r z .. ,~._ ~ st- y ~ 'ury.~. 3` - .. J ~~ _, ขi ~ ii fry,..: . _ - ~~ f3- _ s6 ~'~. _. FlSe VV Health. F%5 /B V Health. Kerr Counfy Proposal for: Medical Claims Administration Health Reimbursement Account Care Management Services Stop Loss Coverage Flexible Spending Account Administration COBRA Administration HIPAA Administration Prescription Drug Administration Retiree Billing Administration October 2006 The information contained in Mis response to the request for proposal is considered confidential. We are providing this information wiM the undersgnding this information will not be used fw any purpose other than the speafic pupose of evaluating our capabilities to provide the services requested. In addifion, this information will not be disclosed to any person(s) w entity(s) other than those who are invdvetl in the process of evaluating the response to the request for proposal. Wdtlen permission must be made pdor to any exceptions of these obligations to maintain the confidentiality of our responses. - F%521V Health. Kerr County Page - Why Fiserv Health? ............................................... 1 - What's Our Approach? ............................................ 2 Product Overview .........................................................4 Claim Services Consumer Products - Retiree Services Pharmacy Benefits Care Management Services _ Provider Networks Stop Loss Coverage Administrative Resources Financial Proposal ...............................................26 - Stop Loss Proposal(s) Questionnaire GeoAccess Reports - Exhibits ~' F%5 l2 V Health Why Fiserv Health? Fiserv Health offers advanced technologies, comprehensive solutrons, and services y- tailored to meet the specific needs of our customers. We're flexible and dedicated to providing benefit solutions. We help our customers not only manage their benefit plans but also understand them. On December 12, 2005, we introduced our go-forward structure of Fiserv Health -one company, one name, offering access to a full consortium of self-funded services. As Fiserv Health, we -- remain flexible while continuing to provide customer-tailored solutions, explore new ideas, share and conserve resources, and pursue cost-saving initiatives and best-practice solutions. We recognize the challenge employers like Kerr County face as benefit costs continue to rise. You can count on us to manage expenses, stay abreast of legislative changes, and assist members in timely and accurate manners. To combat rising costs, Fiserv Health continues to invest in innovative technologies, expanded product offerings, and solutions designed to save customers time and money. Fiserv Health believes the customer comes first. To support customer needs, we have sales and account management representatives throughout the country. Their availability insures access to the personalized service and prompt resolutions our customers deserve. - ~~ ~ s~ ~ John C. Sickels, CEBS Steve McBride, CEBS, CLU, ChFC Senior Vice President Sales Executive Sales 8 Account Management Kerr County 1 P%5e V Hea-th~ What's Our Approach? W e have t W 0 g o a I S: to save customers money and provide top-notch customer ,_ service. We realize every customer's needs are different and no single solution can meet those needs. That's why we're flexible in the way we do business and how we approach benefits administration. We offer integrated care management services, consumer-driven health care, network optimization, infra-company pharmacy administration, and external vendor coordination. Through ,,. these initiatives, we deliver a comprehensive package that meets the administration needs of our customers. Integration ,~ Fiserv Health products and services are fully integrated, which translates into increased savings and better service. We are in constant contact with our customers and with each other regarding plan performance. While our care management team is focusing on the health and wellness of members, our pharmacy benefits staff is negotiating prescription drug discounts and rebates, and our network professionals are seeking out new applications for cost containment products and developing relationships with multiple provider networks. P. We understand the intricacies of stop loss insurance and consider value when selecting a program. We've established and maintained strong relationships with leading carriers, who can ,,, customize products according to customer specifications. Our stop loss activity monitoring gives added peace of mind, providing immediate notification of high dollar claims. _ We have a fully loaded, user-friendly Web site that provides customers and providers accurate benefit information any time of the day or night. Check it out at www.fiservhealthservices.com. "' Performance standards We monitor our claim processing functions for financial, payment, and procedural accuracy. To ~ allow our customers to monitor our performance, we provide them regular reports that highlight their plan's performance. From medical to dental, disability to flex, our customer service _ representatives are thoroughly trained on their assigned product line. We want to be better than the best, so we hold ourselves to levels higher than the industry standard. Kerr Counfy 2 FlSe VV Health. URAC L'RXC U&AC URAC URAC ' ' URAC IUIILp (C'Ri.'ili / ~ ~ \1; R1'INi}P Rl, Nl' l\ „( NIRi INI'FU i t ~1\lr M ( Rl Uffl:U IIII'.\ ~i r •' •. 1 I~1~ l/ \ V \~N.1 \II.~I a 1.1\\\(.1 \II ~I I k irl\I t4 Don't just take our word for it. Fiserv Health is a leader in URAC accreditation, which is nationally recognized as the benchmark for quality in managed care organizations. Our care management ,_ holds accreditation in utilization management, case management, and disease management, while our TPA entities have achieved varying accreditation for claims processing, HIPAA privacy, and HIPAA security. With you every step of the way "- When signing on with Fiserv Health, customers not only gain athird-party administrator; they gain a partner, a resource for benefits questions, and an extension of their human resources department. We'll make sure plan implementation is seamless and coverage is uninterrupted. Our dedicated team of transition coordinators and account managers is available to assist with enrollment meetings, administrative needs, and financial questions. To ensure smooth transitions, we hold frequent transition meetings between the cuslomer and key coordinators. A '- detailed project list is established and maintained throughout the process. Once things are fully functional, we will always be on hand to address questions and respond to customer needs. Kerr County 3 F%52~V Health.. Claim Services P Claim processing and customer service functions are handled by knowledgeable, courteous, and confident staff members who are assigned to specific lines of coverage and dedicated to specific customerteams. These associates are trained on the benefit plans they administer. _ Fiserv Health has a formalized internal education program, dedicated to plan administration regulations, Medicare/Medicaid coordination, terminology, processes, systems, and customer service functions. Following the initial training, associates are assigned to a specific team and an _ individual coach. Our medical and dental claim payment system is designed to provide consistent administration _ for a wide variety of benefit plans and pricing arrangements. The state-of-the-art functionality of our processing system allows us to meet the needs of a diverse client base as well as accommodate changes in the benefits environment. Our administration system is fully integrated and uses common databases and processing functions. We employ highly sophisticated expert logic with claims administration edits to auto-adjudicate all types of benefit structures. Auto-adjudication allows claims to be turned around quickly and limits the possibility of human _ error. The addition of a claim payment system designed specifically for disability benefits enhances our ability to administer these options. Our system is designed to accommodate flexibility in beneft plan design and claim administration. The system allows for customer-specific functionality and self-service features. Medical claim administration Through the use of internal coding, medical benefits are programmed specific to each customer's plan document. Benefit coding controls the payments; and tracks deductibles, out-of-pocket maximums, participation, and plan maximums. Service screening functions within our system review claims prior to payment and allow for the automatic denial or pending of a claim for further review. System flexibility allows us to administer all levels of fee schedules and PPO configurations, usual and customary fees, per diem rates, or any combination of these elements. We have the ability to administer three-tier benefit plan designs, customer-specific contract arrangements, and to interact as a secondary payor to Medicare Part A and B claims. Kerr County F%52~V Health.. Dental claim administration ,~ Fiserv Health administers a broad range of dental plan designs. We work with the customer to select a plan design that meets their requirements. Our dental staff is dedicated to finding ways to increase efficiencies without jeopardizing customer service. Several cost containment _ initiatives are in place to help reduce dental expenses. A team of specialized claim professionals and consultants examine X-rays submitted for major restorative procedures, such as crowns, before benefits are approved. If there is a question about an eligible expense, the dental ,_ consultant corresponds directly with the treating dentist. This procedure minimizes the time required to approve dental treatment plans and claims. Disability claim administration The self-funded disability programs we offer are designed to help employers manage their risk. We offer a full array of standard administrative features and innovative options, which can be tailored to meet specific business needs. Our disability staff includes experienced customer service representatives (CSRs) and registered nurses (RNs). A CSR and RN are assigned to "- each account. This team works together to determine disabilities, estimate the duration of a disability, and manage the case. "- Three claim administration options are available. The first option available is check cut. When the check cut option is selected, we will issue the "- benefit checks, withhold specified taxes for federal, state and FICA, and adjust payments for any employer specific deductions. With this option, we also file the quarterly taxes, issue W-2s, and provide the employer with payment reports. The second option available is advice-to-pay When advice-to-pay is selected, we review the information presented and make a recommendation to the employer on the gross weekly benefit amount and duration. The employer issues all checks. Employers are provided weekly status reports. _ The third option available is salary continuance. When salary continuance is selected, we review the medical documentation received and report the medical determination to the employer. The employer pays the employee following their normal payroll process. Employers are provided weekly status reports. Kerr County 5 F%52~V Health Fiserv Health also provides disability clinical management and return-to-work programs facilitated by our registered nurses. Disability clinical management provides early assessment of claims and review of medical documentation and proposed treatment plans. By coordinating with the treating physician, appropriate medical treatment and rehabilitation services are facilitated. ,.. Early return-to-work recommendations are coordinated with the employer, employee, and medical providers. Our process includes determining if there are accommodations or alternative job assignments available. Flexible spending account administration ~' A flexible spending account (FSA) program is a great way for employees and their families to manage health and dependant care expenses with pretax dollars. With an FSA account, employees can stretch their paychecks by paying for select services with money taken out before _ taxes, thereby reducing their taxable income and total tax liability. There are several advantages to our FSA program: Reduced Social Security taxes for companies offering FSA programs Automatic r e i m b u r s e m e n t on medical, dental, and/or prescription drug claims ,_ administered by approved pharmacy benefits managers (PBMs) Accessible Internet claim information 24hoursaday,sevendaysaweek Comprehensive explanations of benefits (EOB) provided for each reimbursement Prompt-pay debit cards for health care spending accounts Health care spending accounts can be used for a variety of expenses that may not be covered by other sources, including some over-the-counter (OTC) medications. Dependent care accounts allow the use of pretax dollars for qualifying expenses including childcare, in-home housekeepers when needed for qualified individuals, or outside services for dependents who are unable to care for themselves. Kerr County 6 ~' F%Se~V Health. Consumer-Driven Products Fiserv Health offers services and programs designed to encourage member involvement in the management of health care expenses. Our services provide access to knowledgeable staff members dedicated to providing information, education, resource .. connectivity, clarification, and support. Fiserv Health offers flexible plan designs that allow clients to choose the benefits they offer. Web ._ site and personnel resources are available to provide evaluation and consultation services for comparison of our preferred provider organization (PPO), health reimbursement account (HRA) and health savings account (HSA) high deductible plan options and our newest consumer focused program, Fiserv Health Consumer Connections"". Our ultimate focus is on assisting our clients to meet their benefit goals while controlling their yearly medical cost increases. "" Health reimbursement account (HRA) HRAs allow employers to control the benefits they fund to provide long-term incentives for the member's wise use of medical care dollars. Through our system integration the beneficiary receives a single explanation of benefits (EOB) and the provider receives a single remittance all without the member having to submit a claim. If we administer the flexible spending account r (FSA), any claim that exceeds the HRA balance can automatically be sent for FSA reimbursement. ~` HRA plans are designed so client funds not used by the member can be rolled over from year-to- year. These rolled-over funds can be used to cover a member's major medical deductible amount if needed in another year. This feature encourages conservative medical purchases and '- motivates members to better understand how they are using their medical benefits. Clients can limit maximum accumulated rollover amounts. Wellness benefits are typically carved out, but can be included in the HRA. Health savings account (HSA) HSAs, in conjunction with high deductible health plans (HDHPs), have emerged as an alternative to traditional medical plan design. HSAs are portable, interest-bearing accounts that are allowed to accumulate and grow for future medical expenses. They offer payroll tax relief to clients and a pretax health care funding option for employees. Members can contribute to an HSA if they are enrolled in an HDHP and not enrolled in any non- HDHP coverage. After an interest-bearing HSA is set up in the employee's name, the employee or employer can make pretax (pre-payroll and federal income tax) contributions to the account. Once money is deposited into an HSA, it is the employee's money. Kerr County ฎ F%5B V Health. The employee is allowed to draw on the account balance for payment of uncovered medical expenses with no penalty or tax assessments. We offer HSAs to employees with no need for employer sponsorship or the related fiduciary responsibilities. Since we have combined forces with select HSA custodians, the client is only asked to transmit payroll HSA deductions to the custodian. HSA information and Web links to the offered banks are embedded within our Web site. Fiserv Healfh Consumer ConnectionsM ` Fiserv Health Consumer Connections"" is aconsumer-driven product advancement designed to meet the expanding needs of our clients and their members. Resources and features exclusive to the program include: '- Member Activation Leader The Member Activation Leader is a resource to our sales executives and account managers. - They review, analyze, and provide alternative plan solutions that can directly impact the effectiveness of the plan for clients and members. Consumer ConciergesM The Consumer Concierges"' serves as a member advocate who goes beyond traditional customer service to provide the connectivity and knowledge members need to effectively manage the resources offered within their particular plan design. The Consumer Concierges"" works directly with our internal product and care management specialists to gather the information that allows them to completely and thoroughly explain and identify each member's particular benefit options. The Consumer Concierges"" focuses on educating the member on their specific benefits, including: Benefit plan administration Web tools and resources Consumer account benefits and usage Care-targeted benefits (HRA, HSA and FSA) Debit cards HRA incentive benefits Health risk assessments Kerr County _ Fl52/'V Health.. "' Care-Targeted BenefitssM Care-targeted benefits are focused on encouraging and motivating members to get the essential - care and information they need to manage their medical condition in an effort to avoid catastrophic claims later. Exclusively offered to enrolled and actively participating disease management members of our coronary artery disease, congestive heart failure, asthma, chronic ^- obstructive pulmonary disease (COPD), or diabetes programs, care-targeted benefits are monetary funds set aside by the employer to pay for out-of-pocket medical care associated with the condition. Personal Care Notes _ Through the analysis of claims data and the evaluation of health risk assessments, Fiserv Health identifies and targets those members who are not receiving certain clinically appropriate services or who could save money related to prescription drug use by switching to less costly _ therapeutically equivalent drugs. The personal care notes (PCNs) will highlight their recent claim history and care gaps, as well as provide them with suggestions on ways to improve their health and reduce their out-of-pocket expenses. Additional Features To further the economic value of the program, we've included the availability of integrated pharmacy services, a 24-hour health information line, discount card, multi-purse debit card (FSA and HRA funds), lines of credit, and quarterly member statements. We've also identified key incentives to engage plan members in the wise use of plan resources. These incentives are credited to the member's benefit plan (employee and spouse, if applicable) to decrease their deductible expenditures. The following incentive programs and their associated i values are administered within the Fiserv Health Consumer Connections"' product: • CD-ROM review and content quiz in specified time frames (member/spouse); $100 • Coverage Advisor usage (member/spouse), prior to enrollment; $50 "' Health Risk Assessment completion (member/spouse), prior fo enrollment; $100 • Personal Care Note reviews (member and dependents); $50 In addition, Fiserv Health provides the employer reports documenting incentives, account usage and plan pertormance. Kerr County g ' F%52~V Health Preventive pharmacy benefits Fiserv Health offers preventive pharmacy benefts for use with qualified high deductible health plans or medical plans with health reimbursement accounts. Preventive pharmacy benefits enable your members to receive coverage for preventive medications before meeting their deductible. The preventive list related to qualified high deductible health plans and associated with health savings accounts (HSA) meets the U.S. Department of Treasury's definition of preventive care The drug classes included for first dollar coverage are Antihyperlipidemics, Antiosteroperosis, Anticoagulants, Platelet Aggregation Inhibitors, ACE Inhibitors, Prenatal vitamins with iron and folic acid. Medical plans with a health reimbursement account (HRA) may also offer first dollar benefits to their members for preventive drugs. The list specific to HRA plans is not subject to the Federal HSA guidelines and includes additional drug classifications. Preventive drug lists help promote appropriate preventive care before complications arise. These drug lists are not definitive and are subject to change without notice. Kerr County 10 F%Se~V Health Retiree Services ^' W e understand what i t t a k e S to administer benefits for retiree populations. We offer Medicare interactive claims payment services and retiree billing services. These services are sold separately and employers are allowed to choose the services that best meet their needs. Claim administration Specialized teams of claim service representatives (CSRs) have specific training in retiree health plan administration and senior issues. We provide retiree-friendly explanation of benefits (EOB) forms in an easy-to-read format. We've also customized our Web site to include retiree health content resources. With Medical crossover services, retirees over age 65 won't need to submit claim forms or paper coordination of benefits (COB) details for Medicare Part A or B claims. Benefit payments are electronically and automatically coordinated. As part of our services, we will proactively survey either the entire group or only your Medicare-eligible retirees to capture Medicare ID numbers (HIC numbers). Retiree billing administration Retiree billing services are designed to simplify split-billing arrangements in which retirees are required to pay part of the premium for their health plan coverage. Collecting these premium ._ contributions can be time-consuming. We can make this process easier by: • Sending confirmation letters and payment notices to participants • Collecting and processing retiree payments and sending late payment or termination notices, as appropriate • Generating monthly aging reports to document late payments • Answering customer and participant billing questions Preparing and providing monthly reports documenting participant enrollment and payments Kerr County 17 F%52t'V Health. Pharmacy Benefits Fiserv Health Prescription Benefits Administration isaleading provider of prescription benefits administration for third party administrators, self-funded employer s groups, labor organizations, managed care organizations, municipalities, and coalitions. Fiserv Health Prescription Benefits Administration aligns with plan sponsor goals by offering 100 percent full disclosure, lowest net cost, clinical expertise, and service excellence. This effective _ combination provides valuable prescription benefits with an ethical approach and common sense business principles. 100 percent full disclosure Fiserv Health Prescription Benefits Administration is willing to fully disclose all rates, fees, discounts, as well as terms and conditions negotiated with pharmacies and pharmaceutical manufacturers to plan sponsors. Whether utilizing a traditional orfixed fee pricing model, our pharmacy benefit administration strategies result in cost savings, along with well educated plan sponsors and members. Lowest net cost Fiserv Health Prescription Benefits Administration is focused on a strong combination of .., prescription management strategies, program offerings, and business initiatives geared toward managing prescription benefits at the lowest net cost. The lowest net cost focuses on: _ Preferred product list (PPL) management Robust pharmaceutical manufacturer rebates National pharmacy networks -including retail, mail order, Internet, and Retail 90 Rx Generic product utilization programs '" Innovative clinical programs As a result of these efforts, our plan sponsors' average cost per prescription has been 4 percent lower than the industry average, for the last six years.* 'Based upon figures from Novartis Pharmacy Beneft Report, Facts S Figures, 2005 Edition. Kerr County 12 f%52fV Health Clinical expertise s Fiserv Health Prescription Benefits Administration offers a wealth of industry experience and expertise. Our staff of pharmacists and Certified Pharmacy Technicians (CPhT) provides plan sponsors with a menu of clinical programs that can be selected to match specific management goals. Our clinical opportunities include: Preferred product list (PPL) Quantity limits _ management • Rx Instep Drug utilization review (DUR) Rx OTC • Specialty pharmacy program • Wise Choice Rx Prior authorization HaliTab Rx All Fiserv Health Prescription Benefits Administration clinical offerings are provided at no additional cost to plan sponsors. When considering the total value of this strategy, it is important to note we believe clinical programs are a source of savings for our customers, not a source of revenue for our organization. Retail 90 Rx We believe retail and mail order programs have distinct advantages for plan sponsors and members. The Retail 90 Rx program takes the best of both and combines them to create the _ ultimate convenience for members and real savings for employers. A "90-days at retail" program allows members to receive up to 90 days of medication from participating retail pharmacies or mailed directly to their doors via mail service, for a reduced ingredient cost. Members have exceptional access to this program through the Fiserv Health Prescription Benefits Administration Retail 90 Rx Pharmacy Network -more than 30,000 retail pharmacies nationwide. Retail 90 Rx often targets a different audience than the traditional mail order user, one who is ฐ" willing to receive a 90-day prescription, but still wishes to visit directly with his or her pharmacist. Kerr County 13 F%5B V Health - Service excellence The Fiserv Health Prescription Benefits Administration multi-faceted combination of account a- management, clinical consultation, reporting, educational tools and resources, and customer service serve as the foundation of our service excellence. In concert with other health product and service offerings, the prescription benefits systems and customer services are seamlessly -- integrated to provide a comprehensive Fiserv Health package solution to plan sponsors. Highlights include: • Account management Flexibility and adaptability • Clinical consultation expertise • Strategic reporting focused on utilization trends and cost savings opportunities • Customer service center- 24 hours a day, seven days a week • Comprehensive Fiserv Health service integration Goal alignment The combination of 100 percent full disclosure, lowest net cost, clinical expertise, and service excellence creates goal alignment between Fiserv Health Prescription Benefits Administration and plan sponsors. The true value of the Fiserv Health Prescription Benefits Administration solution is realized when combined with the other Fiserv Health products and services offered in a fully integrated package. Kerr County 14 F%5 r2 V Health. Care Management Our care tTl a t1 a g e m e n t program offers an integrated suite of services to help control health care costs, provide appropriate and timely member care, and increase a member's understanding of the health care system and the options available to them. Services available through the program include: Utilization management Case management Precious Cargo -maternity management Disease management _, Health and wellness Health information services .- Independent medical review services Focusing on identification of eligible members through an integrated care management program, front-end utilization and case management edits and processes are applied to early identify members that might require intervention beyond the normal utilization management process. The edits and processes in place allow daily review of medical information and provide advanced _ notice of a possible health concern. Utilization management Our utilization management program reviews medical services for necessity and appropriateness prior to the services actually being provided. The following areas are included: Inpatient hospital or behavioral health services Skilled nursing facility care Home health care Rehabilitation services Durable medical equipment We provide ongoing reviews for both preferred and non-preferred providers and refer to case management and/or disease management, as appropriate, to promote positive clinical outcomes. Kerr County 15 ,FlSB V Health. Case management Case management assists with a member's catastrophic or potentially long-term claim by exploring medical care options to determine which are the most appropriate and cost effective. Resource management is a priority Case management specialists become involved in coordinating care for the patient by communicating with the patient, family, care providers, and facility personnel. Their involvement ensures the member is receiving the appropriate care and offers the member and their family a resource for their questions. Precious Cargo -maternity management Our Precious Cargo -maternity management program is designed to improve the chances of delivering healthy full-term babies. Service includes toll-free telephone access to obstetrical registered nurses who work with both high-risk and normal-risk pregnancies. Our nurses answer questions and provide educational materials on pregnancy and what to expect during a baby's first year. Disease management P The disease management program addresses prevalent chronic conditions known to escalate health care and disability costs. These are high-risk, chronic conditions that have a high probability for successful intervention. i We can manage members with multiple chronic conditions and secondary health problems. These conditions are often identified and reported as subsections of major diagnostic categories (MDCs) within standard medical administration reports. We provide education and guidance about the condition and clinically accepted evidence-based, best-practice treatment for the member and, when appropriate, their family Current selected conditions include: Asthma Chronic obstructive pulmonary disease (COPD) Congestive heart failure Coronary artery disease Depression Diabetes Hypertension Kerr County 16 F%5B V Health. ฎ We employ an opt-out approach to disease management. This approach assumes all members will participate in the program unless they specifically decline participation. Our experience demonstrates this approach increases active participation and successfully links high-risk ^ members with a certified nurse case manager. The disease management program measures and regularly reports statistics on participation, ^ clinical outcomes, participant satisfaction, and financial results. Initial financial results for customers with claim history available are reported approximately 18 months from program inception and then annually from that initial report date. The average return on investment for our ^ disease management clients is in excess of 2:1, and the majority of them have experienced an annual ROI of 2:1 or greater. ^ To expand the outreach of our disease management program Fiserv Health offers personal care notes (PCNs). PCNs are generated based on an analysis of medical and prescription claim data for all members eligible for the disease management program. Fiserv Health identifies and ^ targets those members who are not receiving certain clinically appropriate services or who could save money related to prescription drug use by switching to less costly therapeutically equivalent drugs. The PCN will highlight their recent claim history and care gaps, as well as provide them ^ with suggestions on ways to improve their health and reduce their out-of-pocket costs. - Health and wellness In addition to managing members who have a chronic condition, it is equally as important to focus ^ on the so called "healthy" population who are not currently incurring large claims, but who may have lifestyle habits or conditions that put them at risk for getting a chronic condition. ^ The purpose of the health and wellness program is to reach out to those members who have risk factors and to address those factors before a serious disease manifests itself. The program focuses on risk factors (e.g. obesity, smoking, diet, and exercise) which, if not addressed ~. properly, over time can lead to the onset of a chronic condition. Initially, members are asked to complete a health risk assessment. Stratification of the .,. information allows us to identify and focus on the health of at-risk members. High-risk members are eligible for six to eight confidential health coach consultations at times convenient to them. At the same time, we continue to provide and encourage lifestyle decisions that keep all members ^ healthy. Our health and wellness program tracks behavioral changes, clinical status, and the impact the ._ program has on claim costs. Reporting is provided on participant satisfaction, annual program comparisons, and total versus high-risk participant interventions. Kerr County 17 ~- F%5e/'V Health. Health information services Health care knowledge is the key to effective self-care, empowerment, and protection in the ฐฐ complex health care system, and is ultimately, the gateway to optimal health. We are committed to providing quality information that allows members to take an active role in making good health care decisions and lifestyle choices. We provide members with access to nurses and health care professionals, via the health information line and Web site features. 24-hour nurse line Members can call a nurse to discuss any health questions, 24 hours a day. This call line is a member information service only and is not intended to be a triage service or to replace or ^r question the diagnosis of a physician or health care provider At all times, the provider remains responsible for the member's medical care. Our nurses use Krames On-Demand, aWeb-based patient education library of HealthSheets3 and drug information sheets. This award-winning information design combines illustrations and easy-to-read text to help our nurses communicate key points to the member. HealthSheets3 are available in English or Spanish and can be mailed or faxed to the member at their convenience. Web site features We are continually enhancing our Web site to provide current, quality health care information and interactive management tools. The Web site includes access to online health risk assessments, chat rooms, and health information sources. Conclusion Medical advancements, cost containment concerns, and the push toward consumer awareness have created the need for a care management liaison. Fisenr Health is here to assist as a qualified and knowledgeable resource. Our approach to care management services allows employers to create a program that meets their specific goals and their members' needs. Kerr County 18 F%52~V Health.. Provider Networks '- We have extensive experience developing and administering network arrangements. Our provider network strategy centers around flexibility and maximizing accessibility to in-network providers and discounts. Informing provider network relationships, we evaluate discounts, access to preferred providers, electronic data interchange (EDI) capabilities, repricing and claim turnaround time frames and quality control measures. Our national provider network relationships include but are not limited to: Aetna Signature Administrators PPO Network ฐ' Private Healthcare Systems (PHCS) Beech Street Corporation CCN - Whether national, regional or a combination of both, we have the tools available to assist in determining the best network solution for customers and members. Flexibility Our contracted preferred provider organization (PPO) relationships meet most needs; however, there are times when more flexible cost containment arrangements are required. Through our diverse system capabilities, we are able to provide flexible network and alternative cost-saving products, including open-model PPO options, open access point-of-service offerings (in select markets), and direct client provider contract administrations. We've also put specialty network and program arrangements in place that are consistently offered to our customers. These items are highlighted in the following paragraphs. Centers of Excellence In an effort to assist, Fiserv Health has established a relationship with United Resource Networks _ (URN). The URN network is offered to employers during the implementation process. No access fees are incurred unless a transplant occurs. Kerr County 19 - F%521V Health.. Access fees are then assessed specific to the transplant and facility. URN has been in operation since 1986 and is the nation's leading transplant network. URN's Centers of Excellence program supports safe, successful and cost-effective solutions to solid organ and blood/marrow - transplantation. The network provides average savings of 35 percent to 40 percent off of billed charges. URN credentialing takes into consideration facility transplant volumes and outcomes, transplant team experience and education, and patient and family support services cost reduction and savings program To assist customers Fiserv Health offers a cost reduction and savings (CRS) program. The goal of the program is to ensure customers receive value for their health care dollars. The program ~- incorporates the offerings of travel and secondary network options, fee negotiation and large bill review at the cost of 30 percent of savings. - Travel networks allow members full access to a national network when outside their regional network's service area. Through travel networks, members traveling outside the service area (for business or personal reasons) or those who have college students away from home are - reimbursed at the preferred level of benefits. Secondary PPO networks, behind our national PPO offerings, allow the review of claims for - potential primary and secondary level claims repricing. Employers offering traditional-type plan designs and/or having members residing outside of areas - meeting full network access criteria are often able to realize medical cost savings through contracted discount arrangements. ,_ We will continue to attempt fee negotiations on large dollar claims for providers who do not participate in the primary network or the discount programs. discount card program Fiserv Health is committed to offering value added services to our members and customers. With our discount card program, clients can offer member access to health care services not covered under current medical plan benefits. The program offers employees and their family members discounted services, at designated providers, simply by presenting their card. Our card program - is available in the following prepackaged combinations: vision only, dental only, vision and dental, and vision, dental, and hearing. - Through our relationship with Careington International Corporation, clients also have access to a full portfolio of other products and services at additional fees. Please contact your sales executive for more information. Kerr County 20 F%SeIV Health dental networks To help control the rising costs of dental care, we offer managed care dental plans. The use of network providers is voluntary in most plans and allows both customers and members to save money on dental expenses. For employers with members residing outside of full network access, _ we can offer our networks as an overlay product. Overlay products allow employers to realize cost-savings typically found only in managed care plans. Kerr County 21 ~' F%52~V Health_ Stop Loss F i s e rv Health offers customers access to the insured products needed to provide a complete employee benefit package. Our insured programs are offered through well-known and reputable carriers. Stop loss coverage To assist medical plan customers, we have established relationships with many of the country's best stop loss carriers and can offer enhancements such as: Transplant benefits with step-down deductible provisions Monthly accumulated cap benefits Aggregating specific benefits Common accident benefits Terminal liability extension options or individual stop loss extensions Advanced Specific Funding The purchase of stop loss coverage through our established relationships benefits customers by integrating the premium billing and collection processes. We provide stop loss monitoring reports and immediate claim notification of high dollar claims. Working through us can help avoid the handoffs and eliminate the confusions, confrontations, and lag times that can occur when multiple vendors are used. The stop loss market provides numerous coverage options. We can help sort through this often-confusing area, because our representatives are available to discuss the options and explain how the differences in plan designs and underwriting practices can impact plan offerings. Kerr County 22 F%5e/'V Health.: Administrative Resources '- During the transition p r o C e s s customers witness our commitment to providing excellent and personalized service that is crucial to the implementation and administration of their benefit programs. We have designated units within our company that operate as resources and/or provide administrative assistance to our customers. Implementation We start with an implementation team comprised of a dedicated implementation coordinator, as well as managerial, supervisory, and technical experts. This team works directly with a customer's designated staff to ensure a smooth transition that minimizes disruptions for the members of the benefit program. The implementation team develops a customized time frame identifying the tasks that need to be completed, the individuals responsible for each task and any customer-specific needs. Each task is carefully tracked and monitored. Regular communications between the customer and the team are essential elements of the transition process. Account management ~. Working closely with the implementation team is a designated account manager. This person oversees account administration and the customer's benefit plans. They are involved throughout the implementation process and continue to be the customer's single-source point of contact on .v all issues. The account manager acts as a liaison between the customer and Fiserv Health. Enrollment Fiserv Health accepts standard electronic, Internet, or paper enrollment submissions, including HIPAA 834 format. We must approve any deviations from these standard formats. _ Web enrollment We customize the Web enrollment process to meet the client's specific requirements. This allows the employees to self-enroll via the Web any time, day or night. Web enrollment is a convenient way to reduce the paperwork involved in traditional methods of enrollment. In addition, we have a call center available to employees without Internet access. Kerr County 23 ` F%52~V Health. Banking Fiserv Health works with the customer to establish banking options that meet their needs. Checks are issued through system technologies as claims are processed. The signature on the checks will be a facsimile signature only No manual checks are ever written. Included in the banking options are secure fund transfer methods and online reporting capabilities. Line of credit Fiserv Health offers the CLEAR program, a guaranteed line of credit access to employees. The intent of CLEAR is to assist members with their out-of-pocket health care expenses. CLEAR works as any other credit, debit or check card, members present the card and the payment is processed. Repayments are made through convenient payroll deductions over atwo-month period at zero percent interest (upon request payments can be spread over six months for medical expenses). The CLEAR card is an optional service offered at no charge to employers. Employer ~- responsibility is limited to recordkeeping functions for payroll deductions and eligibility. Employees will be assessed a participant charge that is deducted from their f rst two payroll cycles following enrollment. Reporting Through the use of our online reporting tool, customers have access to prompt and accurate monthly activity reports within a secure environment. Our information systems are designed to provide the financial and plan management information needed to administer effective cost containment programs. We want to be a partner in lowering overall plan costs. Through plan analysis, the customer receives information to help them make sound management decisions. Costs for customized reports will vary, depending on the complexity and required programming time. Legal and legislative services Our compliance department offers guidance on plan documents and compliance with all ongoing federal ERISA regulations. The compliance department has prioritized the Health Insurance Portability and Accountability Act (HIPAA). We are committed to maintaining the confidentiality of our customers, their business associates. and their members. Kerr County 24 ~` F%5e V Health.. r Our entire organization is mobilized in a concerted effort to document and control the use and disclosure of personal health information (PHI). Every effort is made to assist our customers in becoming HIPAA compliant. We believe it is important to establish swell-coordinated privacy program to protect health plan information. We _ are prepared to assist customers with the various disclosure requirements, contractual obligations and operational considerations the HIPAA rules present. "' Identification (I D) cards We produce ID cards in-house on standard 8'/" x 11" laminated, double-sided, card-carrier stock. Our ID card design allows us to combine medical, dental and pharmacy information for our customers. Electronic data capabilities Provider and vendor electronic data interchange (EDI) capabilities allow us to receive medical and hospital claims electronically. These same capabilities allow us to facilitate Medicare crossover coordination for Medicare Part A and B claims. Our imaging system electronically captures and delivers paper documents daily. We process claims with minimal manual intervention by using optical character recognition (OCR) and intelligent character recognition (ICR) features. The efficiency and accuracy of claims processing is increased because paper claims are converted to electronic files that are immediately available for auto-adjudication and/or retrieval. Interactive Voice Response (IVR) system An interactive voice response (IVR) telephone system allows members to direct calls to the appropriate service area. By entering a member's ID number, computer technology integration ~- (CTI) promptly provides member specific information. These advances in technology combine to improve customer service and reduce the cost of paper documentation storage and retrieval. Web site ,.,, Our Web site uses trend-setting initiatives and provides accessible information for members, employers, providers, producers, and our partners. The online applications are completely secure and use a combination ofwell-established security methodologies; including secure „~ sockets layer (SSL) encryption, firewall protection, and intrusion detection software. We invite you to visit our Web site at www.fiservhealthservices.com to preview the information available. Kerr County 25 F%52~V Health.. Administrative Fees Medical Effective 01/01-2007 to 12/31/2007 Contract t pe 12112 first ear Emplo ees PEPM Medical administrative fee 249 $13.77 Network access -Texas True Choice 249 $3.75 Stop loss fee' S% of stop loss premium 'Please refer to the Stop Loss Services page for additional information. Contractt a Paid second fl third ear Em to ees PEPM Medical administrative fee' 249 $15.79 Commission $4.00 •Fee guarantee excludes network access fees. Care Manaoement* Emplo ees PEPM Utilization and case 249 $3.00 management (includes HIL and all web tools) Precious Cargo -maternity 249 $0.80 management Disease management 249 $3.75 `If all of the above care management services are purchased a package fee of $7.00 PEPM applies. Dental (Optional) Contract t e 12112 first ear Em Io ees PEPM Dental administrative fee 249 $2.30 Network access - FHMD 249 $0.90 Contract t pe Paid second & third ear Em to ees PEPM Dental administrative fee' $2.62 `Fee guarantee excludes network access fees. Kerr County 26 F%5e V Health. Flexible Spending Accounts (FSAI Contract t p• 12115 Employoos PPPAPM (per p~rticipaat par account por aronth) Health care account' S0 $4.65 Dependent care account' 10 $4.65 'Health care assumes 20 percent participation rate; tlependent care assumes 20 percent of the health care participation rate. Other Contract type 12112 first year, paid aoeond b third year Employua PEPM Heath reimbursement account 50 $4.00 HSA pharmacy integration fee* 50 $1.00 STD administrative fee 249 $1.70 COBRA administrative fee 249 $0.95 HIPAA administrative fee 249 $0.25 'Assumes 20 percent participation rate. Kerr County P7 F%5B/'V Healtf~ Optional Services This section provides and overview of some of the frequently requested optional services available through Fiserv Health. Your sales executive is available to discuss specific needs and services to meet client requirements. Adminietretion Priee Case management and claim services coordination with insured medical carve-out carriers $0.75 PEPM COBRA termination report $120 per year Initial COBRA letters for new employees (DOL Letter) $0.30 PEPM New York surcharge reporting $1,000 annual fee Subrogation 25 - 33% of recoveries (contingent on legal representation) ID card mailing charge -employee residence $0.07 PEPM United Resources Network (U.R.N.) -Centers of Excellence Cost per transplant Customized ID cards $1,000 per card set up Individual medical conversion option, after COBRA $0.50 PEPM Run-in claims processing -for claims outside the requested contract period $15 per bill Cost reduction and savings (CRS) program 30% of savings CLEAR program line of credit $36 annual fee (employee paid through payroll deduction) Health care discount cards' -vision benefits $0.75 PEPM 'Dental, and/or hearing benefits available upon request, additional fees may apply. Health Reimbursement Aeeount price Debit card' $1.50 Pharmacy integration fee' $1.00 'Required if the pharmacy and medical deductibles are integrated. Kerr County 28 _ P%5e/'V Health flexible Spending Aeeount Price Run-in claims $2,000 set up Mailing statements to participants' home addresses $0.05 peremployee per account per month (PEPAPM) x number of statements requested Print plan booklet and mail to client $0.15 PEPAPM BennyT"' Card (Not available with HSA) $1.50 (with medical) $2.00 (stand-alone) ~ PEPAPM Auto-reimbursement not selected $0.50 PPPAPM Short•tsrm Dleebility (STD) Price STD check processing $0.10 PEPM STD clinical management and return-to-work $0.25 PEPM STD clinical management $0.15 PEPM STD clinical consultation $150 per hour (2 hour minimum per claim) Subrogation 25 - 33% of recoveries (contingent on legal representation) Reporting Prics Medstat Advantage Suiteฎ $0.40 PEPM (additional fees will apply for history loads) Medstat Advantage Suiteฎ user licenses Three included; additional licenses at $500 each Ad hoc reports and analysis $100 per hour (2 hours are included in the ', administrative fee) Results IC reporting licenses $1,000 perlicense (two licenses are included in the administration fee) Banking' Price Check deposit split by other than bank account Fees may apply Positive pay arrangement Fees may apply Reconciliation Fees may apply 'Home bankirg is the standard option. Custodial banking services are available, additional fees may apply. Kerr County 29 _ F%SBIV Health: Other services Upon request, Fiserv Health can administer the following optional services in addition to those listed above: _ HIPAA Turnkey toolkit HIPAA Privacy toolkit HIPAA Security toolkit .80 check minimum for FSA Nondiscrimination testing for FSA _ Medicare Part D pharmacy support Kerr County 30 F%5et'V Health Proposal Conditions "~ • Fees proposed assume that the schedule of benefits complies with the minimum differential which maybe required by the network(s). Fiserv Health will assist with that determination if needed. • Fees proposed are subject to change if a division, subsidiary, affiliated company is added or deleted from the plan, or if the number of covered employees changes by 15 percent or more from this proposal. • Fees proposed are subject to change if the terms of the employee benefit plan change. Proposed terms, rates, benefits, and conditions maybe retroactively or otherwise revised or rescinded if the information provided contains matehal errors or omissions, whether intentional or not. • Fees proposed are based on the plan of benefits as submitted and does not assume .- duplication of benefits or provisions. Fiserv Health requires a review of the complete summary plan document to verify if any nonstandard benefits are requested. Additional fees may apply depending on the complexity of the requested benefits. • Fees proposed are net of commission. • This proposal is valid until 30 days before the effective date and does not bind coverage or ,., obligate Fiserv Health. • All quoted product fees assume Fiserv Health administers the Medical plan. • Requirements for Fiserv Health to payrun-in claims: Claims must be 100 peroemt repriced by the current network prior to coming to Fiserv Health for processing. The planholder must coordinate mail distributions between the network(s) and Fiserv Health. • To comply with the Department of Labor's (DOL) claims regulations, we encourage pre-notification of at least 60 calendar days prior to the effective date of this contract. In the event that a 60-day notice is not feasible, Fiserv Health does not guarantee, but will make "' every reasonable effort to have new plan(s) programmed quickly so claims can be processed within the required DOL timelines. _ • Fiserv Health will assume all services provided will be handled according to our standard format and procedures, unless specifically addressed within this proposal. Specialized services will be priced as necessary. - • When run-in claims or claims from an outside vendor are applied to the stop loss contract, Fiserv Health will contact the prior administrator or outside vendor for reportable claim information. We will not be responsible for pended stop loss claims due to a lack of r information from the previous administrator or outside vendor. Additional fees may apply based on the complexity of the interface. Kerr County 31 F%5Bt'V Health.. • When services are required, fees for independent medical reviews are the responsibility of the plan sponsor. ~ฐ • Special audits may require additional fees. • Claims reprocessing due to situations such as retroactive benefit or eligibility changes may require additional fees. • if COBRA Administration is purchased an additional $0.05 fee is applied for each line of coverage, plan, and/or outside vendor. Outside vendors are subject to our approval process. Fee calculations are based on the product line with the most employees. • Fiserv Health does not administer statutory disability benefits. • FSA fees assume a minimum of 50 employees participating on the FSA plan. • FSA fees assume automatic reimbursement from all plans administered by Fiserv Health and approved pharmacy benefit managers. • High deductible health plan design must conform to applicable legal and regulatory ,_ requirements. • HSA services are offered exclusively to members selecting a high deductible health plan administered by Fiserv Health. • Deductible integration of prescription drug and medical claims requires daily connectivity between the pharmacy benefits manager (PBM) and the plan administrator. External _ vendors are subject to prior approval and may require additional fees. • Fees proposed assume the use of our preferred custodian for the HSA. • Fiserv Health will issue an Administrative Services Agreement (ASA) when selected by the customer to administer services proposed above. The ASA serves as the contractual document to describe the roles, rights, responsibilities, and obligations of both parties. We will incorporate agreed upon terms from this proposal into the ASA. • Do not cancel in-force plan(s) and/or policy(ies) until final approval is received. • Fiserv Health and the stop loss camers are not bound by any typographical errors and/or omissions contained herein. Refer to actual proposal rates, contingencies, and other conditions. Kerr County 32 _ F%5B V Health. Pharmacy Benefits Pricing The following fees are associated with the Fiserv Health Prescription Benefits Administration program. Fees apply to all retail network pharmacies with the exception of pharmacies located in states that may elect to participate on a state fee schedule. claim adjudication fee $0.37 per claim for electronic claims ($1.75 additional for paper claims) '~ retail brand c I a i m s' : AWP minus 15% or usual & customary (U&C), whichever is less r Dispensing fee: $2.25 ฐ generic claims: MAC Non-MAC: AWP minus 15% or U&C, whichever is less "- Dispensing fee: $2.25 optional -Retail 90 Rx brand c I a i m s' : AWP minus 17% or usual & customary (U&C), whichever is less .. Dispensing fee: $3.50 generic claims: MAC Non-MAC: AWP minus 17% or U&C, whichever is less r Dispensing fee: $3.50 'Includes single source generics and the first six months of a nevAy released generic. ... Compound dispensing fee is the lesser of $7.50 or U&C. Kerr County 33 F%52~V Health mail order brand claims Rate: AWP minus 20% Dispensing fee: $0.50 generic claims Rate: AINP minus 50% Dispensing fee: $0.50 rebate share 55% of the rebate to be returned to the customer prior authorizations $20 per prior authorization specialty pharmacy program Rate: AINP minus 12% - 50%, with an average anticipated discount of 17% Dispensing fee: $2.50 Medicare Part D Sunnort Services Certifleetes of credite6l• coverey• Price Data analysis for simplified determination of creditable No charge coverage status (existing clients with data -not valid for subsidy filing) Data experience extracts to quantify subsidy potential No charge Certificates of creditable/noncreditable coverage $1 per certificate, (production and mailing) subject to a $100 minimum Kerr County 34 ~' F%5B/'VHealtl~ Care Management Services '- I f y o u purchase utilization and case management, Precious Cargo -maternity management, and disease management you will receive all three programs for a discounted fee of $7.00 PEPM. Utilization and case management The following services are included in the $3.00 PEPM utilization and case management fee: _ Inpatient hospital certification • Home health care certification (concurrent review, discharge planning, retrospective review) Catastrophic case management • Durable medical equipment 24-hour nurse line • Skilled nursing facilities Personal health Web page • Inpatient behavioral health certification Interactive online health risk assessment This pricing does not include any outpatient services. Additional fees for services not listed above vary depending on the type and number of services requested. Precious Cargo -maternity management Our Precious Cargo -maternity management service is offered at $0.80 PEPM. It is a program that provides prenatal education and health assessment programs designed to help mothers carry their babies to full-term and provide "first-year-of-life" education. The member is connected by phone to a registered nurse who answers questions and provides individualized case management and education. Kerr County 35 ~' F%SL~IV Health Disease management Our disease management program is offered at $3.75 PEPM. Disease management focuses on the management of chronic conditions. Seven conditions have been chosen based on frequency of occurrence, treatment variations, and high direct and indirect costs. The selected conditions include: ~.. Diabetes Depression Asthma Hypertension Coronary artery disease Chronic obstructive pulmonary disease _ Congestive heart failure Our disease management program includes the issuance of personal care notes (PCNs) to identified members. PCNs are generated based on a member's medical and prescription drug claims data and address a wide range of medical issues, including but not limited to the seven disease management conditions. Health and wellness Web-based assessment $6.25 each Paper assessment $12 each The health and wellness program is offered as a package service (components cannot be purchased individually). r The program focuses on individuals with risk factors leading to chronic conditions such as diabetes, cardiovascular disease, depression, and cancer It targets members who have risk factors but are not yet affected by a serious disease. To determine the degree of risk, members are assessed annually through a health risk assessment. Using internally developed algorithms, we identify the risk levels for possible health conditions. Stratification of the information allows us to identify and focus on the health of your at-risk members. The health and wellness program `r offers the following services: high-risk employees One-on-one telephonic counseling Ten sessionswithaspeciallytrained coach - $350 per participant per year high-risk and low-risk employees Standard wellness newsletters $1.65 per participant per quarter Kerr County 36 ~- F%5B V Health Employers receive reports regarding individual compliance of program requirements for administration of an incentive program. We also provide reports documenting the program's impact on measurable risk factors and claim trend results for preventable and modifiable claims. Participant satisfaction results are shared with the employer Kerr County 37 "' F%SB~V Health. Medical and Dental Administration Services ฐ The following services are included in the medical and dental administration fees: claim services Enter benefits into claim system Provide toll-/ree telephone number access Determine plan benefits Accept claims directly from the service provider and/or electronic data interchange Print and distribute standard explanation of benefits (EOl3) forms Update coordination of benefits (COB) coverage and student information Send claim denial notices to providers and claimants Send claim delay notices to employee Administer standard birthday rule COB Administer reasonable and customary fee schedule Provide reasonable and customary processing reports upon request (maximum of two per year) Provide normal correspondence required for processing claims Respond to ERISA review requests Maintain standard claim turnaround times Maintain financial accuracy rates consistent with or exceeding industry performance Maintain an acceptable level of processing accuracy Kerr County 38 f%52~V Health.. • Investigate fraud Identify potential subrogation opportunities Issue checks from customer's bank account • Negotiate claims reprocessing fees upon request document services Prepare and provide plan document(s) • Prepare and provide booklet draft(s) • Prepare and provide standard administrative services agreement (ASA) • Determine plan and benefit coding -' billing • Bill administrative and optional service fees Respond to questions related to billing statements, self billing, or text bill options _ Initiate monthly payment of fees and/or premium from the customers bank account • Invoice fees for additional services not included in the ASA ~- Bill stop loss, life, STD, and LTD premiums (if applicable) banking • Assist wfth home banking arrangements (custodial banking is available for an additional fee) • Setup bank account • Reconcile and assist in collection of fees Kerr County 39 "' F%52~V Health. - enrollment Accept electronic and paper enrollment (standard format) • Accept Internet enrollment - Provide and mail standard ID cards to the customer (additional fees may apply it extra materials are included or ID cards ara mailed to employee homes) • Process enrollment updates and changes • Provide advice on eligibility questions - Assist in administration of eligibility for employees • Provide advice on Fiserv Health Prescription Benefits Administration eligibility - Provide eligibility data transfers to outside vendors (other than as offered in this proposal) for an additional fee - legal and legislative services • Provide benefit plan solutions - Provide general guidance on benefit plan matters ._ Provide legislative updates on benefit plan issues • Provide administrative procedures compliant with federal law and regulation actuarial and underwriting - Provide recommendations for plan modifications • Provide plan cost projections • Provide standard reports • Provide information for 5500 forms, issue form 1099 - • Massachusetts surcharge reporting (medical claims) Kerr County 40 F%5Bt'V Health. account management • Provide a designated account manager • Ensure high quality services • Communicate administration procedures • Facilitate up to three enrollment site visits ฐW Manage stewardship program _ Internet services • Claim, eligibility, and benefit inquiries • ID card ordering • Health information and provider links • Forms • Prescription drug ordering/refilling (through Fiserv Health Prescription Benefits -- Administration) • Enrollment (if applicable) • Provider network links Employer administration manual • Results - IC (employer reporting fool) Kerr County 41 '~ F%Se~V Health Flexible Spending Account Administration - Services The flexible spending account (FSA) services indicatedbeioware "' included in the administration fees for health care, dependant care, and transportation reimbursement accounts (TRA) as appropriate. FSA administration • Process claim payments • Provide duplicate claim screening d • Pend claims based on the availability of funds • Deny claims exceeding benefit elections • Provide reports • Control check and payment processes • Maintain transaction claim, deposit, and payment histories • Import and export data as required (additional fees may apply) claim payment options • Electronic fund transfer (EFT) allows direct deposit transactions to be formatted for _ processing by the automatic clearing house (ACH) system. (EFT election can be received on the enrollment file ormanually.) • Printed explanation of benefits (EOIi) and check mailed to members Kerr County 42 F%SB~V Health. claim claim enrol submission options Automatic reimbursement for approved medical, dental, and pharmacy claims Manually submitted paper or faxed claims (required with dependent care and transportation accounts) system options $25 and $50 check-request minimums for all employees (standard) ment Electronic enrollment with Fiserv Health standarcl format One file for all employees One plan year for all employees One maximum amount for each type of account billing `~ Bill administrative and optional service fees ฐ customer support • Interactive voice response (IVR) inquiry system: y Available 24 hours a day, seven days a week FSA/TRA account balance inquiry FSA/TRA claims history inquiry FSA/TRA check history inquiry Kerr County 43 ~' F%5e V Health. ฐ~ Internet inquiry site: Available 24 hours a day, seven days a week ~.. FSA/TRA account balances inquiry FSA/TRA claims history inquiry FSA/TRA check history inquiry "" Health care FSA calculator Dependent care FSA calculator FSA eligible expenses • Toll-free customer support available Monday through Friday, 7 a.m. to 5 p.m., Central time standard report • Quartedy employer forfeiture report electronic copy of the FSA/TRA plan document Kerr County 44 ฎ f%5 /B V Health. Health Reimbursement Accounts Health reimbursement accounts (H RAs) combine major medical preferred provider organization (PPO) coverage and Internet-based tools to assist plan members/employees in becoming smart consumers of medical care. The plans are funded - annually by the employer. They allow unused balances to roll from year-to-year; that is, rollover HRA funds combine with new funds and are available to pay any HRA-eligible expense incurred after the date the employee is eligible for the plan. Keep in mind, this includes a family benefit and is not accumulated for individuals within a family. Additional HRA plan considerations: • HRAs cover the same services covered by the medical plan and do not expand to cover all Section 213(d) coverage. However, additional specific services can be covered upon request. • Coinsurance amounts are paid if HRA funds are available • Point-of-service co-pays, including pharmacy and office visits, are not reimbursed - HRA employer contributions for mid-year enrollees are prorated to the 1st of the month prior to enrollment plan integration HRA c I a i m administration integrates with the claim administration of the medical plan to pay provider claims with no separate forms. The system adjudicates any claim that exceeds the HRA balance, with the remainder of the claim automatically sent for flexible spending account (FSA) reimbursement (if we administer FSA and the employee has elected automatic reimbursement). HRA and medical plan claims are paid on a single check. A single explanation of benefits (EOB) and a single provider remittance advice are issued. The HRA claim administration system allows for a wide variety of benefit plans; an HRA deductible which can be automatically reimbursed by a Fiserv Health FSA, a family plan deductible, or individual deductibles accumulating to a family maximum, or a PPO benefit structure for deductibles and coinsurance. Kerr County 45 '~ F%52~V Health ' Internet inquiry site available 24 hours a day, seven days a week and provides access to account balances, health information including Healthcare Advisor, health care cost estimators and summaries, and a benefit decision Web tool which is available if we have "- account structure, benefits, and employee contributions 30 days before open enrollment begins. "' reports aggregate amounts used and available are reported to the employer. carve -outs pharmacy claims and other benefits we do not administer are carved out in stand-alone programs. They do not accrue to the HRA or medical deductible. Wellness benefits are typically carved out but can be included in the HRA. ' HRA plan document provided with medical plan document provides assistance in developing, preparing, and printing the HRA plan. 'ฐ' HRA options three-tier orfour--tier dependent structure with different HRA amounts by tier, cap on rollover total accumulation of funds for each employee (each year), COBRA medical premiums and retiree medical premiums reimbursed from the HRA. Kerr County 46 F%521V Health. i Health Savings Accounts Health savings accounts (H S A s) are portable, interest bearing accounts that allow funds to accumulate and grow from year-to-year. HSAs offer payroll tax relief to employers and a pretax health care funding option for employees. To coordinate the benefits of an HSA, we - have combined forces with select financial institutions to assist employers and employees. Our service offering includes: Account management We will provide you with an assigned account manager. Our account managers will provide educational assistance for your human resources staff and be available to answer member questions during the enrollment period. They will also be available as a source of ongoing support when benefit questions arise. C I a i m and customer service Our claim services unit will administer your high "- deductible health plan (HDHP) and provide customer service to your members. Reporting functions within our claim system monitor and record member deductible and out-of-pocket accumulators. To support members, and insure the right organization is providing the light answer, soft-transfer telephone connections have been established between financial institutions and us. Member calls are transferred to the appropriate organization, as needed. ฐ~ C o m p I i a n c e services Our compliance services unit will continue to monitor and evaluate IRS regulations and requirements affecting HSA plans. We will incorporate these requirements into the services we provide, including a model high deductible health plan i document that supports HSA offerings. 0 n I i n e services Our Internet-based tools are available to educate and assist your plan members/employees. Our tools promote smart consumerism and help members evaluate and decide on the medical plan that best meets their needs. The financial institutions act as custodians/trustees for plan member HSA accounts. These facilities set up and maintain individual employee, interest-bearing, HSA accounts. They receive payroll deduction funds from employers, provide the employee with monthly statements, and disburse member-initiated check or debit payments from the account. HSA questions are addressed by the financial institutions and medical benefit questions are -- addressed by our customer service staff. Kerr County 47 F%SeIV Health.. Disability Administration Services The following services are included in the disability administration fees: -- claim services • Enter benefits into claim system • Provide toll-free telephone number access • Determine plan benefits • Accept claims directly from the employee and/or physician • Print and distribute standard explanation of benefit (EOB) forms • Update coordination of benefits (COB) coverage • Send claim denial notices to claimants due to lack of required medical information or unbundled charges s Send claim delay notices to employee • Provide normal correspondence required for processing claims • Respond to ERISA review requests '- Maintain financial accuracy rates consistent with or exceeding industry performance • Maintain standard claim turnaround times • Investigate fraud Provided R.N. consultation • Identify potential subrogation opportunities (additional service) Issue checks (additional service) Kerr County 48 f%5 f2 V Health. document services ,_ Prepare and provide plan document(s) Prepare and provide booklet draft(s) Prepare and provide standard administrative services agreement (ASA) Determine plan and benefit coding billing • Bill administrative and optional service fees Respond to questions related to billing statements, self billing, or text bill options • Initiate monthly payment of fees and/or premium from the customer's bank account • Invoice fees for additional services not included in the ASA '"' banking • Assist with home banking arrangements (custodial banking is available for an additional ,_ fee) Set up bank account Reconcile and assist in collection of fees enrollment • Accept electronic and paper enrollment (standard format) Accept Internet enrollment • Process enrollment updates and changes Provide advice on eligibility questions ฐ' Assist in administration of eligibility for employees Kerr County 4g - FI5 /e V Health. - legal and legislative services • Provide benefit plan solutions Provide general guidance on benefit plan matters -' Provide legislative updates on benefit plan issues • Provide administrative procedures compliant with federal law and regulation actuarial and underwriting '~' Provide recommendations for plan modifications Provide plan cost projections • Provide standard reports - Provide information for 5500 forms - account management • Provide a designated account manager Ensure high quality services • Communicate administration procedures • Facilitate up to three enrollment site visits - Manage stewardship program Internet services • Claim and eligibility inquiries - Forms • Enrollment (if applicable) - Employer administration manual Kerr County 50 F%55~V Health.. COBRA Administration Services - The following services are included in the COBRA administrative fee: • Send COBRA notification letters and election forms to qualified beneficiaries and/or .- dependents by certified mail whenever a qualifying event occurs -the information provided addresses COBRA rights and obligations and also includes a monthly payment schedule • Send confirmation letters and payment coupons to qualified beneficiaries electing COBRA continuation • Collect and process monthly payments from qualified beneficiaries • Send rate change letters to participants when required Provide service for second qualifying events when they occur _ Review disability status and approve or deny COBRA extensions • Inform qualified beneficiaries of health conversion rights at the proper time during the COBRA continuation period, if applicable • Send termination notices prior to the end of the COBRA period • Send unavailability letters to individuals who have requested COBRA continuation if COBRA is unavailable to them • Answerquestions from qualited beneficiaries Prepare and provide monthly reports documenting COBRA notification letters sent, enrollee payments received, and a current list of active enrollees Kerr County 51 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 Nealtl~. 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 ฐ' enhancements such as: • Enhanced transplant benefits with astep-down deductible provision '- • Monthly accumulated cap benefits • An aggregating specific benefit • A common accident benefit ฐ- 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. Kerr County 1111200] to 11113008 BP Inc Assumes UR/CM antl precertbcadon,DZM, Birth Line, antl epprovetl Transplant network-without these programs increase specific rates6% f a stop loss proposal s acceptetl other 0anthow provided through Fiserv Health as shown above, an external stop loss inlertace fae of $2 00 PEPM wll apply. Ne iher Fiserv Health nor the Stop Loss Carvers will be bound by any typographicalenors andlor omissions containetl here n. Please refer to actual proposal for rates; enrollment counts', contingences antl other conditions f%5~V Health: BP Inc. 6160 Snmmit Dnvz, Suitz 345 Brooklyn Crxnzr, MN 55430 ~l,3-569-3210 Fax 7635ti9-3238 Proposed Schedule -Excess Loss Coverage Combined Insurance Company of America Group Name: Kerr County Proposal Prepared On: 10/1912006 Effective Date of Proposal Underwriter: MarkTe6ben Expiration Date of Proposal: o Administrator of the Plan: Fiserv Health Revision Date A. SPECIFIC (INDIVIDUAL) EXCESS LOSS COVERAGE: Specific Deductible per covered participant for the policy year: 50 000 60 000 75 000 _ Company's Limit of Liability (Reimbursement Factor) 100% of payments in excess of the Specific Amount to Specific Lifetime Amount per covered person: 950 000 940 000 925 000 Monthly Premium Rates: # Units 15112 15112 15112 Single 180 58.09 50.87 39.62 Family 69 116.33 102.89 81.12 Annual 22$ 1796 195072 152747 Total 249 Specific Run-In Limits: so 00o sa o.000 7s o00 Covered Benefts under Specific: MedicallRX Advance Funding Benefit is included at no cost. B. AGGREGATE EXCESS LOSS COVERAGE: Monthly Aggregate Factors: # Units Single 180 Family 69 Annual Total 249 Aggregate Run-In Limits: Covered Benefits under Aggregate: Aggregate Premium: Optional Aggregate Accommodation: Optional Aggregate Terminal Liability: Minimum Annual Aggregate Attachment Point: Company's Limit of Liability (Reimbursement L to a maximum of $1,000,000.00. 1/1/2007 1/1/2007 15112 15112 15112 396.33 404.26 416.15 771.65 787.09 810.24 1 495 003 1 524 903 1 569 753 zzaooo zza s,ooo z3sooa X Medical Dental X Rx Card $4.55 /EEIMon i3sss.a X No Yes, Prem: /EE/Mon X No Yes, Prem: /EEIMon Greater of quoted attachment point x 95% or 1st month's enrollment x 12 x 95% nil) 100% of payments in excess of the Annual Aggregate Attachment Point C. COMMISSIONS: 5% Specific Specifc TLO D. PROPOSAL QUALIFICATIONS shown on page 2. 5% Aggregate Aggregate Accommodation Aggregate TLO .- E. PLEASE CIRCLE SELECTED TENTATIVE OPTION. Page 1 of 2 BP Inc. Proposal Qualifications Group Name: Kerr County This tentative proposal will not be considered firm until all 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 for an effective date o 11112007 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 wl e a ministered by a facility which has been approved by BP Inc. x Additional Data Requirements: MONTHLY CLAIMS/LIVES THROUGH 11115106. APS/LCM reports, etc. on members 45205351, 45220351, 45235651. Separate deductibles may apply. ~- LARGE CLAIM LISTING FOR 111105-1/1/06. 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 participation Is required unless specifically approved by underwriting. x Requires utilization review, large case management, precertification and transplant network -Case ManagemenUTP network are - available through BP Inc. Contact BP Inc. for additional information. Without these products increase saecific rates 6% 1x1.061. x Stop-lass coverage Is far 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 non-confinement provision for 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. ,~ X We will require updated diagnosis and prognosis including anticipated treatment and estimated costs for any claim exceeding 50% of the specific level as of 45 days prior to the Effective date as well as details on any Individual on a transplant waiting Ilst. x Run=m 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 more 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 passible 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 oft Kerr County Specific and Aggegate Stop Loss Insurance Third Parry Claims Administration Group Term Life and AD&D I IRA 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 ฐ 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 ฐ 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 ฐ give the 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 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 ฐ pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of the Kerr County in connection with information regazding 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 harmless the Kerr County, all of its officers, agents and employees from and against all claims, actions, suiu, 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 ฐ items submitted meet specifications. COMPANY: Fiserv Health ฐ AGENT NAME: Rick M Sch 1 ~ional /ice Pre 'dent of Sales AGENT SIGNATURE: ADDRESS: 194 S. Main CITY: Bceme STATE: Texas ZIP CODE: 78006 ฐ 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 Aggregate Stop Loss Insurance Third Party Claims Administration - Group Term Life and AD&D HRA Adminishation 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 antitrust 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 may be 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) years, or both. Rick M. Scheel, Regional Vice President of Sales Name d itle of thorized Representative (Typed) i ^ Si' tur fA thorizedRepresentative 10/12/2006 Date I am unable to certify to the above statements. My explanation is attached. Page 2b ฐ-- Conflict of Interest Questionnaire For Vendor or Other Person Doina Business with a Local Government Entity This questionnaire is being filed 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 filed. 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 fling an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate fling authority not later than September 1 of the year for which the activity described in Section 176.006(a) Local Government Code, is pending and not later than the 7'" business day after the originally filed 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 filer 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, B, C & D must be wmpleted for each officer with whom the filer '- has affiliation or business relationship. Attach additional pages as necessary. A. Is the local government offcer named in this section receiving or likely to receive taxable income from the filer 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 filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer 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. 7. 10/12/2006 Date Not applicable. F%5B V Health. 6' Kerr County Specific and Aggregate Stop Loss Insurance Third Party Claims Administration Group Term Life and AD&D HRA Administration This portron 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. KERR 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 tB VHealtl~. i Kerr County Specific and Aggregate Stop Loss Insurance This portron 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: c. 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 Hell Herbort 830 990-2017 151 Ci of Gartand Robb Neill 972 205-2481 1618 Sid Peterson Memorial Hospital Sandra Patterson (830) 258-7441 463 F%5B V Health. PLEASE ANSWER QUESTIONS 4 THROUGH 7, IF STOP LOSS INSURANCE IS BEING SUBMITTED BY MANAGING UNDERWRITING GROUP OR OTHER BUSINESS ENTITY 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? F%5e VHealtl~. Yes No If yes, please describe: F%5B VHealtl~.~` 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? r 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)? _ 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 VHealth. 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 11. Does your Stop Loss insurance contract have any exclusions or limitations that are more r 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 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%5e V Healti~. 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%5B V Healti~.. r 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 portron 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 r Particip ants Specific Premium: Single Family Composite Aggregate Premium Composite Aggregate Attachment Pts. Single Family F%5 tB V Health Kerr County Third Party Administration Questionnaire ฎ TPA Organization 1. Name, Address, City, State, Zip Code and Telephone Number of Firm. Fiserv Health 5550 Wayzata Boulevard, Suite 500 ,,. Minneapolis, MN 55416-1241 Telephone: (763) 549-3359 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 portfolio services for the financial and health care industries. 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? r 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. Wrth 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 offices 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%5e VHealth.~= i 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 ฎ 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 ฐ- 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 55416-1241 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 (409'0) 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. e 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 6e happy to certify that the coverage meets your company's r 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 peroent (99%) accurate to the plan of benefits. Turnaround Time 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.; Random Review - On average, 3.5 percent of all claims are routinely reviewed for accuracy. Random review includes the two processes listed below. - System-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 - Provider ID, TIN #, Nama, Address, Phone (TIN only) • DiagnosisrProcedure Code (Procedure Code) • DollarAmount - • Typ@ Of $eNICe - 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 staff 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%5e V Health. 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 identtfed, 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. Intemal security We also maintain Intemal security through a specially designed system of checks and balances built into our organizational structure. This structure separates claim administration r 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%5 tB 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 internally-developed software works in conjunction with the McKesson logic to identify inappropriate or potentially excessive charges not currently flagged 6y current vendor - systems. An example of this is software to flag potentially excessive physical medicine charges over time. We can also use DRG and HCPS codes ff requested by the employer. - There is no additional charge for using the software. 8. What coordination of benefits (COB) procedures do you follow? Coordination of benefits (COt3) provisions are pursued aggressively at all dollar levels and 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? - We will provide service at your preferred screening level. We can provide reasonable and customary screening levels from 70 peroent 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? - 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- certification 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 monftored when payments reach 50 percent of the specific level, trigger diagnosis codes when medical management is provided by Fiserv Health and with long hospdal 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 peroent of specific deductible ฐ • Case management • Precertfication activity Claimants are tracked on a daily basis. Reporting parameters are based on the timeframe 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, ฎ subrogation opportunities are investigated and evaluated. Our claim system contains edits that automatically flag claims when the potential for third-party liability is identified. When an _ edit is Mggered, 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. Our processors conduct/coordinate the appropriate claim investigation. Our procedures and standards require regular communication with the employee by the claim _ examiner. These communications may include telephone contactslnterviews 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. r F%5e VHealti~. F 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 percent to 33 percent of recoveries, contingent upon the need for legal representation. Our standard plan language includes Right of Subrogation, Reimbursement, Thircl-Party Liability and Assignment of Rights Provision wording. The provision requires restitution if there are any recoveries made. Benefits era 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. 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%5B VHealtl~.: 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 1.0% for all calls received in our claims department. 19. What submission rate has been assumed when calculating your fee? Our fee 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%5B VHealtl~. 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 intertace fee equivalent to 590 of the stop loss premiums is displayed as a separate line item in the financial 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. System 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 Health.: 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 be 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 Gaim inventory reports to ensure this happens. We also have an inventory management specialist that specifically monitors our inventories at all levels, to ensure all claims are r 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%5B V Health..-~ 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 ^ the history and maintain it on computer tape. A copy of the computer tape is kept at the claim offtce. 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 ^ . 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 claim payment system is designed to provide consistent administration for a wide variety ~. 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. m F%5 /B V Health 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: • EnvoyNYebMd • 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 Banking (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. - F%5e V Health..= Check Holds - 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. Customerspec~c check hold arrangements, are available at an additional charge. Custodial Bankinc ~' Wrth custodial banking, we set up a Fiserv Health owned bank account for you at Marshall & llsley (M&1) Bank. All payments are made through this account. - This arrangement is optional and addtional 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 - account as long as it is active and there are still items on the outstanding list. This deposit serves three purposes: - • 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 - 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 - Stop payment requests • Check copy requests • Outstanding list maintenance • Monthly reconciliation and management • State reporting of uncashed checks We accept the following forms of weekly account replenishment: • ACH Debit (initiated 6y Fiserv Health) • ACH Credit (initiated by the customer within three business days of notification) - • Wire Transfer (initiated by the customer within three business days of not cation) F%5B V Health. ~ฐ 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 pertorm 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. r 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, r croncurrent 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? r 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? Pre Notification -Yes, an additional fee may apply. F%5 !B VHealth. 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? ฐ' Fiserv Health has the ability to intertace 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 F%5 IfB V Health ~' networks depending on their capahilities. 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 with. 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%5B VHealth: 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. K, r ~. 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 Netwod< 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 Care Network Signature Care Netwod< F%5B V Health. Sloans Lake Preferred Network Texas True Choice Network Virginia Health Network Dental Benefits Providers Network DenteMax Fiserv Health Reporting ~- 1. Provide a list of reports available in your standard reporting package. What is the cost of these reports? 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 '- charge? Yes. We understand your company is like no other. You may have a need for customer- - specfic 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. ^~ 3. How are paid claims reported? Both paid and incurred values are used in various reports. The value used in any specific 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 identfied with a potential trigger diagnosis and they in tum notify the stop loss carriers. F%SB~V Health.. 5. Can you report on PPO savings? _ Our online reporting tool, Results-IC, provides network analysis and discount reports that show peroent 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 Kerr 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 Description is included in our (ees. 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 10 cams 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 set up. 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 VHea/th. 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 Timelv 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 be sent to the _ qualified beneficiary with a description of his/her rights within 14 calendar days. The qualifying event letter is sent via certified 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 perod is automatically calculated within Fiserv Health's COBRA administration system. The COBRA election notice will indicate the appropriate election period during which the qualified 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. r F%5e V Healtl~._-' Provide the Continues with Coupons for Monthly Pavments 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 Pavments and Submit Pavments to Client Monthlv Payments will be collected and posted to the continuses' payment history. On a monthly basis, a Voucher Report showing premiums received from the participants will 6e 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 6e sent to the COBRA continuae 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 continuae 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 continuses and qualified beneficiaries pending enrollment prior to the effective date of the rate change. F%5e V Health Maintain Eligibility on Continuees .r 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. if 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 qualified 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 ._ obligation and assure compliance with COBRA. Provide Legislative 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 Certificates of Credible Coverage. - f%5e VHealtl~.- .Y 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 ฐ 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 ฐ 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 VHealth. 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. Fiserv Health Managed Care Accessibility Analysis October 9, 2006 A report on the accessibility of the Texas True Choice for the employees of Kerr County „_ Texas True Choice -Kerr County ~ Accessibility summary _ ~, ~ ~ +.. t; Yy ~.. i 3.S Ik ;.; ~' F s'k lp,'e. ht X06` ~ ,~ KERRVILLE, TX 166 166 100 2.5 INGRAM, TX 22 22 100 8.2 COMFORT, TX 11 11 100 17.8 o MOUNTAIN HOME, TX 7 7 100 24.8 BANDERA, TX 6 6 100 24.8 HARPER, TX 6 6 100 22.7 BOERNE, TX 3 3 100 22.0 FREDERICKSBURG, TX 2 2 100 2.1 JUNCTION, TX 2 2 100 2.7 MEDINA, TX 2 2 100 23.0 ~ g ,~ Texas True Choice -Kerr County Z Accessibility summary _ Texas True Choice -Kerr County ZIP Code radius information 3 wph~c ~ Pe~# ~~' ;. ~ ,~ ~ ; 78003 6 0 0 0 0 0 7eoas 3 o a 4 a~ ; a 78010 14 0 0 0 2 2 78013 71 0 0.' 0 - 2 : 2„ 78624 2 1 1 1 1 1 731 8 0 0 '` 0 . i 0> 2y`rc 78024 4 0 0 0 0 0 78025 22 4 4' 2 2 ~<ฐ:~ 76849 2 1 1 1 1 1 78028. 144 2 2 2 2 ,r 78029 22 0 2 2 2 2 78055 2' 0 0 4 t7 A 78058 7 0 0 0 0 0 77507 1 1 ~ . 4 :. 1~ ~, i? 78063 1 0 0 0 0 0 7&248 f 0 ~,% 8 :. 18 2Cf' 78074 1 0 0 0 0~ 0 Employee group: All Employees Provider group: Hospitals Texas True Choice -Kerr County q State detail information q5'. ~ q N' S ~ .. k' ~ ry 1 3 4 ' ~~{ ~ arC i3:. { T~ n r4'n f.. *+~~ f:' anti ~ chA l.t N':"'~iL`Y?19 W.n{ .y!xny^ a S~~ 3 Y 55 <~ 'k ~ ~ 1 k~` ~ ~4 ` i ' E ~~~ ~ f~ ~j; ,J .n d ~ ,J~ ~ }~ ~ ~dT'u~~' j ~ , ~~ ~ ':~ ~ Y ~.' i ~ . bad .~ Tpi~ 'Fa~6, : ~.~: ~ e~ ~ " t ~ f{ ~ ~^' '~ ' ~ y ~y y~ Y~" y ~ . . x ~ . . 'e C f . r~ F ~~ TEXAS 249 390 92 8 7 7 6 5 Access standard: 1 hospital within 25 miles Provider group: Hospitals „^ Texas True Choice -Kerr County 5 ZIP Codes not meeting the access standard ~~ ~. ' _" ~y~k.1 1 t }ft; 7'4 ~E4r.W d~3 kฃ( %' , ~ p a 1N5^. ~ Ah~~i,41b. A l',f , c, a LN .$~"t24 t~! ~ :. ' . f V fy"!Y~ ~ > . •. v .. 1 y u II j, bp' $ ~ ~ . CENTER POINT, TX 78010 14 0 14 100 25.8 HGNT,TX. 78024: 4 '. ,0 q' ; 400 2S~ '~`-ฐ PIPE CREEK, TX 78063 1 0 1 100 27.6 .TOTALS ... t8 p. '!8 100 ~.::. ." ..... s L~ LaIIV IIVJFIIIGI WILT IIII GJ II IIICJ Provider group: Hospitals Texas True Choice -Kerr County Accessibility summary 6 .~ ; ~ ฐ SE~F~ ; . Primary Care Physicians t Y T,Ay ~; 3 ฐ- ฐ ,~ 16,277 providers at 5,488 locations (based on 16,277 records) 'a r..' ~:~ฃ~'` ~. All Employees ~ 249 employees ~, Q z; ~ , ,+ ~ t ~ ~, 2 providers within 15 miles .., ,:~w,,, F ~: >;t ~ j fi a. < 232 (93.2%) 5'ntV ~ r y~ S } % "~~. . a ; ~ " rM r wb SY~ 4y`'a S1 ~ ~i4 3 f y ~ ' t T ,wxa .d d . i .. ' e ~ .mV iH.$ o ~. "~* ,q h .\ Yt _e bฐd Y r' ~, (, ' nt C ~. { t, l X . 'i.'. ,. ,rG 1 Y.g ~~. ~ .4 ) 4 , j". '" t ~~ ~~. o P d~~ Elk j V' ~,~~ d ~~ Ak"Q`~I k g JR' f'v ฐ ~ e ~ ! I f34 ~ T ~ t f % r ` h KERRVILLE,TX 166 166 t00 1.6 INGRAM, TX 22 22 100 7.3 CENTER POINT, TX 14 14 100 12.6 COMFORT, TX 11 11 100 0.7 BANDERA, TX 6 6 100 1.1 BOERNE, TX 3 3 100 1.0 FREDERICKSBURG, TX 2 2 100 2.4 JUNCTION, TX 2 2 100 2.6 MEDINA, TX 2 2 100 9.1 PASADENA, TX 1 1 100 0.7 g Texas True Choice -Kerr County 7 Accessibility summary ._. Texas True Choice -Kerr County $ ZIP Code radius information z.: ":. sp e .~ w~ f ,~5.. 2.. S! 4 " •, 1 4 t~~1~'~~~::, i ,~y tom" t ,~:. _. e~ ~ f M? `~ f a .A .Tc'.: }~ N .:,~ ~ ~ r ~ ~ ,: ~ '^ r ~.. } t f R ~ i'.-.. w }` ~ft ~ f~ Y ~ 2 { ~ .. , ri {d .rt k 2 t • . ~ ~ ~`~i ~ d 'CC ~ q ~ : 3 X+ I , , ~/yp~r u "MAi ~ ~ 3 'A `5 A - .-4 ~~ d 1 x ~(~{~ `!nom f i~(~y~p, Y"T.^.~w' .~~ ~ ต v /~. M,TRj~b v ~5 ~V~ *6 ~_ i „~. ^ i BANDERA, TX 78003 6 2 2 2 2 4 St'~RNE, TX 7$40fi' 3 17 .17 t7. ,` .- r79. >2d", CENTER POINT, TX 78010 14 0 0 0 50 54 ,_ GOMEOI;T, TX 7$473 71' 6 5 . S t :' = 4.4'" ;B~iF' FREDERICKSBURG, TX 78624 2 30 29 29 29 30 I~R-"r ~X. 78634. l .. & 4' ,4 ; 4 : 9 ' ' HUNT, TX 78024 4 0 0 0 0 10 '_ ~ TX < > - 78425 22' fl! 4 ,: 45 46: 46' , JUNCTION, TX 76849 2 6 6 6 7 1 7 KฃRRVItLE, 77( ~: 78428. ]44 ~46: ;46,:.x. ~: -- 78029 22 0 46 46 46 51 MfDNA, TK 78455 2 0 4`,: ` 4 2 ~ .;~, MOUNTAIN HOME, TX 78058 7 0 0 0 0 0 P,SS~AENIk. TX' 77542 ;>' 4 t2 721 s - 28~ , f;498 ~ 1;949 PIPE CREEK, TX 78063 1 2 2 1 2 4 14 ,1#P}TQ14IQ,'F'3~" '7$248. 1' 2 -217` ~: 73$' 1,335 '1,559 r WARING, TX 78074 1 0 1 6 I i i I i I 8 23 I r D tmpioyee group: ,vu employees Provider group Primary Care Physicians Texas True Choice -Kerr County State detail information 9 Access standard: 2 providers within 15 miles Provider group ~ Primary Care Physicians ,~ Texas True Choice -Kerr County 10 ZIP Codes not meeting the access standard f ~~ 4~ ~ ~ '~ f h'b k a ~,h "r ~~ y ,r) ~iya4(k .P"' . hrf rJ'~a KTY 6 ~ P x ~. ~ } ~ b t ~ v V q Y4 * . # i /~ k Y fSfr 1" L. :~ ~ ~YA 4 Y ~ ~ ~N Y. ~~~ ~'~; . ข R RGn . ry t dฐ rt`.' ,Y% ' L i d e 'tl ( m V y~~ f~ p .gyp ~~ ~ ~ .i }}}}}}~ ~ ~~ ~ HARPER, TX 78631 6 0 6 100 21.0 ! 21 7 _ HUNS; TX 78624 4 0 4 dQQ '2$;5.~ ~~~o. it Y ~jF>t~`. ~„~, K ;3 , t ye t Ax~a4~ ti g' " `~ ~ ~~& ~ F , 1YC i .l . { .2p # a t ~ 'M Fj'i:T ~GR ~ ~" 5 , x m..: n ~ T." ~ ~ 'x1lMN ~ s y V t ~~y , ! Y:.i . ? ~' % '~ '~ ง X ' , ~ ~, ~,~ "~~N ~~ Yf9d I .v pI Y I ~ :'. ~y ~~ g}yj y~e "'U''~ ~ th t~ lj.x. "~,*,3r ~. U ~. S`. *'hM1Y M WAd HARPER, TX 78631 6 0 6 100 19.0 19.7 HUNT,7X 78024 4.. `. tY ' „~~. ..,..~(~. :`.22~'~.,:2',, JUNCTION, TX 76849 2 0 2 100 33.6 45.2 MOUNTAIN }lpME. TX 7~Ya8 Z ' 0 ~. "; 100' , p~ " ` ;~1<2 2T,;2'' TOTALS 19 0 19 100 22.0 24.5 d AGGC55 JlGfIUGl O. L pfOVIOBB WIIDI^ l J fTIIleS Provider group: S pecialists _ Fiserv Health GEONETWORK REPORTS SUMMARY Kerr County Medical Networks Proposed: Texas True Choice GeoNetworks Report Results (Using specified access criteria): Access to Hnsnitals (1 in 25 milesl Network Total Employees Employees With Access Employees Without Access Percent With Access TTC 249 230 19 92.4% Total Access 249 230 19 92.4% Access to PCPs (2 in 15 milesl Network Total Employees Employees With Access Employees Without Access Percent With Access TTC 249 232 17 932% Total Access 249 232 17 93.2% Access to Snecialists (2 in 15 milesl Network Total Employees Employees With Access Employees Without Access Percent With Access TTC 249 230 19 92.4% Total Access 249 230 19 92.4% 07/07/2006 Fiserv Health Weighted Savings Analysis Kerr County TTC State Market Ratin Area #EE's In atient Out atient Ph sician TX Houston-Ba town-Su ar Land, TX 1 45.0% 32.1 % 28.4% Kerrville, TX 213 19.3% 11.5% 27.6% Non-MSA 10 18.0% 13.2% 23.4% San Antonio, TX 25 20 5% 12.7% 28.0% TX Total 249 19.4% 11.8% 27.5% F%Se~V Health.. Exhibits Number Fiserv Health Customer Reporting 1 Online Services Overview 2 HIPAA Turnkey Overview 3 Fiserv Overview 4 Disease Management Product Update 5 Performance Guarantees 6 I customer Repฐrting ~ 1 ~ 1 ~ 1 ~ i 1 ,, ~, er Repฐ~t~n~ •ees Custom ndard Serve .Sta rung Tฐo1 ,~ormance Meaning monthly updated hoc reports available Ad _ Monthly' YTp and supported by drill-down S _ Can be lth F `nancial Repฐ Hea sactions F iser~ financial trap checks _ petails monthly menu to Written _ Reconciles claim pay Internet Repฐ d dental plan Pe Results .lC easures ฐn health an ful m F15E V Health. i ~ t ~ ~, RepQ~in~. Gustomer• nai Se~~~es -Opt~o concerns of your is Serylces addresses high cost Ana~ys ckage that ` sis pa _ Detailed analy health plan lan improverr1ent etc.} for p annual, quarterly, _ Recommendations uency ~ ntent and freq 1zed for cp& Data Seryices _ Custom Custom Repo~t~ng data requests _ One time roduction report suppฐrt _ P s or Internet file transfers _ Claim tape setup FI9 fB V Health. { { { 1 t 1 1 1 ~ Health Plan I I Results -G " Measures perFormanoe Claim Overview Claims BY PrOVider jYpe I 201npatient F acilities T p 20 Outpatient Facilities fop 20 Professional Entities ember Per Month Cost Per M raphics Year pemog 000 -Current nts Over $25, 000 -Prior Year Glaima ants Over $25, Claim Network Usage Pricing Savings nd Utilization Indicators Costa nostic Categor1es r Key or piag ~ Mal __~~"-~~1- _--.-., LOgS Resu-ts IG -Stop S Monitoring Repo ort Monitoring Rep Aggregate Stop Loss itoring Report Specific Stop Loss Mon Health Glaim and Result Ce Sus Repo~'S Month Paid Paid Amount b Month Incurred paid Amount ~Yents by Patient Health P Claim Lag Census by Cover Relaf~on Census by Empl Member Census by pental Claim and Result census Repots b Month Paid Paid Amount Month Incurred paid Amount by is by Patient pental Payn-en d Enrollment by Coverage pental Claims an Relationship pental Claims by Category pental Claimsla m Lag pental C Census by Coverage Census by Relatger Census by Niem Y ~~SHealth- ~~ Health Plan Performance Measures Claim Overview •Compares current year to prior year claim data •Shows claims from a processed date and service incurred basis •Shows high level census information (current and prior year) Roceesed Date Basic Service IncurredBasis C61f?f1 {d:rdsr'rTC Pfl7';AEfLt3"'~' EH :,ri d-EKEI'f .13 ~JY~: ~3kf1~3t ~~'"7 ~I Lr {EI:-C&'r 2tr Est +rru3l Rs'c;r1{hg Eiet am~Ert j 11,'87,da~+. S 3,'.C Vii( :8Bb S"2,916r3~ (9,5'.:.0 ii 14 L:sshefcbES Ii$13,EU 51,.d8,i2f E4.~~ 51,:[8,83_ t1,3'_E~' 63fฐ~ tarrcered amnrt 3 `•+861; S' S i,E:?,-r 31 :4b:~ 6.7,_1?,33: t 811:38 i3 EฐE Less=rd-cfari-cs 3:,1,11? S2,1E7,11E 4iS% S2:Oi;3~ f?,3i1:~ qT~ +IEwed+mnrt ;'~17,E5B 5 i,iE5,81_ '83t S r,=__E' $i1 t 583.1.8 i3 =~ :ssEen:flCESi.rSa~+i'cs - t91iEU ;TE5,51T A3.i3~ t ~8~31 S.==T84 i=TOr jEr''9.3,E~ S=,TC8p3: EO.ib Si,7:3JJiA (a,03=:9d i3Eฐr. rc ~.~+m~ drersceCo;.r~c 6nrb;.ES ' ,6i~ i i64 12 f? nvEtE~ ;Ai Ef.C LIVE$ 4,031 : f'? 11 Eฐt krrdzrsperErpl}yEe ~',q .4. tip ~~~erEge ~J7 PErCw::. Em:lo3'E 5 3,E10 1321[ 4?Fi, f 4A~= S _ iT4 cl E? n1"3_E {DSt yet C.seredl'E Sl,EB' t',3J1 1403, t',8~= 31a6s ~'. <<,~ f%5 r2 VHealth. '' ~ 1 A ~ S ~ 1 ~ 1 ce Measures ฐrman cilities Health Plan Pe atient Fa TฐP Zd Inp embers facilities accessed by m riar yearl listing of inpat1ent .petailed a lan network (current and p is within th p d riot year) •Identit1eS if facility ch facility (current an P •Number of adm-ssions at ea ear) d riot y riot year) ach facility (current an p current year and p savings ate charges .pricing t of considered s as a percen d riot year} .pricing swing current an P aid amount at each fac~l~ty •Total p ~~'--~y Health. , ~ - t ~ r ~ ~ ~ - ' ance Measures Health Plan Pert a ent Facilities Top 20 ~utp hers 'ent facilities accessed by mem ear) of outpat- current and prior Y .petailed listing Ian network ( is within the P rior year) if facility current and P ~ •Ident-f-es at each facility ( .Number of admissions d rior year) ear) 'tit (current an P tear and prior Y sat each fac- y r es (curren Y .pricing saving sidered cha 9 I s as a percent of con ear) saving t and Prior Y .pricing facility (curren .Total paid amount at each P~S~Health. ~~. - 1 - i 1 - 1 performance Measures Plan al Entities HeaTop 2p profession gers mem _--_ -- fessional entities accessed qy ear) ~__- ro ork tcurrent and pr-ฐr Y ~, .peta-led listing of p netw is within the plan rior year) c-1-ty current and p .Identifies if fa at each facility t .Numger ฐf admissions d rior year) ear) current an p and prior y I savings at each facility t es (current year .pricing a percent of considered charg and prior year) I .pricing say-ngs as current aid amount of each facility t .Total p `- F~S~Health- Health Plan Performance Measures Claims By Provider Type •Breaks out claims (service incurred) into four specific categories •Compares current year to prior year •Shows Incurred But Not Reported (IBNR) factor for each category •IBNR is based on our internal book of business Metrics MR Groun Tvoe Inp atient Fadlity Outpatient Facililv Prdessional Services Prescri ption Bruns TMa4 Paitl Amount-Current Year $1,257,115 $ 2,271,566 $ 2,211,405 $ 992,978 f %ofTotal Paid 19% 34% 33% 15% 169% Paitl Amount-Prior Year $ 1,135,319 $ 1,557,243 $ 1,912,358 $ 481,474 %of TOtal Paitl 22% 31% 36% 9% 161!% Est Annual %Change 32.9% 75.0% 36.8% 147.5% Annualization Factor 1.20 1.20 1.20 1.20 IBNR Factor-Current Year 1 1630563 1.3465099 1.2686409 1.0000000 /.T2i]i0T6 IBNR Factor-Prior Year 1.0025251 1.0026792 1.0027294 1.0060090 1.90211iD5 rerceni of c~aims uy Year 33% 15% 19% 34% Current Year 38ฐ!ฐ 9% 31ฐ!ฐ 22% Prior Year ^ Inpatient Facility ^ Outpatient Facility Professional ^ Services ^ Prescription Drugs F%5 ,rB VHealth. Health Plan Performance Measures Cost Per Member Per Month •Compares current year, prior year and book of business benchmark costs per member per month •Based on service incurred claims •Shows a trend line of costs from month to month 1=_0 reo .-0 ,,o 1:0 =a :a i0 a of ah'el ka~ Otlpafient ฐail T)~ PrHax oral ฐern]6'n:m(5 loltl Se~xs Paid Per Member Per Morltli trend ?a ^.a :uren."aer C s~iu'ear a ~ Eeremar~ :] :~ _~ i e F~ ~t ~; o f~I ~1: a~ - ฐ • n }' --i ' -'r r' ~~ .`I ฐ_ Q J A [ A A 0= CI r r. 9 C 0[. D Q_ -- C ] `_ ~ ] C C ] O - ] ] ~ C ] C ] C ] ] C r [ ] = 0 ] C C 3 0 ] ] ] [ ] ] C ] ] C ' C] C O J C C J O- J J] C J= J C J] C- r, A 9 A r. r. M rl :1 a Y r. :! `_ CI r. p y r. -~hpdell'ad I~ ]Orh.i=rc Faaq~ ~Prle. o-a ~, $F •1:3 i nex~i>to- i~r, -f Tt. F%SBIVHealth Paid Per Nemher Per month Health Plan Performance Measures Demographics •Shows current and prior year demographic information •Details age of employees as well as all covered lives in plan •Census by gender and coverage selection employees by Age [orere L res y Age '. Census by GendE4 IOY F)f FU X11 CuleK"gar Pncr Year rH en]wbr~ !R .Ve6adx' fMN [Ia1MYlY Ay 6lglryea NW Ypy py FngF'.„ee 19fl--19 I qฃ xseiu-u 6 f1~63fB })% f5}}31 11% }BR Mue4Vlpskelelel 3819 fiJ3 1B }% ifi1959] 119% 1fi9R " $tl% Bkn Braasl 8}03,1 3 15% ib16]E 68% 58% Meh[Oli {159,9}fi 36% 31fi919] 3]% }5Y GOrev $91 IIfi ]6% f181686 35% 35% 90V6 Nale Peplotlu YNa 819,191 0<% fB5,635 19% 11%, ae RepmtluYFe e SzlB,pll 55% fz116z8 53% I9%'. ' epnanry CDI tlbIM f]Be 5]6 fi<% f]80 113 81'6 t5%I , . 6091 Ve+hpfns ffi_,901 1.1% f85,fi:fi 19% 2141 31pptl 3134696 30% fd9dd9 09% 10%'. 3p ne,Brne Martpw 35S'~5 1]% ftg5}9 n]% 21%' S0% r(eoLOm q}6,'0} 6.6% U]3d8 3]ฐF 1.0% Nenh $81,3}9 184 f110,B53 Z14 ]]% UdabbllBUgllie gt],I66 6: 4 81].]91 014 9fi% q]q5 nivles, Pp spn ngs 856010 11% gp,666 1-% 1J% Sums Bid68 9[% f86d 90% p}% ieatlh 6lalus f}']d1B 6}% 333]5]9 ].3% 58% 30'b 11V lnfesllpns pn% S}81 00% Op% raal lasitrool mnalf sl.vsmf Soong faaaa 10%6 I]% H of Tebl PaiE- Cunenl Veu Top 10 MSC Categories BeneDmaM RecpiaoN 6kn, tlRa51 Fni. Nwe. laUolli& ~ ThNaI . Fertale ReoroEUCaive ~ NeahD Slaus ^ Pregnancy, LDIIED111D Ilmoua ~ Cimulagory ^ Digestive 'I MlsculoskelHal f%5 /P VHealth,r Definitions __ AOmbibn-ahospgal cordinementfor an Illness ar lMury. _._ AtlMasiom Per1000 MSmbers-the nunlbar dhoapgal sdnisabns per 1,000 covered lNea Number of admisalom br the period /Idol msmbir months for the perbd x 12000. Allowable Cast- delm tlolars alter proNder tlbcouMS bd before patient cast sharing. Allowable Oaw -the number d inpdknt days cweretl by your health plnn. Alloentl Charee oar YISR er SeMCa - Nlowetl charges tlivitletl by the number of Nsgs x number d seMCes (depending on the messun). ', Awraae LerMn d Slsv- the awrcge number d days a patleM Is coMlnetl to a hospgal. The Idol number d inpdiant '~ tlays /the trial number d sdmissions ' Corsidxatl CMmes - Tdx eleim dollars before proNtler tlscouns and pdient cost anadng bM alter rMUdlona fa ~:IneIIglDli ehargos. ', ''.Cmt ParAdmission -the avenge allowebk coal per inpatient conhnemeM. Trial inpdiaM cast (hoapgel, physkian, lab, '~. xny. etc) tlMtled by the number d al owable atlmisslons Cost Per Mambar ox Month fPMPMI- tlolars paid par covered Me per month. Increases InUCde you are spentlirg more I, .per cowratl Ige. tlecreaax Indcata you xa spentling less. ', Cowretl Emolavaes amployeea enroaed In a health plan as d the 1Nh d a month. '~, Cowretl Laws-rMmben (empoysas, apousw antl tlegndeM chiltlran) ennllel In s health plan as dihe 151n da- ', nxdh. Deoentlents • cowretl ippuaH and dependent cMltlren enrolletl In a health plan ea d iM 151h d e month. "., _... Heaah Plan- a namatl group d proNtlen who agree to negdidetl dseouMS antl retlucetl fees. Cowretl INes then enroll In'. a health plan to ddein Ihese tliscounts on cwaretl saMCea. Inclrratl BM Nat Reoonetl Faders IIBNR)- kdors applktl to seMCe Incurted bash claims to eslimde blel claims when all' bias hew nd yd been receNetl antl processetl. Maim 6aarwstlc Cdagory- A group d 25 tllagnoslic calegorias maintametl by HCFA (Health Care Flnandng AdmlMShdbn). Tha soltwara usatl to creole the category Is a product d HIS (Heaah IMOrmdbn Systama), a subsitliary of 1M. Tha program logl9 563 $ 343 $ 4ฃ4 $ 2,206 S 4,x_5 $ 5,556 $ 52~]] $ 33,349 t ~ ?00:01 $ o? $ 3Z€ -S 74 S 43 $ 3l l $ 987 S 1,:SS S =i5 $ 4,075 9 71A42 $44,335' $15,285 200205 $ 32 $ ~E S ~ S SZ $ SD $2,20€ S i.`I5 $1:147 $ 2,833 $ 24,358 $1=,528 ฃ 5g81" ~j 300:0= $33. -$SD $.5 5?8 5193 $66 $203 $15C $.6 5432 $31613 $,0,23?$d€,73e $€3,9".d 523 15E S~.lO rwl , 84~,;~I; lne~ p n~;a~4 s ts3~w { ;ซs~en # zu~,a~s g ~2e,~ S Coen i tlrcA~s s Din l lr.~irs S lt~,trt teli+~ E w1,*4~ r z3,l~l c 1,1~o,~t f%5B VHealth., I 1 1 1 I 1 I I 1 1 1 I 1 1 1 1 1 3 Census Reports Census ey Coverage -Current Month Employee b Employee b Rate ID Employee Employee Dependents Dependents Total Total Only Only (famiyrl (tamityl Number of Number Number of Number of Number of Number Employees of Employees Covered Employees ar MetnCS Covered Lives Covered Service YearANordh Policy Group Location Class Lives L"Ives F LLTM 001 EMPE IN 17 17 29 91 48 1~ WPHP LC F LLTM 002 EMPE 20 20 38 122 58 142 000 Waassan WIAHO COBRA 005 EMPE 1 1 1 1 WPHP- LC Trial 98 38 8T 219 #Q5 251 FLLTM 004 EMPE IN 16 18 32 93 50 111 003 Green Bay NOVASYS 100811 ABC Company To4al 18 18 92 99 58 111 NOVEMBER 2001 f15 lB V Heal th. Census Reports Census BY Employee Relation - Current Month Employee Relationship CH EE SP Total Number Number Number Number ~ of ~ ~ Metrics Covered Covered Covered Covered ServiceYear~llordh Policy Group Location Class Lives Lives Lives Lives 001 LCLTM EMPE IN WPHP 38 46 24 11~ 002 FLLTM EMPE WIAHC 49 58 35 142 000 W~d01 COBRA EMPEWPHP- 1 ~ 005 LC Totd 87 it15 59 251 004 FLLTM EMPE IN 35 50 26 111 003 CrreenBay NOVASYS 10086 ABC Company ( Total 96 50 Zd 111 NOVEMBER 20D1 003 FLLTM EMPE CAPP 4 4 OD4 Milwaatkee CARE-EXP Toth 4 4 007 COBRA EMPECAPP 2 ~ D05 7sllCobra CARE-EXP Total ~ 2 Toad Toth 122 161 85 7b1 Tatd Total Tdd 122 161 B5 Tdd Tatd Tdd Tdd 122 161 65 dd F%5P VHealth~..f~ i t ~ t ~ t ~ ~ I t ~- Census Repots Census BY Member dumber ฐ` Covered ~ ~~ page Mensber Gender Lives Page-~ Service YearlMflnih'.20UGD2 1 EnNrlOyee Relationship Memb M ou LOGatIOn Rate Ili 19580712 Class Gr P E~pYee ~ 1 Colrtract Number Member ID 3 DependerRs EE 010 053 (fartufY) F 1365051 E~oyee & 19591108 3 DependerAs ~ 1 010 053 tfamiY) M 1365052 EmpaYee ~ 19450724 3 Dependerds EE 1 01D 053 (famifY) F 1365D55 19420422 1 EmpfoYee & M 3 Uependerrts 5P (1a~niYs`) 19-080622 1365056 010 053 1 EmpMYee C7r'fY EE i 1365057 010 053 r F~SPdW H'~alth-x~ _ ~ฐss Mฐn-tฐring Repฐ~'s RESULTS ~C Stop Monitoring Repo p,ggre9ate Stop Loss I Specific Stop Lass Monitoring Repo _---~- ~15e y Health Stop doss Monitoring ~epo~.- ~~~~,te ~-ta-p ~~~ _ ~I gpecific Stop ~~ss _- ~~~Heaith~ ~~ ~ 4 1 ~ 1 ~ ink I~epฐ~'s ~~~~ ~ฉn;tQr Step ai 1nf ormatien ew Results-IC Aggr som of then ort Here ~7e'n'~~ e table components ific Stop Loss Monitoring Rep slides you will see the ec d the SP re title bar. ' art In the fiolLowin9 Report, an orts the P Monitoring to the rep an exPo'~ option'. tint icon in Stop Loss anon related the P tint options and b clicking on 2 ages. Dyfed. You additional inform two P whole report Y tint an be Printed or exp I I .There are tint the it wiN likely P report printing ~) You can P use this option main report followed for I-IPP~ table (a bolded i I Whe table y within tee nethodologY under each into another ou se the sam ort subtitle table 2) Each this using this will take the ofi the new need to select the rep the upper right area execute Clicking on which means Y description) ~ . rent icon in tint icon and underlined can click the P ort icon next to the P From there You tinting eXercise. the exp view • and complete the P step 2 and click on , s result, view ou follow a prior month Locally orting Y v1ewing keep this history 3) FQr exP ort title bar. is interest in results and ort for additional on the rep thly lfi there ort monthly I is updated mon Tint or exp ofi each online rep . pata arties should P the bottom ..~~ earth- I interested P overview boxes ฐn ort, F!'SBtV H . Review the ~nPcific to each re Agqregate Stop Loss Monitoring Report ~ FgLLcy titnhu tiMp Inca I'nliry tifwp Ivan IMlicy A~ F4rgnrnry Cusmmer Cmvp Peltcy Code Nulnber CurrentffiDau ApR, 5mp Ines Baa1s Carrier Indll'amr ARf fnmpanY 12~ 1234 AcfTVr. 129A4 ll MI1111 111 IriCUxred iri l2 nx,n}Its, hmrl in l}t Tinilnl Health lcw. N months Swop Losa Policy 9cnrire Ye ulMwnrh Fi.gLyce r~rpLn3"t'n Mrltu:e G71ฐ7ฐซ C:naMmnr frepp IVnmarr Tbliry - nmp Inns Mnneha - Fiaxln Mwn /'wmily rha - Mnntha - TnGI ' .TA1J1ThA4' XNIt 111 Id9. 19 } F'1_diMUA11Y :IllUl 113 IG4 :L'!/ MRNI_H lW1 11V 1G4 ~! APP3L 2001 130 lu4 2II4 YV_r:.....v..,v 1'3 L1J4S 1834 MAV ?.f101 71? IRI ^All JL1MF 2001 11>f 154 2d8 JULY 21A1 ]U/ Iป :102 AVGU~T 2001 112 15u 2c8 SP.P'1'P.MRR.A XV 1 1 14 f ir5 ^rvl MTtIRFR RM1 11f1 Ii7 ?d7 19V 4N:iv1Hk2t 2LR11 113 lid 2(+L~ 119 iSA 2'J2 ~3pn~ilx: AK 13 Wp 'aliwriw F'anWr Manunwawl Mvtunaut2 Matinrnt:l S'wrp Tnan Mnhirz Sagt Tnnn innn Tinr Tinr App Min AmY Tirrhy Firm Mnntb Cusmmer Group Policy Nvutber Potlcy Ltndt Percent Facmr Facmr Month Aawualired .t Br COxty anv .19'i 13393 ,t1J4 ~~.,;, ~ ifl,flnfl 1. ,. G~ ~ ?^742 i. 7h 1 41 .,fait! 1 4l14,i1 r5 . 1,A4ft Stop Loss Policy )?'ai.d liralih Drum Paid Total Paid Lcwa SpcciSc Amount Applied C'usmmer Metlu:s Group Number YearRemntla Paid Arnt Amt Amt lieimb unemenb m Agffegate 2UU]Ul S bJl $ r5Jl $ bJt 200102 255,1x6 216,295 $71,4.71 271,111 2nn1n~ Rr2,a7; '111,114 177,29 :&74_i49 20010+] $ 141,100 $ 11,71& $ 155,glg $ 155,81% ADC Cutauanv L23 17945 2UUlU> $yB,SIU'1 S]I,XM $11U,"1>l S-lY,4U6 $X1,S~15 200106 $ !31,917 $ 15 265 $ 97,215 $ 9ฃ?5 $ 96,200 200107 $>5.293 310,^012 3GG.105 21,790 3G4,315 200108 $ 70,?48 S ] 8,380 $ 88 028 $ 2,447 $ 8b,280 :RUUIU51 7;6>,1"!2 S1'd SI'd4 $IH,lUl '.1"-fx,LUl 200] 10 $ 95.721 $ 11,102 $ 109 ฐ23 $ ]09,523 200111 $S6,llo 3]4,472 '5101.090 31U1A90 TaMI R d lll,dliR t l9dyd77 a Mi~,37kf S :16,d!!1 1/7R,d7'r 7ata! $iU}bil 21JAr137 $153$15 S3A}{28 $!L{t[i7'1 I 1 1 I t 1 I I 1 1 I 1 I 1 1 1 D 1 Aggregate Stop Loss Monitoring Report Table (1) Policy Staius Slop Loss Policy Stop Losa Policy Agg Frequency Customer Group Policy Code Number Current Eff Date Agg Stop Loss Basis Carrier Indicator ABC Company 123 1234 12345 Incvexed in 12 United Active 2010101 months, paid vi 18 Health Ins. A months i - I This Table of the report provides the basic policy and contract information including: • Customer Name, Group & Policy numbers. • Effective date of the Aggregate Stop Loss contract. • Terms of the contract period (i.e.., 12/12, Paid, etc..,.). • Reinsurance Carrier Name •Agg frequency indicator where `A' stands for an annual contract. This is the only contract type currently in Results IC. Monthly Aggregate customers will continue to receive Aggregate reports from the Account Services Finance Group. F%Se~V Heal tii!. ~~~` I ~` 1 ~ } A~ date { 1 1 r-n~ Repฐ~ j"~ 1.os~ ~ฐn~tQ ""' `"r ~ I,db1e l~'~ r~.rlฐr" .,r *".`w~w T",~,'. PrTM €€1'o'1i.Y ~licY Nw~^~'n, C+n`M' 153't i3Jab tea wu'- r:..mv"rv ..n ~yd. j.(LULCrvu Mwwyh€ . t 11 1~ $rs'~r Yr at lwsa t ',SA1 113 ~a 1~ la` €~. ty.Wti hR'+ 3W1 lt 120 1f.1 }D13Y.U P'K tWl 11~ Lam' ~A@J:LI 2~1 11`t V~ AI'RSL t `~ lLr1 tx M~,v ~1 Its 5 7U1AE '~1 t /'~ t ,~ JULY 1 t1h ~ l~- p Vi_UPT~P'PR 1 '''~~t "M 113 lax ~PPT .,~.npPR ~,g 1U1 114 ~ rsna~ 1 w" nth by month enrollment rovides the mฐ • s table of the report p Thy including e employees• information le covera9 loyees' of Sing coverage emp . Gounts for nu-.nber of Family enrollment. I for numand Family counts. view of the . Gounts{ Single onthly I . Total o ng average ฐf each m . p, runny I Fj~re VY Health., t ' 1 ~ ~ ~ ! ~ 1 ~ an-t~rin~ Repฉ -~~~Ce~ate Tab-e t31 ~,w.~., I Myiinax~Z ~rxt M~~~ayu~d ~wj~pW~~ ~ -~~r FY ~1L4r+"~ !'aH~i1Y n~pd9a Ar"t p+pnTh ofi ~V~ ~{inr 1,4~e„a. ~.:tiw Ar..~bx 'fxrr FygTpr ~ ~a,51R Yeroam ,p-, an T,an,,;r.'~ Ill ;r,:n a~ fi~ Tn<. er po11cY R ~ nnn ,;+, :v:. polLr.y NuA~" ,~1: is 'n` t ~,~~ G,.,~ ,23a, to the calculation tha ,.~,• ~~...v~..., ort provides informs IimitkeY final Aggregate cla This tabl nฐi e the p . will dete vel is shown ecific Deductible le o 0 or margin is shown. NgFt are shown. . The p regate Stop ~ฐss develop aximum S ed ey art, the m I .The A9g le and Family, of the p ulas I for Sing licated pad' three unique form . Tier factors the mast comp ed using the resent the I .And finally, develop ill eventually rep ฉ~ oVerview im liability amฐunts~aim amount `N regate rep I cla -ne what c See the Ag9 I that determ Loss amount. Aggregate Stop these calculations. box for the details on Fi5 f8 Y Health- ฐ~' I i 1 I I I I I I i i 1 1 i 1 1 1 Aggregate Stop La-as Monitoring Report Taale t4} Tipp Laaa raliey Paid Mehus Health Uru~Yaid 'Pohl Paid Lca~ bboeifu Amommi Applied C'mt•me: Gto'~ Numher Ye~arflut•nth Pais hmt Atnt Amt R,evabmsemenla ioA~egate 200]01 $6y1 $6V7 $691 200102 $ SS.IA6 $ 16.29II $ 71,944 $ 71,444 200103 E 62,425 B I l,l l4 Z 73.139 8 73.534 200104 $ 144,104 $ 11,71% $ 13?,818 S 1 X3,818 ADC Cu,nuenr 123 ~ 734 i 200105 $ VII,VU'! $ ] l x41 $ 110,757 $ 2S',~IU6 '.~' K1,S/IS 2001 D6 S ฐ1,7A7 $ 15,26E $ 97.215 $ ?35 $96.230 200107 E 55.293 $ !0,^012 $ 66,105 8 1,790 S G4.31i 2M10R $7(7_l4A $, 1R'iR11 SR4,47R f7,'S47 RP,~S_7.4f1 300109 $ 63,173 $ 13,A39 $ 78,101 $ 78,101 200110 $ 9ฐ,721 $ 11,102 $ 109,E23 ~ 109.E23 200111 fi IIb,llff $ 14,972 $ 101.090 S 101,090 'Ittnl S!l9,1W ~l•'ii.4.T7 t459,31ks 394tt711 ~l1N,1NT 7ah1 Sl1R,Alii SlYt,6l7 tl5),'SOS =34,120 ~ltB,B"77 This table of the report provides paid claim amounts that are accumulating toward the Aggregate Stop Loss limit. • Health Claims and Drug Claims (where applicable) and total claims are shown for each month. • Adjustments for Specific Deductible payouts are made. Other potential adjustments like exception payments are not factored in. • The final column shows the accumulating contract year to date Aggregate amount. f%9PIV Health ~~~ Specific Stop LOSS Monitoring Report Policy Stop Lose Policy Stop Loss Policy Specific Stop Loss Metrics Specific Stop Customer Policy Status Code Number Current EffDate Basis Carrier Loss Amount ABC Company 1234 Active 12345 20010101 Incurred in 12 months, United Health $ 50 000 paid in 18 months Ins. Employee Member Health Drug Total ฐ/a of Stop Loss Member Cert Employee Age - Member Metrics Paid Amt Paid Paid Specific Customer Policy Number ID Nwnber Member Name Relationship Currant Gender Amt Amt 506768 3968 EE M $ 83 947 $ 1 653 $ 85 60D 171% STEVEN , , , ABC Company 12345 506712 3963 ]OHN ~ M $ 31,255 $ 2,381 $ 33,636 67% 506432 3905 F EE M $ 25 812 $ 1 047 $ 26 859 54ฐ/ฐ I T TOT , , , SD6300 3873 EE M $ 19 227 $ 6 678 $ 25 905 52% 70HN , F , , , Total $ lti0,241 $11,758 $172;$09 Total $ L1g341 $11,758 $172,698 F%SBIVHealth. 1 1 1 j 1 t ~ . jr1t~ R~~O~ I ~~~~ ~ฉn1itQC S gGi~iG ~~~`~ Tab-e t1l K ~ee~ic S1a4 ~i unt pdetxics y.st A~ Sgecific SAY 1'0ss Carder ealth $ 5D,[ SidPLOUpOIieY C~urientFSDau ~~~~ineduYl2n~nds> i~tedH Falic9 CedeNum~r 1p1 Y~ui18~ Status 2(1010 {,, P•~y 12345 to tl to ~yytasner ~~t~ n related '~ infiormatiฐ ~gG CoiaPaz'Y re ort provides the contras of the p contract including This table eductible ' Specific ~ date gasis)• ffective Stop Loss . The contract e S ecific erms of the contract ~ p e T rance carrier nam . The Reinsu eductible leve . The Specific D I ~15Health. • • ass Monitoring Report Spec~f~~ Stop ~ Tame t2~ Health Drug Total ฐib of Member P•id ~~~ + Member Metrics Paid Amt Paid { loyee ~~ Age Amt I gpop Loss Member Cent RelatiensluP C'~at Gendor 653 $ 85,600 171ฐtฐ N,uaber Member Name M $ 83,947 $1. C„stomer PolicyNwnl'erID ~ $ 31,255 $ 2,381 $ 33,636 67ฐ!ฐ Sp6768 3968 STEVEN M ~ 047 $ 26,859 5Aฐ!> SD6712 3963 JOHN M $ 25,812 $1. ASC Comp~Y 12345 ~ 5`l% SD6432 3905 ~pT M $19,227 $ b,678 $ 25,905 ~ 11p,341 511,7+59 $172,d~ SD63p0 3873 JOHN , F 15.241 111.759 S 173,~- Total Tatal ort rovides detailed informationle amount,cnc ud ng: re p ctib This table of the p ecific Dedu who have met 50ฐlฐ or more of the Sp r Contract holder • Member ID. I0 ee ฐ endant • The Social Security nu Bees SS# w N display for dep (the associated Employ to ee, and claimants). me of the Claimant, Relationship to the Emp Y • The Na their age S Dru claims, and total for the ers the nd the COHealth., • Heath and in claims as they relate to • The % relationship Deductible. He~ith eN ort F~n~,ncia~ ReP ~ tJS~R,~ ~U~D~ ~,~~ ~~ ~ ~ '~,.a t f F15e VV Health-~' Table of C'orucsate INmdnction .................................................................................................... ..................... 1 Pektionship of Reports . . . .. ......... . .... 2 WBF001.01 - Cash Reconciliation Swttmary Report .. 3 WBF001.01.CashReconciliationbyContrnctReport ................................. .................... 4 WBFOOlAI Roedmep .........._............_ .............................._........................._ ..........._....... 5 WBF002.O1- Ckeck Recontilintion Repot .................. ...........__ ........_ _.. _....._........ 7 WBF003.01 -Other Payments Report ... . , . 8 Y1BFD03.01 . Reanbwsement export ...__ ....._.... 9 B1V022.01 • HeakleCkienPayrmnt Report ............................_...................... ........__........ 10 BEF035.01 - Omup Denlal Claim Paymesua by Clnirmnt ............................ .................... 11 FieHDelSnitiom _......._ ................__..... ._._.__.._............. . _ 12 i f%SBIVHealth ., ~ > > i - i i s ~ i t t t t Intivdactisn pmgose T:~e ~crXose o'the ~,~atฑc~ni F,sp~~ta jcr ('ar,:drr!sr~r is tt Proede a dam- arnd ccnci~ a vray to ealatemenl,cs~e cY~'n ani ~tYer ~~5metl:s t~ c3st arc t~n]ang Fmquencr T:1e F'h:anc+~x.' P.e~~rts jcr G4is'o,msr: (tti'B~,j : eparLng pacl~age rs Xr4d.uedrycntY,ly. t*+ &Ya22~ y~gpy3 R~~a'~ฐ1C ,~, Rra taan ~~~! NbYN`~ ~tJA~eS6'9jQ5ฐ"' PaYi"e ~ystt'{~ba~laY'Ceiothis 'petdalClautu e~ ~Py~edtobe added ta~~=Tto tatal~ Alk~+~+Aq+AS ievisedB1V022A1He~dtoEe~Y~ฐ etothis A= ~YC,~aateac ~ ~~ araut~~~r~5~eatobe Ba]aT~eS m the ~iiasltiY~ e~Y~$' ~ ~ 1{ iCY~ the 'd022lis ~ u~`$I+B2t$3+B4 ~.tsedBlVO ~ Olbe ~d to~et~T~ฐbalaise toth~ B = Moxdh1Y ~~` W ~ mcedhlYtฐtals ~ gibe ccadY~s ne BI BI~2 its ~+ir~~arฐxact, ~ C4 IW22A1 STppaY~~reP~' N~ ~nnF E C=Cl+C2+C~+ coka~~onYO`>r~re`"edB NL~shIYT~~~~ D~~~D~.~4+A5 Blvt}7.2.otHeakh ~pt~~xdht`i~ farcall ~d'tle phoxdhiy N~ ~~j czL1e)~ B] JOEL lssts milt~le cv B1V022D15TD ~Pajaedto~tl+kxtobalascetotku~ฐ"`d. tle ca~s~5 ~e}t~+Fr ~~E~}~~~ ~~V Nealtt-. 1 } { ~ 1 1 ~ apwTNl• !V9' p~,es B G ~....e~ 8il~+w K Wf~ eeP~ E~ Spe Sa~eSotil ,...- ~p~7p2 ~ 7 Y~ldeld~+ tot$a`t4'ฐStaPQ~`ฐฐb~' rtr:il fJU~^'~ J 4iil p"'r'"int .~ Sau<. ~ ph neof rSPti" a w~ os t $ t ab D k Code„~ ~ y Tyt pu e btheSA~ tlu K . -- ~ nuh ' -!.~ Didฐ~~t,~....s Y o~e)o 04~pa~~i epod Roe1pKOtil~M p~h~.otd+eWBP~S H+ ฐ'&cCadu~tatJontir A9-7u~bMMaReTb'aEh9~ork ~~n~nY~ Wsd" Nd~~P+e~++d"s oftM~~ HaUtrฐ ~ Reeei^d mh`mn ro ~ CataacllatiloptWe P~ 6 ~iS~Health.,~ O6/O]J 00 C OBTPACT 8AM8: AHC Cmp any ACCOT~T: 00001 97296 SOVAC6 CODB: CP 100 c~cx cปBac 8U2B8R RATS PAYBB xAHe 1000003786 5/01/00 XYH PSYCHATRIC GROUP 1000003953 5/03/00 I6f8RIDSL 88DI CAL GROL& 1000003987 5/03/00 HฎICAL RHCORDS 1000003999 5/03/00 HBDI CAL RBCORDS 1000004365 5/04/00 PADVID~HR SURC1@3lG8 1000004266 5/04/00 ICS P88 1000004267 5/04/00 xPPB PSH 1000009368 5/04/00 PAOVID8R2 1000004369 5/04/00 PAOVIIBR3 5000004370 5/04/00 PHDVID8R4 1000004371 5/04/00 PPAVID8A5 1000004372 5/04/00 PADVID8R6 1000004373 5/04/00 PPAVID8A7 1000004374 5/11/00 pROVID8R8 1000009375 5/11/00 PAOVIIBR9 1000004376 5/11/00 PROVID8R10 1000004377 5/13/00 HฎICAL R8VI8P7 IHSTITVTH 1000004378 5/15/00 HSOI CAL RHVISP7 IBSfITUTB 1000004379 5/17/00 !ฎICAL RSVIBP] IxSfITUTB 1000004380 5/21/00 1ff80I CAL RHVIBP] IHSfITVTB 1000004361 5/25/00 1[ฎICAL RHVIH4] IBSTITUTB 1000004382 5/31/00 N80ICRL RSVIS47 IxSTITUTB 5000004383 5/31/00 PAOVID8R11 SOUACB TOTAL ACCOT~T' TOTAL WBF002.01 -Check Reconciliation Report PAGE 1 CHB CB RBCOHCII.IATI08 ABPOAT ABPOAT 80. WBP002.01 PBAI OD: OS/01)2000 TO 05/31/2000 RBPOAT DATE OS-31-00 CASH HST CASH DI SBURSSHSBTS VOIDS STOP PAYS DI SBURS@18RTS 2,572.96 [2,572.961 27b. 12 [216.12) 7 00 7.00 51.86 51.86 23.00 23.00 11,376.78 11,376.78 ~~ 18,309.80 18,309.80 '' 6,457.00 6,457.00 36,987.90 38,987.90 41,112.50 41,112.50 89,175.41 69,175.41 109,564 56 109,564.56 97,970.98 97,970.98 148,675 98 148,675.98 100,000.00 100,000.00 38,560.33 38,560.33 ]A. 00 30. 00 50.00 10. DO Si0 OD 10.00 1A. 00 10. PO ]A.00 10.00 ]A 00 10.00 5,546.44 5,546.44 J 705,879.54 K 2,572 96 I 216 72 703,090.46 705,879.54 2,572.96 256.12 703,090.46 Purpose - WBF002.171 -Check Reconciliation WBF002.01 Check Reconciliation report provides the monthly activity generated within a bank account of a self-funded plan. There are subtotals by banking source code that equal the total per hank account. The details listed above are provided for all claim and non-claim payments. Dental Only accounts will continue to receive CP5258. i f%SB~VHealth WBF003.01 -Other Payments Report 06/OS/OD C 08TRACT SAHB: ABC Cmp av~y COSTPACT BUHBSR: 767117090037 SOVRCB CODB: CP 100 PAYSS P2SY7[8Sf TYPH PAID DATE RUSBHA PRDVIDBA SVRCtilSAfBS 5/18/200D TOTRL PROVIDSR SURCIRRGHS SSTWORA ACCB SS PSBS 5/31/2000 6/31/2000 TOTAL liS1WORIC ACCS SS PBHS HBDI G4L ASVISP ISSTITDTB 6/08/2000 978676867 6/12/2000 978676867 6/12/2000 978676867 6/22/2000 978676867 6/22/2000 978676867 6/31/2000 978676867 TOTAL HeDขCAL RHVIH47 ISSPITVI'8 CORTBACT TOTAL SOLACB TOTAL PAGH 1 OTSBA PAYH@7TS ASPORT RBPORT 80 WBP003. OS PEPS Om: 05/01/2 000 TO 05/31/2000 RHPORT DATH OS-31-DO CLAM COATRCY CBP.T PRTISST 88 88 PAID PAYHB AA7B SVi~BA DPI SUSBSA ID FIASf SANB IAST Nk1f8 ANOOST 00136861233 000022160 00 PAOVIDBR S1` SURClIISRGH 23. 00 23 00 00146802283 00002314D DO PAF1l8ST ICS PS8 11,376 78 00146802356 000013141 00 PAF194ST SPPS P88 18,309 $0 29,709 58 HHDICAL RBVISfO ISSTITLTB 00129801886 186486744 02 LAlISR98 SPILLS 10 00 SSDICAL A8VI8W IASTITVTS OD 175863749 384678374 00 A088RT G?SN 10 00 SSDICAL RSVIBW IDSTITV38 00094809917 466739284 00 WAi.TSR CLARK 10 00 HBDICAL RSVIHW IRSTITUTS 00138868713 394867622 DO LARRY SCNARPVSLD SO 00 HBDICFSL A8V2847 ISSTITVl7i 00138868718 689386474 O1 SSAISt HC GILL SO 00 SBDICAI ABVSSW ISSTITDTP 00147804083 392867463 01 V7Ri.TSR CLARK SO 00 60. 00 29,769. 68 F 29,769 68 Purpose - WBF003.01 - Oiher Payments Report WBF003.01 details all non-claim payments made on behalf of a self-funded plan with a home banking arrangement. Examples include, but are not limited to, service fees, stoploss premiums, withholdings, provider surcharges, consulting, vendor charges, in- house subrogation program, capitation arrangements, or access fees If payee number and name are blank, the payee is Wausau Benefits. Please refer to the EE First Name and EE Last Name for a description of the payment. F%SB~V Health., WBF005.01 -Reimbursement Report 6/01/00 pAgg 1 COHT-ACT HA10;: AHC COHPRHY RHI2BURSHHHHT RBpOPl RHP ORf H0. WRP005. O1 '~, COHTPACT HVHBHR: 767117040037 PHRS OD: 05/01/2000 TO 05/31/2000 RHP ORT DATB OS-31-00 SOUACB CURB: CP 500 CREDIT CHRf CREDIT PICA/P8D WITI4IOLD AHOVHT CLAM CONTROL SHRVICB RVSL RVSL DATB HUHHeR BHPLOYBH HP11(e PATIBRT AHOVHT AHOll9T RHOUBT R8CffiVHD CLRSS LO CATI OH HLOBHR DATH RSA COmH 5/23/2000 999999999 SHITH JC4lH A JOHN 35.78- T. 20 0.00 28.58- 001 016 00054806301 3/14/2000 90 10 5/23/2000 999999999 SHITH JONH A JONH 84.00- 12.58 D 00 71.42- 001 016 00054806301 3/21/2000 90 30 PATIBHT TOTAL 119.76- 19.78 0.00 300.00- COHTPACT TOTAL 119.78- 19.78 0.00 100.00- 06/01/00 pp~g 2 COHTPACT RAHH: ABC CNCPAHY BHIlBiJ1lSSHeHf RSP ORT RHP DRT HO WBP 005. O1 COHTPACT HUHSHR: 767119040037 PBRI OD: 05/01/2000 TO 05/31/2000 RHPOHl' LATH OS-31-00 S OLRCH CC418: CP100 CREDIT CHRT CREDIT PICA/PHD {PITHHOLD AHOLt7T CLAM CONTROL SSRVICB RVSL RVSL DATH BUHHHR HHPLOYSH BAHH PATIHRT AHOUR'I AHOVHT AHOUHT R8CffiV8D CLASS LOCATION HC@BHR LATH RSR COmH 5/19/2000 999999999 JOHSS NARY A ~.1~5 187.93- 39 95- 0.00 152.26- 001 016 00054983758 4/18/2000 90 10 PATIHRT TOTAL 187.93- 39.95- 0.00 152.26- COIPTHACT TDTAL 187.93- 39.95- 0 00 152.26- SOVR.CB TOTAL 307.71- 59.73- 0 00 252.26- H Purpose - WBF005 01 -Reimbursement Report WBF005.D1 will show every refund that Wausau Benefits received from entities such as other insurance companies, providers, or 3rd party liability companies. Examples of outside reimbursements include, but are not limited to, claims paid in duplicate, excess U&C, subrogation recovery, or coordination of benefis. Home Banking Customers will receive reimbursement checks under separate cover. P%SB~V Health ~~a BIV022.01 -Health Claim Payment Report 06/02/00 PAGE O1 AHC COR+fl'AHY REPORT H0. BIV022.01 CON17tACT 767117040037 TOTAL REGION O1 HEALTH CLAIM PAYMENT REPORT REPORT DATE 05/31/00 05/01/00 TO 06/01/01 PERIOD COVERED: 05/01/0 0 TO 06/01/ 00 OPI CODE: WN ALLOWABLE DIDHCTIHLE COB TOTAL CAPITATID CLAIM NET COPAY SUBROGATION PAVam.F. CLAIIdS WITHHOLDS PAYMENTS Al B1 C1 E1 MONTHLY TOTAL 226,685.79 1,794.91- 16,551.30- 210,339.58 0.00 D.00 210,339.58 QTR TOTAL 593,378.45 4,355.76- 29,493.82- 559,528.87 0.00 0.00 559,528.87 YTD TOTAL 819,755.09 7,028.58- 33,826.25- 778,900.21 O. BO 0.00 778,900.21 MON7'H1.Y HILLS PROC3;SSID = 96 Purpose - BIW22.01 -Health Claim Payment Report BIV022.01 Health Claim Payment Report shows monthly, quarterly, and year to date Allowable Claims less deductibles, Co-Payments, and Coordination of Benefits to arrive at Total Payable Claims The report totals by contract number (policy) and each contract's total will balance to the appropriate contract on the second page of the WBF001 Cash Reconciliation report. f%5Bt'V Health..=~~' F 1 Defilritions Account Amount Receitied Allowable DoOars Banking Source Code Capitated Claims Cash Disbursements Cert Number Check Number Interns code usedtฐ tni0uely identify mdxvxdualbank aceounts Amount of the payment returned atier& sort sharing ~ loc b~ before p chaxadesistics such agexpsovidesdiscous~s stemusediodesignatecextain Claim dollars mnerds sy cash dish ~n~ from medical etc' Bement An identifier within our asating ca itatiฐri a~ sepazating classes, s'~' aidinthe absence of the P ฐ~ts ttxat would have been p Encounter d~a, or am xovider for sexvxces the employee's SocialSecuxity Amount paid tฐ the p e employee (usually The uni0.,ae certificate identification my~nber of fir number) ssuedto the Pa`1ee Check Date Claim Control Number Claim Withholds Class COBfSubrogation Cred'd Date The number of the checY, that was r checkth~was issueclto the PgS`ee of claims. The dateontha far processing~'d~actdnS ~ exnent.Ifa bexassi@riedtฐtheclaim axisksharing~ aer. Internal num al deficits in ~ to d.,e pxovi retained to offn ~P~ ~ty~hotds are reiuxn of an aligble claim older (i e. 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Web Based ical and RX da ration of Med . lnte base data n a monthly bas-s a u dated o answer specific pat p • dr-II -nto data to . Ab-I-ty to s quest-on arking stomized Benchm r comparisons • cu ear over Yea nationa- _ Ability to do y er lines of business an _ Compare to oth database f~S~Health- ~` m are to Market Scan _ Co p ' ~ t ~ t ~ ฐf ~edStat Rep pverv1ew bye information aningful, actiona . Provides must data orted into instead ฐf ! be easily -mP . lnfor,mat~on o el MiGrOSฐft EXC lin dictive mode g Pre orting star Fiser~- Health internal rep * pe~fiormed by ~~-~ y Heaith~ -- MEDSTAT ADVANTAGE SUITE TABLE OF CONTENTS 1: Financial Trends 1. Cost and Use Key Indicators -Paid 2. Cost Driver Analysis -Incurred 3. Financial Trends by Service Category -Paid 4. Financial Trends by Provider Type -Paid r 5. Cost Trends by Paid Month 2: Cost and Use Benchmarks _, 1. Cost Benchmark Comparison 2. Price/Use Benchmark Comparison ,_ 3: Clinical Analysis 1. Inpatient Trend Analysis 2. MDC Cost and Use Analysis e 3. Top 25 Clinical Conditions 4. Top 25 Hospitals _ 4: Care Management 1. Preventive Screening Benchmarks 2. Chronic Conditions Profile r 5: Product Line Evaluation 1. Cost Overview by Product Line 2. Medical Utilization by Product Line 6: Prescription Drugs _ 1. Prescription Drug Cost and Use Analysis -Paid 2. Generic Prescription Drug Analysis -Paid 3. Top 25 Drugs -Paid 7: Member and Network Analysis 1. Enrollment Overview -Employee/Paid 2. Network Performance 3. High Cost Patients 5/16/2006 02 -Online Reporting Samples ฐ- 1.1 Cost and Use Key Indicators -Paid Cost and Use Key Indicators displays ayear-to-year comparison of several key cost a nd use indicators of performance. The report is divided into sections representing Total, Inpatient Acute, Outpatien t Med ical, and Prescription Drug data. SUMMARY ^' • ~ 11~ 11 . 11 11. . ~' Net Pay Med $914,597,669 $916,866,844 0.20% Net PaylP Acute $340,478,774 $334,194,610 -1.80ฐ'0 -- Net Pay OP Med $567,705,600 $575,189,362 1.30% Net Pay Med Other $6,413,295 $7,482,873 16.70% Net Pay Rx $107,713,196 $111,722,836 3.70% PEPM SUMMARY ~~ 11~ 11 ~~ 11 11. •-. Net Pay PEPM Med $384]6 _ $428.50 ~ t 1 40% Net Pay PEPM IP Acute $143.23 $156.19 9.00% Net Pay PEPM OP Med $238.82 $268.82 12.60% Net Pay PEPM Med Other $2.70 $3.50 29.60% Net Pay PEPM Rx $45.28 $52.17 15.20% INPATIENT ACUTE ~ 1 1~ 1 1 . 1 1 1 1. .- Net Pay PEPM IP Acute $143.23' $156.19 9.00% Net Pay IP Acute Per Admit $11,022.30 $11,635.90 5.60% Admits Per 1000 Acute 74.7 76.91 3.00% Net Pay IP Acute Per Day $2,560.01 $2,699.80 5.50% Days Per 1000 Admit Acute 321.62 331.4& 3.10% OUTPATIENT MEDICAL ~ 1 1~ 1 1 ~. 1 1 1 1. Net Pay PEPM OP Med' $238.82' $268.82 12.60%. Net Pay PEPM OP Fac Med $99.81 $113.92 14.10% Net Pay PEPM Offce Med $88.91 $99.94 12.40% OP Utilization Rates '~ ~. 11~ 11 •. 11 11. .• Visits Per 1000 ER 193.36 193.63 0.10% Services Per 1000 OP Lab 5,423.38 5,912.75 9.00% Services Per 1000 OP Rad 1,767 48 1,933.87 9.40% PRESCRIPTION •. 1 1~ ~ ~ . 1 1 1 1. .- Net Pay PEPM Rx. $45.28 $52.1T 15.20% Net Pay Per Script Rx $52.48 $51.67 -1.50% Scripts Per 1000 Rx 4,960.44 5,786.07 16.60% Scripts Per Patient Rx 10.9 10.8 -0.90%, 5/17/2006 02 -Online Reporting Samples (2) 5-16 1.1 1.2 Cost Driver Analysis -Incurred The Cost Driver Analysis displays the year over year change in net payments, and then attributes the change to key drivers of cost trend: cost sharing, price, use, and eligibility. Nel Pay Med and Rx Cmpl Net Pay PMPM Metl and Rx Cmpl IMPACT DUE TO: Enrollment Cost Sharing Metlical Cost Trend „r Drug Cost Trend $1,027,425,685. $200.55 $1,030,899,585 0.30% $222.84 11.10% $22.29 $3,473,900 ($99,647,817) ($9.55) ($44,174,238) $27.17 $125,692,040` $4.67 $21,603,91 Net Pay Metl Cmpl $921,714,610 $918,072,839 -0.40% ($3,641,771) ENROLLMENT CHANGE Member Months Med 5,122,880 4,625,940 -9.70% ($89,470,031) NET PAYMENTS PMPM Net Pay PMPM Med Cmpl $179.92 $198.46 10.30ฐ~ $18.54 $85,768,259 COST 3HARING CHANGE Cost Shadng PMPM Med Cmpl $146.13 $176.83 21.00% ($8.63) ($39,923,780) r ALLOWED AMOUNT PMPM AHOwetl Amount PMPM Med Cmpl $326.05 $375.29 15.10% $27.17 $125,692,040 MEDICAL COST TRENDS Allowed Amount PMPM IP Acute Cmpl $124.88 $136.88 9.60% $6.63 $30,649,894' ~' Cmpl $76.87 $92.88 20.80% $8.84 $40,670,432. Allowed Amount PMPM Office Med Cmpl $76.54 $91.06 19.00% $8.01 $37,076,890 ANOwed Amount PMPM Med Other Cmpl $47.77 $54.47 14.00% $3.70 $17,094,823 INPATIENT PRICE AND USE (admits) /flowed Amounl lP ACUte Per Admit $20,360.57 $21,717.67 6.70% $4.68 $21,662,168 Admits Per 1000 Acute Cmpl 73.6 75.83 2.80% $1.94 $8,987,727 INPATIENT PRICE AND USE (days) '~ Allowed Amount IP Acute Per Day $4,745.06 $5,070.60 6.90% $4.82 $22,279,476 Days Per 1000 Atlmit Acute Cmpl 315.81 323.95 2.60% $1.81 $8,370,419 OP FACILITY PRICE AND USE Allowed Amount Per Visit OP Fac Med $1,202.12 $1,376.66 14.50% $6.40 $29,626,963. Visits Per 1000 OP Fac Med Cmpl 767.3 809.58 5.50% $2.43 $11,243,448 OP OFFICE PRICE AND USE Allowed Amount Per Visit Office Med $187.45 $204.78 9.20% $4.08 $18,681,459 Visits Per 1000 Office Med Cmpl 4,699.67 5.336.18 8.90% $3.93 $18,195,432 5/16/2006 02 -Online Reporting Samples 1.2 Net Pay Rx Cmpl ENROLLMENT CHANGE ~. Member Months Rx NET PAYMENTS PMPM Nel Pay PMPM Rx Cmpl COST SHARING CHANGE Cosl Sharing PMPM Rx Cmpl ALLOWED AMOUNT PMPM Allowed Amount PMPM Rx Cmpl DRUG PRICE AND USE Allowed Amount Per Script Rx Scripts Per 1000 Rx Cmpl 5/16/2006 $105,711,075 $112,826,746 6.70% $7,115,671 5,125,215 4,628,854 -9.70% ($10,237,786) $20.83 $24.37 18.20% $3.75 $17,353,457 $7.06 $9.57 35.60% ($0.92) ($4,250,458) $27.68 $33.95 22.60% $4.67 $21,603,915 $70.05 $72.17 3.00% $0.64 $2,965,787 4,742.20 5,644.35 19.00% $4.03. $18,638,128 02 -Online Reporting Samples 1.2 1.3 Financial Trends by Service Category -Paid Financial Trends by Service Category displays medical and prescription drug costs on a per employee per month basis by a service category attribute such as Place of Service. Costs are displayed for the most recent year as well as one year prior. The percent change between the two years is also displayed. Inpatient Hospital $143.13 $156.07 9.00% 33.28% 32.47% Outpatient Hospital $101.21 $113.09 11.70% 23.54% 23.53% Office $88.91 $99.94 12.40% 20.68% 20.79% Pharmacy $45.28 $52.17 15.20% 10.53% 10.85% Ambulatory Surgical Center $16.05 $18.33 14.20% 3.73% 3.81% _ Emergency Room -Hospital $10.34 $10.92 5.60% 2.40% 2.270 Patient Home $8.33 $9.61 15.40% 1.949'0 2.00% Independent Laboratory $6.60 $7.50 13.60% 1.54% 1.56% End-Stage Renal Disease Facil $4.71 $5.94 26.30% 1.09% 1.24% Ambulance (land) $1.34 $1.56 15.90% 0.31ฐ'0 0.32% Unknown Medstat Place 0 $1.00 $1.33 33.70% 0.23% 0.28% -Missing $0.75 $1.02 35.70% 0.18% 0.21% Skilled Nursing Facility $0.59 $0.75 27 10% 0.14% 0.16% Ambulance (air or water) $0.64 $0.65 0.40% 0.15ฐh 0.13%. Urgent Care Facility $0.21 $0.46 122.80% 0.05% 0.10% ~, Federally Qualified Health Ctr $0.14 $0.25 74.70% 0.03% 0.05% Hospice $0.23 $0.23 -0.60% 0.05% 0.05% Outpatient, NOS $0.03 $0.23 552.70% 0.01 % 0.05% Comprehensive Outpt Rehab Fac $0.14 $0.16 13.90% 0.03% 0.03% Comprehensive Inpt Rehab Fac $0.08 $0.12 39.70% 0.02% 0.02% Inpatient Psychiatric Facility $0.08 $0.09 14.60% 0.02% 0.02% Rural Health Clinic $0.07 $0.09 32.20% 0.02% 0.02% '- Community Mental Health Center $0.06 $0.06 1 10% 0.01% 0.01% All Place Groups $430.04 $480.67 11.80% 100.00% 100.00% 5/16/2006 02 -Online Reporting Samples 1.3 _ 1.4 Financial Trends By Provider Type -Paid Financial Trends by Provider Type displays medical and prescription drug costs on a per employee per month basis by provider type. Costs are displayed for the most recent year as well as one year prior. The percent change between the two years is also displayed. PEPM Med and Rx Acute Care HospitaC $179.28 $200.71 12.00% 41.69% 41.76ฐh Pharmacy $45.72 $52.64 15.10% 10.63% 10.95% Family Practice $24.51 $24.78 1 10% 5.70% 5.16% Other Facility (NEC) $16.29 $16.59 1.80% 3.79% 3.45% Internal Medicine (NEC) $10.17 $12.18 19.70% 2.37% 2.53ฐ~ Radiology $10.87 $11.25 3.50ฐk 2.53% 2.34% Obstetrics 8 Gynecology $10.16 $10.28 1.20% 2.36ฐh 2.14% Anesthesiology $8.89 $9.64 8.40% 2.07ฐh 2.01 Pediatrician (NEC) $8.24 $8.20 -0.50% 1.92% 1.71% Ambulatory Surgery Centers $5.79 $7.55 30.50ฐ~ 1.35% 1.57% CardiovascularDis/Cardiology $6.51 $7.45 14.40% 1.51% 1.55ฐh Surgeon (NEC) $6.96 $7.36 5.70ฐ~ 1.62% 1.53% Orthopaedic Surgery $5.25 $6.37 21.40% 1.22% 1.32% Laboratory $5.48 $5.90 7.80% 1.27% 1.23% -Missing $5.23 $5.78 10.50% 1.22% 1.20% Oncology $4.28 $5.38 25.80% 0.99% 1.12% Treatment Center $2.87 $4.95 72.90% 0.67% 1.03% Hematology $4.50 $4.94 9.60% 1.05% 1.03% Supply Center $4.07 $4.93 21.00% 0.95% 1.03% Home Health Organiz/Agency $4.19 $4.47 6.80% 0.97% 0.93ฐh Pathology $3.70 $4.08. 10.50% 0.86% 0.85% Emergency Medicine $3.28 $3.71 13.10% 0.76% 0.77% Imaging Center $2.69 $3.53 31.30% 0.62% 0.73% Pediatric Orthopaedics $3.23 $3.46 7.10% 0.75ฐh 0.72% Gastroenterology $3.13 $3.36 7.30ฐh 0.73% 0.70% Chiropractor/DCM $2.81 $3.20 13.60ฐh 0.65ฐh 0.67% Therapy (Physical) $2.48 $2.98 20.10% 0.58% 0.62% Otolaryngology $2.93 $2.96 1.30% 0.68% 0.62ฐ~ Rehabilitation Facilities $0.89 $2.91 226.10% 0.21% 0.61% Ophthalmology $2.64 $2.82 6.70% 0.61% 0.59% Urology $2.32 $2.50 7.80% 0.54ฐh 0.52% Transportation $2.28 $2.38 4.60ฐh 0.53% 0.50% All Provider Types $430.04 $480.67 11.80% 100.00% 100.00% 5/16/2006 02 -Online Reporting Samplesl 4 1.5 Cost Trends by Paid Month Cost Trends by Paid Month displays the monthly trend in medical and prescription drug net payments, as well as enrollment, by month of payment. A year-to-year summary comparison is also included. PMPM Med and Rx May-04 Jun-04 Jul-04 Aug-04 Sep•04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-OS Oct-05 Nov-05 Deo-05 Jan-06 Feb-O6 Mar-O6 Change (Pd Roll Yrs) 5/16/2006 215,174 $87,050,546 $404.56 215,311 $8,745,252 $40.62.. 212,692 $78,597,912 $369.54 212,823 $8,912,822 $41.88- 209,941 $72,784,171 $346.69 210,076 $8,241,827 $39.23 209,020 $75,044,571 $359.03 209,153 $9,000,233 $43.03 193,905 $74,976,451 $386.67 194,041 $8,912,585 $45.93 190,221 $67,557,302 $355.15 190,360 $8,648,914 $45.43 191,040 $84,186,729 $440.68 191,181 $9,766,128 $51.08 193,157 $73,059,522 $378.24 193,299 $9,092,035 $47.04 191,972 $74,740,877 $389.33 192,136 $8,070,585 $42.00 191,766 $81,564,411 $425.29 191,953 $8,878,989 $46.26 190,052 $69,617,040 $366.31 190,216 $10,565,639 $55.55 188,128 $75,418,138 $400.89 188,299 $8,878,188 $47.15. 187,807 $83,134,860 $442.66 187,977 $9,041,391 $48.10 185,710 $73,601,094 $396.32 185,877 $10,067,304 $54.16 185,812. $72,292,210 $389.06 165,984 $10,091,054 $54.26 185,072 $76,358,162 $412.59 185,241 $9,933,897 $53.63 185,498 $74,043,347 $399.16 185,845 $9,804,930 $52.76 184,538 $76,006,875 $411.88 184,712 $9,746,691 $52.77 184,717 $99,752,953 $540.03 184,891 $10,796,524 $58.39 168,308 $77,988,410 $463.37 168,402 $8,529,033 $50.65 167,732 $65,834,104 $392.50 167,832 $7,874,529 $46.92 167,949 $67,890,649 $404.23 168,050 $8,707,328 $51.81 168,180 $67,954,397 $404.06 168,275 $8,452,591 $50.23 168,371 $82,009,784 $487.08 168,458 $8,677,565 $51.51 -10.00% 0.20% 11.40ฐ/a -10.00% 3.70% 15.20% 02 -Online Reporting Samplest.5 2.1 Cost Benchmark Comparison The Cost Benchmark Comparison provides an overview of benefit plan costs compared to selected norms. Allowed Amount Allowed Amount PMPY Med CmpD $4,503. 50 $2,774. 75 82. 30% Allowed Amount PMPY Admit Acute $1,545. 81 $895. 08 72. 70ฐh Allowed Amount PMPY OP Med Cmpl $2,831. 42 $1,773. 73 59. 60% Allowed Amount PMPY Rx Cmpl $407. 38 $738. 03 -44. 80% Allowed Amount PEPY Med Cmpl $9,447. 36 $6,380. 38 48. 50ฐh Allowed Amount PEPY Admit Acute $3,242. 77 $2,034. 90 59. 40% Allowed Amount PEPY OP Med Cmpl $5,939. 69 $4,158. 20 42. 80% Allowed Amount PEPY Rx Cmpl $854. 34 $1,839. 47 -53. 60% Out of Pocket Net Pay PMPY Med Cmpl' Net Pay PMPY Admit Acute Net Pay PMPY OP Med Cmp6 Net Pay PMPY Rx Cmpl Net Pay PEPY Med Cmpl Net Pay PEPY Admit Acute Net Pay PEPY OP Med Cmpl Net Pay PEPY Rx Cmpl $2,381.54 $803.96 $1,512.90 $292.50 $4,995.95 $1,686.52 $3,173.73 $613.40 5/16/2006 02 -Online Reporting Samples 2.1 $2,273.03 4.80%: $757.15 6.20% $1,427.07 6.00% $588.34 -50.30% $5,130.78 -2.60%, $1,693.65 -0.40% $3,296.31 -3.70% $1,491.84 -58.90% 2.2 Price and Use Benchmark Comparison The Price and Use Benchmark Comparison provides an overview of benefit plan prices and utilization compared to selected norms. Allowed Amount _ rr Allowed Amount Per AdmitACUte $24,922.87 $16,235.32 53.50% Allowed Amount Per Day Admit Acute $7,172.92 $3,257.66 120.20% _ Allowed Amount Per Service OP Med $135.77 $95.32 42.40ฐh Allowed Amount Per Patient OP Med $2,885.24 $1,999.58 44.30% Allowed Amount Per Script Rx $59.11 $70.60 -16.30% Allowed Amount Per Patient Rx $603.81 $903.33 -33.20ฐ% Utilization Admits Per 1000 Acute r Days Per 1000 Admit Acute Days LOS Admit Acute Services Per 1000 OP Med Visits Per 1000 Office Med Visits Per 1000 ER Scripts Per 1000 Rx Scripts Per Patent Rx Scripts Rx % Generic $47.17 $60 .62 -22 .20% $163.90 $237 .66 -31 .00% $3.47 $4 .01 -13 .30% $16,514.89 $16,075 .47 2 .70% $3,640.22 $4,811 .83 -24. 30% $154.31 $190 .76 -19 .10% $6,827.90 $7,499 .75 -9 .00%. $10.22 $12 .80 -20. 20% $0.47 $0 .41 13. 80% 5/16/2006 02 -Online Reporting Samples 2.2 Net Pay Per Admit Acute $17,064.96 $13,544.71 26.00ฐ% Net Pay Per Day Admit Acute $4,911.38 $2,678.46 83.40% Net Pay Per Service OP Med $80.82 $72.95 10.80% Net Pay Per Patient OP Med $1,717.47 $1,530.24 12.20% Net Pay Per Script Rx $51.21 $55.04 -7.00%. Net Pay Per Patient Rx $523.10 $704.29 -25.70ฐ'ฐ 3.1 Inpatient Trend Analysis The Inpatient Trend Analysis displays the monthly trend in inpatient admissions, days, and net payments by month of service. A year-to-year summary comparison is also included, as well as a chart showing the trend by month for admission rates and inpatient days per 1000. Jan-04 2,046 62.3 277.43 4.45 $9,565.89 $2,148.15 i Feb-04 2,108 59.61 248.44 4.17 $9,252.25 $2,219.87 Mar-04 2,587 67.93 300.22 4.42 $9,118.63 $2,063.14 Apr-04 2,298 60.16 259.82 4.32 $9,172.84 $2,123.85 May-04 2,451 64.07 289.18 4.51 $10,058.29 $2,228.41 Jun-04 2,522 66.19 297 4.49 $9,718.95 $2,165.87 Jul-04 2,644 69.73 292.9 4.2 $10,425.89 $2,482.09 Aug-04 2,550 67.42 287.34 4.26 $10,263.13 $2,408.30 Sep-04 2,602 69.59 317.44 4.56 $10,868.16 $2,382.39 Oct-04 2,681 71.64 316.61 4.42 $10,380.76 $2,348.99 Nov-04 2,582 70.12 314.14 4.48 $10,714.02 $2,391.39 Dec-04 2,632 71.38 312.5 4.38 $10,732.28 $2,451.60 Jan-OS 2,461 66.72 308.18 4.62 $11,260.84 $2,437.80 s Feb-05 2,603 71.06 308.13 4.34 $10,272.32 $2,369.00 Mar-05 2,648 70.37 345.61 4.91 $11,416.13 $2,324.30 r Apr-05 2,427 65.06 277.12 4.26 $10,205.37 $2,395.86 May-05 2,764 74.27 313.63 4.22 $10,394.81 $2,461.55 Jun-05 2,716 73.41 317.97 4.33 $10,690.51 $2,468.16 _ Jul-05 2,713 73.69 329.69 4.47 $10,953.64 $2,448.28 Aug-05 2,603 71.78 301.26 4.2 $10,634.75 $2,534.08 Sep-05 2,547 71.71 289.75 4.04 $10,276.41 $2,543.39 ._ Oct-O5 2,557 74.06 287.93 3.89 $9,914.30 $2,550.13 Nov-05 2,487 75.28 309.67 4.11 $10,800.96 $2,625.81 Dec-O5 2,449 84.17 336.32 4 $9,722.26 $2,433.30 5/16/2006 02 -Online Reporting Samples3.1 Dec 2004 29,703 66.74 293.02 4.39 $10,055.09 $2,290.09 Jan 2005 - Dec 2005 30,975 72.5 310.7 4.29 $10,550.86 $2,461.98 Change (Roll Yrs) 4.30% 8.60% 6.00% -2.40% 4.90% 7.50% -- 3.2 MDC Cost and Use Analysis The MDC Cost and Use Analysis displays key measures of cost and use by Major Diagnostic Category (MDC). Musculoskeletal $141,317,416 116,285 $1,215.27 6.03 4.12 104.06 962.92! Circulatory $115,438,159 76,315 $1,512.65 9.39 3.94 50.63 352.82 Digestive $86,180,165 69,253 $1,244.43 6.37 4.59 77.03 212.48. Nervous $55,991,205 42,456 $1,318.81 3.47 5.23 35.24 195.48 Health Status $54,804,779 199,370 $274.89 0.92 11.04 119.14 642.47 Skin, Breast $47,242,829 108,616 $434.95 1.45 4 63.13 408.06 Respiratory $46,027,969 67,606 $680.83 5 5.52 36.6 223.42' Ear, Nose, Mouth 8 Throat $44,242,770 151,858 $291.34 0.94 3.2 52.62 751.58r Female Reprodudive $39,492,510 45,210 $873.53 4.13. 2.72 23.05 155.57 Kidney $38,027,004 36,187 $1,050.85 2.01 4.36 35.38 115.27 Pregnancy, Childbirth $36,477,130 8,921 $4,088.91 11.24 2.84 15.6 35.99 Metabolic $28,854,433 71,279 $404.81 2.63 3.43 38.88 268.27 Liver, Pancreas $27,506,928 8,895 $3,092.40 2.13 5.36 11.94 24.86 Myeloproliferative Diseases $24,743,925 5,969 $4,145.41 0.74 7.29 9.04 30.12 Newborns $24,163,321 6,045 $3,997.24 7.19 4.01 2.2 6.48. Eye $15,937,535 57,862 $275.44 0.12 2.38 11.75 195.89! Mental $13,046,026 32,189 $405.29 2.05 6.84 9.68 216.93 Blood $11,209,842 13,564 $826.44 0.63 5.49 8.7 45.93 Male Reprodudive $9,574,879 14,582 $656.62 0.56 3.14 6.76 48.04 Infedions $9,338,146 21,711 $430.11 1.05 6.72 8.42 44.23 Injuries, Poisonings $8,418,499 19,478 $432.21 0.89 3.68 11.12 27.13 -Missing $3,875,212 12,008 $322.72 0.03 2.75 3.4 20.79 Alcohol/Drug Use $2,342,305 1,292 $1,812.93 0.72 7.27 1.99 3.72 HIV Infedions $904,230 329 $2,748.42 0.08 9.08 0.23 1.93. Burns $796,435 842 $945.88 0.03 9 0.91 1.87 All MDCs $885,953,651 388,432 $2,280.85 69.96 4.29 730.91 4,648.79 5/16/2006 02 -Online Reporting Samples 3.2 - 3.3 Top 25 Clinical Conditions The Top 25 Clinical Conditions report displays wst antl use statistics for the 25 clinical conditions with the highest net payments. A summary table at the bottom of the report compares the totals of the top 25 clinical conditions to the grantl totals across all conditions. t;oronary artery uisease 543.581,513 4.92% 11,155 53,907.80 3.7 6.57 47.13 Back Disorders 541,089,107 4.64% 45,463 $903.79 1.55 25.13 390.75 Signs, Symptoms, Oth Contl NEC 535,933,173 4.06ฐk 59,964 $599.25 2.59 36.28 143.86 Gastroint Disord, NEC 532,588,092 3.68% 44,474 $732.74 1.6 39.37 103.13 Prevent/Admin Hlth Encounters $30,316,964 3.42% 168,829 $179.57 0.06 75.68 484.19 Pregnancy w Vaginal Delivery $25,609,611 2.89% 5,123 $4,998.95 6.86 0.12 0.82 Osteoanhdtis E21,455,797 2.42ฐh 15,723 $1,364.61 1.75 7.32 73.97 Arthropathies/JOint Disord NEC $18,006,113 2.03% 39,070 $480.87 0.23 18.94 168.18 Musculosk Trauma Etc Fractures $17,503,998 1.98% 28,284 $618.87 0.31 24.72 69.73 ENT Disorders, NEC $15,841,117 1.79ฐ,6 83,973 $188.65 0.36 16.73 396.01 Respiratory Disord, NEC $15,685,073 1.77% 30,874 5508.04 0.43 14.92 63.23 Newboms, Normal 515,460,436 1.75% 4,894 $3,159.06 3.99 0.08 0.31 Infections-ENT Ex Otitis Med $14,505,452 1.84% 77,135 $188.05 0.3 20.58 232.17 Pregnancyw Compl or Abortion 514,404,068 1.63ฐ~ 10,537 $1,367.00 0.93 25.09 67.1 Renal Function Failure $13,813,532 1.56% 1,492 $9,258.40 0.16 6.93 5.82 Musculosk Disord, NEC $13,503,283 1.52% 34,900 $386.91 0.42 14.27 129.78 Cancer-Breast 513,241,273 1.49ฐh 2,479 $5,341.38 0.29 6.77 27.8 Cholecystitis 512,263,491 1.38ฐ~ 2,545 $4,818.66 0.95 3.69 4.29 Cardiovasc Disord,NEC $11,635,453 1.34ฐ.6 13,877 $852.88 0.5 6.54 35.88 Endocrine Disorders, NEC 510,533,861 1.19% 51,048 $206.35 0.78 18.37 143.23 Gynecological DisoM, NEC $9,905,736 1 12% 19,262 $514.26 0.66 7.04 46.17 Cerebrovascular Disease 59,506,037 1.07% 4,120 $2,307.29 1.31 2.94 10.76 Nonspecific Disorders, NEC $9,406,524 1.06ฐh 36,446 $258.09 0.09 12.78 75.86 Tumors-Gynewlogical, NEC 59,274,408 1.05% 5,809 $1,596.56 1.57 3.21 11.95 Newborns, w Complice8on $9,255,598 1.04 % 2,905 $3,186.09 3.19 2.11 5.99 5/16/2006 02 -Online Reporting Samples 3.3 Top Clinical Conditions 5464,529,892 15,311 175,419 1,212,271 All Clinical Conditions 5885,953,651 30,975 323,627 2,058,366 Top Clinical Conditions as Pct of All Clinical Conditions 52.43ฐh 49.43% 54.20% 58.89% Note: "All Clinical Conditions" represents data limited to the slicer selections. 3.4 Top 25 Hospitals The Top 25 Hospitals displays inpatient admission information for the 25 hospitals with the highest inpatient net payments. A summary table at the bottom of the report compares the totals of the top 25 hospitals to the grand totals across all hospitals. CARSON-TAHOE HOSPITAL $6,200,498 1.90% 619 3.15 $10,016.96 $3,176.48 MEMORIAL HERMANN HEALTHCARE SY $6,167,328 1.89% 335 3.92. $18,409.94 $4,693.55. WASHOEMEDICALCENTER $6,001,191 1.84% 751 4.48 $7,990.93 $1,783.41 BAYLOR UNIVERSITY MED CTR $5,631,771 1 72% 246 6.98 $22,893.38 $3,281.92. MOTHER FRANCES HOSPITAL $4,678,271 1.43ฐ/a 522 3.68 $8,962.20 $2,434.06 SW TEXAS METHODIST HOSPITAL $4,203,357 1.29ฐh 447 3.92 $9,403.48 $2,397.81 THE METHODIST HOSPITAL $4,167,109 1.28% 235 4.43 $17,732.38 $4,006.84 SUNRISE HOSPITAL $3,807,410 1.17% 384 4.71 $9,915.13 $2,103.54 ST LUKES EPISCOPAL HOSPITAL $3,772,281 1.15% 219 5.38 $17,225.03 $3,202.28 M DANDERSON $3,481,470 1.07% 159 6.14 $21,896.04 $3,563.43 SOUTHWESTTEXASMETHODIST HOSP $3,068,826 0.94% 191 4.52 $16,067.15 $3,556.00 VALLEY HOSPITAL MED CTR $3,020,376 0.92% 248 4.43 $12,178.94 $2,748.29' WOMANS HOSPITAL OF TX $2,780,375 0.85% 212 3.37 $13,114.98 $3,888.64 PROVIDENCE HOSPITAL $2,579,609 0.79ฐh 234 3.82 $11,023.97 $2,882.24 HOUSTON NORTHWEST PARTNERS LTD $2,501,674 0.77% 161 4.09 $15,538.35 $3,801.94 MEDICAL CENTER OF PLANO $2,407,261 0.74% 121 6.78 $19,894.72 $2,935.68 SAINT MARYS REGIONAL MED $2,282,644 0.70% 254 5.13 $8,986.79 $1,750.49 ST ROSE DOMINICAN SIENA $2,160,496 0.66ฐk 192 3.96 $11,252.58 $2,839.02 LDS HOSPITAL $1,961,818 0.60% 273 3.19 $7,186.15 $2,249.79 MEMORIAL HOSPITAL & HCC $1,864,785 0.57% 380 2.79 $4,907.33 $1,757.57 ARLINGTON MEMORIAL HOSPITAL $1,835,291 0.56% 193 3.67 $9,509.28 $2,588.56 ST LUKES HOSPITAL $1,819,281 0.56% 358 3.26 $5,081.79 $1,558.94 CHILDRENS MEDICAL CENTER $1,771,995 0.54% 48 4.77 $36,916.56 $7,737.97 MHHS MEMORIAL CITY HOSP $1,766,640 0.54% 158 3.09 $11,181.27 $3,612.76 PRESBYTERIAN DALLAS $1,747,719 0.53% 202 4.3 $8,652.08 $2,013.50 Top Hospitals $81,679,477 All Hospitals $326,812,927 Top Hospitals as Pct of All Hospitals 24.99% Note: "All Hospitals" represents data limited to the slicer selections. 7,142 29,537 30,975 132,744 23.06% 22.25% 5/16/2006 02 -Online Reporting Samples 3.4 4.7 Preventive Screening Benchmarks The Preventive Screening Benchmark Comparison displays screening rates for preventive services which typically indicate a high level of quality of care. The Cervical Cancer Screening Rate 42.44% 44.00% -3.50% Cholesterol Screening Rate 24.58% 23.00% 6.90%. Colon Cancer Screening Rate 18.56% 23.00% -19.30% Mammogram Screening Rate 44.22% 53.00% -16.60% PSA Screening Rate 29.49% 31.00% -4.90% Well Baby Visits Per 1000 3,597.70 3,969.22 -9.40% Well Child Visits Per 1000 406.78 415.9 -2.20% 5/16/2006 02 -Online Reporting Samples 4.1 - 4.2 Chronic Conditions Profile The Chronic Conditions Profile report displays financial and prevalence information for chronic diseases such as Asthma, Diabetes, and Hypertension. A summary table at the bottom of the report compares the totals of the chronic conditions to the grand totals across all clinical conditions. Asthma $3,985,337 12,830 $310.63 0.78 3.36 4.12 44.49. COPD $4,151,721 11,739 $353.67 0.68 5.55 5.08 29.91 - Coronary Artery Disease $43,591,513 11,155 $3,907.80 3.7 4.01 6.57 47.13 Diabetes $7,821,006 17,570 $445.13 0.7 4.8 11.71 100.27 HIV Infection $923,893 348 $2,654.86 0.07 9.55 0.28 2.11 - Hypertension, Essential $7,939,062 41,558 $191.04 0.43 4.19 10.8 165.1 Mental Hlth -Affective Disord $5,322,660 7,154 $744.01 1.41 6.65 2.7 63.07 Mental HRh -Anxiety Disorder - $888,390. 5,402 $164.46 0.05 2.26 1.26 22.6 Mental Hlth -Depress Ex Major $1,502,943 7,400 $203.10 0.19 5.61 1.21 33.94 Osteoarthdtis $21,455,797 15,723 $1,364.61 1.75 4.01 7.32 73.97 - Rheumatoid Arthritis $2,929,011 1,692 $1,731.09 0.03 4.27 1.34 12.89• All Clinical Conditions $885,953,651 30,975 323,627 2,058,366 - Chronic Conditions as Pct of Alf Clinical Conditions 11.34% 14.03% 7.17% 12.81% Note: "All Clinical Conditions" represents data limited to the slicer selections. 5/16/2006 02 -Online Reporting Samples 4.2 ฐ- 5.1 Cost Overview by Product Line The Cost Overview by Product Line displays key acute inpatient and outpatient medical cost information by product line for the most recent year as well as one year prior. The percent change in these measures between the two years is also displayed. Jan 2005 -Dec 2005 GOLD PLAN SILVER PLAN ` BRONZE PLAN All Product Lines 5,724 8,205 1, 080 15, 009 30.7 $269.70 $94.47 $139.55 27.4 $204.16 $62.56 $113.19 25.8 $20.04 $0.00 $17.15 28.4 $216.10 $70.23 $116.52 $0.31 $35.37 $0.17 $28.24 $0.00 $2.89 $0.21 $29.14 Jan 2004 -Dec 2004 GOLD PLAN SILVER PLAN BRONZE PLAN All Product Lines 6,190 29.9 $215. 48 $49. 42 $129.34 8,196 27.2 $165. 28 $49. 07 $94.39 888 27.8 $46. 45 $0. 89 $43.94 15,274 28.3 $178. 71 $46. 41 $105.62 $0.84 $35.88 $0.40 $21.43 $0.03 $1.60 $0.56 $26.12 Percent GOLD PLAN SILVER PLAN. -- BRONZE PLAN All Product Lines 5/16/2006 -7.50% 1.20% 25.20% 91.10% 7.90% -63.30% -1.40% 0.10% 0.90ฐh 23.50% 27.50% 19.90% -56.60% 31.80% 21.60% -7.20% -56.90% -100.00% $1.00% -100.00% 80.80% -1.70% 0.30% 20.90% 51.30% 10.30% -61.80% 11.50% 02 -Online Reporting Samples 5.1 5.2 Medical Utilization by Product Line The Medical Utilization by Product Line displays key acute inpatient and outpatient medical utilization information by product line for the most recent year as well as one year prior. The percent change in these measures between the two years is also displayed. Jan 2005 -Dec 2005 GOLD PLAN' '- SILVER PLAN. BRONZE PLAN All Product Lines Jan 2004 -Dec 2004 Percent GOLD PLAN SILVER PLAN BRONZE PLAN All Product Lines 477 5,724 684 8,205 90 1,080 1,251 15,009 516 6,190 663 8,196 74 888 1,273 15,274 54.26 4.48 243.09 861.36 4,514.06 131.62 52.1 2.74 142.5 577.8 3,553.30 182 218.49 1, 250.68 138.64 49.11 3.47 170.64 660.9 3,753.98 159.67 69.81 2.69 188.11. 909.46' 4,443.40 178.44- 63 4.19 263.72 509.73 3,195.34 171.37 13.52 1 13.52 202.75 1,068.01 94.61 62.88 3.48 218.52 653.89 3,579.80 169.77 GOLD PLAN -7.50%' -7.50% -22.30% 66.30Yo 29.20% -5.30% 1.60% -26.20% SILVER PLAN 0.10% 0.10% -17.30% -34.70% -46.00% 13.40% 11.20% 6.20% BRONZE PLAN 21.60% 21.60% -100.00% -100.00% -100.00% 7.80% 17.10% 46.50% All Pft)duCt Lines -1.70% -1 70ฐ/a -21.90% 0.00% -21.90% 1.10% 4.90% -5.90% 5/16/2006 02 -Online Reporting Samples 5.2 6.1 Prescription Drug Cost and Use Analysis -Paid The Prescription Drug Cost and Use Analysis provides an analytical summary of cost and utilization associated with prescription drug coverage. A summary of prescription drug membership information is also included. Net Pay Rx $98,143,743 $99,951,532 1.80% Net Pay PEPM Rx $37.67 $39.69 5.40% Net Pay PMPM Rx $18.13 $19.08 5.20% " Net Pay Per Script Rx $47.92 $53.08 10.80% Net Pay Per Days Supply Rx $0.96 $0.87 -9.70% Copay Per Script Rx $15.63 $16.88 8.00% ฐ Discount Off AWP Pd 77.04% 80.46% 4 40% Scripts PMPY Rx 4.54 4.31 -5.00% Scripts Per Patient Rx 11.86 11.57 -2.40% Days Supply PMPY Rx 226.35 263.77 16.50% Scripts Rx % Mail Order 11.68% 13.43% 15.00% Scripts Rx % Generic 38.21 % 40.61 % 6.30% Scripts Generic Efficiency Rx 81.67% 84.34% 3.30% Employees Avg Rx Employee Months Rx 555 6,657 554 -0.20% 6,643 -0.20% 5/16/2006 02 -Online Reporting Samples 6.1 6.2 Generic Prescription Drug Analysis -Paid The Generic Prescription Drug Analysis compares f nancial and utilization information for generic and brand name drugs by General Therapeutic Class. It also provides a year to year summary comparison of this information. Central Nervous System 408,793 207,775 50.83% 92.90% $16.14 $97.98. Cardiovascular Agents 319,287 108,943 34.12% 89.80% $21.72 $72.48. Hormones & Synthetic Subst 311,602 87,664 28.13% 54.18% $15.83 $46.11 Anti-Infective Agents 223,617 107,821 48.22% 95.13% $17.95 $63.62 Autonomic Drugs 88,822 55,472 62.45% 90.46% $15.83 $97.72'. Antihistamines & Comb. 86,716 15,720 18.13% 87.52% $11.03 $51.13': Gastrointestinal Drugs 84,584 25,413 30.04% 92.87% $59.61 $153.00 Skin & Mucous Membrane 66,240 26,599 40.16% 80.84% $16.48 $47.43' Electrolytic, Caloric, Water 63,787 59,081 92.62% 94.91% $6.75 $32.39'` Eye, Ear, Nose Throat 58,457 11,793 20.17% 91.06% $9.23 $51.25: Unclassified Agents 54,231 9,109 16.80% 97.60% $8.75 $117.64 Antituss/Expector/Mucolytic 35,173 26,109 74.23% 91.92% $8.34 $16.00, Blood Form/Coagul Agents 21,256 8,075 37.99% 67.69% $18.13 $154.38 Vitamins & Comb 15,630 7,742 49.53% 58.61% $21.51 $49.77 Diagnostic Agents. 12,257 $78.01 Smooth Muscle Relaxants 8,064 1,326 16.44% 75.60% $11.47 $95.71 AntineoplasticAgents 7,449 4,198 56.36% 97.56% $72.56 $827.84: 5/16/2006 02 -Online Reporting Samples 6.2 Apr 2004 -Mar 2005' 2,048,235 782,671 38.21 % 81.67%, $15.97 $67.67 Apr 2005 -Mar 2006 1,883,183 764,776 40.61 % 84.34% $17.78 $77.21 Change -8.10% -2.30% 6.30% 3.30% 11.40% 14.10% 6.3 Top 25 Drugs -Paid Top 25 Prescription Drugs displays key measures of cost, use, and intensity for the 25 prescription drugs with the highest net payments. A summary table at the bottom of the report compares the totals of the top 25 drugs to the grand totals across all drugs. LIPITOR $4,134,957 4.14% 40,281 $102.65 $1.21 $24.57 4.37 NEXIUM $2,924,629 2.93% 18,824 $155.37 $2.31 $27.83 3.45 PREVACID $2,492,598. 2.49% 15,531 $160.49 $2.25 $28.49 3.46 ZOCOR $2,043,646 2.04% 14,155 $144.38 $1.74 $31.89 3.99 CELEBREX $1,674,917 1.68% 13,838 $121.04 $1.68 $25.10 2.75' PRAVACHOL $1,473,559 1.47% 10,613 $138.84 $1.70 $26.46 4.38 EFFEXOR-XR $1,445,385 1.45% 12,821 $112.74 $1.40 $24.87 4.31 ZOLOFT $1,393,205 1.39% 17,225 $80.88 $1.09 $24.87 3.78 ALLEGRA $1,257,415 1.26% 19,701 $63.82 $0.91 $21.64 2.5 _ WELLBUTRIN SR $1,132,766 1.13% 10,580 $107.07 $1.46 $25.03 3.12 VIOXX $1,085,155 1.09% 11,819 $91.81 $1.31 $24.54 2.43 ACTOS $1,060,247 1.06% 5,703 $185.91 $2.00 $26.87 4.39 NEURONTIN $1,059,503 1.06% 8,022 $132.07 $2.03 $24.71 3.62 OMEPRAZOLE $1,041,369 1.04% 7,316 $142.34 $1.52 $12.22 3.37 SINGULAIR $1,030,433 1.03% 12,258 $84.06 $1.00 $23.63 3.1 PLAVIX $1,028,393' 1.03% 7,453 $137.98 $1.82 $26.28 4.34 ENBREL $985,858 0.99% 622 $1,584.98 $21.04 $45.17 4.47 NORVASC $923,231 0.92% 16,755 $55.10 $0.66 $21.60 4.58 ZYRTEC $916,151 0.92% 21,459 $42.69 $0.63 $23.39 2.43 PROTONIX $875,544 0.88% 7,809 $112.12 $1.37 $26.40 3.17 OXYCONTIN $848,780 0.85% 2,972 $285.59 $4.04 $36.21 4.94. AMBIEN $818,102 0.82% 14,209 $57.58 $1.06 $22.28 2.99 -- IMITREX $802,163 0.80% 3,866 $207.49 $5.89 $26.28 2.92 ACIPHEX $794,569 0.79% 5,507 $144.28 $1.64 $28.49 3.41 FOSAMAX $785,821 0.79% 9,881 $79.53 $1.12 $23.09 4.56 _ Top Drugs $34,028,397 309,220 All Drug Classifications $99,951,532 1,883, 183 Top Drugs as % of All Drugs 34.04% 16.42% 5/16/2006 02 -Online Reporting Samples 6.3 7.1 Enrollment Overview -Employee/Paid The Enrollment Overview displays year-over-year changes in the number of members and employees, followed by a chart displaying the age/gender distribution of the population. Average Members Med by Age and Gender 600000 500000 400000 300000 200000 100000 0 Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages Ages < 1 1-4 5-9 10- 15- 18- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 75- 85+ 14 17 19 24 29 34 39 44 49 54 59 64 74 84 5/16/2006 02 -Online Reporting Samples7.1 Average Employees Med 217,021 209,712 -3.40% Average Family Size Med 2.08 2.08 0.20% Average Members Med 450,848 436,368 -3.20% Member Months Med 5,410,177 5,236,413 -3.20% Average Age Med 33.3 33.7 1.10% Average Employees Rx 217,133 209,845 -3.40% Average Family Size Rx 2.08 2.08 0.20% Average Members Rx 451,023 436,559 -3.20% Member Months Rx 5,412,275 5,238,703 -3.20% Average Age Rx 33.4 33.7 1.10% 7.2 Network Performance Network Performance provides an overview of network costs both in total and by setting of care. TOTALS ~ . 1 1 ~ ~ ~ ~ . ~ ~ 1 ~ . Net Pay Med $820,347,769 $903,278,350 Net Pay IP Acute $314,790,960 $343,080,019 Net Pay OP Fac Med $206,102,498 $231,202,549 Net Pay Office Med $180,819,258 $204,960,009 Visits OP Fac Med 328,392 340,574 Visits Office Med 1,938,254 2,125,454 Paid In Network 1_VI • . er.7i ~41IILS19F.i'i'4~IIL7,_r.Ti ~4~DL'1019F.Ti'4~I~I:1 Net Pay Med' $697,093,191 $777,218,568 Net Pay IP Acute $273,875,364 $302,507,893 _ Net Pay OP Fac Med $186,027,073 $206,344,291 Net Pay Office Med $157,723,820 $181,798,809 Visits OP Fac Med 289,587 301,895 Visits Office Med 1,599,271 1,793,135 .. Net Pay Med' $123,254,579 $126,059,782 Net Pay IP Acute $40,915,596 $40,572,126 Net Pay OP Fac Med $20,075,425 $24,858,258 Net Pay Office Med $23,095,438 $23,161,200 Visits OP Fac Med 39,650 39,547 Visits Office Med'. 348,359 342,208 10.10% 9.00% 12.20% 13.40% 3.70% 9.70% 11.50% 10.50% 10.90% 15.30% 4.30% 12.10%' 2.30% -0.80% 23.80%, 0.30% -0.30% -1.80% 5/16/2006 02 -Online Reporting Samples 7.2 Net Pay Med 84.98% 86.04% 1.30%I Net Pay IP Acute 87.00% 88.17% 1.30% Net Pay OP Fac Med. 90.26% 89.25% -1.10% Net Pay Office Med 87.23% 88.70% 1.70% Visits OP Fac Med 88.18% 88.64% 0.50% Visits Office Med 82.51 % 84.36% 2.20% nta a Paid Out of Network ~. 1 1~ 1 1 ~• 1 1 ~ ~. •- Net Pay Med 15.02% 13.96% -7.10%, Net Pay IP Acute 13.00% 11.83% -9.00% Net Pay OP Fac Med 9.74% 10.75% 10.40% Net Pay Office Med. 12.77% 11.30% -11.50% Visits OP Fac Med 12.07% 11.61% -3.80% Visits Office Med 17.97% 16.10% -10.40% 5/16/2006 02 -Online Reporting Samples 7.2 ~ฐ- 7.3 High Cost Patients High Cost Patients provides a listing of the 25 patients with the highest net payments during the most recent 12 month period. A summary table at the bottom of the report compares the totals of the top 25 patients to the grand totals across all patients. Person 216114 Child/Other Dependent Female Ages < 1 Tetralogy of Fallot $2,000,000' r Person 464100 Child/Other Dependent Male Ages < 1 Perinatal Condition NEC $1,000,000.: Person 087428 Employee/Self Male Ages 50-54 Compl Liver Transplant $879,717 Person 539064 Child/Other Dependent.. Male Ages < 1 Oth Mult LB-Hosp wo Cs $858,823 Person 698486 Child/Other Dependent Male Ages < 1 Single LB In-Hosp w Cs $794,704 Person 527007 Spouse/Partner Female Ages 459 Oth Lymp Unsp Xtrndl Org $792,498 Person 005426 Employee/Self Male Ages 30-34 Acute Pancreatitis $763,605 Person 252807 Child/Other Dependent Male Ages 10-14 Mal Neo Soft Tissue Leg, $758,384 Person 333041 Employee/Self Male Ages 60-64 Postinflam Pulm Fibrosis $735,083: Person 154806. Child/Other Dependent Male Ages < 1 Infest Postop Nonabsorb $712,293 Person 407545 Child/Other Dependent Male Ages < 1 Extreme Immatur 750-9998 $697,017 Person 904368 Child/Other Dependent Male Ages 18-19 Chronic Bronchitis NEC $689,432' Person 364938 Employee/Self Male Ages 5559 Intestinal Obstruct NOS $675,958 5/16/2006 02 -Online Reporting Samples 7.3 Grand Total within the Selected Slices $997,553,549 $901,992,984 $95,560,569 Easy Access It's easy and fast to access online services at www.fiservhealthservices.com. Each user type _ has a Web site dedicated to their specific needs. Online options include: • Care Management Tools • Claim Inquiry (medical, dental, disability, flex, Rx) • COBRA Notifications • Coverage Advisor • Contact Us _ Eligibility and Benefits Inquiry • Electronic EOBs • Enrollment (additions, terminations, _ changes) • Flexible Spending Account (FSA) Inquiry • Forms ,_ Healthcare Advisor'"" • Health Care Cost Summary • Health Information • Health Reimbursement Account (HRA) Balance Information • Health Savings Account Access and Information • Interactive Health and Wellness Center including a Health Risk Assessment o Invoice Inquiry • OrderlD Cards • Otherlnsurance updates • Pharmacy Benefits Information • Provider Network Links • Online Reporting (medical, dental, pharmacy, care management, stop loss) • Rx Order/Refill HIPAA Compliance Fiserv Health has worked extensively with a qualified HIPAA consultant to ensure we are following the letter of the law. We take our commitment to provide compliant services seriously. Security Our online applications are completely secure. We require all users to register and log in. We verify identity so users have access to only their information. Technical Support If at any time you experience difficulties while using Online Services, help Is just a quick, toll-free phone call away Free Services Online services are free of charge to Fiserv Health customers and their employees. Discover a wealth of information that's as close as your computer terminal! the online services listed here are just some of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. F%5e V Health. '~ ฎFiserv Health. No part of this document may be reproducetl without permission. CAO'136 5-06 uur Orlllrle S@rVICCS y1Vf' CIICIIID, IIItl111UC1 D, FJIVVIUCI ~, tlIV44a.C1 ~, and partners the information they need, when they need it. riserv neaitn provwea cuxvnnceu vreu ~rao~-vr pvr woo-~.+~ tea", ..~ our user groups: members, employers, producers, providers and partners. Our portal environment gives each user access to online information quickly and easily. Once users login to their "information ~- center;' they are presented with snapshots of information-or portlets. These portlets are designed to answer a majority of questions upfront, without having to delve into the underlying applications. Name Description Users Check Register Summary by source code of a company's most recent check Employers, producers, partners Summary run Claim Activity Summary of the number of claims in the Fiserv Health Claim Members System Claim Cost Summary Medical and pharmacy claims summarized by type of Members, employers, producers, partners services-the amount the plan paid and amount the employee paid are presented Claim Forms Claim forms specific to each group Members, employers, producers, partners Claim Status Five most recent claims received by Fiserv Health Members, employers, providers, producers, partners Coverage Advisor Assistance in determining which plan offered by an Members employer is right for you Coverage Summary Benefit, effective date, term date and coverage type for Members, employers, providers, each employee and any dependents producers, partners Dental Benefits High-level summarization of the Individual member's dental Members, employers, producers, partners, benefits providers Disease Management Access todisease-specific information for conditions Members Center monitored by Fiserv Health's disease management program Enrollment Workbench List of enrollment transactions that are incomplete Employers, producers, partners Summary Explanation of Benefits Access electronic copies of medical EOBS (in PDF format) Members, employers, producers, partners, (EOB) providers Flexible Spending Link to the Fiserv Health's FSA claim inquiry system Members Account (FSA) Claim Information FSA Resources Links to FSA resources including eligible/ineligible Members expense list, claim forms, calculators, publications and external Web sites Having a Baby Online enrollment program for the Maternity Management Members program Health and Wellness Link to an online health risk assessment, chat rooms, Members Center forums and health news Health News Pertinent articles dealing with health issues-updated Members daily Health Reimbursement HRA starting balance, claims paid-to-date and remaining Members Account (HRA) balance Summary Health Resources Links to health Web sites, health and wellness articles, Members, employers, producers, guides and forms partners Health Savings HSA-specific information Members Account (HSA) Information Healthcare Advisor Program for comparing hospitals and medications and Members learning about specifc medical conditions and procedures Invoice Inquiry Summary of online invoice Employers, producers, partners Summary Medical Benefts High-level summarization of the individual member's in- Members, employers, producers, network medical benefits partners, providers Medical Deductible In-network deductible status-includes the beneft level Members, employers, providers, Status and amounts applied to date for individual lifetime producers, partners maximums, individual and family deductibles and out-of- pocket amounts MyMessages Postings window with messages initiated by either Fiserv Members, employers Healths or the employer MyPharmacy Center Access to pharmacy information including preferred Members, employers, providers Resources products, participating pharmacies and mail order information Provider Directory Link to the member's specific provider network Web site Members, employers, providers, producers, partners Reporting Access online report detailing you plan's performance in Employer, producers, partners medical, dental, care management, pharmacy, and stop loss. F%5el'VHealth..= ฎFiserv Health. No part of [his document may be reprotlucetl without permission. CA0133 S-O6 r What You See You will be able to access two levels of claim detail: At the claim summary level you can view: • Employee name Patient name and date-of-birth • Provider name • Service dates _ Processed date • Claim type (medical or dental) • Billed, paid, other insurance paid and patient _ responsibility amounts • Claim status, along with a description of what is happening with the claim ~- At the claim detail level you can view: • Claim control number • Patient name " Employee name and ID • Service dates • Provider name r Procedure code and type of service Billed, allowable, paid, deductible, not payable, provider discount, other insurance paid and patient responsibility amounts • Benefit percentage _ Payment recipient • Detail (if any) of amounts not payable _ Explanation of Benefits (EOBs) Medical EOBs are available to both members and employers. The EOB is presented in a PDF format and is an exact copy of what the employee receives in the mail. Deductible Status You and your employees can easily view deductible status online. Status is shown at a member level-just like EOBS. You can see benefit level and applied-to- dateamounts for • Individual deductible • Family deductible • Individual out-of-pocket • Famllynut-of-pocket • Health Reimbursement Account (HRA) individual deductible (if applicable) • HRA family deductible (if applicable) Healthcare Cost Summary We also present medical claim information summarized by type of service and plan year. You or your employees can see what your plan paid and the costs they were responsible for. Other Insurance Update Members can update other insurance information online or through an automated IVR phone system. Any claims holding for members without other insurance will automatically be reprocessed. Security and Compliance Employees may gain access only by using their unique ID and password. They can view claim information for only themselves or their dependents. All information presented is HIPAA-compliant. Online Claim Ingwry is just one of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assistyou with any additional questions. F%5e/'V Health. ~' ฎFiserv Health. No part of this document may be reproduced without permission. CA0131 5-06 cur onune calm Inquiry Is avauanle any ilme or ine aay or night. And, not only can you look up claim information, but vour emlglovees can view the status of their claims as well. Eligibility Information With our Online Eligibility Inquiry, you are able to access the following information. • Group name and number • Location • Employee name • Social Security number Date of birth • Gender • Address, phone and e-mail • Relationship • Marital status • Coverages (including benefit, effective date, _ termination date and coverage type) Benefits Information - You can also access specific benefit information for each member Since we customize the pages for each of our customers, you will see benefit detail s for only those services that apply to you. For medical benefits you will see. • Provider network (including a link to that r provider's Internet site) • Co-pays for office visits, urgent care, emergency and hospital admission • Major medical benefits including individual lifetime maximum, individual and family deductibles, benefit level, individual and family out-of-pocket maximums '~ • Routine/wellness benefits • Therapy benefits • Mental, alcohol and drug benefits For dental benefits, you will see. • Limits for specific services including frequency, age limits and special limits Preventive and diagnostic deductibles Additional Information For quick reference, you also have access to the following information. • Pre-certification requirements • Other plan requirements Medical and dental benefit claim filing directions • Glossary of terms and help functionality For Employers and Providers This free service Is also available to employees and providers. By allowing them to check on eligibility and benefits information you cut down on the number of questions asked and calls made to your benefit department. Online Eligibility and Benefits Inquiry isjust one of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. F%SefV Hea/th..= ฎFiserv Heal[h. No part of this document may be reproduced without permission. CAO'136 5-06 have you ever neeaea to verlry meaical coverage ror one or your employees but can't find your plan description booklet? That's never a problem with Fiserv Health. An Easier Way r. Through our Web site you can order replacement or additional ID cards at any time for your eligible employees. To order an ID card, just click on the employee's name. It's that easy-within a few days the new cards wi I I arrive. Employee Access Your eligible employees can also use this feature to order ID cards without your intervention. Once they have registered and logged in to their Member Information Center, they can order an ID card with just two clicks. Online ID Card Ordering is just one of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. "~ 0 Fiserv Health. No part of this document may be reproduced without permission. CA0142 5-06 Ordering employee ID cards can be a hassle. Not with Fiserv Health! We make it fast and easy. overwhelming amounts of paperwork. Benefits Enrollment Made Easy "' Internet Enrollment allows you to: Process new enrollments Terminate employee coverage Add dependents Change employee or dependent demographic information Change individual employee benefit selections Grant employees direct access to enter or update their own information r Business-Intelligent When you access Fiserv Health Internet Enrollment, you are partnering with a "business-Intelligent" system. Only those benefits your organization has chosen are available for selection upon entering enrollment information. The online form requires minimal data entry on your part; most of it can be completed by simply pointing and licking. Also, if you need to re-enroll an employee, all previous Information is stored and can be accessed-saving you time and effort. Activity Center The Activity Center provides a central spot for history of all types of transactions. These transactions remain online so you always have a _ record of entries processed. Save and Finish Later If you begin entering an enrollment transaction but don't have time to finish it, you can save it for later You'll be able to access the incomplete transaction from the activity center at any given time. Employee-Initiated Transactions You may also give your employees access to the Internet Enrollment tool. Any transaction submitted by an employee is sent to the employer's enrollment workbench for approval. Employee-initiated transactions are not forwarded to Fiserv Health until approved by the employer It's Free! Best of all, as a Fiserv Health customer, Internet Enrollment is offered to you free of charge. Find out today how easy it is to enroll or update employee information. Internet Enrollment is/ust one of the service options available to Fiserv Health customers. We also accept enrollment informaLOn through a variety of other media sources including e/ectron~c file transfer. F%SB~V Health.. ฎFiserv Health. No part of this document may be reproduced without permission. CA0743 5-06 wnen ~t comes to your employee oenenr plans, one or ine most time-consuming activities is enrollment. Our Internet Enrollment tool can streamline the process and help reduce Claim Information -- Employees have the ability to view their FSA claim information at both a summary and detail level. At the summary level, they see. ฐ Account type (health care or dependent care) • Claim number • Service from/to dates • Clalm amount • Requested amount '~ Denied amount • Eligible amount ฐ Pending amount • Total paid to date • Last paid date Payment Detail At the detail level, they see. ฐ Payment date Number • Amount ฐ • Aaount type • Total payment amount Balances Employees can also view their most current account balance information including: Employee annual election amount • Total annual election amount Deposits posted to date • Eligible amounts claimed to date • Claims denied to date • Claims paid to date • Remaining claim balance • Account balance Access To access Online FSA Inquiry, employees must complete a simple registration process online where they select their own username and password. Online Flexible Spending Account Inquiry islust one of the sernce options available to R'serv Health customers. Our customer service representatives are standing by to assist you with any additional questions. f%5 Ve/' Health.-= ฐ ฎFiserv Health. No part of this document may be reproduced without permission. CA0137 5-06 1 ~cnwrc .arcn4...a, r•a.a.v w..w ~. +r•a~ a. .. a... .... r,v, ...... r........ the benefit package you offer your employees. Now you can give them the ability to view the status of their account online, 24 hours a day, seven days a week! Diverse Program Our user-friendly format gives members the ability to: • Get current health news Take a health risk assessment Use Interactive tools to manage health issues Interact with others who are facing similar health care concerns • Interact directly with nurse case managers via a secure message center • Use wellness programs Health Risk Assessment Our online health risk assessment provides a synopsis of members' present health and a glimpse of where they may be heading. The more questions that are answered, the more complete and accurate it will be. The evaluation gives suggestions on behaviors that could lead to an improvement in their health. "~ Interactive Tools Whether they need to track immunizations or maintain a daily asthma log for peak flows, members will find a log or record keeper to assist them in our Interactive Tools area. The following tools are available for members: Medications record • Test and measurement results • Medical history - Care plan Message Center Members can communicate directly with nurse case managers via our secure message center. The message center Is also used to send pertinent information to members. Wellness At the wellness area, members can find information to help them lead a healthier lifestyle. The following programs are available: • Fitness • Healthy eating • Weight management • Smoking cessation • Stress management Alerts As members use the Interactive tools, automatic alerts are sent to them if a particular log item (such as a blood pressure reading) falls outside a pre- defined parameter. The alert provides information and encourages members to contact a health care provider. Interactive Health and Wellness is/ust one of the service options available to Fiserv Health customers. Our customer service representaitves are standing by to assist you with any additional questions. l ~%SeIV Healti~.. ฎFiserv Health No part of this document may be reproduced without permission. CA0740 5-06 ~ ne neaiin ana vveuness center can Help your empivyee~ uve healthier lives, thereby reducing medical costs. (Available to clients with utilization management/case management through Fiserv Health.) ._ Our medical and benefit staff has reviewed more than 70 Internet health sites. We've chosen what we feel are the best and offer access via links on our Internet site: '~ Smallstep.gov is sponsored by the U.S. Department of Health and Human Services. It is an interactive and user-friendly Web site that highlights small steps for losing weight and living healthier. • HealthierUS.gov is a source of credible, _ accurate information to help Americans choose to live healthier lives. • MEDLINEpIus is maintained by the National Library of Medicine and the National Institutes of Health. It contains information on specific diseases and conditions. MayoClinic.com allows members to access news items, research updates, disease briefs, drug information, first aid and practical self- care recommendations. • drugstore.com allows members to shop v online for prescription drugs, health and beauty aids, herbal remedies and supplements. They can also access prescription drug prices and use the "ask a pharmacist" feature. Maternity Management Maternity Management is a prenatal education and health assessment program designed to help pregnant women carry their babies to full term. Case managers answer questions about pregnancy, delivery and prenatal care. As an employer, you may purchase this option as part of your benefit package. Your employees can enroll in Maternity Management via the Internet. Other Health Information We also offer the following to assist employees in managing their health. Health Forum-a series of monthly articles authored by Fiserv Health medical professionals. Articles deal with timely subject matter. • Living with Chronic Conditions-articles by Fiserv Health medical professionals that test knowledge and help employees discover new things about living with chronic illness. • Personal Health Information Forms- references members can use to record personal health information which may then be shared with medical providers. • Quality Health Information-links to Web sites that collect information about providers and rate them. Searches can be conducted by provider type, geographic area or specialty The above health information sources are just some of the service options available to A'serv Health customers. Our customer service representatives are standing by to assist you with any additional questions. F%5et'V Health. ฎfisarv Heath. No part of [his tlocument may be reproduced without permission. CA00740 SO6 You encourage your employees io nve nearcnler uresryles. Ivialang informed health care decisions is one step toward meeting this goal. Targeted Conditions We've selected seven targeted conditions based on frequency of occurrence, treatment variations and high direct and indirect costs. They are: • Diabetes • Heart Disease • Asthma • Chronic obstructive pulmonary disease (COPD) • Hypertension e Depression • Congestive Heart Failure Member Information Online When you purchase disease management services from Fiserv Health, your employees and their dependents can access disease management information online or in hardcopy format. - You can access disease-specific: • Booklets • Articles • Simple health monitoring forms • Web links for additional information Interactive Condition Centers Employees and covered dependents have access to interactive condition centers via the Internet. Members with a targeted condition can. • Track their progress with a daily diary • Record medications, test results, medical history, care plans, contact information and medical reports • Access "Quality-of-Life" questionnaires • Read educational material Members who opt to monitor their condition online can print downloadable charts to share with their physician. Computer generated warnings alert them if their data entry signals a potential risk. We also conduct quarterly Web seminars to discuss disease management issues appropriate for anyone with a chronic condition-such as healthy eating and blood pressure goals. The result? Responsible, empowered members. Online Disease Management is just one of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. F%SL~IV Health. - '~ ฎFiserv Health. No part of this document may be reprotlucetl without permission. CA0134 5-06 vur a~sease management program rocuses on ine rnanayemen~ of chronic conditions. Reliable Answers Healthcare Advisor'"" from Subimo provides a '- complete set of tools designed to give members quick answers to their questions, such as: What to expect when facing an illness Which different treatment choices are available What questions to ask a doctor about an illness or procedure • What to know before having surgery How to find the hospital that best fits their health needs • Which hospitals meet the leading standards for patient safety _ Complete Information Healthcare AdvisorT"' delivers information to help members make more informed health care decisions, which may lead to better outcomes. It - provides both explanatory information as well as the statistics that are most relevant to anybody facing a significant health care decision or _ needing to learn how to manage a condition. The resources are organized into three main functional areas: Make aDecision-helps members address - and act on key health-related decisions. Consumers learn how to manage their health and prepare for a health care event. • Community-connects members to a network of experts and other consumers with similar concerns. • Resource Center-provides information in a variety of ways, including an online medical encyclopedia and links to related sites. Conditions and Procedures Healthcare AdvisorT"^ provides information for some of the most common conditions and procedures, such as: • A description of the condition • Who treats the condition • What to expect with the condition including: - Most common procedural visits - Likelihood of an ER visit - Need for hospital care - Treatmenbprevention options - Drug therapy - Alternative treatment - Major surgery - Other factors Information is also provided for various procedures including: A description of the procedure • How common the procedure is • Options Who performs the procedure • Risks and recovery Hospital comparison • Physician volumes (AZ, FL, IA, NV, PA, VA, WA, WI only) Healthcare Advisor just one of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. F/SeIV Healtfx ฎFiserv Heahh. No part of this tlocument may be reproduced without permission. CA00141 5-06 tver wonaer wny Irs easier to Tina oui wnlcn vacuum cleaner to buy than which hospital to choose? Now members can access the same information the experts use. Preferred Product Listing Easy to access and always current, your employees can print the product listing and share it with their physician. They'll also find our "Brands for Generic" listing online, which can reduce medical expenses. Participating Pharmacies Our pharmacy network is a national network of independent and chain retail pharmacies which is open to all pharmacy providers. Members can view _, a list of all participating chain pharmacies online. Mail Order _ Our mail service pharmacy, Innoviant Rx, is another Fiserv Health connection delivered to you. Internet Pharmacy Our online pharmacy, drugstore.com, is a retail online pharmacy dispensing monthly supplies that can save members money Newsletters Pharmacy Passages is a quarterly newsletter for our self-funded customers and health plans. It provides updates on changes to the Preferred Products List. We also publish monthly member education newsletters that provide valuable health and drug information. Claim Inquiry Access prescription claims online, including the total cost of the claim and the copay. Additional Access You can also access the following pharmacy benefit information online: • Claim reimbursement form • Prior authorization list and form these can help you find out which drugs need a physician's prior authorization For Employers You'll receive a quarterly pharmacy benefits report that contains information on your pharmacy plan's performance. Pharmacy Benefits is just one of the service options available to R'serv Health customers. Our customer service representatives are standing by to assist you with any additional questions. F%5 to VHealtl~. '- ฎFiserv Health. No part of this document may be reproduced without permission. CA01a6 5-06 uo you nna rc arrricwi ro Keep iracK or wn~cn prescnpuon arugs are preferred by your health plan? We can help make sense of it with our online listings. (Available to clients with Innoviant Prescription Benefits Administration.) - Our Web site provides a range of information on clinical, cost and lifestyle considerations so your employees can better manage their health and health care dollars. Members can: Understand what drugs are available for - conditions like asthma, allergies, high blood pressure and depression Manage their pharmacy benefit effectively by - seeing tradeoffs between costs and other factors, including side effects, efficacy and dosage • Improve interactions with their health care - provider by equipping them with a customized Ilst of questions • See possible drug interactions with -- medications they are currently taking Complete Information We also provide them with a drug comparison guide and decision framework for key diseases that are often treated with drugs including: Acid reflux disease (GERD) Acute otitis media (ear infection) Allergies Asthma • Depression • Diabetes Hypertension (high blood pressure) • Hyperlipidemia (high cholesterol) • Migraines • Osteoarthritis Fiserv Health has a drug reference tool with information on more than 11,000 prescription drugs-including generics and adrug-interaction checker with drug-to-drug information. Prescription Drugs Comparing drugs side by side allows members to easily see things like side effects, role in treatment and actions of different drug classes used to treat their condition. Other information presented includes warnings, precautions, foods to avoid and advice on when to call a doctor. There is even a checklist of questions to ask a physician that are specifically focused on the condition and the drugs the consumer intends to discuss with them. A robust drug-Interaction checker allows members to list different medications they are currently taking and retrieve information on drug-to-drug, drug-food, drug-disease, drug-alcohol and drug- tobacco interactions. Members learn what to expect after starting a new medication, including how to determine when to call a doctor for a different drug choice or adjusted dose. Additionally, there is a complete comparison of the price differences between brand and generic substitutes-in prescription and over-the-counter strengths where applicable. (The information Is specific to our pharmacy benefits plan formulary.) The above tools are just some of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. l%5e V Health. ฎ Fiserv Health. No part of this document may be reproduced without permission. CA00146 5-06 We take the guesswork out of choosing meaications. rlserv rtearcn orrers an mnovaiive consumer-anven nea~in care program. With it, employers gain a more predictable medical expense with lower cost increases from year-to-year, while employees enjoy _ the choice of another benefit plan-often at a lower contribution level than other plans. Our Web-based tools can help your employees make sound economic health care decisions. Coverage Advisor HSA Inquiry Coverage Advisor helps consumers understand Just like the HRA inquiry, employees can access _ what health care services their family is likely to claim history and status as well as account balance need--whether they are very healthy or have and payment information for their health savings multiple health conditions. It then estimates the account. _ cost for those services as well as out-ot-pocket expenses. Additional Information HRA In uir 4 Y We also offer the following to assist employees in _ managing their health: Employees can access claim history and status as well as account balance and payment information Quality Health Information-contains links for their health reimbursement account. to Web sites that collect information about _ and rate providers. Members can perform Advisors searches by provider type, geographic area or specialty With our Healthcare Advisor'"" members can: Web References-gives links to five carefully _ Learn more about specific procedures and selected health information sites. Users will conditions find information on specific conditions, See how hospitals rate • prescription and non-prescription medicines, _ first aid and practical self care, wellness, news Use an online resource center releases and research updates in the field of • View drug formulary information health. See which drugs are used to treat various Health Information-includes our Health _ conditions Forum, Living with Chronic Conditions section • Compare drugs and view drug interaction and personal health information forms. information Consumer-Driven Health Care is/ust one of the service options available to Fiserv Health customea. Our customer seance representatives are standing by to assist .~ you with any additional questions. F%5 V ealth. ฎFiserv Health. No part of this document may be reproduced wiMOUt permission. CA0132 5-06 Invoice Inquiry With Invoice Inquiry, you can quickly and accurately: View your monthly administrative fee invoices for all lines and consolidate in one bill View your employee counts by line of coverage, plan, class and rate (i.e. single or family) View each bill division separately • View remittance details Export monthly administrative fee invoices, counts or employee detail to Microsoft Excel View up to 18 months of administrative fee invoice history Each month a new administrative fee invoice is presented online and e-mail notifications are sent to each user. Instructions for completing payment are also included. Invoice Ingwry is just one of the service options available to Fiserv Health customers. Our Internet billing specialists are standing by to assist you wrth any additional questions. l%5 !e V Health ฎFiserv Health. No part of this document may be reproduced wiNOUt permission. CA0144 5-06 ruminate paperworK. ~onsouaaie invoices. iniegraie resources. That's exactly what the Invoice Inquiry can do for your benefits department. COBRA Administration, employers can provide notification of new COBRA qualified events using our online tool. COBRA Notifications If you have Fiserv Health administered COBRA services, you will be able to submit notifications of any employees or dependents with new qualifying events. The online form completed to begin this _ process provides the information necessary for Fiserv Health to send correct notifications to members, alerting them their COBRA continuation available to them. Activity Center The Activity Center provides a central spot for history of all types of transactions. These transactions remain online so you always have a record of entries processed. You can search for records using criteria including: "- Employee last name • Employee ID • Employee Social Security Number Confirmation number • Date submitted "- Save and Finish Later If you begin entering a COBRA Notification transaction but don't have time to finish it, you can save it for later. You'll be able to access the incomplete transaction from the activity center at any given time. Integrated with Online Enrollment Clients utilizing the Online Enrollment tool will automatically be asked whether or not a COBRA notification needs to be submitted with completing an employee or dependent termination form. By integrating these processes, Fiserv Health is helping to streamline your tasks. Outside Carriers The customers who have Fiserv Health administer COBRA notifications far outside carriers or lines of business Fiserv Health does not administer directly, can provide details regarding those as well. This incorporates everything needed into one form. Business-Intelligent We have inserted "business-intelligent" login that helps to ensure Fiserv Health receives all the information needed to correctly get the notifications out to your members. COBRA Notification is/ust one of the service options available to Rserv Health customers. Our COBRA service representatives are standing by to assist you with any additional questions. F%SBIV Health.. ฎFiserv Health. No part of this tlocument may be reproduced without permission. AN0017 5-06 ror clients wno nave contractea witn riserv rtealtn to provide Stop Loss Claim Inquiry With Stop Loss Claim Inquiry, you'll quickly be able to find both current and prior year information including: Employee and Claimant Name Policy Number Claim Type Carrier Contract Type Request, Denied and Received Amounts • Dates Requested and Received • Stop Loss Deductible The Stop Loss Claim Inquiry application also provides: • Specific and aggregate monitoring reports, with appropriate access E-mail notification of a stop loss claim activity Stop Loss Claim Inquiry is just one of the service options available to Fiserv Health customers. Our stop loss specialists are standing by to assist you with any additional questions. l ~%SeIV Health ฎFiserv Health. No part of this document may ce reproduced without permission. AN0016 5-06 uon~i oe In ine aarK regaramg rarge crarms imormauon. rvvw yuu can effectively track large claim activity using online Stop Loss Claim Inquiry. Easy Access Our online customer reporting tool delivers information at the touch of a button so you can: Access monthly reports containing benefit plan performance measures Perform online ad-hoc queries to develop reports such as: - Census information - Various levels of claim activity - Large claim information The Latest Information ,~ The information we present to you is organized in a logical manner We've made it easy to follow so you can evaluate your plan in an intuitive manner You will always have the latest information on your ""' plan's results-right at your fingertips. Using Online Reporting When you use Online Reporting you will: Dramatically improve your efficiency because your reports are online Enhance the quality of the information you receive so you are able to pinpoint key dynamics in your plan's performance Our Approach to Online Reports We offer a standard suite of reports that are refreshed every month. If you wish, you may also contact our Consulting and Analysis Services area to have reports prepared exclusively for you. We provide current and prior year benefit plan comparisons as well as benchmarks with your analysis to show how your plan is performing compared to other clients. Our measures are carefully organized to allow you to gain an increased understanding of your health plan's performance. Online Reporting is just one of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. "' ฎFiserv Hea~[h. No part of this tlocument may be reproduced without permission. CA0146 5-06 une or the Keys ro managing your plan is io nave prompt, accurate and meaningful information at your fingertips. s What You See You will be able to access two levels of claim detail: At the claim summary level you can view: • Employee name Patient name and date-of-birth • Provider name • Service dates • Processed date • Claim type (medical or dental) • Billed, paid, other insurance paid and patient responsibility amounts • Claim status, along with a description of what is happening with the claim At the claim detail level you can view: • Claim control number • Patient name '-' • Employee name and ID • Service dates • Provider name Procedure code and type of service • Billed, allowable, paid, deductible, not payable, provider discount, other insurance paid and i patient responsibility amounts • Benefit percentage • Payment recipient • Detail (if any) of amounts not payable _ Explanation of Benefits (EOBs) Medical EOBs are available to both members and employers. The EOB is presented in a PDF format and is an exact copy of what the employee receives ฐ- in the mail. Deductible Status You and your employees can easily view deductible status online. Status is shown at a member level-just like EOBS. You can see benefit level and applied-to- dateamounts for: • Individual deductible • family deductible • Individual out-of-pocket • Family out-of-pocket • Health Reimbursement Account (HRA) individual deductible (if applicable) HRA family deductible (if applicable) Healthcare Cost Summary We also present medical claim information summarized by type of service and plan year. You or your employees can see what your plan paid and the costs they were responsible for. Other Insurance Update Members can update other insurance information online or through an automated IVR phone system. Any claims holding for members without other Insurance will automatically be reprocessed. Security and Compliance Employees may gain access only by using their unique ID and password. They can view claim information for only themselves or their dependents. All information presented is HIPAA-compliant. Online Claim Inquiry isjust one of the service options available to Fiserv Health customers. Our customer service representatives are standing by to assist you with any additional questions. F%5 !e V Health. _- '~ ฎFiserv Health. No part of this document may be reprotluced without permission. CA0131 5-06 tour online calm Ingwry is avallapie any lime or ine aay or night. And, not only can you look up claim information, but your employees can view the status of their claims as well. Fiserv rlealtn partnerea wltn tmployease to proviae the Ieaamg "' eHR and benefits administration solution, delivering Fortune 500 service, functionality and flexibility to companies of all sizes. Over _ 1,000 organizations use Employease to reduce administrative costs, improve employee service and increase Human Resources' value without the cost and limitations of traditional benefits software. Complete Package Employease offers the following benefits-related features: • Ongoing benefits administration -Employer access streamlines and automates the benefits administration process. • Employee communication and enrollment - Communications and enrollment services, as well as interactive voice response, are delivered through Employease. • Carrier billing and reconciliation -Customers calculate, compare and analyze billing information in minutes instead of days. • Carrier and Fiserv Health communication - Employease Connect provides an automated service to communicate enrollment data in proprietary formats to Fiserv Health and all benefits vendors. • Payroll/HRIS Communication -Employease benefits features are seamlessly integrated with your HR functionality and enable easy integration with your in-house or third-party payroll solution. This eliminates redundant data entry ROI Results (average) • 47 percent reduction in HR and benefits time spent on administration • 56 percent reduction in time to process new and terminated employees • Over 50 percent reduction in employee and HR time spent on open enrollment • Significant reductions in IT expenditures and benefits costs Why Now? Because the Employease Network is: • Easy to afford -Employease built its solution from the ground up as an Internet business service, thereby helping customers avoid the cost and complexity associated with traditional software. Easy to implement- Implementations are measured in days or weeks instead of months or years. • Easy to use -Intuitive Web interfaces are as easy to use as popular consumer sites such as Amazon.com or E*TRADE. • Easy to Connect -Customers can improve productivity in house and improve processes beyond the HR department by connecting electronically to Fiserv Health and other systems and entities. Offering Options to Employers In working with over 1,000 employers everyday, Employease recognizes that all organizations have different needs. To meet those varying needs, Employease offers the option to tailor workflows, reports, data elements, user interfaces, user rights and content to meet any organization's unique requirements, without the cost or complexity associated with proprietary development tools or custom programming. F%5 V/@ Health. ~"" 0 Fiserv Health. No pan of this document may be reprotlucea without permission. CAO136 5-06 l %5B~'V Health. Three Solutions to Your HIPAA Compliance Responsibilities The HIPAA Impact HIPAA privacy and security regulations present a major compliance challenge to self-insured health plans and their employers/plan sponsors. Fiserv Health is committed to developing ways to significantly ease the HIPAA burden on our customers. To this end, we have created our HIPAA Turnkey Solution for Privacy Compliance, our HIPAA Privacy Tool Kit, and our HIPAA Security Tool Kit. The HIPAA Privacy Turnkey Solution for Employers/Plan Sponsors The Turnkey HIPAA Privacy and Security Solution is designed to take a substantial part of the HIPAA compliance burden off employers/plan sponsors. For those who opt for this solution, Fiserv Health will take the responsibility of providing HIPAA Privacy Compliance for your company's health plan. We will assume the privacy compliance "~ requirements otherwise imposed on your health plan as the "covered entity." Fiserv Health will be responsible for the health plan's HIPAA compliance obligations, r including, but not limited to: Assuming the role of Privacy Official ^ Assuming responsibility for Employee Notices of Privacy Practices ^ Assuming responsibility for maintaining and managing the Designated Record Set C Assuming the responsibility for managing the contracting between the health .. plan and third-party vendors ^ Preparing and implementing required operating policies and procedures ^ Administering complaint procedures, employee review requests, amendment requests, accounting requests, and authorization programs _ 7 Building a security architecture around the privacy program you outsource through the Turnkey Solution P%5B-rHealth_ Tool Kit for HIPAA Privacy Compliance - The Tool Kit for HIPAA Privacy Compliance is designed to serve as a basic outline for your compliance efforts. If you are interested in handling privacy compliance yourself, the tool kit is designed to meet your needs. The tool kit has two sections: Section 1' Understanding and Implementing the HIPAA Privacy Regulations Section 2: Sample HIPAA Privacy Forms, Policies, and Procedures Section 1 provides background on privacy regulations with an implementation section - containing work steps to assist employers/plan sponsors in becoming compliant. Section 2 provides sample forms, policies, and procedures as discussed in Section 1 Tool Kit for HIPAA Security Compliance - The Tool Kit for HIPAA Security Compliance is also designed to serve as a basic outline for your compliance efforts and lessen the burden of your security implementation process. - The tool kit provides a detailed overview along with specific implementation guidelines to walk you through the three primary security standard benchmarks step by step: - 1. Administrative Safeguards 2. Physical Safeguards - 3. Technical Safeguards Our tool kit will help you tailor your security compliance program to your organization's - particular needs. We have developed our compliance programs to allow health plans sponsors to continue to focus on what is most important - -providing benefits to their employees. Please - contact your account manager for assistance on purchasing the option that is right for your health plan. _ FISERV OVERVIEW Fiserv provides industry-leading information management systems and services to the financial industry, including transaction processing, business process outsourcing, and software and systems '~' solutions. Supporting the banking, insurance, health care, and trust segments of the financial industry, the scope of Fiserv services extend beyond technology platforms to distinctive business processing solutions that help clients streamline efficiencies, reduce costs, and increase customer satisfaction. Fiserv provides traditional service bureau and in-house processing systems, e-commerce solutions, and facilities and resource management. Specialized Fiserv business processing services include - portfolio management, customized contact center solutions and lockbox, generating assets for client funding, developing and managing strategic marketing programs, retention and defection program management, and case management utilization. Fiserv formed on July 31, 1984, through the combination of two major regional data processing firms in Milwaukee, Wisconsin, and Tampa, Florida. At the time, Fiserv had $21 million in revenue, 160 clients, 350 employees, and two locations. Fiserv is now an international organization with $3.7 billion in revenue, more than 17,000 clients, 22,000 employees, and 230 locations. Fiserv is a distinguished industry leader in processing for banks, credit unions, and savings institutions, and is among the leading providers of mortgage processing, health plan administration, and administrative services for self-directed IRAs and 401(k) plans. Clients include credit unions, banks, financial planners/investment advisers, insurance companies and agents, self-insured employers, leasing companies, and mortgage providers. Fiserv has a proven track record of positioning client interests first and successful client alliances. The Fiserv client retention rate is more than 99 percent -one of the highest in the industry. The Company also has one of the highest rates for new sales among financial technology providers. Fiserv is positioned strongly for future growth because it partners with its clients and provides: r Quality support Advanced technology Experienced resources Focused, dedicated management attention Proactive communications at all levels The Company operates more than 230 specialized service centers and offers various forms of outsourcing, in-house licensed software systems, and PC-based systems. Fiserv provides account and transaction processing systems and services to financial institutions and other financial intermediaries. Offerings include core account processing, insurance processing services, and a wealth of complementary "add-on" products to improve business management and efficiency Fiserv also provides plastic card issuance, design, personalization and mailing services, and document management products. (C 2006 Fiserv, Inc All Rights Reserved Fiserv currently processes across its industry segments: ~ 293 million deposit, loan, and lease accounts 6.2 billion electronic/ATM/POS transactions annually 3.3 billion checks/sharedrafts annually $6.9 billion insurance claims paid $38.5 billion assets under administration FISERV VISION STATEMENT To be the leading information services provider for the financial industry worldwide. FISERV MISSION STATEMENT To deliver products and services that help our clients grow their businesses and enhance service to their customers. r To enable our people to achieve outstanding job performance and personal growth. To produce a favorable level of earnings and consistent earnings growth for our Company and increase value for our shareholders. ~~ ?006 Fiserv, lnc All Rights Reserved MARKET STRATEGY The market for products and services offered by financial institutions continues to change. The distinctions among products and services traditionally offered by banking organizations and insurance firms continue to narrow, as these different entities compete for the same customers. New organizations entering the once-limited financial services industry have opened new markets for Fiserv services. Fiserv is dedicated to providing the best and broadest range of technology products and services in four major financial industries: financial institution, insurance, and trust services. This allows Fiserv to provide several solutions to meet a client's challenge. Fiserv evaluates the various solutions current and helps the client find the best fit. The Fiserv strategy is:~~ enables clients to discover the simplicity of obtaining complete solutions from a single technology leader. The market for Fiserv products and services requires software flexibilit , roduct ualit ,service reliabilit , Furore Y P 4 Y Y cdent integration of product lines, timely introduction of new rSSe~ products and features, cost effectiveness, and service excellence. Through its multiple product offerings, Fiserv _ successfully services these market needs and requirements for clients ranging in size from start-ups to some of the largest financial services providers. The Fiserv strategy is to continually develop new products, improve the cost-effectiveness of services provided to clients, aggressively solicit new clients, and make opportunistic and strategic acquisitions. To meet the changing data processing needs of its clients, Fiserv continually develops, maintains, and enhances its systems. Resources applied to product development and maintenance is estimated _ at approximately seven percent of Company revenues. Along with new product development, Fiserv also expands its product lines through acquisition. _ Fiserv keeps a sharp eye on the technology market across the financial industry for companies with state-of-the-art products and services. When found, Fiserv considers acquiring the company so that its products, services, and people become part of the Fiserv line of solutions. Few companies possess the market acumen and financial strength necessary to pursue an aggressive strategy for growth. Substantial capital investment is needed to acquire companies, continue accelerated product and new technology development, and provide the skilled people necessary for building lasting relationships. Fiserv has the ability to make investments in the future. Fiserv taps knowledge from its people around the globe, as well as in its research and development centers in the United States. Fiserv leverages that knowledge across product lines, seeding one ,., product with great ideas and best practices developed for another. A Fiserv solution can be as unique as the client it serves. When Fiserv products and services are combined with the most flexible delivery options in the industry, the results are unlimited. Fiserv brings world-class skills, experience, technology, and expertise to improve the bottom-line performance of clients worldwide. ,~ ~'~ 2006 Fiserv, inc All Rights Reserved COMPANY FINANCIALS Since 1984, Fiserv has grown from $21 million in revenue to $3.4billion in processing and services revenue in 2004. The Company has grown through the continuing development of highly specialized services and product enhancements, the addition of new clients, and the acquisition of firms complementing the Fiserv organization. Fiserv reported record revenues and earnings for 2005. Processing and services revenues for the full year increased 11 percent to $3.7 billion compared to $3.4 billion in 2004. Full-year earnings per share were $2.70 and earnings per share from continuing operations were $2.68. Full-year adjusted earnings per share from continuing operations were $2.30 (which excludes $0.29 per share related to realized gains from sale of investments and $0.09 per share for receipt of a large contract termination fee) versus $2.00 in 2004. Fiserv also reported strong earnings for the fourth quarter of 2005. Revenues increased 14 percent to $987 7 million (which includes a large contract termination fee received of $26.3 million) compared to $866.1 million in the fourth quarter of 2004 Earnings per share were $0.81 and earnings per share from continuing operations were $0.80. Adjusted earnings per share from continuing operations were $0.56 (excluding $0.15 per share related to a realized gain from sale of investment and $0.09 per share for the large contract termination fee), compared to $0.50 for the fourth quarter of 2004 These financial accomplishments are illustrated on the following page. CC 2006 Fiserv, tnc All Rights Reserved aiuw~v sssm .w.~6 al••~oe~iefi va.6ew emnla.a sfioxul aP^P*a munvwe'~pp2 u~euww6ag's66{ui nul fi6olouV f~sF~muely fivnvnoave Vllm aaueweax wl6mpoo6 pv uvnem~owe aal uepew~v~ul)v uawel^meaipgpyela~n6iขy6 ureYe~sapnp+3 5002 f00i LOOZ ZOOZ 1002 0002 666E 8664 L664 9664 566E 96fiL f664 2864 466{ O66L 686E BB6L L864 986E _ 9E LE EZ 8L 9l LL 6 L S Z9 05 l6 9LL 8EL LLL 80Z 99Z SLE a~d~ ~ia~z _ 8LE IaL9o ~' sjyb~~yb~H ~ei~ueu~~ leaf-pZ .vas~j csฐ0,~~,Ws~ 4~oaJ auao~u~ ~aN =a~~a~a„~awas,~pw e„ewe,ena eap,la,3 9662 9002 f002 2002 LOOZ OOOZ 666E 8664 L664 9661 S6fiL 9664 E66L Z66V 166E 0664 686E 8864 L86L 986E I E84 094 nL 9e 6L iff LBZ 995 ~' 86L EOL Z8B _ 9611'L EEZ'4 EL9 4 Z9L L .~ 6S7'Z Z65'Z a.~d.7 %ฃZ LSf~ฃ BOLE _ s~yb~~y6iH ~e~aueu~~ aeaLf-pz n~asij csฐฐ,,,,W $~ y~nnoa~ anuana~ paniasa27 siy9iy py au4 `n~as~3 9002 gl COMPOUNDED ANNUAL GROWTH RATE The 2005 Fiserv Compounded Annual Growth Rates (CAGR) over 20 years are: Revenue: 23% _ Earnings Per Share: 21 Net Income: 27% Stock Price: 21% Cash Flow: 21% The continuing growth of Fiserv is a reflection of its dedication to service quality and the ongoing commitment of its people. Fiserv is a publicly held company Fiserv, Inc. common stock trades on the NASDAQ Stock Marketฎ under the symbol FISV. Fiserv also can be found on the Internet at www.fiserv.com. Cd 2006 Fiserv, Inc All Rights Reserved MAJOR ACHIEVEMENTS The Fiserv business strategy focuses on developing new products and services and making complementary acquisitions. Through this strategy, Fiserv has achieved the following selected milestones: •' ~ 1964 1971 • ~ Mett,7edto form Fiserv: Jul 1984 First Data Processing, Milwaukee, WI Sunshine State Systems, Tampa, FL ~ - • Data processing Data processing 1966 Nov 1984 San Antonio, Inc., San Antonio, TX Data rocessin 1982 Oct. 1985 Sendero Cor oration, Scottsdale, AZ Asset/liabilit m mt 1962 Oct. 1985 First Trust Cor oration, Denver, CO DP for retirement tannin 1962 Oct. 1985 First Retirement Marketin ,Denver, CO Retirement tannin srvs 1973 Jan. 1986 On-Line, Inc., Seattle, WA Data rocessin ,forms 1966 Ma 1986 First Ci Financial S stems, Inc., Beaumont, TX Data rocessin 1962 Feb. 1987 Pamico, Inc., Milwaukee, WI S ecialized forms 1975 A r. 1987 Midwest Commerce Data Cor ., Elkhart, IN Data rocessin 1969 A r. 1987 Fideli Financial Services, Inc., S okane, WA Data rocessin 1965 Oct. 1987 Capbanc Computer Corp., Baton Rouge, LA (sold 1991 Data processing 1971 Feb. 1988 Minnesota On-Line Inc., Minnea olis, MN Data rocessin 1965 Ma 1988 Citizens Financial Corporation, Cleveland, OH Data rocessin 1980 May 1988 ZFC Electronic Data Services, Inc., Bowling Green, KY Data processing 1969 June 1988 GESCO Cor oration, Fresno, CA Data rocessin 1967 Nov 1988 Valle Federal Data Services, Los An eles, CA Data rocessin 1984 Dec. 1988 Northeast Savin s Data Services, Hartford, CT Data rocessin 1982 May 1989 Triad Software Network, Ltd., Chicago, IL (sold 1997 Data processing 1969 Au .1989 Northeast Datacom, Inc., New Haven, CT Data rocessin 1978 Feb. 1990 Financial Accountin Services Inc., Pittsbur h, PA Data rocessin 1974 June 1990 Accurate Data On-Line, Inc., Titusville, FL Data rocessin 1982 June 1990 GTE EFT Services Mone Network, Fresno, CA EFT networks 1968 Jul 1990 First Interstate Mana ement, Milwaukee, WI Data rocessin 1982 Oct. 1990 GTE ATM Networks, Fresno, CA EFT networks 1867 Nov. 1990 Boston Safe De osit & Trust Co. IP Services, MA Item rocessin 1968 Dec. 1990 First Bank, N.A. IP Services, Milwaukee, WI Item rocessin 1979 A r. 1991 Citicor Information Resources, Inc., Stamford, CT Data rocessin 1980 A r. 1991 BMS Processin ,Inc., Randol h, MA Item rocessin 1979 Ma 1991 FHLB of Dallas IP Services, Dallas, TX Item rocessin 1980 Nov. 1991 FHLB of Chica o IP Services, Chica o, IL Item rocessin 1977 Feb. 1992 Data Holdin s, Inc., Indiana olis, IN Automated card services 1980 Feb. 1992 BMS On-Line Services, Inc. assets ,Randol h, MA Data rocessin 1982 Mar. 1992 First American Information Services, St. Paul, MN Data rocessin 1981 Jul 1992 Cadre, Inc., Avon, CT sold 1996 Disaster recove 1992 Jul 1992 Performance Anal sis, Inc., Cincinnati, OH AsseUliabilit m mt 1986 Oct. 1992 Chase Manhattan Bank, REALM Software, NY AsseUliabilit m mt 1984 Dec. 1992 Dakota Data Processin ,Inc., Far o, ND Data rocessin 1983 Dec. 1992 Bank Grou Services, Inc., Somerville, MA Item rocessin 1968 Feb. 1993 Basis Information Technolo ies, Atlanta, GA Data rocessin ,EFT 1986 Mar. 1993 IPC Service Cor oration assets ,Denver, CO Item rocessin 1973 Ma 1993 EDS' FHLB Seattle assets ,Seattle, WA Item rocessin C~7 ?006 F~serv, Inc. All Righ[s Reserved .- 1982 June 1993 Datatronix Financial Services, San Die o, CA Item rocessin 1966 Jul 1993 Data Line Service, Covina, CA Data rocessin 1978 Nov. 1993 Financial Processors, Inc., Miami, FL Data rocessin 1974 Nov. 1993 Financial Data S stems, Jacksonville, FL Item rocessin 1961 Nov. 1993 Financial Institutions Outsourcin , Pittsbur h, PA Data rocessin 1972 Nov. 1993 Data-Link S stems, South Bend, IN Mort a e bankin services 1985 A r. 1994 National Embossin Com an ,Inc., Houston, TX Automated card services 1962 May 1994 Boatmen's Information Systems of Iowa, Des Moines Data processing 1981 Au .1994 FHLB of Atlanta IP Services, Atlanta, GA Item rocessin 1989 Nov. 1994 CBIS Imaging Technology Banking Unit, Maitland, FL Imaging technology 1987 Dec. 1994 RECOM Associates, Inc., Tam a, FL sold 1998 Network inte ration 1970 Jan. 1995 Inte rated Business S stems, Glendale, CA S ecialized forms 1977 Feb. 1995 BankLink, Inc., New York, NY Cash mans ement 1976 Ma 1995 Information Technolo ,Inc., Lincoln, NE Software and services 1957 Au .1995 Lincoln Holdin s, Inc., Denver, CO DP for retirement tannin 1993 Se t. 1995 SRS, Inc., Austin, TX Data rocessin 1992 Se t. 1995 ALLTEL's Document Mana ement Services, CA, NJ Item rocessin 1978 Nov. 1995 Financial Information Trust, Des Moines, IA Data rocessin 1983 Jan. 1996 UniFi, Inc., Fort Lauderdale, FL Software and services 1996 Apr. 1996 The Chase Manhattan Corporation Item processing strafe is alliance 1996 July 1996 Canadian Imperial Bank of Commerce (CIBC) Item processing oint venture 1982 Nov. 1996 Bankers Pension Services, Inc., Tustin, CA DP for retirement tannin 1992 Apr. 1997 AdminaStar Communications, Indianapolis, IN Laser print/mailing services 1982 May 1997 Interactive Planning Systems, Atlanta, GA PC-based financial s stems 1983 May 1997 BHC Financial, Inc., Philadelphia, PA Securities processing services 1968 Se t. 1997 FIS, Inc., Orlando, FL, and Baton Rou e, LA Data processin n/a Sept. 1997 Stephens Inc. clearing brokerage operations, AR Securities processing services 1986 Oct. 1997 Emerald Publications, San Diego, CA Financial seminars and trainin 1968 Oct. 1997 Central Service Cor ., Greensboro, NC Data and item rocessin 1993 Oct. 1997 Savoy Discount Brokerage, Seattle, WA Securities processing services 1990 Dec. 1997 Hanifen, Imhoff Holdings, Inc. clearing business, Denver, CO Clearing services 1980 Jan. 1998 Automated Financial Technolo ,Inc., Malvern, PA Data rocessin n/a Feb. 1998 PSI Grou ,Seattle, WA Laser rintin 1981 Feb. 1998 The LeMans Group, King of Prussia, PA Automobile leasing software 1956 Apr. 1998 Network Data Processing Corporation, Cedar Ra ids, IA Insurance data processing 1977 A r 1998 CUSA Technolo ies, Inc., Salt Lake Cit , UT Data rocessin 1982 Ma 1998 S ecialt Insurance Service, Oran e, CA Insurance data rocessin 1985 Au .1998 Deluxe Card Services, St. Paul, MN Card services 1981 Oct. 1998 FHLB of To eka IP Services, To eka, KS Item rocessin ~~~ 2006 Fiserv, Ina All Rights Reserved 1984 Oct. 1998 Life Instructors, Inc., New Providence, NJ ~ / ~ Insurance/securities trainin n/a Oct. 1998 FiCATS, Norristown, PA Item rocessin 1994 Nov. 1998 ASI Financial Services, Inc., New Jersey and New York PC-based financial s stems 1986 Dec. 1998 The FREEDOM Grou ,Inc., Cedar Ra ids, IA Insurance data rocessin Jan. 1999 The Northern Trust Company Item processing strafe is alliance 1994 Jan. 1999 QuestPoint, Philadel hia, PA Item rocessin 1981 Feb. 1999 Eldridge & Associates, Lafayette, CA PC-based financial s stems 1984 Feb. 1999 RF/S ectrum Decision Science Cor ., Oakland, CA Software and services 1978 Mar. 1999 FIPSCO, Inc., Des Plaines, IL Insurance marketing s stems 1987 Apr 1999 Progressive Data Solutions, Inc. /Infinity Software S stems, Inc., Orlando, FL Insurance software s stems 1973 Jun 1999 JWGenesis Clearing Corp., Boca Raton, FL Securities processing services 1987 Jun 1999 Alliance ADS, Redwood Shores, CA Ima in technolo 1962 Au .1999 Envision Financial Technolo ies, Inc., Chica o, IL Data rocessin 1995 Oct. 1999 Pinehurst Analytics, Inc., Chapel Hill, NC PC-based financial s stems 1982 Dec. 1999 Humanic Desi n Cor ., Mahwah, NJ sold 2001 Software and services 1983 Feb. 2000 Patterson Press, Nashville, TN Card services 1982 Ma 2000 Resources Trust Com an ,Denver, CO DP for retirement tannin 1986 Se t. 2000 National Flood Services, Inc., Kalis ell, MT Insurance data rocessin 1982 Jan. 2001 Benefit Planners, Boerne, TX Insurance data rocessin n/a Feb. 2001 Marshall & Ilsle IP Services, IA, MN, MO Item rocessin 1972 Mar 2001 Facilities and Services Corp., Agoura Hills, Novato, CA Insurance software s stems 1991 Mar. 2001 Remarketing Services of America, Inc., Amherst, NY Automobile finance asset mana ement 1982 July 2001 EPSIIA Corporation, Austin, TX Electronic statement and re ort resentment 1996 Jul 2001 Cata ult Technolo Limited, London, En land Software and services 1985 Se t. 2001 FHLB of Pittsbur h IP Services, Pittsbur h, PA Item rocessin 1959 Nov. 2001 NCR bank rocessin o erations, Da ton, OH Data and item rocessin 1972 Nov. 2001 NCSI, Rockville, MD Insurance software s stems 1940 Nov. 2001 Inte rated Loan Services, Rock Hill, CT Loan services 1954 Nov. 2001 Trewit Inc., Minnea olis, MN Insurance data rocessin n/a Nov. 2001 FACT 400 credit card solution, Bo ota, Columbia Credit card solution 1991 Ma 2002 Case Shiller Weiss, Inc., Cambrid e, MA Software and services 1974 Au .2002 Investec Ernst &Com an ,New York, NY Clearin services n/a Nov. 2002 Willis Grou TPA o erations, Nashville, Wichita Insurance data rocessin 1989 Nov. 2002 EDS' Consumer Network Services business, New Jerse EFT networks 1979 Dec. 2002 Lenders Financial Services, Agoura Hills, CA Lending services 1989 Jan. 2003 AVIDYN, Inc., Dallas, TX Insurance data rocessin 1982 Mar. 2003 Precision Com uter S stems, Sioux Falls, SD Bank rocessin services 1999 A r 2003 ReliaQuote, Inc., Falls Church, VA Insurance data rocessin 1948 Ma 2003 Wausau Benefits, Wausau, WI Insurance data rocessin 1974 Jul 2003 EDS Credit Union Indust Grou ,Plano, TX Data rocessin ~r 2006 P~serv, Inc. All Rights Rzszrved .- .- 1986 July 2003 Chase Credit Research and Chase Credit Systems, Credit reporting services North Holl wood, CA 1996 Aug. 2003 UniSURe, Cincinnati, OH Reinsurance software and services 1996 Se t. 2003 Insurance Mana ement Solutions Grou ,Inc., FL Insurance data rocessin 1998 Sept. 2003 General American Corp., Pittsburgh, PA Real estate settlement services 1932 Nov. 2003 FHLB of Indiana olis IP Services, Indiana olis, IN Item rocessin 1987 Nov. 2003 MI-Assistant Software, Inc., Elva, WI Insurance ratin software 1999 Dec. 2003 Medea Cor oration, Mem his, TN Insurance data rocessin 1994 Jan. 2004 RegEd, Inc., Morrisville, NC Insurance/securities trainin n/a Aug. 2004 Pharmacy Fulfillment, Inc., Huntingdon, PA Pharmaceutical rocessin n/a Sept. 2004 Results International Systems, Inc., Worthington, Insurance data processing OH 1988 Oct. 2004 CheckAGAIN, Herndon, VA Electronic check re- resentment X512006 Piserv, Inc. All Rights Reserved FUTURE PLANS Fiserv is financially strong, client-orientated companies dedicated to helping financial institutions manage their information technology efficiently and effectively. Fiserv has always focused on anticipating the technology requirements of its clients. As a result, Fiserv offers the foremost selection of financial e-commerce solutions and support, and will continue developing e-solutions for this powerful, ever-growing one-to-one marketing channel. Your bank can be assured that Fiserv will continue to provide the products, services, and systems enhancements required to successfully compete in the fast-changing financial environment. Fiserv is where you can find exactly what is needed - an end-to-end solution. U 2U06 Fiserv, inc. All Rights Reserved F%581V Health Care Managemenf Product Update - Fiserv Health Care Management Enhances Disease Management Program By Touching More Lives - Beginning January 1, 2007, the Fiserv Health Care Management Disease Management Program will begin introducing new program enhancements. Feedback from internal and external sources combined with automation, increased efficiencies and the implementation of Personal Care Notes, has resulted in an enhanced program offering for all clients. How do these changes add value for the client? Under the new program design, we will be increasing interventions for the total population allowing us to make a difference with - each member. The result will be increased "touches" or interventions and a greater opportunity to save dollars by administering multiple levels of care. - The following is a brief overview of the Disease Management program enhancements: / Broader program participation by increased levels of care and program interventions. In doing so, we are opening the doors to actively engage more members. - / Increased staff awareness of the behavior change model and the skills required to help members move forward with healthy changes. / Improved ability to engage more members as a result of special staff recruitment - training. / Members who choose not to work 1:1 with a nurse will be targeted with condition specific educational mailings, a-mail campaigns and continued encouragement - toward active engagement with a nurse care manager. / Increased time for recruitment activity as the result of automation of outgoing communication materials. _ / Incorporation of Personal Care Notes into the program to increase the member's awareness of best-practice care recommendations for a variety of conditions (including wellness) and provide money-saving tips on prescription drugs. This results in improved health as well as reduced out-of-pocket costs. - / Increased volume of outbound educational materials via mail, Web, newsletters and e-mail campaigns. / Enhanced DM reports to describe participation levels within each level of care. Additional information and communication materials will be available in the 4th quarter. Kerr County PROPOSED MEDICAL CLAIMS PERFORMANCE STANDARDS (3%) I. 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. If however, the financial accuracy falls below the agreed upon level, Fiserv Health will give the Plan Sponsor a credit as stated on the table below Financial Accuracy will be calculated by dividing the total audited dollars paid correctly by the total audited dollars processed. These areas are measured based on department results. Fiserv Health's Performance Penal 99% or hi her 0% 98.5% to 98.9% 1 Less than 98.5% 2% II. Turnaround Time 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. In the event that Fiserv Health's turnaround time falls below the agreed upon level, Fiserv Health will give the Plan Sponsor a credit as stated on the table below _. Claims will be considered "processed" when Fiserv Health has released the Claim for payment, denial or request for additional information. _ Fiserv Health's Performance Penal 90.0% or hi her 0% 85.0%to 89.9% 1% Less than 85.0% 2% III. Customer Service Fiserv Health guarantees the following levels of customer service will be maintained. ฐ~ These areas are measured based on department results. 1. Average speed-to-answer telephone calls Fiserv Health agrees that on average, calls will be answered in thirty (30) seconds or less. If calls are answered in more than thirty (30) seconds, Fiserv Health will give Plan Sponsor a credit as stated on the table below. Fiserv Health's Performance Penal 30 seconds or less avera e 0% 31 to 45 seconds avera a 1% 46 seconds or hi her average ?% 2. Abandonment Rate Opdated b-8-ฐ5 ss Page 1 of. Fiserv Health agrees that on average, three percent (3%) or less of calls may be abandoned. If - more than the agreed upon level of calls are abandoned, Fiserv Health will give the Plan Sponsor a credit as stated on the table below. Fiserv Health's Performance Penal 3.0% or less avera e 0% 3.1 % to 4.0% avera e 1 _ More than 4.0% avera e 2% - Aggregate Penalty: The aggregate maximum penalty will not exceed 3% of the annual base medical administration fees. - Performance Guarantee Conditions: • Performance Guarantees begin 90 days after plan effective date. Performance Guarantees are for medical claims administration. _ • Performance Guarantees are not in effect until a signed administrative service contract is received. upe~aa s a us ~ aase z oe~ .. 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