.Q ,~ d ~ ~° ~a a ~~~, U~ October 20,2006 SEALED PROPOSAL FOR KERR COUNTY MEDICAL, STOP LOSS, TPA SERVICES, LIFE INSURANCE AND AD & D Attention: Kerr County Commissioner's Court C/O County Judge Pat Tinley Submitted by :Wallace & Associates Don A. Wallace KERR COUNT DECLINE LETTERS SUBMITTED BY DON A. WALLACE WALLACE & ASSOCIATES t? ~ Bluet ro+s 131ueShicld of`I°exas SAN ANTONIO REGIONAL SALES OFFICE 8200 IH 10 West, Suite 420 San Antonio, TX 78230 (210) 357-5300 Nlain Line (21U) 357-5216 Fax Line TO: Don Wallace RE: Kerr County HECTOR LICON Regional Sales Executive (210) 357-5204 -Direct Line (210)885-8078 -Cell hector licon~n~bcbstx.com Thank you for the opportunity to quote on the above referenced prospect. However, we must regretfully decline to provide a quotation based upon the following: NATURE OF BUSINESS IS UNACCEPTABLE EXTREMELY HIGH AGE-SEX FACTOR CARRIER HISTORY X CLAIMS EXPERIENCE: X HIGH RISK CONDITIONS EXCELLENT RENEWAL NUMBERS OUR NUMBERS ARE UNCOMPETITIVE AT THIS TIME INSUFFICIENT DATA: OTHER: Again, we thank you for the opportunity to be of service and look forward to being of assistance to you in the future! If you have any questions or require additional information, please feel free to contact me. Regards, Hector ~ET~.IT~Y I~TATI(~NAL Monday, October 02, 2006 Don Wallace Wallace & Associates 628 N. 123 Bypass #3 Seguin, TX 78155 R~,Kerr County Dear Don: Thank you for your request for a proposal on the above mentioned group. Unfortunately, we will not be able to extend a quote at this time. Thanks for thinking of us and we welcome the opportunity to serve you with your other partially self-funded prospects. Sincerely, Keith Kennington Vice President -Marketing Message Don Wallace From: KC Ferguson [kferguson@pristx.cam] Sent: Wednesday, October 18, 2006 10:12 AM To: Don Wallace Subject: RE: RFP Kerr County Hi Don, Page 1 of 2 We are declining to quote on this group. We appreciate your consideration of Providence and hopefully can work on other business in the future. Thank you, K.C. Ferguson Stop boss Marketing Manager Providence Administrative Services, Inc. 210-403-4128, Direct 800-495-5950, Ext. 128 210-859-7161, Mobile 210-494-7120, Fax K fergusonCpris [x, com E-MAIL CONFIDENTIALITY NOTICE This transmission is strictly confidential. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law. -----Original Message----- From: Don Wallace [mailto:dawallace@satx.rr.com] Sent: Wednesday, October 18, 2006 9:21 AM To: dawallace@satx.rr.com Subject: RFP Kerr County I need your proposal in my office by 3:00 tomorrow Thursday Oct. 19th. f am Veaving Seguin at 8:00 Friday to deliver proposals. Please let me know if I can expect a proposal, if not please send me a decline letter today. Thanks Don GF'CRCTIt7~. G/].i05 Nls~~' R1'[AI:L <1i)DRF,;iS: dawall iceas~ltz_rg c4m Don Wa//ace Wallace et Associates 628 N. 123 Bypass A`3 Seguin TX 78155 (83OJ 372-4042 fax (B3O) 303-3380 This e-mail, including attachments, may include confidential information. It may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or his or her authorized business 10/ 18/2006 Don Wallace From: Matt.Hershberger@sunlife.com Sent: Thursday, October 19, 2006 8:45 AM To: Don Wallace Subject: Re: RFP -Kerr County i?i Don, Onfortunatei y, we are not coming in competitiv> on this one compared to the renewal.... Sorry I could net be more of a help. Matt Hershberger Group Representative Sin Life Financia] P (800) 786-8393 F (713) 225-6817 matt. he rs hberger@sunlife.com "Don Wallace" 10/19/2006 08:26 AM To: cc: Subject: RFP - Kerr County [9att are you going to give me a proposal on the life on this case or the stoploss? Please advise, I nee an answer by 3:00 today. Don EFFECTIVE 6/1(05 NEW EMAIL ADDRESS: dawallace@satx.rr.com pon Wallace Wallace & Associates E28 N. 123 Bypass #3 Seguin, TX 78155 (830) 372-9092 fax (830) 303-5380 This e-mail, including attachments, may include confidential information. It may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or his or her authorized business associate, the reader is hereby notified that any dissemination, distribution or copying of this e-mail i.s prohibited. If you have received this e-mail ir, error, please notify the sender by replying to this message and delete this e-mail immediately. Page l of 2 Don Wallace From: Marsha Ford [mford@AmericanStopLoss.com] Sent: Wednesday, October 18, 2006 4:02 PM To: dawallace@satx.rr.com Cc: Karen Rosati; George Paul Subject: FW: Kerr County Don, Sorry that we couldn't help you with this one. Thank you for the opportunity. Marsha Marsha Ford Sales Coordinator Voice: (800)944-7659, ext. 3034 Fax: (508)799-0161 mford @a merica nstoploss.com CONFIDENTIALITY NOTICE: The contents of this email and its attachments contain confidential and/or legally privileged information, which is for the use of the intended recipient only. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the comments of the contained information is strictly prohibited and that the documents should be returned to the sender immediately. ff you have received this email in error, please notify us by email immediately. From: Don Wallace [mailto:dawallace@satx.rr.com] Sent: Wednesday, October 18, 2006 10:21 AM To: dawallace@satx.rr.com Subject: RFP Kerr County I need your proposal in my office by 3:00 tomorrow Thursday Oct. 19th. I am leaving Seguin at 8:00 Friday to deliver proposals. Please let me know if I can expect a proposal, if not please send me a decline letter today. Thanks Don IF'PFf'1'I~~i:611/06AE~\'F~iVI:1,1Lr\IJ-Rh,SS. da~ila<;e~~5atz.rr.cont Don Wa//ace Wa/lace &' Associates 618 N. 1 Z3 Bypass ,4`3 Seguin, TX 78155 (B3OJ 371-4041 fax (83OJ 3p3-5380 This e-maih including attachments, may include confidential information. It may be used only by the person or entity to which it is addressed. I£ the reader of this e-mail is not the intended recipient or his or her authorized business associate, the 10/ 19/2006 Page 1 of 3 Don Wallace To: Gilbert, C. (Chris) Subject: RE: Request for proposals Kerr County Ok, maybe some other group. Thanks Don t '~FF:CTiCL 611/05 Vt W 1;1fa1L AUUP~N SS_ rlawallire~s2ta.n~.egm Don Wa//ace Wa//ace 8r Associates 628 A/. Y23 Bypass X33 Seguin, TX 78153 (830) 372-4042 fax (830j 303--3.780 This e-mail, including attachments, may include confidential information. It may be used only by the person or entity to which it is addressed. If the reader of this a-mail is not the intended recipient or his or her authorized business associate, [he reader is hereby notified [hat any dissemination, distribution or copying of this a-mail is prohibited. If you have received [his e-mail in error, please notify the sender by replying [o this message and delete this a-mail immediately. -----Original Message----- From: Gilbert, C. (Chris) [mailto:chris.gilbert@us.ing.com] Sent: Wednesday, September 27, 2006 4:41 PM To: Don Wallace Subject: RE: Request for proposals Kerr County Hi Don, Unfortunately I can't work on this one as our minimum spec deductible is $75,000. Chris Christopher J. Gilbert Senior Sales Representative ING Employee Benefits 15455 Dallas Parkway, Suite 1250 Addison, TX 75001 9!28/2006 Kerr County Specific and Ae~-egate Stop Loss Insurance Third Party Claims Admutistmiion Group Term Life and AD&D HRA Administration PLF,ASE FILL IN THE FOLLOWING INFORN[ATION NEEDED AND SUBMI"t WITH PROPOSAL. "I}te undersigned proposer, by signing and executing this proposal, certifies and represents to the Kerr County that proposer has not offered, confetred 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; [he proposer also certifies and represents that the proposer has not offered, conferred or agreed! to conlcr any pecuniary beneftt or other thing of value as consideration for [he recipient's decision, opinion, recommendation, vote or other exercise of discretion concerning [his 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 Ken County concerning this proposal on the basis of any consideration not authorized by law; [he 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 [o 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 [he 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 [he Kerr County in return for [he person having exercised their person's official discretion, power or duty with respect [o [his proposal; the proposer certifies and represents that it has not now and will not in the future offer, confer, or agree [o confer a pecuniary benefit or other thing of value ro any officer, Imstee, agent, or employee of the Ken County in comrcction with information regarding this proposal, the submission of [his proposal, the award of this proposal or [he performance, delivery or sale pursuant to [his 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 of this RFP. I have read all of the specifications and general proposal requirements and do hereby certify that all items submitted meet specific~~at-ions. COMPANY: _'7~ it: Jl~ {T" t• AGENT NAME: =~ /T • Ll, /~-f/~ii~L' AGENT SIGNATURE: Cam`-Z~_ ~`f '~L~^,G`=~:-`-'` ADDRESS: ~ /v ~ OlL' / Z 3 S '~,+ .y .5 CITY: .~~ ~%~: y tL' / _ __ STATE: ~ ~ V ZTP CODE:~JSS ~ S TELEPIION ~' `SC ,; ~~~~ FAX 4~ S` + J ~J lz `;5 ~.) 'J ~ i FT IJERAL TIN#: AHED/OR SOCIAL SECURITY #: DEVIATIONS FROM SPECIFICATIONS IF ANY (Attach documents as necessary or state No Deviations): Page 2a Don Wallace From: Matt. Hershberger@sunlife.com Sent: Thursday, October 19, 2006 8:56 AM To: Don Wafface Subject: RE: RFP -Kerr County 6.1P are at $0.29 and $O.C3........ nct pretty ~` C, ~ ~ ~~~ ,C Matt Heys hberger ,roue Representative Sun Life Financial P (800) 780-8343 'r' (713) 225-6817 matt.hershberger@sunlife.com "Dcn Wallace" 10/19/2006 08:43 AM To: cc: Subject: RE: RFP - Kerr County `lot even on the life? Renewal is .22 & .02 up from .20 & .02. EF`e'ECTIIlE 6/1 /OS NEW EMAIL ADDRESS Don Wall ace Wallace & P.ssociates 628 N. 123 Bypass N3 Seguin, TX 78155 (830) 377_-9092 fax (830) 303-5380 dawallace@satx.rr.com This e-mail, including attachments, may include confidential information. It may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or his or her authorized business associate, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately. -----Original Message----- From: Matt.Hershberger@sunlife.com (mailto:Matt.Hershberger@sunlife.com] Sent: Thursday, October 19, 2006 8:45 AM To: Don Wallace Subject: ke: RFP - Kerr County 1 October 19, 2006 Wallace & Associates Mr. Don Wallace 628 N. 123 Bypass, Ste. 3 Seguin, TX 78155 Re: Kerr County Dear Don, Bene~ Management Administrators, Inc. www.bmatpa.com On behalf of Benefit Management Administrators, Inc., I would like to thank you for the opportunity to quote on Kerr County. Unfortunately we must respectfully decline to quote due to our carrier market being non-competitive. We look forward to the opportunity to work with you in the future. If you have any questions regazding this declination, please feel free to contact me directly at (210} 697- 9900, ext. 212. Best regazds/, Grace Saenz Director of Sales and Service I I SSO IH 10 West, Suite 220 ,a-_ °.,. San Antonio, Texas 78230 ,~ (210)697-9900 Phone ~ i0~ (2!01697-0360 Fax 1'/ S S "CGL[PIi(3NE:~>C",S /~-~ Z PAX:p ~>C~ ",,yL~ ~ ; ~,3 ~ (:1 pFiDl:ItAL 7IN#: ANED%OR SOCIAL SECURI"11, #: DEV[AT[ON5 FROM SPECIrICATIONS IF ANY (Attach documents as necessary or state No Deviations): Pa~c 2a ~, ; ... _~ -, : ~. Genworth Financial Casa Name: Kerr Ccunty Third PaAy Administrator: Group & Pensinn Administrators Network: PHCS Effective Oate: Ot!O VU7 Commission Percentage lncludetl: 15°!< Plan Design: CDhiPMRA. 90;70`% to $1 0,000 coinsurance maximum $1,000in i $2.000OUt deductible, vraived !cr pdysician visits $30 office visit copay. $200 wellness max, No supp accitlent PPO' 8G/W°~ Ic $22.SOOln! $3U,000om coinsurance maxunum $1.5UGin i $4,000cut deductible, waivetl for physician visits 540 cffico visit ropay. 5200 wellness max, No supp accieent $1r]I$2Ul$36 Rx ($2Gf$10f$SD 90 day mail] $1,000,000 lifetime max Current Enrollment: Single: 180 Family: 6.9 Total Employees: 249 Coverages Included Under ISL: AAedical R' Rx CoYerages Included Untler A$L: Medical r Rx r Dental r Vision Specific Deductible Options: $50,000 $60.000 $75,000 $85,000 Contract Type'. ISL Rotas: (Per MOmh) Single: Family: ASL Rate: (Per Employee Per Monti) Optional Monthly Agg Cap: (Per Employee Per Monti) Total Monthly Fixed Costs: Total Annual Fixed Costs: 15112 15112 15/12 15112 $101.28 $87.91 $72.31 $64.11 $217.50 $246.98 $268.96 518981 $8.65 $8 65 $8.65 $8.65 $1,75 $1.75 $1.]5 $1]5 $39,968 $35.455 $30,024 $27,226 $479,610 $425,460 $360,284 $326,715 Contract Type: Attachment Factors: (Per Manor) Single: Family: Annual Attachment Point: Minimum Attachment POint: (g0%of n(tagnment) Run-In Cap: 15112 15172 15112 15112 $460 $468 $477 $183 $7,150 $1.?71 $1,19-0 $1,209 $1,945,800 $1,980,468 $2,018,952 52,044,332 $1,751,220 $1,782,421 $1,817,057 $1,839,899 $286,749 $291,858 $297,530 $3D1,27D Total Annual Maximum Liability: $2,d25,410 $2,405,926 $2,379,236 $2,371.047 This quote is subject to the following: Quote sublet( to uptlatetl claim information, indutling ongoing antllor shocks, employees antl tlepentlen(s not actively at work antl COBRA paniapanls. Ouole Subject to compleleo TBR, rate history, renewal an0 (nal enrollment. ADDITIONAL INFORMATION AND UPDATED CLAIM AMOUNTS, DIAGNOSIS, AND PROGNOSIS IS REQUIRED ON THE FOLLOWING INDIVIDUALS BEFORE CASE ACCEPTANCE THESE INDIVIW ALS MAY BE SUBJECT TO LASERS PENDING REVIEW OF THIS INFORMATION M¢mber 45205351, 45220351, 45235651 Out 30 tlay moddietl aaw waiver provision will apply m this quote once untlerwdting has r¢viewetl the tlisdpsure statement and awep[etl the risk. W¢ reserve Ine dgnl to recalculate the Specific antl Aggregate premiums antl Aggregate factors if [ne actual soltl enrollment vanes by 10% fmmthe WMetl enrolment. We reserve the nght to recalculate Ue Aaacnment factors and premium R Ue aveage o! the last 2 months IN claims m the tortoni polity penotl varies by more than ID% of Ue average monthly dorms fa the Urst 10 moMfis W the cunent policy periotl. Tnis proposal is valid for 60 days form the proposal Oate. October 19, 2006 Robert Anderson ti~4~ Genworth Financial Case Name: Kerr County Third Party Administrator: Group & Pension ACministrators Network: PHCS Effective Date: 01/01/07 Commission Percentage Included: 15°f° Current Enrollment Single: 180 Family: 69 Total Employees: 249 Current Coverages Included Under ISL: MedicallRx Coverages Included Under ASL: MedicallRx Specific Deductible Options: Renewal Medical/Rx Medical/Rx Genworth Medical/Rx MedicallRx $50,000 Contract Type: ISL Rates: (Per Month) Single: Family: ASL Rate: (PerEmployee Per Month) Optional Monthly Agg Cap: (Per Employee Per Month) Total Monthly Fixed Costs: Total Annual Fixed Costs: nvnr Increase/Decrease over Renewal #DIV/0! Contract Type: Attachment Factors: (per Month) Single: Family Annual Attachment Point: Minimum Attachment Point: (so%orgttacnment) Run-In Cap: n,.m. n,..mr oa a i Total Annual Maximum Liability: 15/12 PAID 15/12 $45.89 $101.28 $112.74 $277.50 $12.34 $8.65 $1 75 $19,112 $0 $39,968 $229,343 $0 $479,610 15/12 PAID 15112 $404 $460 5800 $1,150 $1,536,375 $0 $1,945,800 $1,382,737 $0 $1,751,220 $226,413 $0 $286,749 InaeasefDecrease over Renewal #D!V/0! $1,765,718 $0 $2,425,410 increasefDecrease over Current 37.4% Increase/Decrease over Renewal #DIV/0! Kerr County Specific and Age egate Stop Loss Insurance Third Parry Claims Administration Group Term Life and AD&D HRA Administation PLEASE FILL IN THE FOLLOWING iNFORNIATION NEEDED AND SUBMIT WITH PROPOSAL. The undersigned proposer, by signing and zxecuting 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 Pena] 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 [he undersigned a preferential advantage with respect to 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 Kerr County in return for the person having exercised their person s official discretion, power or duty with respect [o this proposal; the proposer certifies and represents that it has no[ now and will not in the fumte offer, confer, or agree to confer a pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of [he Kerr County in connection with information regarding this proposal, the submission of this proposal, [he award of [his 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 of this RFP. I have read al] of the specifications and general proposal requirements and do hereby certify [hat all items submitted meet specifications. COMPANY: r /~~ iL ~/^,}- AGENT NAME: { OI`i.1/~L(.~:~-~~/~C' ~- AGENT SIGNATURE: ~ "` ~- ADDRESS: ~~,/~~r ~. -5 Y ~`~SS z~Q~ -T CITY: ~~w L' / w' S'L'ATE: =^~_,_ ZIP CODE: / ~ ~~S-S TELEPHONE: ~'~G~ ~~ JZ- ~ Q ~ Z FAX: {y',_3Ct ' 3Q.3-s 3 ~Y~'' FEDERAL TIN#: AHED/OR SOCIAL SECURITY #: DEVIATIONS FROM SPECIFICATIONS IF ANY (Attach documents as necessary or state No Deviations): Page 2a HumanaDenta] 1100 Employers Boulevard Green Bay, WI 54344 HUMANA DENTAL KERR COUNTY Administrative Services OnikDental Proposal Base Fee $4.61 Commissions $0.25 PPO Access Fee (optional) $0.30 Total Fee $5.16 Per Subscriber Per Month • Fees are guaranteed for two years, from 01/01!2007 through 12/31/2008. If enrollment decreases to below 200 subscribers as of 09/30!2007, HumanaDenta! reserves the right to adjust the fees effective 01/01/2008. • These fees include a standard commission schedule. • This quote is based upon a plan design comparable to current. A review of the complete benefit booklet is needed to confirm our system can administer the benefits. • These fees assume a minimum of 200 subscribers and a member to subscriber ratio of not more than 3.0. • This quote assumes our standard billing cycle. Premiums are due by the first of the month for which coverage is to be provided. A grace period of 31 days is included. • ASO Set-Up Fees are waived for all dental products assuming a maximum of 2 dental products. • These fees do not include COBRA administration. • The recommended banking arrangement is weekly ACH. • This quote assumes we are not processing run-in. • HumanaDenta! will draft the Summary Plan Description-SPD at no cost to the client. However, if the client would like us to print and distribute a dental SPD, we will charge them accordingly. • Dental claims will not apply to aggregate coverage. • Humana will not have fiduciary responsibility. • HumanaDenta! offers access to our nationwide network. Members can save up to 30 percent on their out of pocket cost when visiting a participating dentist. Access fees apply if you choose to have the network linked to your dental product. Simply here for you DENTAL Service guarantees HumanaDental knows it takes excellent service to keep employers and members happy. Our sound track record proves it. With service as our top priority, we strive for the best people, the most flexible products and the most progressive, service-friendly technology. HumanaDental agrees to meet the following service standards and is willing to place a total of 20 percent of the annual administrative fee, less commission, at risk for failure to meet the stated service standards. We have always met or exceeded service standards. We have never had to pay out a penalty. Performance Definition Service Standard Results - 2005 Penalt Turnaround Time Measured from the date a 85% in 14 calendar 94.3% in 14 5% of annual claim is received through days calendar days administrative fee - the process date. less commissions "Processed" is defined as paid, denied or pended due to missing external information. Financial Accuracy The financial accuracy rate 99% 99.9% 5% of annual is defined as the percentage administrative fee - of dollars paid corzectly. It less commissions is calculated by dividing the total claim dollars reviewed less the absolute value of overpayments and underpayments by the total claim dollars reviewed Payment Accuracy Payment accuracy is defined 97% 98.9% 5% of annual as the percentage of claims administrative fee - paid corzectly. It is less commissions calculated by dividing the total number of correctly paid claims by the total number of claims reviewed. Telephone Response Percent of calls answered 80% in 20 seconds 88.6% in 20 5"/0 of annual within "n" seconds. seconds administrative fee - less commissions Abandonment Rate Percent of callers that hung <3% 0.5% 5% of annual up prior to reaching a claim administrative fee ~ service re resentative. less commissions Service results will be reported annually based upon center results, not client specific results, and payment of any penalties due to the client will be made following the end of each plan year. Payment of run-in or run-out claims will not be included when determining service results. With respect to financial accuracy and payment accuracy, data is obtained through ongoing random audits based on a statistically valid sampling of all claims represented for payment. Medical and dental service results will be tracked, reported and settled separately. Proprie[un~ to IlunranaDen[ul Insurance Campuny Rate Match minus 10% Humana Group Life and AD&D Proposal Schedule of Benefits: Kerr County Proposed effective date: 1/1/2007 Life Class Class Descri lion Life Amount AD&D Amount Class Maximum 1 all active full time $20,000 $20,000 $20,000 2 3 4 Coves a Rates Monthl Premium Annual Premium Life $0.18 er $1,000 $822.06 $9,864.72 AD&D 50.02 er $1,000 $91.34 $1,096.08 Total $0.20 er $1,000 $973.40 $10,960.80 Number of eligible employees Number of covered employees Employee participation (%) Total Sasic Life Insurance amount Total AD&D Insurance amount Guarantee Issue Limits -Employee 234 234 100% 4,567,000 4,567,000 Guarantee Issue Limit $20,000 Employee Life and AD&D benefits reduce by: 35°fo at age 65 55% at age 70 70°!° at age 75 80% at age 80 85°!° at age 85 Provisions: (I) All employees must be actively-at-work. (2) The above Basic Life.~AD&D pricing is contingent upon receipt of requited, prior plan documents and is subject to approval by Humana's Ilnderwri[ing department (Consult your I Iumana sales representative far details.) (3) "this proposal assumes and reflects all other Humana standard Basic Life/AD&D bene6[s,~provisinns. (Consult Humana Life brochure for details) (4) Non-ConVibutory plans require 100% employee participation. Contributory plans require a minimum of 75 % employee participation. (5) This proposal is considered invalid if the proposed effective date precedes the quote print date indicated below. This proposal is valid for sixty (60) days following the quote print dace. (6) The above rates are guaranteed for two (2) years except if the employee census changes more than IO%, in which case Humana may re-rate. (7) Lifc and AD&U benefits terminate a[ retirement. (g) Humana will grandfather all cunently-insured amounts, subject to the Guarantee Issue Lvni[s indicated above. All other requests must be reviewed by the Underwriting department for considcmlion, and remdzr this proposal invalid. (9) OC(er is contingent upon the new sale and/ur retention of Humana medical and/or dental accounts. NOTE: Rates include standard commissions. H/UMANAM (.i taicYtif7e6: when you need it most Herr L ounty Specific and Au~~regate Stop Loss Insurance "]bird Party Clatms Adtnirtisttation Group Term Life and AD&D HRA Adntiriistration PLEASE F1LL IN THF. FOI_L.OWIiVG INFORMATION NEEDED AND SUSMI"f WITH PROPOSAL. The undersigned proposer, by signing and csecuting this proposal, certifies and represents to the Kea County that proposer has not offered, conferred or agreed to confer any pecuniary benefit, as defined by (1.07 (a) (() of the Texas Penal Code, or any other thing of value as consideration for the receipt of information or any special treamient of advantage relating to [his 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, voce 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, hustee, agent or employee of [Ile 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 to this proposal; the proposer further ccrtifes and represents that proposer has no[ 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 Kerr County in return for the person having exercised their person's official discretion, power or duly 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 die Kerr County in connection with information regarding this proposal, the submission of this proposal, the award of this proposal or the performance, delivery or sale pursuant to this proposal. The proposer shall defend, indemnify, and hold harndess the Kerr County, all of its officers, agenh 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 REP. [ have read all of the specifications and general proposal requirements and do hereby certify that all items submitted meet specifications. COMPANY. ~ f; fi~,~ ~ ~ ~~.~, ~-li~ AGENT'NAME: ~ s~: /~~li}-~~}'t' AGENT SIGNATUKL-: ~ Gt ~~~~~ ADDRI~SS: ,,~i0 ,~'. ~~ ~i /.~ n,~SS CI1Y ~~ c z U r !v S"GATE: _~_LTP CODE:_ 'J f S S 'fBLIPHONE:~ .,7G ,y ~.~- r[:UFRr\L TIN#: ANED/OK SOC IAL SECURITY #: DEVIATIONS PROM SPECIFICATIONS IF ANY (Attach docmnenLs as necessary or ataW No Dev18t10n5): Page 2a ~Li ~ % ~ ~~fT_ Nelwark Access Fea All Plana 249 Inpaknt80WW/hM MedcN AN Plarrs 2dH Manegamerrt Bervieea Fee Leas Mene9erronl5erviasFae All Plans 149 CORRq pdminiz(IMbn Fes AN %ens 348 NIPM Atlminialrarlon Fee All Plans 248 pissaee Menagemam PII Plans 149 Oneates6 CVdx TOTAL COMBINEp BILLABLE FEE EXCEPT COMP OPTIONS' ....... .................. NeaNM1Cen Reimbumamartl ACCOUnI Consumer pnva HSaXM1 200 (HRA)Service Fea Wllham Oeblt Gard Plan (CpHPJ Option Only TOTAL COMBINED BILLARLE FEE FOR LONP OPTIONB• ........... ................... • 1M Loun1Y redaY P+YS rM sarm /ea Ia bath the LONP/NRA and PPO Plan aptlons. $ 281 f 325 5 2.10 $ 2]5 S 005 $ 005 5 050 5 0.50 3 O.JO $ 0.]0 $ 201 $ 201 $ J3.43 0.00% E ass E ass f 33,43 f 3i.9i t].fl1% SPECIFIC STOP LOSS: specme slcP LCa. L.vel ssppop ssopap Aggre9aretl Speelnc Slop Lwa Level Nane Nona Accelenlad Ralmbunement Ritler None Nane Terminal Erleneicn Rlder None Nona Appllmbb Llaaaea All Clazses All Claezes Comnd 6uis 15/131ncmredBPeH 15I131xurtM8Peid gppllcable COVen9ef Med"¢e18 Prescriptmn Medcalfl PresEngion Oruq Orug Mulmum lnalvltlual RSlmbumemenl Umll WbiM lnaund E9W,000 E950,W0 SPECIFIC STOP LOSS PREMIUM RATES Emplcyee 150 $9509 552 ]] Empbyarl5pauee 32 5113 ]9 $129.&5 Emplayee/Cbild(ren) P $113.]9 E13g85 Empbye¢ISPoUSe/CniM(renl 14 $11214 $t2H 05 Monthly iNel 199 310,0]9.2fi 510,199.65 15.00% MSW64*~{pY. GvmM ,. t Pe~i~ Ac%.. AGGREGATE STOP LOSS: ~ .... Aggngsle Slop Loss Percenlege 115% 115% AeuNre[ed RaSmbumrrnM Rlder Nane None MonlblyAawnmodallane RlMr Nona None TarminelEneneion Ritler None None APPIIOaEIe Clensee All Classo All Classes Conlnd Rsaie 15R21nmrred BPaq 15/121ncurred&Paitl Mezlmum Annnsl Ag9ragMe Relmbunenartt Llmil $tOW Wp }1000.000 Applicabb Cweragas M¢tlical8 Prezcnplbn Med¢a18 Pr¢xriplion prug prug AGGREGATE STOP LOSS PREMIUM RATES Empbyee Wpn or WlNqut peps 24g $_ 1334 E 1400 f 3,OII.00 f ] 400.00 13.45% AGGREGATE DEDUCTIBLE FACTORS MEOCPP01 CGNpMRA Plan Empbyea $ dWAO 142 $ 40658 Employee/Spouse E ]]340 10 S y3t 30 EmpbycelChild(ren) $ 803 J1 2J $ BOgdd EmploYerlSlwuzdCmM(ren) 8 I,p51 31 u $ _ 100200 $ 1pJ,105 ]6 200 E t01,15]s0 MEOPPO01 PPO Plan Empbyee $ 40140 30 $ 908.58 Empbyeel5psuse E ]]]60 6 3 ]8128 Empbyee/CM1ild(ren) E 60331 p E 84944 Empbyeel5pauae/LM1ild(ren) $ 105131 3 f 106200 $ 26,031-1 98 5 26,2]522 COMBINEp MINIMUM MONTHLY AGGHEGgiE 0E000TIBLE.. _......._.........._ .... f IIT,138.]T E 48,426.30 1.02% Please refer to the following pages for additional terms of your renewal Employer Neme: Herr Ccunry PIen NUmMr'. GOCDdB]P Renewal EMC[ive Oate: January 1, 20p] Tb $MpwiOg ere tha brme of your iSmonib renewal: Employer Name: Kerr County Plan Number: G000487A Renewal Effective Dale: January 1, 2007 Proposed ASubscrihers fbr Renewal ALTERNATE SPECIFIC STOP LOSS LEVELS Alternate Specific Stop Lass Levels Aggregated Specific Stop Loss Level Accelerated Reimbursement Rider Terminal Extension Ritler Applicable Classes Contract Basis Applicable Coverages Maximum Individual Reimbursement Llmi[ While Insured SPECIFIC STOP LOSS PREMIUM RATES Altenate#4 $ 60,000 None None None All Classes 15/12 Incurred & Paid Medical 8 Prescription Drug $ 940,000 Altemate $ 75,000 None None None All Classes 15(12 lncurretl & Paid Medical 6 Prescription Dsug $ 925,000 Subscriber 180 $ 45.89 $ 36.64 Subscriber/Spouse 22 $ 112.74 $ 90.01 SubscriberlChild(ren) 27 $ 112.74 $ 90.01 Subscriber/Spouse/Child(ren) 20 $ 112.74 $ 90.01 249 $ 16,039.26 $ 12,805.89 ~mate#1 AlYemate tM2 gSUR r~ n for e AGGREGATE STOP LOSS WITH ALTERNATIVE SPECIFIC LEVEL ABOVE Aggregate Stop Loss Percentage 115°h 115 Acceleratetl Reimbursement Rider None None Monthly Accommodations Rider None None Terminal Extension Rider None None Applicable Classes All Classes All Classes Contract Basis 15/12 Incurred & Paid 151121ncurred & Paid Maximum Annual Aggregate Reimbursement Limit $ 1,000,000 $ 1,000,000 Applicable Coverages Medical & Prescription Medical 8 Prescription Drug prug AGGREGATE STOP LOSS PREMIUM RATES Employee With ar Without Deps $ 14.11 AGGREGATE DEDUCTIBLE FACTORS MEDCPP91 CDHP/HRA Plan Subscriber Subscriber/Spouse Subscriber/Child(ren j Subscriber/Spouse/Child(ren) Altemete #t #Cavered for Renewal Plan Period 142 $ 420.04 18 $ 803.16 23 $ 626.52 ~ $ 1,091.76 200 $ 107,072.44 $ 14.86 -pltemate;R $ 431 .80 $ 825 .63 $ 644 .06 $ 1,122 .32 $ 110,069 .76 MEDPP091 PPO Plan Subscriber 38 $ 420.04 $ 431.80 Subscriber/Spouse 4 S 603.16 $ 825.63 Subscriber(Chi{d(ren) 4 $ 626.52 $ 644.06 Subscriber/Spouse/Child(ren) ~ $ 1,091.76 $ 1,122.32 49 $ 24,955.52 $ 25,654.12 Total Minimum Monthly Aggregate Detluctible 249 $ 132,927.96 $ 135,723.88 •mere~-s~escnuer also mcwaes coaru a~arnee se~maan mm„s aaeresses. The minimum monthly aggregate deductible is the smallest passible liability for a month tluring the Benefit Period for losses under the plan. The monthly aggregate deductible will be the greater of: (a) the minimum monthly aggregate tletluctible listed on the previous page, or (b) the aggregate deductible factor multiplied by the corresponding number of Coveretl Subscribers under the plan for a given month. Please note that the foal minimum monthly aggregate deductible (actor will be based on the actual enrollment in the plan on the renewal effective date. The specific and aggregate stop loss renewal policy will apply to claims incurred on or aher 12:01a.m. on October 1, 2006, and before 12:01 a. m. on January 1, 2008, and paid on or aker 12.0} a.m, on January 1, 2007, antl before t2.Ota.m. on January 1, 2008. The following procetlures have keen removed irom [he Oupatient Surgical Procedures IisC ` Knee arthroscopy ' Tympanostomy tube insertion The following procedure has been added to the Outpatient Surgical Procedures list ' Septoplasty The following change applies to outpatient mental health /chemical dependency review: ' Review requirement has changed from the 3rd therapy visit to the 1st therapy visit (excludes initial evaluation) The following services have been added to the Outpatient Precertiflcation list. ' Selected High End Radiology services 'Specialty Pharmacy Drugs 8 Medicines Your Stop loss rates and deductible tactors assume the purchase of the myhealthl0 Wellness Program. The following will apply: myhealthlQ Criteria: ' 75% minimum participation of Health Plan enrollees; antl 'Minimum $30 differential in monthly employee contribution between participating employees and non-participating employees. myhealthlQ Assumptions: ' No spouse or retiree panicipation; ' Online educational material includeQ and ' Maximum allowed screening hours equals the number of participating employees divided by 5 (minimum of 2 hours bAled per site). myhealthlQ Fees (biNed separately or deducted from the Plan Benelt Accountf: ' $100 far each eligible employee who receives a worksite screening; ' $190 for each eligible employee who receives an individual screening (other than at worksite); ' $15 for each participating employee who receives educational materials by mail; and ' $100 per hour of screening that exceeds maximum allowed hours. Atlditional Wellness Program terms: ' If foal participation is less than 50%, the Employer shall pay an additional $60 for each Eligible Flnployee. ' IF this program is not implemented, there may bean increase to the proposetl renewal slop loss fees and deductible factors. Your renewal requires the execution of the attached updated ASO Agreement. This agreement contains updaletl provisions for your beneft plan and will supersede the current ASO Agreement. The fees and contlitions included within this Renewal7erms 8 Conditions document are based on the renewal enrollment shown on the fee pages. If, at any time during the renewal plan period, overall enrollment or dependent content increases or decreases +/.10 % from the renewal enrollment stated within this document, we reserve the right to rerate the plan after 30 days notice. In order fo provide continuous, uninterrupted benefit payment services in accordance with your Plan provisions, this Renewal Terms & Conditions form must he signed prior to the renewal date shown on the first page of this document, KERR COUNTY UNITED OF OMAHA LIFE INSURANCE COMPANY By: Title Date ~~ ~~ By: Vice President -Health Risk Management Title October 12, 200fi Date REPORT NL`. DHC518H "" " ASO `""^ p50 GROUP PAID BASIS 3EPORT FOk Go9i P4 d]A KERB COUNTY REPORT SEQUENCED HY npLICY NO., GROUP NAME, EMP COMB CODE, SERV'_CE OFFICE POLICL NO. OS-Y4H4A P.ERR COUNTY COU RT30USE fRJM 1r 05 i'HRO 9i 06 ]00 MAIN STREET PAGE 3 OF 1 RERRt2 i,LE T% ]8028 REG SERVICE COMB FUNDING SPECIAL EFFECTIVE CANCEL OFFICE CODE PRODUCT R ISK METHOD LINES PATE DATE HOVSTCN G039 HEALTH ASO 1/01 /OS ----- ----'--'-- ------------------ H E A L T H A N^ A C C I D E N T _____ __________ AD & D _ _________ _ ENROLLM ENT ?AID O4AFT COi,LECTED PAID DATc COUNm SERVI c FEES CLAIMS CO641T SER'JICE FEES CLAIMS 01/05 261 ],123 10,690 9 0 0 02105 263 '1,188 62,]54 192 0 0 03/05 261 ],095 100,830 312 0 0 04/05 268 '1,508 124,918 202 U U OS/OS 2]5 ],810 1fi 5, 7]C 311 D 0 06/Ud 2]i 6,]38 124,330 39.3 0 U Off OS 266 ],563 159,165 286 0 O OB/OS 268 9,415 126,436 383 0 0 09/05 2]3 7,700 150,409 3d8 0 0 10/US 281 ],995 184,366 399 U 0 11/05 284 5,225 122,482 362 0 0 12/05 276 ],260 269,413 339 0 0 EL'a TOTAL 2]lA tl6,91U 1 ,604,563 3,586 0 U 01/06 265 8,923 116,066 325 U 0 02/06 265 8,856 91,365 28" 0 0 U3/U6 280 IU,557 2U 5, 915 312 0 U 04/06 2ti6 8,1]4 ll9, 952 29] 0 0 05/u`6 268 8,990 88,144 315 0 0 06/06 26] 8.856 9C, 622 289 0 0 J%/O6 25U %,118 99,055 246 U 0 OP/06 299 8,082 61,596 2i4 0 p 09;06 249 8,384 101,]21 24U 0 0 S[IB TOTAi, 262A ]],844 9]4,236 2,565 0 0 GRALIp TOTAL 264A 164,554 2 ,518,]99 6,151 O P PAGE NO 1,411 ' RON DATE O('T Ci U6 ' POLICY NO L5-P98'A ' RATE RENEWAL ' DATE 1. O1i0] REPORT NO. DHCSIAH " POLICYf10LllER " GROLP PAID 6ASIS REPORT t'OH ppCE NJ 69,910 UP 04898 RUN DA°F: OCT OS 06 KERA COUNTY REPORT SEQUENCED BY: pC LICY NO., GAOIIP NAME EMP COMB COCE, SFR9'_CE OFFICE POulCI' NO. UP-O18]A KERR COUNTY COURTHOUSE FROM '_: OS TLiRU 9: ]6 E'O6I C`1 1J0 UP- J481A ]Op MAIN STREET PAGE 1 OF 1 ' KERRVILLE T% ] 8028 kEG SERVICE COMB F!JNDING SPECIAL F.FF ECTIVE CA::CRL fiAT E RENEWAL OFFICE ~ CUCE PRODUCT RISK METF.'OD LIVES PATE DATE DATE ~ HOOSTON ...x...:.. u..u....... G039 STOP LOSS ...a:.,.r..~........~... ..u«w.. NON-RETN .u..........ra REGOLAR ........u.... .....~.u~u.... ~..a«aa«......... ~. 1/O1/OS ::u„a.«~.+~ ..u...+... .: 1:01!0] _____________ __________ H E A L T H ___ __________ __________..____ ________________ L I F E ____ _________ _____ _________ ____ MEDICAL i,I Cp ENROLLMENT. PAID DRAF^ CLAIM ENROLLMENT PAID DRAFT CLAIM COMBINED r DATE COUNT PREMIUM CLAIMS COUNT RATIO COUNT PREMIUM CLAIMS COUNT RATIO RATIO pl(95 259 12,668 0 D 0.0 D D 0 0 0.0 0.0 02/05 261 12,932 0 0 O.p 0 0 0 0 0 0 0.0 03/05 259 12,]]1 U 0 0.0 0 0 U 0 D O 0 0 09/DS 266 13,223 0 U 0 0 0 0 0 0 0.0 D O U5/OS 293 19,135 24,522 1 1]3.5 0 0 0 0 0 0 1~3 5 06/05 2"15 12,159 59,144 9 486.4 0 0 0 0 0.0 486.4 I 09/05 255 13,595 31,395 6 231.3 0 U 0 0 U 0 231 3 OA/05 26] 13,20] 60,21? i0 955 9 0 0 0 0 0 0 455.9 09105 292 13,910 64,159 9 468.0 U 0 0 0 O.U 968 U 10/OS 299 13,"161 4,098 2 29.4 0 0 0 0 0 0 29 9 11/05 282 9,33") 52,324 9 560.9 0 0 0 D 0.0 560.4 12/US 2]4 12,803 98,808 9 615 6 0 0 0 0 O D 615 6 SOB TOTAL 2698 154,281 3"14,619 53 242 8 N/A 0 0 0 0.0 242.8 01/06 264 12,803 3,213 5 25.1 0 0 0 0 0.0 25 1 02/06 265 25,912 0 0 0.0 U U 0 U O.U D O 03/06 280 23,]36 10"1,850 1 454 4 0 0 0 0 0 0 454.4 04/Ufi 26fi 18,189 2A, 213 3 155.1 0 U D 0 0.0 155 1 ' 05/06 268 20,594 2,445 3 11.9 0 0 0 0 0 0 it 9 Dc/Oh 269 20,291 135 1 0.9 0 a 0 a U.0 0.] D9/06 25p 16.213 D 0 0 0 D 0 0 0 0.0 0 0 UB/06 24d 18,303 683 2 3.9 0 0 0 0 0 0 3 9 09/D6 299 19,162 95 1 0.5 0 0 0 0 0.0 D S S08 TOTAL 2628 1]6,106 192,639 16 B1.0 N/A o 0 0 O.U 81.0 GAAND TOT 2668 330,38] 519,248 69 156 6 rv/A 0 0 0 0 0 156 6 RE PURT NO UIIC 618I[ " YULICYHULDE4 " GROCP PASD BASIS REPORT FUR PAGE N0. 67,8I! GLpG 099~A RCN UATF.. OC'T fig 06 KERR COUNTY REPORT SEQUENCED BY: POLICY NO., GROUP NAME, EMP NMB CODE, SERVICE OFFICE POLICY NO. 24- 3489A KERR COUNT'[ WURTnpUSE PROM 105 PHRU 9106 POL?CY ND ?4-048~A 700 MAIN ST REET PAGE 1 OF 2 KERRVILLE T% ]8028 REG SERVT-CE COMB FUNDING SPECSAL EFFECTING CANCEL RA^E FENDWAL OFFICE CODE PRODUCT RISK METHOD LINES PATE UATE DF.^E HOUSTON .•t~r.~:vu~. ~t.r~.::.~ GU39 :.W~~v.~~~~~ Ap6D t~~wx~~a~.aa«~u a~+ NON-RETN ..xit.~~..~nau REGULAR ~.~~~..~~r,445 )g135 50 '5683 595 INELIGIBLE PAYMENTS 52583 5358 568] 5563 58]1 5486 SS6S ./.$546 5633 ACCUMVLATEp CLAIMS LESS SSl/INELIGIBLE 5112,085 5201,165 5295,504 5388]9] 54]3,301 5560,549 5658,389 5]18,218 5819.D2 #NAME? #NAME? 50 50 50 50 mo total 1,301 1]4 232 126 353 50 SO 50 mo avers a 145 19 26 14 39 29 3 32 4 31 3 51,2841]6 5142,686 5965,983 510],331 5139.421 5],290 g0 50 GRAND TOTAL ACCOUNT POSITION: Total Accumulated Aggregate Deduct6le Less Total Accumulatetl Net Claims 51.284,1 T6 Aggregate Deductible Excess - Np Employer Reimbursement Re9uired 5818.2]2 $464,904 Comments: 53.213 tpr spen(ic stop Ipss is reflected on Jan 2006 Paid Basis but is YOr 2005 plan year. This amou[ has been adtled to Dec/2005 15]8,808 + 53,213 = 562,0211 Page 2 Mutual of Omaha Medical Large Claim Summary (81M0022) G000487A Kerr County Claims Paid: 0110112005 to 01101/2006 Claim Threshold: 40000 Sub rou All Class All Plan All Product All) Relationship Member Data De endent Subscriber Grand Total 45205351 Medical Paid $230,314.27 $230,314.27 Drug Paid $443.64 $443.64 Med &Dru Paid $230,757.91 $230,757.91 45213502 Medical Paid $124,388.32 $124,388.32 Drug Paid $553.78 $553.78 Med &Dru Paid $124,942.10 $124,942.10 45211601 Medical Paid $85,152.32 $85,152.32 Drug Paid $55.87 $55.87 Med &Dru Paid $85,208.19 $85,208.19 45235951 Medical Paid $76,149.89 $76,149.89 Drug Paid $910.96 $910.96 Med &Dru Paid $77,060.85 $77,060.85 45214202 Medical Paid $47,580.03 $47,580.03 Drug Paid $1,493.87 $1,493.87 Med 8 Dru Paid $49,073.90 $49,073.90 45218901 Medical Paid $39,139.22 $39,139.22 prug Paid $1,547.11 $1,547.11 Med &Dru Paid $40,686.33 $40,686.33 Total Medical Paid $171,968.35 $430,755.70 $602,724.05 Total Dru Paid $2,047.65 $2,957.58 $5,005.23 Total Med &Dru Paid $174,016.00 $433,713.28 $607,729.28 Address all correspondence to: Houston Group Oflicc I I l1 North Loop West, Suite X35 Housmq Tesas 77008 Phone (713)861-5813 x227 Fax'. (713) R660986 Mun~a~~Omaxia Francine E. Maher jrartcine. maher~.m ufua[ofomaha. com October 19, 2006 Don Wallace Wallace & Associates 628 N 123 Bypass, Suite 3 Seguin, TX 78155 Re: Kerr County Life AD&D Renewal Dear Don: Our underwriters have completed their annual review of the group life accidental death- dismemberment insurance plan that is scheduled to renew January 1, 2007. Based on this review, life rate increased by 10% due to claims experience. The paid basis report (premium vs claims) is also attached with the renewal terms & conditions. f would appreciate the opportunity to share any competitive bids that you receive with our underwriter in a continued effort to retain this case. Since this is a renewable term contract, please acknowledge acceptance of the new contract prior to January 1, 2007 in order to keep the policy in force and guarantee uninterrupted claims payment. Please sign and fax the attached Renewal Terms and Conditions to my attention at (713) 861-0986. We have appreciated the opportunity to be of service to you and KC's employees over the past year and a half and look forward to continuing that relationship during the upcoming policy period. In the meantime, if you have any questions concerning this renewal action, please do not hesitate to call ore-mail me. Sincerely, Francine Maher Group Service Executive :/fm FULLY-INSURED RENEWAL TERMS AND CONDITIONS Policyholder Name: Kerr County Policy Number: G000487A Renewal Date: January 1, 2007 The following are the terms of your 24 -month renewal effective January 1, 2007: Monthly Rates Basic Life/AD&D Plan. Current Rates Renewal Rates Adjustment Life Insurance Rate per $1,000 $0.20 $0.22 10% AD&D Insurance Rate per $1,000 $0.02 $ 00 0% Other Conditions of Renewal In order to provide continuous, uninterrupted benefit payment services in accordance with your Policy provisions, this Renewal Terms 8 Conditions form must be signed prior to January 1, 2007. These conditions are hereby agreed to and accepted by: KERR COUNTY UNITED OF OMAHA L{FE INSURANCE COMPANY .<= _` ~ ___ ~__..YV .~ 1 ~.';..-..-...._. By: By: ! °'' Vice President -Group Underwriting Title Title October 19, 2006 Date Date RB PDFT NO DHCS18k "" YOLICY}IULOER '" GROUP YAID HASIS REPORT FOR PAGC N0. 59,010 ^P 09 d]A RCN -A TE: OCT 04 06 RERR COUNTY ftEYORT S£QUEN CEp HY: PO LICY NO., GROUP NAME, EMP COMB CODE, SERVICE OFFT CE pOLLCY NO. UY-648]A KBRR COUNTY rOpF1`LLOU SE FAOR 'l05 T HRU 9:06 POLI CY NO UP- 040]A ]00 MAIN STREET PAGE 1 OF 1 KERRVi LLE TX ]B p28 AE6 SERVICE COMB FUNDING SPECIAL EFFECTIVE CANCEL RAT E RENEWAL OFFICE CODE PRODUCT RISR METHOD LINES GATE DATE DAT£ HOUSTON G039 STOP LOSS NON-BETH REGULAR 1/O1/OS 1/U1/0] _____________ __________ H E A L T H ____ ______________ _____ _______________ ________________ L I F E ___ __________ ____ ___-______ ____ MEDICAL LIFE ENROLLMENT PALO DRAFT CLAIM ENROLLMENT PAID DRAFT CLAIM COMBINED DATE COONT PREMIUM CLAIMS CDDNT RATIO COUNP PREMIUM CLAIMS COUNT RATID AATS O O1/OS 259 12,668 0 0 0.0 0 0 0 0 0 0 9 9 D2/OS 261 12,932 0 0 0 0 0 0 0 0 0 0 0. 0 OJ/p5 259 11,]91 0 0 0.0 0 0 0 0 0.0 0. 0 04/05 266 13,223 0 0 0.0 0 0 0 0 0.0 0 0 p5/OS 2]3 14,135 24,522 1 193 5 U 0 0 U U O 173 5 06105 2'15 12,159 59,144 9 486.4 0 0 0 0 0 0 48E. 4 07/05 265 13,5]5 31,395 6 231.3 0 0 U 0 O.U 231. 3 08105 267 13,20] 60,214 10 455 9 0 0 0 0 0.0 455 9 09/05 272 13,'110 69,159 9 460 0 U 0 U 0 0.0 968 0 10/OS 2]9 13,]61 9, 09A 2 29.9 0 0 0 0 0 0 29 9 i1/US 282 9,33] 52,324 9 560.4 0 0 0 U 0 0 560 4 12/05 294 12,803 ]8,808 9 615 6 0 0 0 0 0.0 615 6 SUB 'DOTAL 269A 154,281 3'19,614 53 242.0 N;A 0 0 0 0 0 2;2. 8 01/06 269 12,803 3,213 5 25 1 0 0 0 0 0.0 25. 1 02r^6 265 26,912 0 0 O.U 0 0 0 U 0.0 U u 03/06 280 23,]36 109, 850 954.4 0 0 0 0 0 0 459. 4 04106 265 18,189 28,213 3 155.1 0 D 0 0 O U 155. 1 05/06 268 20,549 2,445 3 11 9 0 0 0 0 0.0 11. 9 06/06 26] 20,294 135 1. 0 ~ 0 0 0 U U.0 f, ! 0]/06 250 16,213 0 0 0.0 0 U 0 0 0 0 0. 0 08/06 290 18,303 683 2 3.] 0 0 0 0 0.0 3 ] 09/06 249 19,162 95 1 0 5 0 0 0 0 U.0 0. 5 SUB TO'PAL 262A 1]6,106 142,639 16 81 0 N/A 0 0 0 0 0 81 0 GRAND TOT 266A 330,30] 51"1, 29A 69 156.6 N/A 0 0 0 0 0 156. 6 REPORT N0. DHCSIBH " YDLICYIiOLpHR " GROUO pAID DASLS RE PORP FOR PAGE NO 6^,811 GLOG D49'Iw RUN DA PE: OCT 04 06 RERR COUNTY REPORT SEQGENCED BY POLICY NO., GROUP NAME, EMP COMH COLE, SERVT CE OFF T_CE POLICY NO. 29- 046]A KERB COUNTY COURTHOUSE E'HOM 1(D5 '1'HRU 9D6 POLICY Id]. 29- 04 d"1A ]00 MAIN STREET PAGE 1 OF 2 KFARVILLE T% ]6C2a REG SERVICE COMB FUNDING SPECIAL EFF ECTLVE CAf1CEL RATE RENEWAL OFFSCE CODE PRODUCT RISK METHOD LINES GAPE PATE PATE HOllSTON «.xx..r~•«n. u~~r~.u ~v G039 AD&D W US.~~~..•~t~u.u rr~~x u~..u NON-RETN a~ra.<<.~~~.ru REGL`LAA R.a«ru~.r..~a+~<•' Ya~