~ Healthy Pregnancy Program The Healthy Pregnancy Program offers personal support through all stages of pregnancy and delivery. It features a pregnancy assessment vie phone, 24- hour toll-free ac cess to nurses, and education materials. Other Wellness Programs and Services Depending on your employer's selected benefit offerings, you may have access to other special wellness programs. Call our Customer Care toll-free phone number at 1-866-848-WELL from 8 a.m. to 8 p.m. Central Time, Monday through Friday ii you have questions. CANCER RESOURCE SERVICES ~I UnitedHealthcare' ,III AllniteAHealt6 Gmup Cnmpnny ~„.... VVV~~~/// Potential benefits resulting r-• from treatment at a CRS Centers of Excellence network facility include the following: • Accurate diagnosis and fewer complications • Care that is planned, coordinated and provided 6y a team of experts who specialize in the patient's specific cancer • Appropriate therapy neither too much nor too little) • Nigher survival rates, shorter length of stay and decreased costs We're there when you need us. If you or a loved one is diagnosed with cancer, you may have many questions and be faced with making some difficult and important decisions. You may have questions such as: • What will it mean to me to have cancer? • What treatments will I need, and what side effects might I experience? • How can I maintain my health and well being during treatment and recovery from cancer? • What resources are available to help me? Among the most important decisions you can make are what treatment to get and where to get it. You will want to know: • Where is the best place to go for the treatment of my kind of cancer? Can I get the care I need in my local community? Should I get a second opinion before I make a decision about my treatment? Cancer Resource Services is pleased to be part of your health care coverage. Through this program, experienced cancer nurses can provide information and help answer your questions. They can also arrange for your access to cancer treatment services at a cancer center within the CRS Centers of Excellence Network. It just makes sense: The Cancer Resource Services Centers of Excellence Network Why is it called a Centers of Excellence Network? Because the cancer centers within the Network provide: • Comprehensive, highly specialized teams of experts with extensive experience in cancer diagnosis and treatment, including rare cancers. • Second opinion services if you are unsure about your diagnosis or what treatment is right for you. • Experience in performing a large number of cancer surgeries and other complex treatments and procedures. • Access to newer treatments that may be the best option for you. To learn more about Cancer Resource Services, please call 1-866-936-6002 (toll-free) between 7:00 a.m. and 7:00 p.m. Central Time, Monday through Friday, excluding holidays. Or, visit the Cancer Resource Services Web site at www.urncrs.com. There is no charge for this service, and you have no obligation to use a Cancer Resource Services cancer center. Remember, cancer is not one disease but rather a wide spectrum of diseases. Each case is different, and the needs of each person with cancer are different. We encourage you to decide where to receive your care in consultation with your physician, based on your personal values, needs and preferences. UnitedHealthcareฐ AOmredHealth Group Company maa~ss aids t= zoos un~~d Heaimra,e sen~a.,t inc ALABAMA • University of Alabama at Birmingham Comprehensive Cancer Center (Birmingham) CALIFORNIA • Ciry of Hope Cancer Center IDuartel • Stanford Hospital and Clinics (Stanford) • UCSF Comprehensive Cancer Center (San Francisco) FLORIDA • H. Lee Moffitt Cancer Center and Research Institute (Tampa) ILLINOIS • Robert H. Lurie Comprehensive Cancer Center of Northwestern University (Chicago) MARYLAND • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (Baltimore) MASSACHUSETTS • Children's Hospital Boston (Boston) • Dana-Farber/Partners Cancer CarelDana-Farber Cancer Institute, Brigham & Women's Hospital and Massachusetts General Hospital) (Boston) MICHIGAN • Karmanos Cancer Institute (Detroit) MINNESOTA • University of Minnesota Medical Center, Fairview NEBRASKA • The Nebraska Medical Center (Omaha) NEW YORK • Memorial Sloan-Kettering Cancer Center (New York) • Roswell Park Cancer Institute (Buffalo) OHIO • James Cancer Hospital atThe Ohio State University (Columbus) PENNSYLVANIA • Children's Hospital of Philadelphia (Philadelphia) • Fox Chase Cancer Center (Philadelphia) TENNESSEE • St. Jude Children's Research Hospital (Memphis) • VanderbiltUniversiryMedical Center (Nashville) UTAH • Huntsman Cancer Institute at the University of Utah (Salt Lake City) WISCONSIN • University of Wisconsin Comprehensive Cancer Center (Madison) Note: Network subject to change. For up-[o-date information, go [o www.urncrs.com. Cancer Resource Services is here to help when you need us. The medcal uenteis and prayranrs In UnltedHeal[hrare s netwerkand within United Resourca Netwnrka are independent contranors who render case and treatment to United Healthcare customers UmtedHealtlwaie does not provide health servicea or piaubce niediuine_ The medical crenters and programs are solely responsible fnr medical judgments and related treatments. UnitedHealtlmare is not liable forany act or omission, includiny wyliyence. cnmmrtted by any independent conbacted health care protescwnal, medical center or piopiam. 1 ""` DEFINITYSM HEALTH REIMBURSEMENT ACCOUNT EMPLOYER TOOLKIT BP, Inc. BP Inc. is a member of the Fiserv Health group of companies. BP, Inc. serves as a managing general underwriter (MGU) • Carrier --- Combined Insurance Company of America _ Rating: A.M. Best "A Excellent" .- Web site: www.combined.com States not yet approved: AL, AK, IA, LA, MI NH, NM, • BP, Inc. functions "- Underwriting • Full underwriting authority and binding authority _ Prohibited groups: MEWA, Associations, Employee Leasing _ Minimum specific level $20,000, minimum 50 participating ee's • Contract types: Run-in, run-out, incurred and paid • Contract options Issue Contracts • Fully authorized to issue Combined stop-loss contracts '~ Claims • Full specific and aggregate claims authority ~' Minimum initial filings: Specific $1,000, Aggregate $3,000 F%5e V Health.. Excess Risk through Fiserv Health The advantage of choosing excess risk coverage through one of our arrangements is clear. We have arrangements that provide access to many of the country's excess risk carriers. Fiserv Health has access to arrangements that allow us to provide product - enhancements such as: • Enhanced transplant benefits with astep-down deductible provision •- Monthly accumulated cap benefits • An aggregating specific benefit • A common accident benefit • A terminal liability extension option or individual excess risk extension • Advanced specific funding What's the advantage of working through Fiserv Health? Integration! We can provide you with integrated immediate claim notification to get a jumpstart on managing these high claims. No handoffs! We eliminate possible (and probable) confusion, confrontations and time lags that occur when using multiple vendors. Fiserv Health also provides you with premium billing and collection as well as stop loss monitoring reports. Finally, we can help you sort through the often confusing world of excess risk. This market provides numerous coverage options. Your Fiserv Health representative is available to discuss options with you and how differences in plan design and underwriting practices can impact your plan and the coverage provided. It's our goal in providing excess risk coverage to ensure along-term and successful relationship with you, our customer! ,_ Attached, please find an Excess Risk quotation from BP, Inc. Please refer to the Financial Proposal section of the proposal document for information on the services included. i I I I i I M I 1 1 I ) 1 1 1 1 I I Kerc County 1111200] to 1/112008 & ~ ., " ~~~ ~ ~ s z ~ 15/12 15112 tl ca Rx M ~ a l Metla:al Rz e ~~' ~""~1 ~ $1,000,000 $1000,000 s's }.n ~ $50,000 560,000 a ..~ ~ 'S w~~~'~~"'~ ฐ"'' `r 'a ~c , ~ ,',"" Fs > ~ `'1dD ~- $58 09 550 81 ~ ti 1•Y~yฐ ~~ 5116.33 $10289 ~ ems.„ '-- ` $22119564 $195,012.12 . ,x ' 125 % 125% 5112 _ ~. '~ 15112 1 /~~~ ~ L Metlical Rx Metlical Rx ~, x ~ ,x $1000000 $i ~O11.000 ~~ ~Y49` Sd 55 $455 ~ ~ $13,59540 $13,59540 ?: p~yKpa~~ 823539100 $208,861.52 .^ vx~~~p ~F'~nv _ M1 y.a v.x r* ,jam. 5317.06 $32341 x ฑ69:. $61232 $62981 ` ~~~~' ~ $1,195,99@20 $1,219,92910 ~v Aง(~IapOffi~AA~$~ , ~' ~ /BD 539633 $404?6 y pt~•_ x t a ~.. ~B ~ bg $111 fi5 $781.09 t ~nwT~1ROCNEIE'n `- $1494,988 00 $1,524,91212 rr- ,~_ ' 111~bpl - '. 2d$' ' $t,790,9g0:04 81,739,579.64. ~: ~ j~ - 30 tleys 30 tlays :., "+' - Rbi81{'~~~~~ ~ through 11 through 11 th . months mon s BP Inc.. Assumes UR/CM antl precerti0caeon, DZM. BirihEine, and approvetl Transplant netwoM -without these programs increase specttic rates fiYo Ifa stop loss proposal is acceptetl otherthan those provitletl through F serv Health as shown above, an ezlemal stop loss intertace fee of $2 00 PEPM wll apply Neither Fiserv Hea N nor the Stop Loss Carvers will ba bountl by any typogaphical errors antllor omissions containetl herein. Please rofer to actual proposal for rates; enrollment counts; contingencies antl other wntlit ons. l%S~VHealth:ฐ` BP Inc. 6160 Summi[ Drive, Swte 345 Brooklyn Center, MN SSa30 763-1693310 Fax 762-569-3338 Proposed Schedule -Excess Loss Coverage Combined Insurance Company of America Group Name: Kerr County Proposal Prepared On: 10/19/2006 Effective Date of Proposal : 111/2007 Underwriter: Mark Tebben Expiration Date of Proposal : 111/2007 Administrator of the Plan: Fiserv Health Revision Date A. SPECIFIC (INDIVIDUAL) EXCESS LOSS COVERAGE: Specific Deductible per covered participant for th e policy year: 50 000 60 000 75 000 _, Company's Limit of Liability (Reimbursement Factor) 100% of pay ments in excess of the Specific Amount to Specifc Lifetime Amount per covered person: 950 000 940 000 925 000 Monthly Premium Rates, # Units 15112 15112 15112 Single 180 58.09 50.87 39.62 ,~ Family 69 116.33 102.89 81.12 Annual 221 796 195 072 152 747 Total 249 Specific Run-In Limits: s$ o.aoo soooo 7sooo Covered Benefits under Specific: MedicallRX Advance Funding Benefit is included at no cost. B. AGGREGATE EXCESS LOSS COVERAGE: Monthly Aggregate Factors: # Units 15112 15112 15112 r Single 180 396.33 04.26 16.15 Family 69 771.65 787.09 810.24 Annual 1 495 003 1 524 903 1 569 753 Total 249 Aggregate Run-In Limits 2zaooo zzsooo zss sooo Covered Benefits under Aggregate: X Medical Dental x Rx Card Aggregate Premium: $4.55 /EEIMon iasgs.a Optional Aggregate Accommodation: X No Yes, Prem: IEE/Man Optional Aggregate Terminal Liability: X No Yes, Prem: IEE/Man Minimum Annual Aggregate Attachment Point: Greater of quoted attachment point x 95% or 1st month's enrollment x 12 x 95% Company's Limit of Liability (Reimbursement Limit) 100% of payments in excess of the Annual Aggregate Attachment Point to a maximum of $1,000,000.00. r C. COMMISSIONS: 5ฐ/ Specific 5ฐ/ Aggregate Aggregate Accommodation Specific TLO Aggregate TLO - D. PROPOSAL QUALIFICATIONS shown on page 2 . E. PLEASE CIRCLE SELECTED TENTATIVE OPTION. Page 1 of 2 BP Inc. ^ Group Name: Kerr Proposal Qualifications This tentative proposal will not be considered frm until ali additional requirements, disclosure requirements, and other qualifcations have _ been received and approved by BP Inc. This tentative proposal is based on the data submitted, plus other information furnished relevant to underwriting the risk, including statistics with reference to premiums paid and claims incurred with the present carrier. Any inaccuracy in the data or statistics submitted will necessitate additional calculations. Variations will of course affect results. We will not be bound by any typographical errors contained herein. Subject to the qualifcations stated below, the proposed terms are valid far an effective date c 1/1/2007 provided ^ application and deposit premium are submitted before 11112007 .Note that producing agent mus o a current and valid accident and health license. Quote assumes that the claims wi e a ministered by a facility which has been approved by BP Inc. ^ x Additional Data Requirements: MONTHLY CLAIMS/LIVES THROUGH 11/15/06. APSILCM reports, etc. on members 45205351, 45220351, 45235651. Separate deductibles may apply. ^ LARGE CLAIM LISTING FOR 111105-111/06. x Other Qualifications THIS OFFER WILL BE NULL AND VOID UNLESS THE COUNTY ELECTS TO WAIVE THE REQUIREMENTS OF 21 49-16, ^ AS OUTLINED IN HB 1466. Proposal Qualifications x Quote is subject to receipt of completed disclosure statement and our acceptance of same. X Underwriting reserves the right to change the terms and/or the conditions of coverage when the participation varies by more than 10% and/or ^ whenever plan or network changes occur. x 75% minimum panicipation is required unless specifically approved by underwriting. X Requires utilization review, large case management, precenifcation and transplant network - Case ManagementlTP network are ^ available through 8P Inc. Contact 8P Inc. for additional information. Without these aroducts increase specific rates 6% 1x1.06). x Stop-loss coverage is for non-occupational injuries and illnesses, X Quote assumes that the plan has elected to make surcharge payments directly to the New York Department of Health, Surcharges, pool charges, covered lives assessments, and PPO access fees are not covered by this Excess Loss Policy. ^ X Actively at work provision for employee and nonconfinement provision far dependent(s) waived subject to disclosure. X This proposal is not valid for MEWA's, Associations, Employee Leasing, Professional Employment Organizations X If this conditional quote is accepted by the client, circle the selected option on page 1, client should sign on page 2, then forward to BP Inc. with any ,_, additional required information. Disclosure statement will be provided by BP Inc. for completion by client. We accept scanned, copied or original documents. Plan Assumptions X Assumes duplication. ^ Assumes suggested plan design. Disclosure Qualifications -Disclosure statement must be requested from BP Inc. s,. X We will require updated diagnosis and prognosis including anticipated treatment and estimated costs for any claim exceeding 50% of the specifc level as of 45 days prior to the Effective date as well as details on any individual on a transplant waiting list X Run-in options are subject to BP Inc.'s review of: See below X Pending claim report. '- X Known confinements that have not yet generated a bill. X Pre-certs for mare than seven days during the past 3 months. X Subrogated or denied claims. ,~ X All claimants reported in the request for proposal as being "deceased", "terminated", "inactive" are excluded from stop-loss coverage. X Quote Is subject to receipt and approval of BP Inc. disclosure statement -available upon request. X If we later learn of any material inaccuracy in such information, or failure or refusal to disclose any such information, including all claims or possible claims which you would know about, BP Inc. may reject a claim to which such information applies, reject the application change the terms, '- conditions, premiums, or void coverage. X Client understands and acknowledges that Fiserv Health and BP Inc. are affiliated companies and that through their parent corporation, they have a financial interest in the placement of this stop-loss product through a related company. x PLEASE CIRCLE SELECTED TENTATIVE OPTION on page 1. Client Signature is required : Page 2 oil Kerr County Specific and Aggregate Stop Loss Insurance Third Party Claims Adminishation Group Term Life and AD&D HRA Administration - PLEASE FILL IN THE FOLLOWING INFORMATION NEEDED AND SUBMIT WITH PROPOSAL. _ The undersigned proposer, by signing and executing this proposal, certifies and represents to the Kerr County that proposer has not offered, conferred or agreed to confer any pecuniary benefit, as defined by (1.07 (a) (6) of the Texas Penal Code, or any other thing of value as consideration for the receipt of information or any special treatment of advantage relating to this proposal; the - proposer also certifies and represents that the proposer has not offered, conferred or agreed! to confer any pecuniary benefit or other thing of value as consideration for the recipient's decision, opinion, recommendation, vote or other exercise of discretion concerning this proposal, the - proposer certifies and represents that proposer has neither coerced nor attempted to influence the exercise of discretion by any officer, trustee, agent or employee of the Kerr County concerning this proposal on the basis of any consideration not authorized by law; the proposer also certifies and represents that proposer has not received any information not available to other proposers so as to - give the undersigned a preferential advantage with respect m this proposal; the proposer further certifies and represents that proposer has not violated any state, federal, or local law, regulation or ordinance relating to bribery, improper influence, collusion or the like and that proposer will not in - the future offer, confer, or agree to confer any pecuniary benefit or other thing of value of any officer, trustee, agent or employee of the Ken County in return for the person having exercised their person's official discretion, power or duty with respect to this proposal; the proposer certifies and represents that it has not now and will not in the future offer, confer, or agree to confer a - pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of the Kerr County in connection with information regarding this proposal, the submission ofthis proposal, the award ofthis proposal or the performance, delivery or sale pursuant to this proposal. The proposer shall defend, indemnify, and hold harmless the Kerr County, all of its officers, agents and employees from and against all claims, actions, suits, demands, proceeding, costs, damages, and liabilities, arising out of, connected with, or resuliting from any acts or omissions of contractor ~- or any agent, employee, subcontractor, or Supplier of contractor in the execution or performance ofthis RFP. I have read all of the specifications and general proposal requirements and do hereby certify that all ""' items submitted meet specifications. COMPANY: Fiserv Health - AGENT NAME: Rick M. Sch 1 Tonal ~ ice Pre 'dent of Sales AGENT SIGNATURE: ~ ADDRESS: 194 S. Main CITY: Boerne STATE: Texas ZIP CODE: 78006 - TELEPHONE: 210-558-2100 FAX: 210.558-2151 FEDERAL TIN#: 41-1879681 AND/OR SOCIAL SECURITY #: - DEVIATIONS FROM SPECIFICATIONS IF ANY (Attach documents as necessary or state No Deviations): Page 2a Kerr County Specific and Aggegate Stop Loss Insurance Third Party Claims Administmtion Group Term Life and AD&D HRA Administration CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS Name Of Entity: Fiserv Health - The prospective participant certifies to the best of its knowledge and belief that it and its principals: - a) Are not presently debarred, suspended, proposed for debarment, declazed ineligible, or voluntarily excluded from covered transactions by any Federal department or agency: b) Have not within a three year period preceding this proposal been convicted of had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with - obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitmst statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false - statements, or receiving stolen property; c) Are not presently indicted for or otherwise criminally or civilly chazged by a government entity (Federal, State, Local) with commission of any of the offenses enumerated in paragraph (I) (b) of this certification; and - d) Have not within a three yeaz period preceding this application/proposal had one or more public transactions (Federal, State, Local) terminated for cause or default. - I understand that a false statement on this certification maybe grounds for rejection of this proposal or termination of the award. In addition, under 18 USC Section 1001, a false statement may result in a fine up to a $ 10,000.00 or imprisonment for up to five (5) yeazs, or both. Rick M. Scheel, Regional Vice President of Sales Name d itle of thorized Representative (Typed) Si ~ tur f A thorized Representative 10/12/2006 Date I am unable to certify to the above statements. My explanation is attached. Page 26 Conflict of Interest Questionnaire For Vendor or Other Person Doing Business with a Local Government Entitv This questionnaire is being fled in accordance with chapter 176 of the Local Government Code by a person doing business with a government entity. By law this questionnaire must be filed with the records administrator of the local government not later than the 7`" business day after the date the person becomes aware of the facts that require the statement to be tiled. See section 176.006, Local Govemment Code. A person commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C Misdemeanor 1. Name of person doing business with local government entity. Fiserv Health/Rick M. Scheel, Regional Vice President of Sales 2. ^ Check this box if you are filing an update to a previously fled questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for which the activity described in Section 776.006(a) Local Government Code, is pending and not later than the 7'^ business day after the originally fled questionnaire becomes incomplete or inaccurate.) 3. Describe each affiliation or business relationship with an employee or contractor of the local government entity who makes recommendations to a local government officer of the local government entity with respect to expenditure of money. Not applicable. 4. Describe each affiliation or business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local government entity that is subject of this questionnaire. Not applicable. 5. Name of local government officer with whom fler has an affiliation or business relationship. (Complete this section only if the answer to A, B or C is YES) This section, item 5 including subparts A, 8, C & D must be completed far each officer with whom the filer has affiliation or business relationship. Attach additional pages as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income from the fler of this questionnaire? ^ YES X NO B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government officer named in this section? ^ YES X NO C. Is the fler of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an off cer or director or holds an ownership position of 10% or more? ^ YES X NO D. Describe each affiliation or business relationship. 6. Describe any other affiliation or business relationship that might cause a conflict of interest. Not applicable. 7. Signat~ires " j ,_ Si not a of rso doing bu Iness with the Governmental entity 10/12/2006 Date F%5 !B V Health.. Kerr County Specific and Aggregate Stop Loss Insurance Third Party Claims Administration Group Term Life and AD&D HRA Administration This portion of the questionnaire will be completed upon being named as a finalist. Individual Stop Loss Insurance (ISL)/Aggregate Stop Loss Insurance (ASL) Request for Proposal Submission Form - RFP ASSUMPTIONS: 1. Proposal is to be based on duplication of the existing Plan of Benefits, unless otherwise specified, Any - deviations must be clearly identified and explained. All proposals will be assumed to have been submitted without anydeviations unless clearly noted. 2. Proposal is to be based on the provided census. 3. Contract effective date is to be January 1, 2006. All participants enrolled in the insurance plan as of December 31, 2005 are to be covered on a "no loss/no gain" basis. "No loss/no gain" for participants are to include crediUdebit for accumulated deductible, coinsurance, and lifetime maximum benefits. 4. KERB COUNTY desires to receive proposals for a three (3) year period on one of the following basis: - Fixed price for the three (3) year period, or • Two annual renewal adjustments determined by formula at the time the contract is awarded, or • One (1) year contract with two annual renewal options for rate and premiums deemed to be favorable to KERR COUNTY. Renewal rates are to be provided to KERR COUNTY by October 1 (90 days prior to - anniversary date). 5. KERR COUNTY will only consider stop loss insurance policies meeting the following: - a. Specific and Group Aggregate Policy on a 15/12; paid/12; or paid /15 basis for Medical and Drug (Rx). We do not wish to see an aggregating specific; however; a 24/12 contract may be proposed. b. Medical and Drug (RX) Specific Coverage with $40,000; $50,000; $60,000 Stop loss. - c. Medical and Drug Aggregate Coverage at 120% and 125% of expected claims d. Final determination on all lasers, if any, including deductible amounts and conditional lasers should be clearly identified and provided with RFP response based on provided claims data - e. Insurance Company Quotation Document with all terms clearly listed f.. Waive Actively at Work Provisions 6. Renewal rate must be received by KERR COUNTY at least 90 days prior to date of rate change. 7. Any estimated savings, performance or other guarantees should be specific, quantifiable and should include a method for validation. F%5@@ VHealthr" Kerr County Specific and Aggregate Stop Loss Insurance - This portion of the questionnaire will be completed upon being named as a finalist. QUESTIONS: - 1. Describe the business entity submitting the proposal: a. Insurance Company Name: - b. Address: a Contact Person: d. Telephone Number e. Year Founded (Ins. Co): f. What percentage of overall business is Health related? .- g. Managing Underwriter's Name: h. Year Founded (Managing Underwriter): '~ i. Number of Years for Representing Insurance Company: 2. Describe Financial Stability of - Insurance Company: a. Financial Rating Service Current Rating Prior Year Rating - A.M. Best Standard & Poors Moody's b. Is Insurance Company authorized to do business in Texas? X Yes No - 3. Provide three (3) Texas client references (preferably public entities): Name of Client Contact Telephone Number of Employees Ci of Fredericksbu W nell Herbort 830 990.2017 151 C' of GaAand Robb Neill 972 205-2481 1618 Sid Peterson Memorial Hospital Sandra Patterson (830) 258-7441 463 r F%5e V Health... PLEASE ANSWER QUESTIONS 4 THROUGH 7, IF STOP LOSS INSURANCE IS SUBMITTED BY MANAGING UNDERWRITING GROUP OR OTHER BUSINESS ACTING AS AGENT OR REPRESENTATIVE FOR ANY INSURANCE COMPANY. 4. Describe the business entity submitting the proposal: a. Name of Business Entity: b. Current Business Address: c. Mailing Address: d. Contact Person: e. Telephone Number: f. Type of Business Entity: _Corporation General Partnership _ Sole Proprietorship Registered Limited Liability Partnership _ Limited Liability Company 5. a. Has the business entity been a defendant in any lawsuit in any state or federal court during the preceding five (5) years? _ Yes No If yes, identify each lawsuit by party, case number, court, subject matter, and disposition: b. Does the business entity have any claims filed against it which are unresolved and presently pending before any State of Texas Administrative agency? _ Yes No If yes, please provide a full description of the charges 6. Financiallnformation: a. Has the business entity filed a voluntary or involuntary petition in bankruptcy, obtained an order for relief, or received a discharge on any debt under the U.S. Bankruptcy laws during the preceding seven (7) years? Yes No If yes, please describe: b. Has any owner, member, or partner of the business entity filed a petition in bankruptcy, obtained an order for relief, or received a discharge on any debt under the U.S. Bankruptcy laws during the preceding seven (7) years? BEING ENTITY F%5e V Health. If yes, please describe: Yes No F%5B VHealth.~g 7. Describe insurance coverage (include copy of Insurance Certificate): a. The business entity must provide satisfactory evidence of existing insurance coverage in the amount of $1,000,000.00 for Errors and Omissions or other fiduciary liability. If the business entity is selected to provide services it must provide evidence that such coverage will be in effect for the duration of the agreement. 8. Describe ISL and ASL claim payment: a. Where will claims be paid? b. What is the definition of "paid claim" to be eligible for reimbursement? c. Can KERR County's Treasurer and consultant speak directly to claim examiner for ^- questions related to payment of claim? Yes No Comment: d. What is the normal processing time for ISL claim? e. What is normal processing time for ASL claim? f. What are eligible expenses related to investigation of claim (e.g. hospital audit, medical records, etc)? o g. If KERR COUNTY has negotiated with providers, will these discounts be accepted, in lieu of doing a hospital or other audit? Yes No h. Describe documentation needed for ISL claim reimbursement: F%5e V Health.. 9. Describe Underwriting: a. Will any claimants be excluded or assigned a higher deductible (lasered)? _ - Yes No If so, please describe: b. Will renewal rates be provided to KERR COUNTY 90 days prior to renewal date? _ - Yes No 10. Did you provide a Specimen Stop Loss Contract? Yes No - it. Does your Stop Loss insurance contract have any exclusions or limitations that are more restrictive than those used in KERR County's booklet? _ Yes No - If so, please describe: - 12. Are the active-at-work and disabled dependent provisions waived for the effective date of the contract? _ Yes No 13. If Centers of Excellence are used for your transplant coverage, please provide specific .r information for facilities cost and procedures to be used: Please attach a schedule with complete information: 14. Please state any variations to the Request for Proposal Assumptions or other qualifications for your quote: 15. After the ISL deductible is reached will the stop loss carrier pay claims directly to vendor or require Kerr County to pay claim and be reimbursed? If reimbursed what is turnaround time? 15. For what period of time are quoted rates guaranteed? F%5 tB V Health. s 16. Is a longer rate guarantee available? No If so, please describe: 17. Are quoted rates net of agent commission? _ No If no, please describe: 18. Do quoted rates include advance funding for: a. Specific Claims? Yes If no, additional cost to provide: b. Aggregate Claims? Yes If no, additional cost to provide: 19. Is the quote based on the services of a specific provider network? 20. Please give rate differential to use the following networks: Specific Aggregate a. PHCS _ b. Healthsmart _ c. BC/BS _ d. CNN e. Beechstreet _ f. Other (Name) _ Differential Yes Yes No No Yes No F%5 /B VHealth.F ._ 21 The following rate exhibit may be used for rate submission however included with the CD or available by Internet is an Excel Spreadsheet titled, "Self Funded Quote Spreadsheet". Complete this spreadsheet as it will be used for bid analysis. This portion of the questionnaire will be completed upon being named as a finalist. HIGH PLAN $ Specific Deductible Basis for Deductible: Incurred Paid Number Rates Monthly Premium Annual Premium of Particip ants Specific Premium: Single Family ,~ Composite Aggregate Premium Composite Aggregate Attachment Pts. Single Family F%5e V Health. Kerr County Third Party Administration Questionnaire "' TPA Organization 1. Name, Address, City, State, Zip Code and Telephone Number of Firm. Fiserv Health 5550 Wayzata Boulevard, Suite 500 r Minneapolis, MN 55416-1241 Telephone: (763) 549-3359 a. Toll-free: (800) 547-9767 Fax No.: (763) 549-3359 2. Is your firm owned or operated by a parent company? If yes, please identify the parent and its primary business. Yes. Our parent company is Fiserv, Inc. Fiserv is the industry-leading provider of management systems and poMolio services for the ฐ` financial and health care indusMes. Services include software and systems solutions, transaction processing, and programs that significantly enhance client portfolio profitability. 3. How long has your firm been in business? How long have you done claims administration? In 2005, Fiserv Health, a division of Fiserv, Inc., combined its individual third-party administration (TPA) businesses into one organization under the Fiserv Health brand. This move enabled us to leverage technology, best practices, and strengths to provide customers ~. with industry-leading tools for controlling health care costs. With a combined history of more than 200 years, Fiserv Health has the experience and strength to accommodate our customers' needs and the flexibility to tailor solutions that make sense. We serve more than four million members and more than 1, 700 customers, making us one of the largest third party administrators in the country. Fiserv Health is headquartered in Minneapolis, Min., with satellite sales and claim processing otices located throughout the U. S. We currently employ approximately 4, 000 people. Fiserv Health is a division of Fiserv, Inc., which provides information management systems and services to the financial and health benefits industries, including transaction processing, outsourcing, business process outsourcing and software and systems solutions. F%5B VHealth. 4. Who are the principal officers in your firm? How long have they been in their positions? Jay M. Anliker, Division President, Health Plan Services, 2005 - Jeff Mills, President, Health Plan Administration, 2005 Robert W. Wulf, Senior Vice President and COO, Health Plan Administration, 2005 Jeffrey J. Sjobeck, Chief Financial Officer, 2005 - John Sickles, Senior Vice President, Sales and Marketing, 2005 - 5. Is this a branch facility? If so, please identify the main office location. Yes. Our main office is at the following address: - 5550 Wayzata Boulevard, Suite 500 Minneapolis, MN 5541&1241 6. How many claim processors are Full Time employees in your firm? We currently have 97 full time claims processors at our San Antonio service center. 6a. How many claim processors will be appointed to service this account? - We currently have a ratio of 1 claims processor to 2, 200 employee lives. 6b. Approximately how many years of experience does each have with medical claims - processing? The average length of experience for our claims analysts is seven years. 7. Do you have bilingual claims personnel available to plan participants who call your office for customer service and/or claims processing? Over forty percent (40%) of the customer service representatives in the San Antonio service center are bi-lingual. If a call is received by a representative who cannot assist the caller due to a language barrier, the caller has the option of being transferred to a Spanish speaking representative or leaving a confidential voice mail message. These messages are responded to before the end of the business day. 8. How many clients do you perform claim administration services for? What is the average size? Fiserv Health has over 1,800 clients that we perform claim administration services for. The average client size is around 1,500 employees. F%5e V Health.. - 9. Do you carry Errors & Omissions coverage? Please disclose Name of Carrier and Limits. _ Fiserv Health has a blanket bond of $5 million. In addition, Fiserv Health has fidelity bond and error and omissions coverage with limits adequate to cover our exposure under the proposed agreement between Kerr County and Fiserv Health. We consider the limits to be _ confidential. However, we will be happy to certify that the coverage meets your company's requirements. Claims Administration 1. What are your claim office performance standards for claim accuracy and turnaround time? Financial Accuracy Fiserv Health agrees that Claim payments, on an aggregated dollar basis, shall be ninety-nine percent (99%) accurate to the plan of benefits. Turnaround Tlme Fiserv Health agrees that ninety percent (90%) of all clean Claims will be processed within 10 business days from the date that Fiserv Health receives all information necessary to adjudicate the Claim. 2. What is your average turnaround time? We process more than 90 percent of all claims within 10 business days. 3. What is your current per day production minimum expected of your claims processor? The standard daily productivity level for claims processors in the San Antonio service center is 225 claims. 4. What are your internal audit procedures? '- All claims in excess of $10,000 will not auto-adjudicate and are pended for review. In addition, we have the following quality assurance program in place. Our quality assurance program includes the reviews and audits listed below: F%5B V Health.ขs~ Random Review .- On average, 3.5 percent of all claims are routinely reviewed for accuracy. Random review includes the two processes listed below. Svstem-generated random review Our system randomly selects 2 percent of processed claims daily for review. These claims are analyzed for coding, payment and procedural accuracy. The quality analyst conducts the review. If he or she detects an error, it is corrected and feedback is immediately provided to the processor who processed the claim. ~' Special case review The unit supervisor reviews additional claims that exceed specific dollar values, involve payment to athird-party other than the employee or provider, or are special cases. Targeted Review Our quality assurance unit audits various claims to be certain our system is functioning correctly and that our processors are accurately handling claims. These targeted reviews hit every aspect of claim administration and are used for quality improvement. 5. What edits and controls are used to avoid duplicate payments? Our edits for duplicate claims include: • Date of Service r • Provider ID, TIN #, Name, Address, Phone (TIN only) • Diagnosis/Proeedure Code (Procedure Code) • DollarAmount • Type of Service 6. What safeguards exist to protect against claims abuse and fraud? Components of Fiserv Health's fraud control procedures are outlined below. Computer system edits and staN training We work with industry organizations to identify and monitor trends in insurance fraud. We have built in computer system edits, developed review procedures and provided special training to our claim professionals to help them identify potentially fraudulent situations. F%5B V Healtl~.>= Claim Special Investigation Questionable cases that cannot be resolved through claim professional verification are referred to our claim special investigation (CSI) area. This area is dedicated exclusively to detecting and investigating situations that could negatively impact our customers. The area's investigation technicians work closely with our on-site attorneys and medical personnel. In order to minimize possible fraudulent activity, CSI keeps detailed records of questionable cases in an in-house system that tracks the key components of a case from start to finish. Suspicious activity is recorded and providers with recurring problems are identified. Once identfed, any future claim from the provider is referred to CSI for review prior to payment. Because they understand the importance of communication during the investigation process, our staff keeps in close touch with the provider, employer and the "' member throughout the process. Internal security We also maintain internal security through a specially designed system of checks and balances built into our organizational structure. This structure separates claim administration into four distinct areas, each with highly controlled authority levels. The four primary functions are: '" Adding providers to the system Updating and adding member eligibility information Entering the plan benefits into the claim system Processing the claim Employee hotline and education In addition, we encourage members to participate by providing atoll-free hotline for their use in reporting suspected cases. The toll-free number appears on each explanation of benefits (EOB) statement, along with a brief explanation on the importance of controlling fraud. If desired, we will also provide you with educational material for distribution. 7. What program do you use to unbundle claims? Fiserv Health claim payment system automatically detects unbundling and upcoding through the use of programmed edits. F%5e V Health., Fiserv Health routinely uses both purchased and internally-developed software to detect unbundled and upcoded charges. The purchased software is the Code Review System from McKesson. This system has very extensive logic to help determine inappropriate charges. The intemally-developed software works in conjunction with the McKesson logic to identify inappropriate or potentially excessive charges not currently flagged by current vendor ฐ systems. An example of this is software to flag potentially excessive physical medicine charges over time. We can also use DRG and HCPS codes if requested 6y the employer. ^ There is no additional charge for using the software. ^ 8. What coordination of benefits (COB) procedures do you follow? Coordination of benefits (COB) provisions are pursued aggressively at all dollar levels and ฐ claims are investigated before payment. To facilitate this process, Fiserv Health routinely captures, maintains and accesses spousal coverage and employment data for COB purposes. Our system alerts the customer service representative (CSR) when there is „ evidence of prior COB activity. It will not allow payment for individuals when the plan is secondary, unless the "other insurance allowable"and 'paid" fields have been entered. '- 9. What database do you use to determine Reasonable and Customary fee allowances? How frequently do you update your R&C screens? ฐ We will provide service at your preferred screening level. We can provide reasonable and customary screening levels from 70 percent to 95 percent for medical claims. Typically, our customers request the 85th percentile. The Ingenix file is updated twice annually. 10. Describe your procedures for professional Medical claims review? ฐ Fiserv Health Care Management can perform retrospective reviews that are conducted at customer request as long as the request is received within thirty days of the original determination. Retrospective reviews are conducted according to our standard pre- ฐ cert~cation policies and procedures. 11 Explain your hospital bill audit procedures. Our standard is to perform hospital bill audits on all claims exceeding $50,000. Customers can choose lower thresholds; however, there is an additional service fee associated with lower review thresholds. F%5e VHealtl~. 12. Describe your procedures for tracking and reporting excess claims? Large claims are monitored when payments reach 50 percent of the specific level, trigger diagnosis codes when medical management is provided by Fiserv Health and with long - hospffal stays. Reporting parameters are based upon the size of the payment and are done on a monthly, weekly and daily basis. Fiserv Health has developed a proprietary stop loss activity monitoring (SLAM) system. SLAM intelligently and proactively manages stop loss trigger reporting requirements pursuant to your policy. SLAM captures claim based on any of the following: ICD-9 Codes • 50 percent of specific deductible - • Case management • Precertfication activity - Claimants are tracked on a daily basis. Reporting parameters are based on the timefreme agreed upon with the stop loss carriers. 13. Explain how you handle subrogation and third party disbursements? We are very active in pursuing subrogation opportunities. From the time of claim intake, - subrogation opportunities are investigated and evaluated. Our claim system contains edits that automatically flag claims when the potential for third-party liability is ident~ed. When an edit is triggered, the system generates an inquiry that is sent to the member. The member - can either return the inquiry or call customer service to supply the information needed to process the claim. Once this is completed, the claim will be processed according to plan benefits. Ourprocessors conduct/coordinate the appropriate claim investigation. Our procedures and standards require regular communication with the employee 6y the claim - examiner. These communications may include telephone contactsrnterviews and the collection of all records concerning the event. This communication, early identification and the securing of a reimbursement agreement, along with our Social Security advocacy - program, has resulted in an excellent record for customer plan payment restitution. We have a dedicated subrogation unit that is experienced in handling subrogation claims. - Our processors work with the subrogation specialists within this unit to evaluate and resolve any outstanding issues. If a third-party has been identified as being potentially libel, the claim will be forwarded to J.W. Hutton, Inc. J.W. Hutton will place all of the necessary parties on - notice and secure the appropriate liens for the purpose of protecting the plan's interest. J.W. i F%5 tB V Health.; Hutton will follow the case until funds have been recovered or it has been determined that no third-party funds are available. The fees for this service are 25 peroent to 33 percent of recoveries, contingent upon the need for legal representation. Our standard plan language includes Right of Subrogation, Reimbursement, Third-Party Liability and Assignment of Rights Provision wording. The provision requires restitution if there are any recoveries made. Benefits are advanced to the participant when the injuries are the result of a negligent third-party and sought from them through the subrogation process. Our standard plan language further states "If the Plan has already made payments or provided benefits to You for charges incurred as a result of an accident, illness, injury or other medical condition for which any Other Party may be liable and You fail to comply with - the requirements set forth above, the Plan may reduce future benefits otherwise payable under the Plan for any illness, injury or medical condition by the amounts recovered by You or Your Dependent(s) from the Other Party." 14. List the excess carriers which you are approved with for claims administration? Upon request, Fiserv Health will market stop loss for self-funded employers for whom we pay claims. We have direct relationships with the stop loss MGUs and carriers listed below. MGU or Carrier Aetna Allianz BP Inc Com anion Life Elite Underwritin Great-West Healthcare Hartford HCC Life subsidia of HCC Insurance Holdin s, Inc) ING Intermedia Insurance Services Inc (IISI) J Allan Hall & Associates Mutual of Omaha National Benefit Resource (NBR) Sun Life S metre Trustmark Zurich _ In addition to the direct relationships listed above, Fiserv Health is currently administering cases for numerous other MGUs and carriers on anon-direct basis. F%5 !B V Health 15. Do you provide a toll free number for claim inquiries? If yes, what is the cost? _ Yes, Fiserv Health provides atoll-free telephone service to address both employer and member questions. We routinely monitor telephone usage to ensure that call volume is managed effectively and inquiries are promptly and correctly answered. There is no additional charge for this service. 16. What are your normal hours of operation to answer calls for claim inquiries? Our Customer Service department is available from 7:00 a.m. to 7:00 p. m. (CST) Monday through Friday. 17. Describe your customer service process when an employee calls with a claim inquiry Customer service representatives are available for employee inquiries regarding claims inquiries, including status and history, plan benefits, eligibility, dependent information, provider questions, etc. Our representatives have access to all information online and are able to assist the client during the initial phone call. They are trained to resolve issues during that initial contact. All calls are documented in our online Diary System. Our Diary System requires the customer service representative to identify a status of the inquiry (Open vs. Close). This allows for the customer service manager to determine turn-around resolution to all inquiries and to identify trends. 18. If you have a separate customer service unit, what are your standards for: Answer Time: Our 2004 and 2005 average speed to answer was less than 15 seconds. Abandon Rate: Our 2004 and 2005 call abandonment averages were less than 1.0ฐ/, for all calls received in our claims department. ~- 19. What submission rate has been assumed when calculating your fee? Our lee is based on an average of 18.73 bills per employee per year. 20. Does your fee assume a first year claim lag? If so, what is the cost to purchase mature claim year administration? Yes. First year fee is based on a 12/12-contract. To mature to a 15/12-contract would result in a rate impact of 3.5%, or a fee of $14.26. F%5 !B V Health 21. Does your fee assume any excess loss carrier overrides? No, there are no excess loss overrides built into the admin fee. A stop loss interface fee equivalent to 5'yo of the stop loss premiums is displayed as a separate line item in the (nancial proposal. Eligibility Svstem 1. How is an insured's eligibility assigned and maintained? We maintain employee and dependent eligibility information in our database. This information includes subscriber and dependent Social Security numbers, historical coverage information and other relevant eligibility information. '- 2. How often can eligibility information be updated? For electronic enrollment, we recommend weekly files. We can accept more or less frequently at your request. We work with you and your vendor to determine how often the eligibility information will be sent. Changes are loaded usually within one day of receipt. For Internet enrollment, changes approved and submitted are updated the evening they are received. 3. Do you maintain information on each of the family members separately, as well as the employee? We collect and maintain dependent information including name, date of birth, gender, and effective and termination dates. We also check for and update the status for students and disabled dependents. 4. What is your accuracy standard and turnaround time for loading new groups, updates, and changes? Fiserv Health will work with Kerr County to develop mutually agreed upon implementation deliverables and dates, with the appropriate contingencies. Svstem Capabilities 1. Is your claim processing system completely automated? Our claim processing system is not completely automated. We have increased our auto- adjudication to greater than75 percent. This was accomplished by adding new coding that f%5e V Heal th.: allowed for the automation of more benefit plans, as well as automating letters and requests for information. 2. Are there any significant manual activities required to process claims? Pended claims are claims that cannot 6e processed without manual intervention. These Gaims are placed into a processor's queue. Daily inventory reports list all claims in each _ processor queue in chronological order. Processors are required to process claims on a first- in, first-out basis. The claim supervisor and claim manager review and manage the daily claim inventory reports to ensure this happens. We also have an inventory management _ specialist that spec~cally monitors our inventories at all levels, to ensure all claims are processed timely and in accordance with internal claim turnaround standards and Department of Labor (DOL) regulations. 3. Describe your claims payment system, including hardware and software? Our mainframe environment is located off site. Our data center adheres to IBM architecture. It has an uninterruptible power supply and is on separate climate control from the rest of the building. The server has daily off-site backups, SHARK Raid 5 storage, and redundant power supply. Our claim payment system was internally designed and is monitored by a team of system analysts who specialize in employee benefit administration. Updates and modifications are made on an ongoing basis to respond to the changing needs of customers, as well as trends in claim processing, employee benefit plans and the health industry. Since initial installation, our claim system has been upgraded to meet the changing benefits environment. These upgrades supported newer technologies, higher levels of automation, and rapidly developing managed care support. Our system is differentiated from others by our state-of--the-art functionality. We have a very flexible adjudication module which can be structured to pay or deny all industry standard coding. We employ highly sophisticated expert logic with claims administration edits to auto- adjudicate all types of benefit structures while saving customers loss dollars when appropriate. 4. Do you own or rent your claim payment system software? We own our claims processing system. F%5e VHealth.>~' r 5. How is a person's claim history tracked? Claim history is maintained online in the claim payment system for 18 months. We also image r the history and maintain it on computer tape. A copy of the computer tape is kept at the claim office. An additional copy is maintained off-site as part of our disaster recovery program. 6. How many benefit components (IE -separate deductible, totals, lifetime benefits, etc.) can be maintained by the system? Our claim payment system maintains all policy maximum benefit limitations online, including: • Individual and family deductible • Individual and family out-of-pocket limits • Deductible carry-over • Lifetime maximum 'ฐ • Individual stop loss • Separate payments for noncompliance with utilization review procedures • Separate internal limits (such as outpatient psychiatric treatments) 7. Can the system track number of visits by procedure? Yes, our system can track visits by type of procedure (CPT code). 8. Can the system handle different benefit levels for PPOs? Our Gaim payment system is designed to provide consistent administration for a wide variety s. of benefit plans and pricing arrangements. The system is flexible and is easily enhanced for new products and services. Our claims processing system, located at our corporate headquarters in Wausau, Wis., was internally designed to meet the needs of a diverse client base, as well as to accommodate changes in the benefits environment. This flexibility gives us the ability to administer all levels of fee schedules and PPO -- configuration. We can also administer conversion factor pricing, negotiated or fixed-fee schedules, provider discounts, usual and customary fee administration, per diem rates, or any combination of these elements. This is a single, fully integrated claims and administration - system which uses common databases and processing functions. '- 9. How many PPOs can the system handle for one client? We are able to administer multiple networks and plan designs by entity. 10. Can your system accept Electronic Data interchange claim submissions? - We have been receiving claims electronically for the past 10 years and use the following EDI Gearinghouses: • EnvoyrWebMd • HBOC • ProxyMed - McKesson • ClaimLynx • Medifax • SSI - ENS • TK Software • ppoOne We also have some direct connections with higher volume providers and networks. 11. What percentage of your claims is currently accepted on an electronic basis? - Currently, 63.6% of hospital claims and 69.5% of physician claims are received electronically. Banking Arrangements 1. Do you require the use of a specific bank for claim accounts? If so, please provide the name, address, and phone number of the bank. Fiserv Health offers two banking options for paying claims. Our standard option is home banking. The second option is custodial banking. Home Bankinc (Standard) Home banking allows you to establish a bank account at the financial institution of your choice. Fiserv Health is authorized to issue and sign checks from this account, utilizing a facsimile signature only, no manual checks are written. The advantage of home banking is that you determine the type of bank account and method of funding. There is no initial deposit required. You retain complete control of the account, - which includes reconciliation, management, and state reporting of un-cashed checks. ฐ F%5 fB V Health. Check Holds ฐ We issue checks daily and offer several check hold options, which are included in the standard pricing. Our standard check hold procedure is to issue provider checks weekly, and employee checks daily. Fiserv Health will work with you to determine an option that best meets your needs. Customer speck check hold arrangements, are available at an additional charge. Custodial Banking ฐ With custodial banking, we set up a Fiserv Health owned bank account for you at Marshall & llsley (M&I) Bank. All payments are made through this account. ฐ This arrangement is optional and additional fees are associated with the set up and maintenance of the bank account. An imprest security deposit equal to three weeks of estimated claim activity is required. The imprest security deposit must remain in the bank ฐ account as long as it is active and there are still items on the outstanding list. This deposit serves three purposes: ฐ It allows you to fund the account once, weekly, based on the claim checks that are issued from the account during the prior week It protects against large-loss claims clearing prior to the funds being deposited ฐ • It creates the sufficient compensating balance needed to offset bank fees associated with the account (bank fees are not incorporated into the Fiserv Health custodial management service fees). '"~ Fiserv Health manages all aspects of the account, including: • Daily positive pay processing ฐ- Stop payment requests • Check copy requests • Outstanding list maintenance ฐ Monthly reconciliation and management • State reporting of uncashed checks We accept the following forms of weekly account replenishment: • ACH Debit (initiated by Fiserv Health) • ACH Credit (initiated 6y the customer within three business days of notification) ฐ Wire Transfer (initiated by the customer within three business days of not cation) _ F%5B VHealth.~~ 2. Is an initial claims payment deposit required to establish banking arrangements? We require an initial deposit for custodial banking arrangements only. 3. Will you perform bank account reconciliations? Fiserv Health would do the bank reconciliation on the claims paid account, if Kerr County selects the Custodial Bank option. 4. Are there any additional costs to the banking? (I. E.: -EFT charges, monthly charges, etc.) '- Please refer to the Financial Proposal for fees associated with banking. 5. What is the cost of the check stock you provide? Fiserv Health prints all checks on laser printers, and does not use pre-printed check stock. There is no additional fee for the check stock. 6. How many checks are provided in your cost assumptions? There is no limit to the number of checks issued. Utilization Review 1. What U.R. services are performed in-house? All Utilization Management services are performed internally by Fiserv Health Care Management. Standard services provided through this service include inpatient review, concurrent review, and discharge planning. Prenot~cation, outpatient review, and retrospective review can be performed for an additional fee. 2. What outside U.R. services do you use? How long have you used them? All Fiserv Health Care Management's utilization review services are performed internally. No portion of the program is out-sourced to another vendor. 3. Indicate which U.R. services you have assumed in your proposal? r Pre Notification -Yes, an additional fee may apply. F%5e V Health. Preadmission Review -Yes. '! Concurrent Review - On Site or Off Site -Yes, off site. Retrospective Review -Yes, an additional fee may apply. Large Case Management -Yes, through our Case Management program. Discharge Planning -Yes. 4. Can you accommodate Pre-Notification for the following? Specialty Care referrals -Yes Home Health Care -Yes Ancillary Services -Yes Inpatient Surgical procedures -Yes Outpatient Surgical procedures -Yes Lab & X-ray procedures -Yes Inpatient Mental Health and Substance Abuse -Yes Outpatient Mental Health and Substance Abuse -Yes Preferred Provider Organizations 1. Do you have capabilities to process PPO discounts in-house? Fiserv Health has the ability to interface with networks electronically, either through a direct connection or through an EDI clearinghouse such as WebMD. Although this is our primary method for receiving repriced claims, we have various other types of interfaces with other networks depending on their capabilities. We can build contracting in our system and reprice here; we can also route a paper claim to the network where repricing takes place. 2. Which PPOs do you have access to processing in-house? - Fiserv Health has the ability to interface with networks electronically, either through a direct connection or through an EDI clearinghouse such as WebMD. Although this is our primary method for receiving repriced claims, we have various other types of interfaces with other r FIlSB VHealtl~._=` networks depending on their capabilities. We can build contracting in our system and reprice here; we can also route a paper claim to the network where repricing takes place. 3. Can you install PPO discounts for Direct contracts with providers? If so, what is the charge? Yes, we can install PPO discounts for Direct contracts with providers. Fees will vary dependent upon the complexity of programming required. 4. How many different PPOs do you interface with currently? Who are they? _ For your review, the following page contains a sample list of the networks Fiserv Health has agreements wdh. In addition, we work with many additional networks not listed. Aetna Signature Administrators Network Great-West Healthcare Network Beech Street Network CCN Network MultiPlan Network NPPN Network PPO-Next Network Private Healthcare Systems (PHCS) Network Alliance Network Arizona Foundation Network Encore Network First Medical Network Network Health Care Savings Network HealthEOS Network Healthlink Network Interplan Network MedCost Preferred Network Medical Mutual of Ohio Network Midland's Choice Network Network Health Prevea Fiserv Health PPOM Network Preferred Community Choice Network Preferred Health Partnership Network Preferred Health Professionals Network Preferred One Network Sa amore Network Select Care Network F%5e V Healtf~. Signature Care Network Sloans Lake Preferred Network Texas True Choice Network Virginia Health Network Dental Benefits Providers Network DenteMax Fiserv Health 5. Which PPOs are you currently using? (attach directory or website access) For your review, the following page contains a sample list of the networks Fiserv Health has agreements with. In addition, we work with many additional networks not listed. ~.: ~ ., ~, ~,, y a Aetna Signature Administrators Network Great-West Healthcare Network Beech Street Network CCN Network MultiPlan Network NPPN Network PPO-Next Network Private Healthcare Systems (PHCS) Network Alliance Network Arizona Foundation Network Encore Network First Medical Network Network Health Care Savings Network HealthEOS Network HealthLink Network Interplan Network MedCost Preferred Network Medical Mutual of Ohio Network Midland's Choice Network Network Health Prevea Fiserv Health PPOM Network Preferred Community Choice Network Preferred Health Partnership Network Preferred Health Professionals Network Preferred One Network Sagamore Network Select Cara Network Signature Care Network ฐ F%5e VHealtl~.: Sloans Lake Preferred Network Texas True Choice Network Virginia Health Network Dental Benefits Providers Network DenteMax Fiserv Health Reoorting - 1. Provide a list of reports available in your standard reporting package. What is the cost of these reports? ฐ Please refer to Exhibit #1 to view the reports included in our standard reporting package. 2. Can you generate customized reports? Are reports available through Internet? What is the ฎ charge? Yes. We understand your company is like no other. You may have a need for customer- ฐ specfc reports. We have the flexibility to tailor reports to help you isolate certain areas of your health care plan, such as mental health claims at a particular location or utilization of outpatient services. In addition, you can request reports directly from Fiserv Health or use raw claim data to _ create your own reports. Customer report costs depend on complexity and required programming time. ~ฐ 3. How are paid claims reported? Both paid and incurred values are used in various reports. The value used in any specific ฐ report is dependent upon the parameters of the reports. Please refer to Exhibit #1 for our standard reporting package. 4. How does your firm report claims to Excess Loss carriers? The case managers notify the stop loss specialists when individuals hit 50% of the spec or are ident~ed with a potential trigger diagnosis and they in tum notify the stop loss carriers. F%5e VHealth.- 5. Can you report on PPO savings? Our online reporting tool, Results-IC, provides network analysis and discount reports that show percent of paid claims in- and out-of-network as well as discounts by provider network. This information is updated monthly. General _ 1 What is the cost for producing a plan document? Is it included in your cost assumptions? We have template plan documents for Karr County to use at no additional fee. 2. What is the cost for producing a Summary Plan Description? Is it included in your cost assumptions? Production of a Summary Plan Descdption is included in our fees. 3. What is the cost of having the Plan Document and SPDs changed due to regulatory changes? Is it included in your cost assumptions? ~- Plan modifications due to regulatory changes are included in our fees. _ 4. What is the cost of printing the 500 Summary Plan Descriptions for the plan participants? Is it included in your cost assumptions? The cost of printing the booklets is included in our fees. 5. What is the cost for printing 1000 ID cards? Is it included in your cost assumptions? Standard ID cards are included in our fees. Our standard ID cards print with the employers' name and unique group number. Fiserv Health is also able to add further customization of ID cards as an optional service at a cost of $1, 000 per card setup. 6. What is the cost of Explanation of Benefits: Is it included in you cost assumptions? If so, how many do you assume? Yes, we include Explanation of Benefits in our fees. f%5B V Healti~. 7. Is there an initial set-up fee charged for the installation of our plan? No. There is no set-up fee charged for the installation of your plan. 8. Please disclose any additional fees or expenses that are borne by the client. Please refer to the financial proposal for all fees. 9. Do you offer assistance in the administration of COBRA benefits? HIPPA Certificates? Please explain the type of assistance and/or administration duties you provide. COBRA Administration Services The following services will help you meet COBRA requirements. Fiserv Health will: Provide Timely Notification of Continuation Rights Since the employer is typically the first to become aware of a qualifying event that triggers eligibility for continuance of coverage under COBRA, it is imperative that you communicate closely with Fiserv Health's Eligibility Department whenever a qualifying event occurs. You will continue to communicate qualifying event information to Fiserv Health's Eligibility Department as you have in the past. The Eligibility Department will enter the information in ~' the eligibility system and produce a daily electronic file which will be downloaded in the Fiserv Health COBRA administration system. The COBRA election notice will 6e sent to the qualified beneficiary with a description of his/her rights within 14 calendar days. The qualifying event letter is sent via cert~ed mail. Track the 60 Dav Election Period Qual~ed beneficiaries have 60 days from the date they are sent the initial notification letter to ,,. elect COBRA coverage. However, if coverage under the plan ends after the date the notice is sent, the 60-day period begins on the date coverage is lost. The election period is automatically calculated within Fiserv Health's COBRA administration system. The COBRA election notice will indicate the appropriate election period during which the qual~ed beneficiary must elect coverage. Our COBRA department will monitor this election period to assure only those individuals making elections within this period will be enrolled. f%5e V Health.. Provide the Continues with Coupons for Monthly Payments _ When a qualified beneficiary elects COBRA coverage and remits their initial COBRA payment, Fiserv Health's COBRA Administrator will send a confirmation letter including payment instructions and a set of payment coupons to the qualified beneficiary. Record and Process Continuation Payments and Submit Payments to Client Monthly Payments will be collected and posted to the continuees' payment history. On a monthly basis, a Voucher Report showing premiums received from the participants will be sent to you. The premiums collected will be remitted to you once a month in one lump sum. Send Termination Letters ~ฐ A termination letter will be sent to the COBRA continues when the following occurs: o If the former employer no longer provides group health coverage to any of its employees, o The COBRA participant fails to make the required payment for continuation coverage before the end of the grace period, o A COBRA participant becomes covered under another group health plan which does not contain any exclusion or limitation with respect to any pre-existing condition, o When a COBRA participant becomes entitled to (covered by) Medicare. Send Unavailability Letters An unavailability letter will be sent when an individual requests COBRA coverage, but is determined to be ineligible for that coverage. Send Conversion Information If your plan contains a conversion option, a letter will be sent with the name of the person to contact for additional information regarding conversion privileges. The letter is sent to the COBRA continues within the 180 days preceding the end of the COBRA period, as required bylaw. Send Rate Chance Information Fiserv Health's COBRA Department will send rate change letters and updated coupons to COBRA continuees and qualified beneficiaries pending enrollment prior to the effective date of the rate change. i F%5e V Health. Maintain Elioibility on Continuees _ Fiserv Health's COBRA Department will update the eligibility system or will communicate changes in eligibility to your outside vendors so current eligibility is maintained to pay claims accurately. Reviewing Eligibility for Disability Extensions When a request for a disability extension is received, Fiserv Health's COBRA Department will review the request to determine if all requirements for extension of COBRA coverage have been met. !f all requirements are met, coverage will be extended and the qualified "' beneficiaries affected will be notified. If all requirements are not met, a notice of unavailability will be sent to the qual~ed beneficiaries. Provide Answers to Questions Our professional, well-trained staff of COBRA Administrators is available every business day, during normal business hours, to answer questions from qual~ed beneficiaries as well as any member of your organization. Provide Monthly Management Reports The monthly reports you will receive will provide you with the names of the individuals who: 1. Have been notified of their continuation rights during the previous month, 2. The names of the individuals who have elected and are maintaining COBRA continuation coverage, 3. Made premium payments during the previous month. Reporting these facts to you will give you an opportunity to audit and verify your reporting r obligation and assure compliance with COBRA. Provide Levislative Updates The COBRA Administration Department is part of the Corporate Compliance Department of Fiserv Health located in the Wausau, Wisconsin office. We stay abreast of regulatory and compliance issues which may affect your plan. When IRS regulations change, impacting our clients, we will send an update letter outlining - the changes so that you may take the appropriate steps to stay in compliance with the laws. Fiserv Health can also provide HIPAA Cert~cates of Credible Coverage. F%5B V Healtl~.r HRA Questionnaire 1 Do you offer HRA administration in conjunction with your claims administration? Yes. HRA administration is available in conjunction with claims administration. 2. How often do you reimburse a claimant for expenses incurred that are filed on a paper claim form? Once the claim has been processed, a check or electronic funds transfer to the member's bank account is issued within the next business day. 3. Do you provide a debit card for all participants? _ No. Please refer to the financial proposal for fees associated with this optional service. 4. Do you require the use of a specific banking institution? Fiserv Health does not require the use of a specific banking institution. 5. Is there a minimum funding requirement? If so what? Standard home banking arrangements allows you to fund the account by any means or '~ frequency you prefer, daily or weekly. 6. Please describe your HRA administration in relationship to your medical claims administration. Fiserv Health has integrated the HRA claim processing into our medical claim engine. In many respects, the HRA is just another benefit plan variation. Claims enter the system, are screened for eligibility and provider discounts, and then accumulate to deductible and bridge amounts. Those accumulations are then compared with any available HRA balance for payment to the provider. Claim checks, explanation of benefits and provider remittance advice all contain both HRA and health coverage payments and information. No special _ claim filing is required. Fiserv Health owns, manages and controls the entire process within the normal course of paying a claim. "~ 7. Identify all costs associated with your HRA administration package to include all costs and services provided. Please refer to the Financial Proposal for all fees associated with HRA administration. ^ f%5B V Health..- 8. Do you include access to accounts via the Internet? At what additional cost if any? Yes. Members may access their HRA account online at no additional cost.