ENTRUST 14701 St. Mary's Lane #150 Houston, TX 77079 (281) 368-7878 HEALTH BENEFIT PLAN PROPOSAL PREPARED FOR: KERB COUNTY PRESENTED BY: BRIAN DAVIDSON REPRESENTING ENTRUST, INC. 2~~~ HEALTH BENEFIT PLAN PROPOSAL KERR COUNTY ENTRUST INFORMATION SM INSURANCE AND BENEFIT PROFESStIONAL9 THE EVOLUTION OF THE ENTRUST COMPANIES The Entrust family of companies emerged as the successor of the first, Houston, Texas based third party administrator (TPA) and health care benefit consulting firm, Insurance Management Administrators, Inc. (IMA), specializing in the design, implementation and administration of self-funded benefit plans in 1975. IMA grew to become a regional, industry leader; spawned three affiliated TPA's in two states operating under one banner; and, was acquired in 1986 by venture capitalists, ultimately becoming a part of the first, publicly-held TPA in the United States Our founder's previous experience included sales management with a major national group health insurance company and employee benefit plan consulting with anationally-known compensation and benefit planning firm. This industry experience provided an awareness of the distinct advantages to both plan sponsors and their employees created by the passage of the Employee Retirement Income Security Act of 1974 (ERISA). Disillusioned with the change in paradigm from meeting and servicing customer needs to maximizing the value of the stock, our founder resigned and created Entrust Agencies, Inc. (EAI) in 1988 in Houston, Texas. EAI provided advice and counsel to employer plan sponsors on the different options available to design, provide and finance medical expense reimbursement plans, whether insured or self-insured. Many former, highly-skilled employees returned to this new entity to support its goals and objectives. In July 1990, Entrust, Inc. (Entrust) was licensed as a TPA in Texas and purchased the assets of an existing TPA, Automated Benefit Services, Inc. The now reunited, experienced, professional staff immediately began to develop the processes necessary to support unique and creative health care expense financing solutions. In March 1993, Entrust Risk Management Services, Inc. (ERMS) was created to provide professional services to clients desiring independent, fee-based risk and insurance cost management consulting, unprejudiced by the commission incentives offered to agents/brokers by insurance companies. ERMS provides professional services to private businesses, publicly-held corporations and governmental agencies throughout the United States. Expertise encompasses the full spectrum of risk financing and actuarial services; including life, disability, health and property and casualty coverage. In May 1998, Rx Concepts, LLC joined the growing family of companies. Rx Concepts helped engineer and bring to market a financial vehicle to allow for the shifting of risk on the prescription drug component of a health plan to a third party. This allowed for accurate budgeting and forecasting of the most rapidly increasing component in healthcare...the prescription drug benefit. In addition, Rx Concepts offers contract consulting services and retrospective, concurrent and prospective auditing of Prescription Benefit Management (PBM) vendors to insure quality assurance, contractual compliance and maximum cost control. In February 1999, Medical Helpline, Inc. was added to the Entrust family to coordinate the delivery of single source medical management services. Approaching this valuable service as a patient advocate and information resource, an experienced and dedicated, professional staff of doctors and registered nurses provide traditional Utilization Management Services, Demand Management, Nurse Triage Services, Disease Management and Claim Negotiation Assistance aimed at containing costs without compromising quality of care. In February 2002, Encore System Professionals, Inc. (ESP) was created to acquire the assets of an established and well-respected health care claim adjudication software vendor. Entrust was one of a large list of satisfied licensees of this software along with other national and international claims processors and insurance companies. The addition of a software development facility added a new dimension of technological capability, flexibility and administrative capacity to all companies within the Entrust family. Most recently, Encore was asked to co-develop an advanced data warehousing product with Ingenix, called "Mindset", to round out the Entrust technology tools. This enables the rapid drilling of data to add support and empirical credibility to both the qualitative and quantitative decision-making processes. Data warehousing is a critical tool to assist in evaluating all aspects of benefit plans, including predicative modeling. We are committed to growth -- growth in our capabilities and capacity to serve, growth in the knowledge and expertise of our dedicated staff, growth in our client relationships, and industry growth in our respective areas of commerce. Currently, over 2.2 million employee lives are directly served or indirectly affected by the Entrust companies, every day! We consider it an honor and privilege to strive toward our goal of continuing to bring practical ideas and solutions to the table that benefit our valued customers. ENTRU~T°' INSQRANC6 •PID ffi~RPS PROI'L9SIONAL4 The following department managers, backed by highly qualified staff members, are assurance that all your employees will receive prompt and efficient service. EDWARD A. JACOBSON PRESIDENT AND CHIEF EXECUTIVE OFFICER e_iacobson @ entrustinc.com EXT 111 ROBYN JACOBSON CHIEF OPERATING OFFICER rLacobson @ entrustinc.com ExT 126 DAVID L. JACOBSON VICE PRESIDENT -SALES d i acobson @ entrustinc.com EXT 114 BRIAN DAVIDSON SALES REPRESENTATIVE bdavidson @ entrustinc.com ExT 124 BARON GIDNEY SALES REPRESENTATIVE kgidney @entrustinc.com ExT 136 LISA BORDELON SALES REPRESENTATIVE Ibordelon @ entrustinc.com ExT 158 RICK MEDRANO SOUTH TEXAS REGIONAL DIRECTOR rmedrano @ entrustinc.com EXT 211 DIXIE A. GUNNING CHIEF FINANCIAL OFFICER dgunning @ entrustinc.com EXT 104 DEREK THOMAS UNDERWRITING DEPARTMENT MANAGER dthomas @ entrustinc.com ExT 107 ERIC SCHULMAN SENIOR UNDERWRITING ASSOCIATE eschulman @ entrustinc.com ExT 143 BETTY HUNTER ACCOUNT MANAGEMENT SERVICES MANAGER bhunter @ entrustinc.com EXT 131 DELENE RAMIREZ SENIOR ACCOUNT MANAGER dramirez @ entrustinc.co m EXT 105 SHELLY NEWMAN ACCOUNT MANAGER snewan @ entrustinc.com EXT 169 JANE LOWRY BETTY RAY CLAIMS MANAGER STOP LOSS AND AUDIT MANAGER jlowry @entrustinc.com bettyrav @entrustinc.com ExT 125 ExT 119 PIYANAD "PONG" CHOOPHAICHITR, PH.D. RESEARCH ANALYST pon8@entrustinc.com ExT.157 Feel free to contact Entrust at 1-800-436-8787 or E-mail us. ENTR,usT=~ INSQRANCS AND B6NSB'II' PROFS3~SIONAL3 Qualifications Entrust, Inc., with corporate offices located in Houston, Texas, is a licensed, full-service Third-Party Administrator (TPA) that prides itself in its ability to administer a broad range of plan designs and features, like Family Monthly Deductibles or customized fee schedule allowances. Entrust has an excellent track record in assisting employers in the design, implementation and administration of self-funded, employer-sponsored healthcare benefit plans. Additionally, Entrust also provides sales and operational management consulting, supervision and support services for managed care organizations, insurance companies, other third-party administrators and employee benefit professionals. Entrust has a reputation for providing innovation, creativity and professionalism, with an emphasis toward personalized service, while continually striving to be the best administrator in the benefits business by working together as a team to meet our clients' needs with honesty, integrity, sensitivity and character. Additionally, with roots dating back to 1975, Entrust has always been at the forefront of a constantly changing industry... providing clients and their constituencies with state-of-the-art technology, including ahigh-tech claims administration system that enables Entrust to provide not only the necessary and/or desired support and services, but also to provide services not typically offered by other entities. This state-of-the-art technology also includes predictive and benefit modeling through a proprietary data warehouse, aptly named "Mindset." Entrust compliments this cutting-edge technology with managers and staff who bring years of experience to all areas of its business. All staff members are imbued with a strong sense of client service, and the customer service personnel all have prior experience as claims processors; thereby, bringing a high level of competency to every aspect of the business. Furthermore, Entrust has always taken great strides to be compliant with all laws and regulations relating to its business operations and the affected services, and continues to take the necessary measures to remain fully compliant with these laws and regulations. In fact, in July 2002, Entrust expanded into a new, state-of-the-art HIPAA compliant office and is proud to have had a HIPAA compliance plan in place prior to the effective date of the HIPAA Privacy rule. Finally, with in-house legal counsel heading the LegaVCompliance Department, Entrust has the capacity to perform all contractual terms and to provide the necessary and required services in a timely and effective manner in order to successfully design, implement and administer self-funded healthcare benefit plans. Having a competent and experienced LegaVCompliance department also enables Entrust to meet all applicable written policies, principles, and regulations. In summary, Entrust not only has the capacity to provide superior personal service, innovative concepts and unmatched professionalism, but also has the experience to stay at the forefront of changing industry trends in order to provide the most flexible, cost-effective solutions possible to meet the every need and requirement of the client. HEALTH BENEFIT PLAN PROPOSAL REQUEST FOR PROPOSAL COUNTY 'EVIATI~ Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement An-angement Cafeteria Pl1n (II2S code l?~) Administration Prescription Benefit Management PLEASE FILL IN THE FOLLOWING INFORMATION NEEDED AND SUBMIT WITH PROPOSAL. The undersigned proposer, by signing and executing this proposal, certifies and represents to Kerr County that proposer has not offered, conferred or agreed to confer any pecuniary benefit, as defined by (1.07 (a) (6) of the Texas Penal Code, or any other thing of value as consideration for the receipt of information or any special treatment of advantage relating to this proposal; the proposer also certifies and represents that the proposer has not offered, conferred or agreed! to confer any pecuniary benefit or other thing of value as consideration for the recipient's decision, opinion, recommendation, vote or other exercise of discretion concerning this proposal, the proposer certifies and represents that proposer has neither coerced nor attempted to intuence the exercise of discretion by any officer, trustee, agent or employee of Kerr County concerning this proposal on the basis of any consideration not authorized by law; the proposer also certifies and represents that proposer has not received any information not available to other proposers so as to give the undersigned a preferential advantage with respect to this proposal; the proposer further 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 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 pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of Kerr County in connection with information regarding this proposal, the submission of this proposal, the award of this proposal or the performance, delivery or sale pursuant to this proposal. The proposer shall defend, indemnity, and hold harmless Kerr County, all of its ofticers, agents and employees from and against all claims, actions, suits, demands, proceeding, costs, damages, and liabilities, arising out of, connected with, or resulting 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 specitcations and general proposal requirements and do hereby certify that all items submitted meet specifications. COMPANY: Entrust Inc. AGENT NAME: D id L_ acob AGENT SIGNATURE: ADDRESS: 14701 St. Mary's Lane #150 CITY: Houston STATE: Texas TELEPHONE: (281) 368-7878 FEDERAL TIlV#: 76-0312320 ZIP CODE: 77(Y79 FAX: (2131)368-7828 ANED/OR SOCIAL SECURITY #: DEVIATIONS FROM SPECIFICATIONS IF ANY (Attach documents as necessary or state No Deviations): No Deviations Page 1 of 3 USPENSION, 'EBARMENT, OTHER RESPONSIBILITY MATTERS COUNTY CERTIFICATION REGARDING Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Tenn Life and AD&D ~rrr Health Reimbursement Arrangement Cafeteria Plan (IRS code 12~) Administration Prescription Benefit Management CERTIFICATION REGARDING DEBARMENT, SUSPENSION. AND OTHER RESPONSIBILITY MATTERS Name Of Entity: Entrust Inc. 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, declared 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 charged 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 year 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. "ir-° David L. Jacobson, Vice President of Marketing Name and Title of Authorized Representative (Typed) a Signature of ut ~ ed Representative Date: October 31, 2007 I am unable to certify to the above statements. My explanation is attached. Page 2 of 3 KERR COUNTY CONFLICT OF INTEREST FORM Conflict of Interest Questionnaire For Vendor or Other Person Doina Business with a Local Government Entitv This questionnaire is being tiled in accordance with chapter l76 of the Local Government Code by a person doing business with a government entity. `fir By law this questionnaire must be filed with the records administrator of the local ;overnment not later than the 7`~ business day after the date the person becomes aware of the facts that require the statement to be tiled. See section 176.006, Locu! Got~ernrrtent 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. L Name of person doing business with local government entity. 2. ^ Check this box if you are filing an update to a previously tiled questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September I of the year for which the activity described in Section 176.006(a) Local Covemment Code, is pending and not later than the T° business day after the originally filed questionnaire becomes incomplete or inaccurate. ) 3. Describe each aftiliation 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. N/A 4. Describe each aftiliation 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. N/A 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) N/A This section, item 5 including subparts A, B, C & D must be completed for each officer with whom the tiler has affiliation or business relationship. Attach additional s as necessary. A. [s the local government officer named in this section receiving or likely to receive taxable income from the filer of this questionnaire? ^ YES ^ 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 ^ NO C [s 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 l0°Ic or more'' ^ YES ^ NO D. Describe each affiliation or business relationship. N/A 6. Describe any other affiliation or business relationship that might cause a contlict of interest. October 31, 2007 Date Signatures Wv'• Signature of erso doing business with the Governments entity Page 3 of 3 ERROR OMISSIONS err' ~-r AUG-08-2007 11:32 Jackie Vezza 8567677590 P.O1 ~~. CERTIFICATE OF LIABILITY INSURANCE DATEIMMIpDM'YYI os as/2oo7 PROpucER (B56) 767-7500 Excel Undar~eriters Alliance, Ina. 150 N. CoopQr Road, Suite A-3 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Nt0 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEp BY THE POLICIES BELOW. Wost 8arlin NJ 0$091- INSURER8 AFFORDING COVERAGE NAIC # NQBUREO INSUliERA TYavoler8 C$BUalt SurAt Entrust, Inc. wsuRERe 14701 St. Mary's Lan® ~ ~ERc Suite 150 N R Houston Tx 77079- I~~R• V V VCRAGEiS THE POLICIES OF INSURANCE LISTED BELOW HAVE 8@EN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED. NOTWTTHSTANDWG ANY REQUIREMENT, TERM OR CONDITN)N OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUED OR MAY AERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR oD'L TYPEOF INBURANCE POLICY NUMBER OATH EFFETE POUC EXP RATI N LI~» GENERAL UABRJTY / / I / E AGH uRRENCE f COMBM1ERCUILGENERALLMBIUTY p P E _QCCUnenca S CWMSMADE ~ OCCUR / / / / MEOEXP ona 6ot1 { PER80NAl 8 ADV INJIbiY i / / / / GENERALA~GGREGATE f GENL AGGREGATE LI M I T APPLES PER RODUCTS • COMPtOP AG S . pp ~~ pp . POLICY JECT LOC / I / / AUTOMOBILE LNIBILITY ANYAUTO / / / J COM8PIE0 SINGLE LMAR (Ei Y0dd6M) s ALL OWNEOAUTOS SCHEDULEOAUTOS / / / / BODILY INJURY (pe,pMOn) i HIRED AVT08 NON•OWNEUAUTOS / / / / BODILY INJURY (PereaAdenl) S / / / / PROPERTYDAMAfiE (Per esteem) S OARAOELIABILITY AUTOONLY•EAACCIOENT S ANY AUTO / / / / OTHER THAN EA ACC S AVTOONLY: AGO i EXCESSNMBRELLA LIABILITY / I / I OCCURREN S OCCUR ~ CLAIMS MADE AGGREGAT t t DEDUCTIBLE / / / ! S RETENTN)N S S YfORNF1i8 COMPEN8AT10N AN0 EMPLOYERS' LIABILITY / / / / I ANY PROPR~TOR/PARTNERA_7(ECUTIVE E.L. EACH ACCIDENT S OFFIClIIlMEMBER EXClUDE07 « ee deaaile Mer / / / / E.L. DISEASE - EA EMPLOYEE 3 y , u SPECULL PROVISXINS bebw E L. DISEASE • POLICY LIMIT S A OTHER PxoPasbional i,iab111t 304788537 / / 07/23/2007 / / / / 07/23/2006 / / EacllClpim 2,000,000 Aq ets 2, 000, 000 066CRR~710N OF OPERATIONSILOCATIONSAfeHICLESfEXCLUBNNQ8 ADDED BY ENOORSlMENTISPECML PROVISIONS CER7IFI ATE HOLDER CANCELLATION ( ) ( ) - Fpx' Informational /Illustrative PLlrp08®B SHOULD 4NY OF 7H! ABOVE BESCRMED POLICIES BE CANCELLED BlFORE THE EXPIRATION OAT! THEREOF, THE 188UIN0 INSURER WILL ENDEAVOR TO MAIL 10 DAYS iNRTITeN NOTICE TO THE CERTIFICATe HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 8 LL IMPOSE NO OBLIGATION OR uABU.ITY OF ANY HIND UPON THE BiSURE ENTB OR R EN ATIV AUTHORIZED RE TATIVE AW Itl) TO (LYYTIUifI ~~; fN80281o-os}o5 ELECTRONIC LASER FORMS, INC. • (8001327-055 '*.,•,,,,,'~""`~ \l/~..~/R1dItD~CQRPORATION~i988- Psge 1 q 2 KERR COUNTY INDIVIDUAL STOP LOSS INSURANCE (ISL) AGGREGATE STOP LOSS INSURANCE (ASL) REQUEST FOR PROPOSAL SUBMISSION FORM ~r-' Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Pl•tet (IRS code 125) Administration Prescription Benefit Management Individual Stop Loss Insurance (ISL)/Aggregate Stop Loss Insurance (ASL) Request for Proposal Submission Form RFP ASSUMPTIONS: 1. Proposal is to be based on the 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 any deviations unless clearly noted. 2. Proposal is to be based on the provided census. 3. Contract effective date is to be January 1, 2008. All participants enrolled in the insurance plan as of December 31, 2007 are to be covered on a "no loss/no gain" basis. "No loss/no gain" for participants are to include credit/debit 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 (l) 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 l5/l2; paid/12; 24/12 or paid /15 basis for Medical and Drug (Rx). We do not wish to see an aggregating specific. 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°Ie 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. QUESTIONS: l . Describe the business entity submitting the proposal: a. Insurance Company Name: American National c/o Alliance Underwriters b. Address: 120 International Pky #220 Lake Marv, F L 32716 c. Contact Person: Jamie Roberts d. Telephone Number: (800) 272-1340 xt. 121 e. Year Founded (Ins. Co): 1905 '~+ Page 1 of 6 Kerr County Specific and Aggregate Stop Loss Insurance f. What percentage of overall business is Health related? 100% ~,,, e. Managing Underwriter's Name: Alliance Underwriters h. Year Founded (Managing Underwriter): 1987 i. Number of Years for Representing Insurance Company: 1998 2. Describe Financial Stability of Insurance Company: a. Financial Rating Service Current Rating Prior Year Rating A.M. Best A+ Su erior A+ Su erior Standard & Poors N/A N/A Moody's N/A N/A b. Is Insurance Company authorized to do business in Texas? 3. Provide three (3) Texas client references (preferably public entities): Company Name: Hill Country Mental Health Mental Retardation Center Company Contact information: Name: David Weden Phone Number: (830) 792-3300 Company Name: City of Kingsville Company Contact information: Name: Diana Gonzalez Phone Number: (361) 595-8017 "fir Company Name: El Campo Memorial Hospital Company Contact information: Name: Steven Gularte Phone Number: (979) 578-5251 4. Describe the business entity submitting the proposal: ~r- a. Name of Business Entity: Alliance Underwriters b. Current Business Address: 120 International Pkv #220 Lake Marv, FL 32746 c. Mailing Address: 120 International Pkv #220 Lake Marv, FL 32746 d. Contact Person: Jamie Roberts e. Telephone Number: (800) 272-1340 xt. 121 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 tiled 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 Page 2 of 6 6. Financial Information: ,~ 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? _ Yes / No If yes, please describe: 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. Agreed• 8. Describe ISL and ASL claim payment: a. Where will claims be paid? Lake Marv Florida b. What is the definition of "paid claim" to be eligible for reimbursement? PAID CLAIM means charges that '~ are covered and payable under your Plan ,that have been adjudicated and approved ,with check or draft issued and placed in the US Mail ,for which sufficient funds are on deposit on the date said check or draft is issued ,and which said check or draft is paid upon presentation. c. Can KERB County's HR Director and consultant speak directly to claim examiner for questions related to payment of claim? Yes No Comment: Entrust would prefer Kerr County to go d. What is the normal processing time for ISL claim? Clean Claim within 10 Business Days e. What is normal processing time for ASL claim? Aggregate claims audits generally take 30 days when an On-Site audit is required. f. What expenses related to investigation of claim are eligible for reimbursement (e.g. hospital audit, medical records, etc) by the stop loss carrier? Hospital Bill Analysis fees with supporting documentation, Negotiated savings fees with supporting documentation, Independent physician review fees with prior approval, LCNI fee with supporting invoices and reports. g. If KERR COUNTY has negotiated with providers, will these discounts be accepted, in lieu of doing a hospital or other audit? Yes_X_No - Negotiated savings are reviewed on acase-by-case basis. The revisi~ranoe carrier should be conAdted prior to agreeing to a negotiated discount whenever Advance Funding wi71 be ~, h. Describe documentation needed for ISL claim reimbursement: See our Specific Stop-Loss Check List on our website www.allianceu.com Page3of6 9. Describe Underwriting: a. Will any claimants be excluded or assigned a higher deductible (lasered)? Unknown err ~r If so, please describe: Please refer to the Terms & Conditions in the Financial Sections of the Proposal. l0. 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 restrictive than those used in KERB 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 (with Dixtcnure Statement) 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: United Resource Networks. The information is proprietary. www.urnclient.com l4. Please state any variations to the Request for Proposal Assumptions or other qualifications for your quote: Please see Terms and Conditions in the Financial Section of the Proposal. I5. After the ISL deductible is reached will the stop loss carrier pay claims directly to vendor or require Ken County to pay claim and be reimbursed? Specific Advancement has been included in the quote provided. If reimbursed what is turnaround time? N/A 16. For what period of time are quoted rates guaranteed? ,Ianuary 1, 2008 -December 31, 2008 17. Is a longer rale guarantee available? If so, please describe: Yes / No 18. Are quoted rates net of agent commission? / Yes No If no, please describe: All Stop-Loss quotes have been provided net of commissions. 19. Do quoted rates include advance funding for: a. Specific Claims? If no, additional cost to provide: b. Aggregate Claims? If no, additional cost to provide: $1.50 Per Employee Per Month 20. Is the quote based on the services of a specific provider network? Texas True Choice was the quoted PPO Network for Kerr County. 21. Please give rate differential to use the following networks: Specific Aggregate a. PHCS No Change No Change b. Healthsmart No Change No Change c. BC/BS N/A N/A d. CCN +10% +5% e. Beechstreet +10% +5% f. Other (Name) N/A N/A / Yes No Yes / No / Yes No Page 4 of 6 21.The fo(lowine 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 Spreadsheef'. Complete this spreadsheet as it will be used for bid analysis. `'~.- Current Plan 50 000 Specific Deductible Basis for Deductible: Incurred: 15 Paid: 12 Number of Rates Monthly Premium Annual Premium Participants Specific Premium: Single 165 $59.16 $9,761.40 $117,136.80 Family 78 $136A7 $10,613.46 $127,36L52 Com osite 243 $83.85 $20,375.55 $244,506.60 Aggregate Premium Composite 243 $4.93 $1,197.99 $14,375.88 Aggregate $1,687,780.80 Attachment Pts. Single 165 $438.15 $72,294.75 $867.537.00 Family 78 $876.31 $68,352.18 $820,226.16 Alternate $500 FMD Plan 50 000 Specific Deductible Basis for Deductible: Incurred: 15 Paid: 12 Number of Rates Monthly Premium Annual Premium Participants Specific Premium: Single 165 $59.16 $9,761.40 $117,136.80 Family 78 $136.07 $10,613.46 $127,361.52 Com osite 243 $83.85 $20,375.55 $244,506.60 Aggregate Premium Composite 243 $4.93 $1,197.99 $14,375.88 Aggregate $1,586,494.08 Attachment Pts. Single 165 $411.86 $67,956.90 $815,482.80 Family 78 $823.73 $64,250.94 $771,011.28 Page 5 of 6 'fir `ir" Alternate $1,000 FMD Plan 50 000 Specific Deductible Basis for Deductible: Incurred: 15 Paid: 12 Number of Rates Monthly Premium Annual Premium Participants Specific Premium: Single 165 $59.16 $9,761.40 $117,136.80 Family 78 $136.07 $10,613.46 $127,361.52 Com osite 243 $83.85 $20,375.55 $244,506.60 Aggregate Premium Composite 243 $4.93 $1,197.99 $14,375.88 Aggregate $1,535,869.44 Attachment Pts. Single 165 $398.72 $65,788.80 $789,465.60 Family 78 $797.44 $62,200.32 $746,403.84 Page6of6 SPECIFIC CLAIM UBMISSION CHECKLIST '~rrr SPECIFIC CLAIM SUBMISSION CHECKLIST Completed Specific Stop Loss Claim form Cumulative Paid Claims Report or completed Summary Worksheet Copy of original enrollment card (including hire date and effective date) Completed claim form or verification of other insurance investigation Employee work status (last date worked/method of continuing coverage) COBRA election form and proof of COBRA premium payments Copies of claim checks or report including check numbers and paid dates Copies of supporting claims and EOBs Proof of Deductible and Coinsurance (Out-of-pocket) satisfaction Copies of itemizations Copies of precertifications Copies of physicians' prescriptions and/or treatment plans err Case management reports Copies of investigative materials to support the claim (when applicable) R&C calculations Hospital audit results Medical records Divorce or separation decrees or court orders Full-time student status verification Accident details, police report, PIP payments, subrogation agreement Pre-existing condition investigatioNcert. of Creditable Coverage Starting date of dialysis Signature THIRD COUNTY ADMINISTRATION QUESTIONNAIRE Kerr County Third Party Administration Questionnaire TPA Organization 1. Name, Address, City, State, Zip Code and Telephone Number of Firm. Entrust Administrative Services, Inc., 14701 St. Mary's Lane, Suite 150, Houston, Texas 77079, (2811 368-7878 or (800) 436-8787. 2. Is your firm owned or operated by a parent company? No. If yes, please identify the parent and its primary business. 3. How long has your firm been in business? Entrust has been in business since July 1990. How long have you done claims administration? Ed Jacobson, the Founder and President of Entrust, Inc. has administered plans for over 30 years. Full claims administration services have been performed at Entrust since its legal conception in 1990 and its predecessor administration company, IMA, back to 1975. 4. Who are the principal officers in your firm? How long have they been in their positions? Princi al Officers Len th of Time Edward A. Jacobson - President/Owner 40 Years + Rob n Jacobson - Chief O eratin Officer 15 Years + Dixie Gunnin -Chief Financial Officer 25 Years + 5. Is this a branch facility? No. If so, please identify the main office location. 6. How many claim processors are Full Time employees in your firm? There are 8 full time claim processors. 6a. How many claim processors will be appointed to service this account? The Entrust claim adjudication software auto-adjudicates approx. 6(1% of all claims so the traditional model of using claim processors to evaluate every claim is no longer necessary. Notwithstanding, Entrust will dedicate as many processors as it takes to adequately handle the group. We initially assign 2 v`,,. processors to review and examine any edited or facility claims, and then make whatever adjustments are necessary, predicated on volume. 6b. Of those approximately how many years of experience does each have with medical claims processing? All of Entrust's claims processors/examiners are experienced, with many having over ten (10) years of medical claims processing experience. The manager of the claims department has over twenty (20) years of medical claims processing and management experience. Do you have bilingual claims personnel available to plan participants who call your office for customer service and/or claims processing? Entrust has bilingual personnel in each department to enhance customer service satisfaction, including several in the claims department. 8. How many clients do you perform claim administration services for? What is the average size'? Entrust currently provides services to approximately 77 employer organizations. The clients range from 50 to 5000 employees, with an average of 548 per organization. 9. Do you carry Errors & Omissions coverage'? Y'es. Provide a copy of your current policy. Please see the Request for Proposal Section. Page 1 of 12 Claims Administration 1. What are your claim office performance standards for claim accuracy and turnaround time? The following chart illustrates our standards for both Financial Accuracy and Claim Payment Accuracy which are tracked by ~,,. each group and each examiner according to industry standards. The performance standard for turn-around time for claim payment for all types of claims (see question 2) is less than 15 days which we have exceeded every year for the last seven years. Financial Accuracv Financial accuracy is considered to be the most important industry measurement of performance. It is obtained by adding over and underpayments, without regard to minus or plus application, and subtracting that total from total paid dollars audited. The result is divided by the total paid dollars audited. ~ Etttrast % Indust SfandaM ._ ~~ ~ 99.8% 99.5% or above 99.0%- 99.4% Less than 99% Claim Payment Accuracv Claim payment accuracy is obtained by taking the total number of transactions handled correctly, without either a dollar error or a procedural error, divided by the total number of transactions audited. ntrust % Inc! , :Standard 98.6% 97% or above 95.0% - 96.9% Less than 94.9% `Industry standard derived from: Trilogy Consulting Group, Inc. ~r 2. What is your average turnaround time? The average turn-around time for Entrust to adjudicate all types of claims -COB, subrogation, pended, third-party, and clean claims - is 12.69 days. This is based on when the check "went in the mail" versus when the claim was processed. This is an important distinction when evaluating the adjudication efficacy of an administrator. The average turn-around time for claim processing prior to check issuance is less than 7 calendar days. 3. What is your current per day production minimum expected of your claims processor? The expectation of each claims processor/examiner is approximately 700 claims per week, which equates to an expected minimum of at least 140 claims processed per day, 20 per hour. T'he Rapid Data Entry module converts paper claims into electronic claims and the minimum production standard is 50 claims per hour. 4. What are your internal audit procedures? Entrust has an Auditing Department that uses the following guidelines for their quality control standard: 1. All HCFA's (provider or ancillary bills) with payments of $2,500 or greater. 2. All UB-92's (hospital bills) with payments of $5,000 or greater 3. 100% of all claims that are over the specific deductible. 4. A random 10% of alt claims regardless of the paid amount. 5. In addition, once Entrust starts processing claims for a new group, 100% of all claims are audited until such time as it is determined that the % can be reduced to meet internal quality guidelines. 6. 100% of all RDE (system processed/auto adjudicated claims) are also audited for data entry accuracy. 7. 100% of all Member-direct payments over $500. 8. 100% of all claims processed by examiners within the first ninety days of hire. Auto-Adjudication of Claims: For even greater quality control, Entrust performs a 100% audit of all critical fields that are entered for auto-adjudication. Page 2 of 12 5. What edits and controls are used to avoid duplicate payments? Entrust begins their edit process in the Rapid Data Entry module wherein common eligibility edits, provider edits and date of service edits are performed prior to release into the batch adjudication process. The Entrust claim adjudication system has a sophisticated internal auditing process which identifies common duplicate claims (same date of service for ~/ same participant with a common grouping of procedures), fraudulent claims (dates of service performed on national holidays or weekends) and workers compensation or subrogation claims (common accident procedure codes). The impacted claims are batched in a manner so an examiner must actively work through a screen prompt to continue processing (such as bundling) or return the claim for other action. Custom edits are commonly created during the plan build stage so certain plan-specific or participant-specific elements can be further reviewed by an experienced examiner. 6. What safeguards exist to protect against claims abuse and fraud? Even though Entrust recognizes that no system can eliminate 100% of all claim abuse, we maximize the system set up so we can identify potential claims and aid the processor to utilize his/her best judgment. As a result and previously stated, Entrust has created programming changes to flag what is identified as common duplicate claims (same date of service for same participant with a common grouping of procedures), fraudulent claims (dates of service performed on national holidays or weekends) and workers compensation or subrogation claims (common accident procedure codes). The impacted claims are batched in a manner so an examiner must actively work through a screen prompt to continue processing, review the claim for bundling or return the claim for other action. Additionally, there is security set up for each department so every employee only has access to the minimum amount of system modules to enable them to adequately complete their job. For example, employees in the eligibility department can not access the claims data module or provider database. These security measures are maintained by one employee and reviewed by senior management for appropriateness. Each department is responsible for creating and maintaining quality control procedures. What program do you use to unbundle claims? A variety of "unbundling" edits are built directly into the Entrust claim adjudication architecture (called "Encore") so the internal auditing process can identify common concerns, based on procedural codes, place of service, dates of service, CPT codes or diagnosis codes. The impacted claims are batched in a manner so an examiner highly skilled in the specific area must actively work through a screen prompt to continue processing, audit for bundling errors or return the claim for other action. What coordination of benefits (COB) procedures do you follow? Even though the Summary Plan Document will dictate the rules by which Entrust will adjudicate claims, Entrust defaults to the birthday rule for our order of benefits when coordinating with other health coverage plans. There are 5 basic steps that Entrust uses to administer the COB provision in a plan. They include 1) recognition of other coverage, 2) documentation of other coverage, 3) determination of primary/secondary status, 4) determining allowable expense for COB purposes, and 51 processing for payment. Claims received for which the spouse of the covered employee is the patient, or in which there are covered minor children and the spouse of the covered employee is employed are investigated for COB. This COB investigation also applies to stepchildren or natural children that have an address different from that of the covered employee whether there may be a court degree requiring a divorce parent to provide coverage that would be primary to the plan. What database do you use to determine Reasonable and Customary fee allowances? Typically, Entrust utilizes Medical Data Research (MDR) to determine Reasonable and Customary charges when evaluating out-of- network and non-PPO claims, multiple and bilateral surgeries, and for assistant surgeon fees. For in-network charges, the contracted rate is used. Entrust also has several other fee schedules that are used for clients, depending upon their need and plan design. These include Medicare/RBRVS Allowable, Industry Allowable, Data Warehouse or custom created fee schedules. How frequently do you update your R&C screens? Our Reasonable and Customary allowances are updated on an annual basis, wherein we typically take 95% of the rate to determine the charge; however, this percentage can change as deemed appropriate. On a selected plan design basis, the RBRVS schedules are utilized at varied percentage rates. The Entrust system has the flexibility to pert in any fee schedule(s) for any physician provider group in the system or create a customized schedule as appropriate for the plan. 10. Describe your procedures for professional Medical claims review? Entrust Customer Service Representatives and Claim Analysts have been trained by Aledical Helpline -the Utilization Review and Case Management service company --0 to aid in the screening of benefit calls and claims by diagnosis, treatment and dollar amount for potential cases. Additionally, the Entrust claims adjudication system has been programmed with identification of certain CPT and DX codes that trigger further examiner review for possible case management necessity. Both have been successful in the early identification of large claims especially breast Page 3 of 12 and prostate cancers, which may never require inpatient treatment. Trigger Diagnosis reports are also created to identify those patients who have incurred claims with those industry defined diagnosis and are reviewed by both Medical Helpline and Entrust staff. Furthermore, Entrust's Audit and Stop Loss department is trained to identify potential cases long before the claims surpass the customary "50% of the stop loss threshold" notification guideline required by the carrier. Once a case is identified, review of medical ~rrr necessity is initiated which includes assessing cost effectiveness of the treatment plan, making recommendations and referrals, providing patient education and negotiations as necessary. The Case Managers of Medical Helpline review all opened files and refer any required medical opinions to an independent physician review board with over 150 physicians available in multiple disciplines. Second opinions and appeals are reviewed as necessary. 'tilt/ 1 1. Explain your hospital bill audit procedures. Hospital bills exceeding $10,000 (with no PPO discount) or charges in excess of the norm for the particular diagnosis, or categories that appear unusually high such as IV drips, medical supplies or implants/devices are referred to the claims manager or audit department for further review or audit. The claim is reviewed for non-covered or excess charges and may be submitted to a case manager or a contracted medical specialist for further review. Entrust uses several medical service organizations to audit hospital procedures for not only medical necessity but appropriateness of care or coding. On site hospital reviews are performed on a case by case basis as the need may or may not arise. 1?. Describe your procedures for tracking and reporting excess claims? The Entrust Stop Loss/Audit Department has several means of knowing and notifying the stop loss carriers of potential reinsurance claims. After every check run a specific stop loss report is generated that reflects the name s of all individuals who are in excess of 50% of the specific deductible. Once an individual hits this reports, a notice is sent to the carrier. If a claimant is being handled by the client's Large Case Management or Utilization Review Company the carrier as well as the Stop Loss Department is put on notice. The Stop Loss Department will also send up a report that reflects the amount of claims paid during the current contract period, if any. Occasionally there may not be anything paid but we have apre-certification on file or a phone call from the claimant or provider. In anticipation of a potential excess claim, hospital bills exceeding $10,000 (with no PPO discount) or charges in excess of the norm for the particular diagnosis, or categories that appear unusually high such as IV drips, medical supplies or implants are referred to the claims manager or audit department for further review or audit. The claim is reviewed for non-covered or excess charges and may be submitted to a case manager or a contracted medical specialist for further review. l3. Explain how you handle subrogation and third party disbursements? All subrogation is monitored and managed by experienced in-house subrogation claim reviewers at Entrust and referred to outside subrogation counsel as deemed appropriate. The plan will contain appropriate subrogation language, reflecting the past and recent case law, necessary to establish and protect the plan's subrogation rights. This language is written in a manner sufficient to notify any participant that such subrogation rights exist. If selected for the Contract, Entrust can include, among the annual enrollment materials already provided by Entrust, information regarding the plan's subrogation rights, which can be presented by Entrust during the annual enrollment process. Entrust also has experienced claims staff trained in identifying claims for which there is a potential for subrogation under the plan. Once identified, there is a careful investigation of the claim and, if determined to be a claim to which subrogation exists, a notice is then sent to the participant advising of the plan's subrogation rights and requesting accident information, including any Third Party involvement. Upon receipt of the requested accident informatior-, all claims will be processed according to the plan document. Any money recovered under the subrogation rights of the plan will be documented in F,ntrust's system, a copy made of the submitted check and then immediately Forwarded to the Clier-t for reimbursement to the plan. 14. List the excess carriers which you are approved with for claims administration? Entrust management has been on the forefront of the self-funded industry since 1975. In this current, tight sellers market for stop loss the Entrust management's philosophy of enduring, long-term stop loss relationships has really paid off. We have been working with the same few underwriters (MGU's) or carriers, some for as long as twenty years. Some of the carriers represented are: I) American National 2) Pan American Life 3) American Fidelity 4) QBE Insurance 5) Standard Security Life 6) AIG Life 7) Gerber Life 8) Companion Life Page 4 of 12 1 ~. Do you provide a toll tree number for claim inquiries? Yes. If yes, what is the cost? There is no additional cost for Entrust toll free number. 16. What are your normal hours of operation to answer calls for claim inquiries? We receive live inquiries anytime from 8:0(lam - 4:30pm Central time, Monday -Friday. Additionally, there is a Fax Back and Web Claim Portal system available 24/7 for providers and/or patients to verify claim status and benefits within seconds. ~"` We also maintain a voice mail system for handling after-hours calls, which each customer service person claims processor is required to empty and resolve by the end of the morning of the next business day. 17. Describe your customer service process when an employee calls with a claim inquiry. Entrust is committed to the belief that the "customer comes first" and takes pride in assisting employees or their dependents in answering questions and resolving problems. The average speed of answer is less than 21 seconds (national average is 41 seconds) with a live, professionally trained customer service representative and the first call resolution rate is 96%. The standard for follow up call resolution is within 24 hours and the average call abandonment rate is <1% whereas the national average is 5%. All calls are recorded and monitored for quality control purposes and are documented as described below. Computer system: One of the premier features of the Customer Service module on the Entrust claims adjudication system is its ability to track and record "events" that occur during routine calls. These "events" can be as specific or as broad as necessary and then reports can be generated about these events for further quality control review. Entrust currently utilizes a lengthy list of events to monitor activities, such as complaints. This sophisticated Customer Service module not only tracks, monitors, and records every call but it logs and tracks all correspondence to the claimant. Phone system: Entrust utilizes the latest telecommunication version of Intertel's telephone system which records every call received at Entrust. Furthermore, the phone system enables the Claims Manager, or other department managers, to monitor their staff for quality control purposes and it tracks every call to determine abandonment rates, hold time and average length of call per person per department. l8. If you have a separate customer service unit, what are your standards for: The average length of time for a call to be answered: 00:00:21 seconds (irat'l average speed to answer >-10 sec) Abandonment Rate: 0(1:00:01 seconds, (1.01 % (nat'l average is >.S%) Hold Time: 0(1:00:02 seconds Return Calls: Messages left in the morning are returned in the afternoon and messages left in the afternoon are returned the following morning if they are unable to return ~' the same day as the initial inquiry. The customer service standard is to return the calls the same day as received or within 24 hours, whichever is less, unless instructed otherwise. (nat'l average is 48-72 hours) 19. What submission rate has been assumed when calculating your fee? The claims submission rate assumed when calculating fees is .7 claims per member per month. 20. Does your fee assume a first year claim lag? If so, what is the cost to purchase mature claim year administration? The claims transaction fee is rated on a per claim basis. The fee is charged when a claim is processed, whether paid or denied. Since the transaction fee is not based on enrollment or a flat monthly amount, the cost remains the same for mature or immature claims. First year claim lag has no impact on the transaction fee. 21. Does your tee assume any excess loss carrier overrides? No, the fee does not assume any excess loss carrier overrides or commissions. Eligibility System How is an insured's eligibility assigned and maintained? Eligibility is maintained using the Encore Claims Administration System. Eligibility records are updated "real time" on the system so Customer Service Representatives or claim examiners can access this information as soon as it becomes available. After the initial enrollment, enrollment information is entered into the system within 24 hours of receipt. Each group is configured by the specific eligibility classes, sub- groups, locations or other delineations of each type of plan offered for the group. Member elections and information are entered by trained and experienced Administration Staff and can not be changes by unauthorized personnel. Controls are set at the group/plan level and maintained by management staff. Entrust strongly recommends a meeting between Entrust Administration Staff and the Human Resources staff to ensure the procedures are properly defined. Additionally, Entrust has a new product wherein they offer payroll and benefits integrated onto adebit-modeled card at an additional fee. Page 5 of 12 ?. How often can eligibility information be updated'? After the initial enrollment, eligibility information is updated "real time" as it is received and entered into the eligibility module by Entrust. Furthermore, monthly billings are mailed to our clients for verification of enrollment. Enrollment information received prior to the 15'~ of the month will be reflected in the next month's billing. Information received after the 15"' will be reflected in the following month's billing. Invoices ~rr-' are to be paid as rendered so adjustments can be properly reflected. Once the correct enrollment is received in our office, we process within 24-48 hours of receipt. 3. Do you maintain information on each of the family members separately, as well as the employee'? Yes, Entrust maintains full information on each of the family members separately, as well as the family unit. 4. What is your accuracy standard and turnaround time for loading new groups, updates, and changes'? After initial enrollment, Entrust's standard turnaround time for updates and changes is within 24-4K hours of receipt, assuming the information on the enrollment form is complete. The initial enrollment turn-around time is subject to the manner in which Entrust receives the eligibility data, typically this is within two weeks of receipt of completed forms. Commonly, groups that have been with a carrier for more than 1 year want a full eligibility audit performed to assist in identifying any potential errors. A recent Wall Street article indicated such audits have yielded as much as 20% changes in enrollment. Entrust recently performed such an audit on a fairly large Austin group which yielded such a change. Entrust reviews all initial enrollment materials for accuracy and completion before submission into the eligibility module. System Capabilities I . Is your claim processing system completely automated? Entrust owns and operates the Encore Claims Administration System, formerly known as BeneSys, www.encoresyspros.com, astate-of-the-art computer claims processing system operating on the HP platform considered by technicians as one of the most comprehensive and efficient systems on the market today. This is an on-line direct access system specifically designed for managed care plans and complex plan designs. The computer system automatically adjudicates claims according to the benefit and pricing structure customized by each client/plan. Co-payments, deductible, eligibility, premium paid-through dates, validated diagnosis, procedure payment and location of service codes are fully automated thereby facilitating a cost effective and ~"` accurate adjudication of claims. Data is ether received electronically or entered into the system by dedicated personnel who are experienced, fast and accurate in rapid data entry and claim processing. Auto-adjudication of claims can account from 50-94% of all eligible claim payments, subject to plan design. ?. Are there any significant manual activities required to process claims? In the event that claims are received in a paper format, then Entrust will convert that claim into an electronic claim through the Rapid Data Entry system. With minimum key strokes, this system auto-populates HCFA's with the member or provider information then converts it into an electronic claim in the batch system. 100% audit of all critical fields are reviewed prior to release for adjudication. Describe your claims payment system, including hardware and software? The principals of Entrust own and operate the Encore System Professionals, formerly known as BeneSys, www.encoresyspros.com, astate-of-the-art computer claims processing system operating on the HP platform, considered by technicians as one of the most comprehensive and efficient systems on the market today. With over 2.2 million participants using this system nationwide, it has proved itself as a quality leader in the industry today. This is an on-line direct access system specifically designed for managed care plans and complex plan designs. The computer system automatically adjudicates claims according to the benefit and pricing structure customized by each clientlplan. Co-payments, deductible, eligibility, premium paid-through dates, validated diagnosis, procedure payment and location of service codes are fully automated thereby facilitating a cost effective and accurate adjudication of claims. Data is ether received electronically or entered into the system by dedicated personnel who are experienced, fast and accurate in rapid data entry and claim processing. Auto-adjudication of claims can account from 50-94°Io of all eligible claim payments, subject to plan design. Page 6 of 12 Entrust operates on the most recent upgrade of the Encore Claims Administration System which enhanced the system reporting, data base analytics and created even more flexible plan building (design) options. The modules include claims administration, eligibility, customer service, consolidated billing, capitation, Rapid Data Entry, Reporting, COBRA and Trust Accounting. Since the principals of Entrust own and operate the Encore Company, Entrust has a direct line of communication with Encore and has the ability to institute necessary changes and/or upgrades as needed. The benefit to the District is that the typical TPA does not have ~' the luxury of being the owner of the claim software co-npany so they are victim to the priorities that their software company sets. This is not true for Entrust. Entrust is in control of the development and future enhancements of the software to ensure they best reflect what is mirrored in the health market industry today. To our knowledge, Entrust is the only independent third party administrator that owns a claim adjudication software company not only in Texas, but nationally. With over Z.2 million participants on the En Core system, Entrust believes they are in the best position to maximize the benefits any claim system can bring to a client in today's marketplace. 4. Do you own or rent your claim payment system software? As stated above, the principals of Entrust own and operate the Encore System, formerly known as BeneSys, www.encoresyspros.com, astate-of-the-art computer claims processing system with over 2.2 million participants nationwide. So, Entrust not only owns the software, but the entire software co-npany so enhancements and special projects are customized to fit the need's of Entrust's clients, as needed. 5. How is a person's claim history tracked'? Employee and family history is tracked in the claims payment module and accumulated as events occur. Every verification of benefits, status of claims or member inquiry is attached to the member's file and is easily retrievable by the customer service staff. History of claim data can be kept and tracked as long as ten years. 6. How many benefit components (IE -separate deductible, totals, lifetime benefits, etc.) can be maintained by the system? The claim system can maintain virtually an unlimited amount of benefit components. Currently, there are over 480 different benefit codes available to be utilized on an~plan. 7. Can the system track number of visits by procedure'? Yes. 8. Can the system handle different benefit levels for PPOs? Yes, this is a key feature ot'the plan design system and ~r can be reported differently, as needed. 9. How many PPOs can the system handle for one client? Entrust has never experienced a maximum limit on PPO's for a client. The PPO decision is driven by many factors and the networks selected are built into the eligibility module so the members can be enrolled directly into the applicable plan. Each adjudication plan is then attached to the appropriate PPO for proper processing. 10. Can your system accept Electronic Data interchange claim submissions? Yes, Entrust can accept Electronic Data interchange claim submissions, provided they are in full compliance with all HIPAA regulations and guidelines. In Texas, very few providers are able to submit compliant 837/835 transmissions so custom gateways are often required. l 1. What percentage of your claims is currently accepted on an electronic basis? Claims can be either delivered to Entrust as paper or in a HIPAA compliant EDI Format. All paper claims are received, and begin processing in Entrust's mailroom. Compliant electronic claims, if available, are captured through the state-of-the-art EDI system in "Encore" and are translated directly into the auto- adjudication system. In anticipation of HIPAA eight years ago, Entrust created abatch-adjudication and auto-entry process that edits and electronically adjudicates anywhere from 50- 94% of all claims ,subject to the various plan design elements. Whether the claim is received in paper or electronically, Entrust translates the claims into an electronic format and applies the customized edits required for the specific plan design. It is this type of capability that has yielded such extraordinary accuracy rates which is virtually unsurpassed in the industry. Unfortunately, less than 1% of the claims are received in a HIPAA compliant fashion. Entrust has one provider that can submit up to 45% of their claims electronically. Page 7 of 12 Banking Arrangements 1. Do you require the use of a specific bank for claim accounts'? No. If so, please provide the name, address, and phone number of the bank. There are several banking options available to be considered by the client. One option is ~, for the client of to use their own bank; however we will need to set up a new Trust Account for Entrust to process payments. Subject to the financial institution, the bank may allow for a zero pay or other electronic means of transmitting transactions. Entrust is happy to discuss the various options to assist the client in selecting the method that would satisfy both their financial departments and budget goals. 2. Is an initial claims payment deposit required to establish banking arrangements? Depending on the bank of choice, there may be a minimal deposit requirement. 3. Will you perform bank account reconciliations? Entrust provides as part of their comprehensive service administrative services, full trust accounting for every client. This includes monthly Income & Expense statements, as well as a Balance Sheet. 4. Are there any additional costs to the banking? (I.E.: -EFT charges, monthly charges, etc.) This will be subject to the bank and their banking fees and services requested. 5. What is the cost of the check stock you provide'? For groups over 300, there is no charge for claim checks. 6. How many checks are provided in your cost assumptions? N/A Entrust is aclient-oriented third party administrator (TPA) and, as such, affords its clients significant flexibility in funding and banking arrangements. We suggest that the client establish their benefit account at a bank of their choice (Entrust can assist with this process) and that this account be funded and used to track all plan expenditures; i.e., all claims, administration fees, premium payments for stop loss coverage, other vendor payments (e.g., PPO access fees, Rx transaction fees, capitated services, pre-certification utilization review or case management fees, etc.), stop loss reimbursements and any other plan income and expense. Entrust has a fully staffed administration and accounting department, which will perform the monthly reconciliation of the account and provide the client ~r with the plan sponsor with completed financial statements, each month. Obviously, this complete financial reporting would be further augmented by claim and utilization reporting. We find that over the past 30 years of providing TPA services, most clients want to minimize their staff's involvement in the day-to-day plan activities. This approach minimizes plan sponsor involvement; yet, provides maximum reporting and accountability. However, Entrust systems are more flexible than most TPA's and all insurers that provide ASO services. Clients may choose to fund one of three ways; a) to maximum, b) to expected or c) as needed. Entrust recommends the group fund to maximum (premium + fees + maximum claims) for the ls` year. This should allow a claims reserve to develop over the length of the plan. The reserve may then be used to help offset future increases and claims cost the plan may incur. If the group considers the reserve to be a sufficient amount the group may want to alter their funding to the "expected" (premiums + fees + expected claims) level in future years. Entrust does not recommend the group "fund as needed". No reserve will be established when utilizing this funding method. Regardless of the funding mechanism chosen by the group, all premiums and vendor fees must be paid each month in full. Other options that may be considered to mitigate the risk on a plan include capitating certain types of risks. Entrust has a unique capitated generic drug program that limits the risk on all generic drugs to a per- member-per-month basis by carving it out of the self-funded risk. This is an excellent tool to control costs and bring budget ability to a plan. Entrust also has an outstanding capitated EAP/behavior health program that is also carved out of the risk and brings an excellent value to the plan. This is just a sample of the type of programs that are uniquely available through Entrust, Inc. It is important to remember that any employer, when taking on the responsibility of sponsoring an employee benefit plan, whether fully insured of self insured, is adding a new line of "business" to their primary "business" purpose. A plan that functions using prudent business principals has a greater chance to become a successful, long-term endeavor. Entrust staff has "managed" thousands of plans over the past 30 years, including school districts, and once our systems plan design concepts and procedures have been put in place, these health plans outperform others for years. Page 8 of 12 Utilization Review 1. What U.R. services are performed in-house? All U.R. services will be performed by Medical Helpline, Inc. which has on-line access directly into the Entrust system to update on authorizations and notes. 2. What outside U.R. services do you use'? Entrust primarily utilizes the services of Medical Helpline, Inc. located in Orange, CA', a sister company, to provide Utilization Review, Concurrent/Retrospective Review, Case Management, Special Claim Negotiation and Large Case Management. How long have you used them'? Entrust has utilized Medical Helpline since 1998. Indicate which U.R. services you have assumed in your proposal? Pre Notification Preadmission Review Concurrent Review - On Site or Oft Site Retrospective Review Large Case Management Discharge Planning Medical Helpline will provide all the services listed above. These services are included in the price of our inpatient utilization management fee. Concurrent review is performed off-site telephonically. A second surgical opinion program is an option available to the employer should they choose to incorporate that language into the plan document. The identification and notification to the plan administrator of potentially high dollar claims and large case management cases is included in this fee. Once a case is opened, however an hourly rate is applied for management and interventions provided on that case. 4. Can you accommodate Pre-Notification for the following? Specialty Care referrals Home Health Care Ancillary Services Inpatient Surgical procedures Outpatient Surgical procedures Lab & X-ray procedures ~'" Inpatient Mental Health and Substance Abuse Outpatient Mental Health and Substance Abuse Itledical Helpline can for an additional fee provide review for any or all the outpatient services listed above. The needs, costs and benefits for such a program would be reviewed with the client individually to develop a customized plan. Inpatient surgical procedures, inpatient mental health and substance abuse are included in Medical Helpline's inpatient utilization management fees as addressed in question #3. In the event the group decides to utilize the services of the capitated CIGNA Behavioral Health/EAP program, then they will perform those specific certifications. Preferred Provider Organizations 1. Do you have capabilities to process PPO discounts in-house? Yes. 2. Which PPOs do you have access to processing in-house? Texas True Choice, First Health Network, Galaxy Health Network, HealthSmart, Best Care, various Mississippi networks, Evolutions, Southeast Texas Health Network and miscellaneous other regional networks. 3. Can you install PPO discounts for Direct contracts with providers? Yes. If so, what is the charge? In a typical environment, this is included in the administration fee. If there is extensive custom contracting required, Entrust has experienced Provider Relations Contractors to negotiate fee structures. Without knowing the extent of this request, a fee specific is unknown. 4. How many different PPOs do you interface with currently? Approximately 10. Even though the Entrust is fully capable of loading and adjudicating fee schedules for networks "on the fly", we find most networks are not ~,+ interested in releasing their proprietary fee schedules. Who are they? Entrust directly accesses the networks listed in question #2 above as well as some regional networks in Louisiana, Wyoming and South Texas. Page 9 of 12 ~. Which PPOs are you currently using'? (attach directory or website access) Texas True Choice First Health Network SPOHN Health Network Beechstreet Best Care ~' Evolutions HealthSmart MPCN First Health MS Mississippi Health Partners South Texas Health Network Galaxy Health Network Various Miscellaneous Regional Networks Reporting Provide a list of reports available in your standard reporting package. What is the cost of these reports? The reporting capacity of the Entrust claim adjudication system as well as the sophistication of their proprietary data warehouse "Mindset" is one of the foremost features of this proposal. Entrust feels so strongly about sophisticated analytics that they hired a Ph.d. in Business Management & Logistics to head up their research department. Reports are generated as follows: 1) system generated reports, 2) ad hoc reports, 3) data warehouse customized reports, and 4) stand alone financial reports. Attached please find sample reports in the Report Section, which are normally provided on a monthly or quarterly basis, depending upon the type of report. 2. Can you generate customized reports'? Are reports available through Internet? What is the charge? Ad Hoc reports and other customized special reports are available upon written request and will be delivered no later that the agreed upon due date and price. 3. How are paid claims reported? Paid claims are reported in various different analyses as demonstrated in the ~ sample reporting package. How does your firm report claims to Excess Loss carriers? The Entrust Stop Loss/Audit Department has several means of knowing and notifying the stop loss carriers of potential reinsurance claims. After every check run a specific stop loss report is generated that reflects the name s of all individuals who are in excess of 50% of the specific deductible. Once an individual hits this reports, a notice is sent to the carrier. If a claimant is being handled by the client's Large Case Management or Utilization Review Company the carrier as well as the Stop Loss Department is put on notice. The Stop Loss Department will also send up a report that reflects the amount of claims paid during the current contract period, if any. Occasionally there may not he anything paid but we have apre-certification on file or a phone call from the claimant or provider which is then transmitted to the carrier for their proper notification. 5. Can you report on PPO savings? Yes. Data Warehouse Analysis and Plan Forecasting Entrust believes so strongly in empirical decision-making that they hired a PhD. on staff in Business Management & Logistics that is available to assist in extensive forecasting and plan analysis. Based on the needs of the client and extent of the research desired, there may an additional fee for these services. Dr. Pong Chopichitiar heads up the Research Department at Entrust and utilizes star schema logic to access and analyze data on a warehouse of five years of accumulated health information. Trends can be identified in areas and normative comparisons to group utilization can be made. If extensive plan design changes are contemplated then a new plan can be built within the Encore system to forecast the potential impact to the group and thereafter such data can be brought over to the warehouse for comparison analysis. The fees for such reports are quoted upon request. General I . What is the cost for producing a plan document? The cost for producing one plan document is included in the Implementation Fee. Is it included in your cost assumptions'? Yes, this is included in the Terms & Conditions in the Financial Section. Page 10 of 12 2. What is the cost for producing a Summary Plan Description'? Entrust incorporates the Summary Plan Description and Plan Document into one document, the cost of which is included in the Implementation Fee. Is it included in your cost assumptions? Yes, this is included in the Terms & Conditions in the Financial Section. 3. What is the cost of having the Plan Document and SPDs changed due to regulatory changes'? None. Is it included in ~'" your a>st assumptions'? Since there are no known regulatory changes, then the cost could not be assumed. 4. What is the cost of printing the X00 Summary Plan Descriptions for the plan participants'? The cost of the Summary Plan Descriptions is borne by the group; however, Entrust will create a sample document for approval and arrange for printing as requested by the group. Is it included in your cost assumptions? n/a 5. What is the cost for printing 1000 ID cards? Entrust produces customized, integrated ID cards on hard mil plastic and as their standard, produces 1 card per employee coverage, 2 cards per employee + family coverage and I card per full time student if living at a different address and Entrust is notified. The cost of producing standard cards is included in the administration fees. Is it included in your cost assumptions'? Yes. 6. What is the cost of Explanation of Benefits: This is included in the administration fees. Is it included in you cost assumptions? Yes. If so, how many do you assume? Even though this answer is dependent upon the actual utilization, the assumption is .7 per member per month. 7. Is there an initial set-up tee charged for the installation of our plan? The Implementation Fee is $1500 and the Annual Maintenance Fee is $3(10(1 as disclosed in the Financial Section. 8. Please disclose any additional fees or expenses that are borne by the client. Please see Terms & Conditions in the Financial Section. 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. Entrust provides full Compliance Services which includes COBRA administration, HIPAA administration and Medicare Part D administration. All of these employer required services are offered for $1.95 per employee per month as disclosed in the Financial Section. ~"" HRA Questionnaire Entrust administers many Medical Reimbursements Plans, or commonly referred to as Deductible Reimbursement Plans, and understands that this group currently has this type of reimbursement plan. Therefore, the following questions will be addressed as though the group will continue with some type of reimbursement for deductible exposure under the plan. 1. Do you offer HRA administration in conjunction with your claims administration'? Yes, Entrust will set up a separate plan for the reimbursement component and will treat the reimbursement as an integrated part of the health plan. The system will be able to track utilization of both plans and report on an individual and combined basis. 2. How often do you reimburse a claimant for expenses incurred that are tiled on a paper claim form? Assuming that all of the information has been provided to properly process the claim, then the reimbursement should be make within our average of 12.69 days from receipt of such information. 3. Do you provide a debit card for all participants? No, a debit card would not be needed unless the Plan intended on setting up a compliant Health Reimbursement Account wherein funds would be made available for withdrawal by the Plan and rollover provisions were accounted for. However, Entrust provides an integrated ID card that incorporates both medical, Rx and reimbursement instructions for the provider as part of their major medical administration services. 4. Do you require the use of a specific banking institution? Assuming that the Plan would be reimbursing the participants for certain deductible exposure amounts, then the reimbursements would occur from the same banking institution as the Plan selects for the major medical plan. Entrust will assist the Plan with this process. 5. Is there a minimum funding requirement? If so what? Assuming the reimbursements are being made by the Plan, then the Plan's fiduciary duty is to promptly fund for those amounts as they become due or called for. Page 11 of 12 6. Please describe your HRA administration in relationship to your medical claims administration. As described in question #1 above in this section, the reimbursement plan will be set up as a separate plan but will be able to be combined with the major medical plan for reporting and utilization tracking purposes. This wilt enable an analysis of the efficacy of both plans for future plan design considerations. ~"` 7. Identify all costs associated with your HRA administration package to include all costs and services provided. These costs for services are itemized on the Terms & Conditions. Since there is a claim transaction fee for each transaction, albeit paid or denied, then the cost will be limited to those claims which are incurred by the plan. Please see the Financial Section of the proposal for a listing of such fees. 8. Do you include access to accounts via the Internet? Thirty days after the Plan Document is signed, employees and providers have access 24/7 to the Entrust Claim Web Portal wherein they can review claim status, eligibility, plan details and make certain requests. At what additional cost if any'? The basic claim web portal is included in the claims administration fees. "`ar Page 12 of 12 COUNTY PRESCRIPTION BENEFIT QUESTIONNAIRE Prescription Benefit Mana>?er Questionnaire Please find the current prescription drug plan design in the medical plan summary attachment. I. Please describe your retail pharmacy network (number of independents and number of chains; are all chains ~r-` in the network?) including its relationship to you (e.g. owned or leased). WHI owns and contracts with all participating pharmacies in its networks. The proposed Preferred Network is composed of over 63,000 independent and chain pharmacies (including all major chains) and spans all 5(1 states, Puerto Rico, Guam, and the U.S. Virgin Islands. There are roughly 44,000 chain pharmacies and 19,0011 independent pharmacies in our network. In addition, we can offer your members the freedom to pick up 90-day supplies of maintenance medications at 39,000 retail locations. 2. Please confirm that prescription drugs prescribed by any licensed health care provider, including dentists, will be covered by the pharmacy program. An appropriately licensed prescriber can write prescriptions; but by federal law, prescriptions for controlled medications must be written by a prescriber with a DEA number (typically a physician). 3. Is the use of a formulary mandatory? Please attach a copy of the formulary for review. No. However for Kerr County to attain the highest possible savings, we highly recommend utilizing WHIs Preferred Medication List (PML). WHI created its formulary as a low net- cost formulary, meaning that it is modeled with generics-first and cost-effective preferred brand medications. WHI has provided its Preferred Medication list as an Attachment. 4. Does the retail brand discount include savings from formulary, network spread, clinical savings, DUR savings? No. 5. Is the brand discount a hard discount? The brand discount is a fixed guarantee. 6. Is the brand discount an average? Is it based on 11 digits NDC? The brand discount is a guaranteed discount. The price is a fixed discount otI' AWP based on the 11-digit NDC number submitted. WHI uses First DataBank as its drug data .source. AWP prices within First DataBank are updated daily, with new drugs and clinical updates revised weekly. 7. Is the brand discount at mail order based on 100 units or actual acquisition NDC? Our "truth-in-pricing" philosophy is evidenced by the fact that we adjudicate claims based on the 11-digit NDC submitted by the pharmacy provider. This means our clients receive the savings provided from larger package sizes as opposed to average package size or 100-count pricing. Further, WHI does not "repackage" products in its mail service facilities, in order to assign unique NDCs and arbitrary Average Wholesale Price (AWPs) that could inflate your cost. 8. Is the mail discount based on 11 digit NDC? Yes. Claims are submitted based upon the originator NDC. When there is a cost savings to the client, we bill the actual 11-digit NDC of the product dispensed on new prescription requests. Thus, if we dispense from a larger-sized package, the client gains the advantage of our purchasing power. For those drugs where there isn't a savings, or it is cost neutral, we use the standard NDC in our company price file. Page 1 of 13 9. Is pricing for retail brand and overall generic effective rate guaranteed? Retail brand discounts are guaranteed. The non-MAC generic discount is also guaranteed. WHI is not providing an overall generic guarantee. 10. 1<'our quote must include a traditional pricing model and a transparency full pass-thru model. Is the pricing `'~ guaranteed? The proposed pricing is a traditional financial model. 11. What is the discount for specialty drugs? What is the dispensing fee? Is the specialty drug program apass- thru under a transparency model? Are supplies included in the pricing? Specialty pharmacy medications are available via adual-distribution network. These medications are restricted to Walgreens retail stores as well as via home delivery through mail service. As part of WHI's cost management strategy for specialty medications, supplies are limited to a 3(1-day supply and are available at the standard retail rates as proposed. 12. Please provide your definition of "generic". Also provide a definition of the generic included in the overall generic guarantee. Generic: A chemically equivalent copy designed from a brand name drug whose patent has expired. A generic is typically less expensive and sold under a common or "generic" name for that drug. Also called a generic equivalent. 13. What quantity is an AWP based on for mail order? Mail service pricing is predicated on an 8d to 90-day supply. 14. How are manufacturer rebates handled? Will KERR COUNTY share in the rebates? If so, what percentage? WHI shares rebates with Entrust based on plan design. ~` 15. Do rebates have a minimum guarantee per claim? Per brand? The rebates provided to Entrust are fixed, flat dollar amounts based on plan design and group size. 16. Are rebates paid quarterly? If not, when? WHI sends claims data for rebates within two weeks after the end of each quarter. (No member names are sent.) WHI accumulates rebate dollars and then disburses them to our clients on a quarterly basis, based upon the contractual terms. Payments usually run 180 days in arrears, based upon when payments are received from manufacturers. 17. Under transparency pricing model, are rebates a 100% pass thru of Gross? Not applicable. 18. Will coverage of OTC impact rebates? If so, how much? No. 19. Do rebates survive termination? When are they paid after termination? No. While WHI intends to honor all commitments made with regard to rebates, termination of services, in whole or in part by Kerr County prior to the contracted period, would void all rebate agreements. No monies would be returned to Entrust/Kerr County subsequent to the termination notice. 20. Are rebates paid on specialty drugs? All manufacturer's drugs, including specialty drugs, that are contracted to generate a rebate, are eligible and payable to Entrust/I{err County. Page 2 of 13 21. Do you contract directly with manufacturers for formulary rebates or do you use another PBNI° If yes, who handles° WHI contracts directly with manufacturers and administers its own formulary program. 22. Please describe how the drugs for the formulary are selected, and who is responsible for the selection. ~Iwr+' Key to an optimal medication use process for any organization is its Pharmacy and Therapeutic (P&T) Committee, an organized group of clinical specialists and key stakeholders from varying practice areas. This group functions as an advisory panel on the safe and effective use of medications covered by a client benefit. This Committee of national thought leaders includes Physicians, Pharmacotherapists, Pharmacoeconomics and Outcomes experts, and others from various disciplines and professions. P&T Committee members are selected on the basis of their credentials and their body of work, whether within the literature or within the clinical setting. Our physicians are academic and practice experts from a variety of areas. Every P&T Committee member signs a conflict of interest statement that ensures their objectivity. WHI typically utilizes an open, actively-managed formulary, otherwise known as our Preferred Medication List (PML). For clients with a 3-tier plan design, the P&T Committee recommends medications be placed on the preferred (2nd tier) list if they have demonstrated significant clinical and economic value. Medications are generally placed on the WHI Preferred Medication List (PML) in the following manner: New brand medications are initially non-preferred (3rd tier) until the P&T Committee can conduct its evaluation process. This can occur very quickly for high impact medications on a priority basis. During the time a medication is set to arrive on the market, the P&T Committee applies a safety check on the medication. It may have been deemed safe and effective by the FDA, but placed under special distribution restrictions to ensure that happens. Other medications may remain on the market after significant safety ~„ issues have been identified because they are used in special populations that need it. These medications remain non-preferred (3rd tier). • Generic medications are always preferred and are placed on the lowest copay tier (l st tier). Multisottrce Brands with generics available are always non-preferred and are placed on the highest copay tier (3rd tier). Remaining brands are evaluated thoroughly using the following criteria. "Does the medication have'?": • Therapeutic Merit (Is it tenique and therapeutically vahtable?) and/or a • Therapeutic• Advantage (Is there medical evidence and/or standard of care to srtpport it having some advantage over other medications in its class?); and if so, then does it have • Therapeutic Value (Does it deliver overall economic value to members and their plans?). New drugs can be added to the PHIL at any time based on the above evaluation process. WHI removes - or deletes- drugs from the formulary every January. It is important to note that WHI's P&T Committee's bases its evaluations solely on clinical and clinical economic (Pharmacoeconomic) criteria, as suggested in the Academy of Managed Care Pharmacy (AN1CP) Format for Formulary Submission. Once clinical efficacy has been established, net cost considerations play a legitimate and important rote in the development process. At no time are drugs chosen based on business alliance "steerage". Page 3 of 13 23. Do you own your own mail service? If not, who do you sub-contract with and do you retain revenue? Mail service is provided through Walgreens Mail Service. Walgreens Mail Service is owned and operated by the Walgreen Co. and has facilities located in Orlando, Florida and Tempe, Arizona. We propose mail service from our state-of-the-art facility in Tempe, Arizona. 24. Do you own your own Specialty Pharmacy? Or subcontract? If yes, who handles specialty pharmacy? Yes. WHI will administer the specialty pharmacy benefit through Walgreens Special Pharmacy (WSP). WSP, including recent acquisitions such as Option Care, Schraft's Infertility and Medmark Specialty Pharmacy, is a wholly-owned subsidiary of the Walgreen Co. As afull-service specialty Pharmacy provider, WSP provides both central fill and retail distribution of 30 day supply Specialty products across a wide array of biotech categories. Product can be delivered to physician offices, patient homes, community health clinics as well as through any of the _5,900 Walgreen retail pharmacies across the country. The real value proposition of the Walgreens Specialty Pharmacy is the patient consultations and clinical savings through care management. 1~Iost products are managed through a Specialty Prior Authorization process whereby patients are evaluated on initial fills to ensure clinical appropriateness, and disease-state specialized clinicians work directly with patients to discuss the symptom expectations for their disease state as well as ongoing counseling pertaining to the therapy administration. These various efforts help reduce waste and misuse of highly expensive medications ensuring both optimal patient care outcomes and plan cost savings. 25. What is the average turnaround time for mail order pharmacy? We define and measures dispensing efficiency in terms of average Turnaround Time (TAT). Average Turnaround Time is the time from receipt of a prescription to time of manifesting and shipping. We track TAT for both "clean" and "exception" (any kind of manual intervention required, regardless of issue) prescriptions. Our goal for clean prescriptions is two business days. Our goal for exception prescriptions is five business days. On a book of business basis, the turnaround time for clean claims during 2006 was 0.$ ~, business days. Turnaround time for intervention prescriptions was 1.73 business days respectively. For the Tempe mail service pharmacy, the turnaround time for clean claims during 2006 was 0.66 business days. Turnaround time for intervention prescriptions was 1.74 business days respectively 26. Can mail order pharmacy be ordered on-line? Yes, once the original prescription is on file, we can accept refills by mail (mailing the copay amount and the order form), by phone, by fax, or by Internet. Nlail Refills To request a refill by mail, the member simply completes an order form and mails it to the facility along with the appropriate copay. Provided no intervention is required, WHI usually dispenses the drug within two business days of receiving the order. Phone Refills Mail Service participants who choose phone refills can call a dedicated toll-free number and order refills using atouch-tone phone. The toll-free number for the touch-tone refill service is dedicated solely for phone- in refills and is available on a 24-hour basis. Fax Refills Members also can refill prescriptions by filling out fax forms. This form is provided as a part of the member packet, and would also be available via the Internet or through the benefit administrator. The completed ~'° form must be submitted to a prescriber who may then fax the form to WHI. Only a prescribers fax will be accepted. Page 4 of 13 Internet Refills Members also have the option of ordering refill prescriptions online 24 hours a day, seven days a week. If the member is not already registered with our online refill service, they can complete an online mail service registration, update their mail service registration, and prink mail order forms and physician fax order forms. RX Order Status E-mails Additionally if the member has a mail benefit and has registered for it with a valid a-mail address, the member may track order fulfillment through our RX Order Status E-mails service. This program notifies our members when we have both received and shipped their medication, thus increasing satisfaction while decreasing account management issues related to shipping expectations or uncertainty. 27. Does the PBM allow 90-day fills at retail in addition to mail order? If so, what contracted pharmacies participate? What is the discount to KERR COUNTY fora 90-day network? What plan design is used? Yes. WHI pioneered the concept of a 90-day supply at retail. Designed far members utilizing maintenance medications, Advantage90® has proven to be a viable alternative for members. For many people using maintenance medications to treat long-term health conditions, their only choice is to get prescriptions filled via mail. While mail has proven to be an effective and convenient approach for some, others favor the comfort and familiarity they enjoy with their neighborhood pharmacy. To address both preferences, Advantage90® offers members the freedom to obtain a 90-day supply of maintenance medication from over 39,000 retail locations. Mail service remains an option for members who prefer home delivery. The following is a list of the top 10 participating Advantage90® pharmacies in the State of Texas: • Walgreens • CVS Pharmacy • Wal-Mart • Kroger • Albertsons ~"` • Target • Randalls • Tom Thumb • Sam's Club • Brookshire Brothers Pharmacy WHI has included its national pharmacy network list as an Attachment. The discounts available for 90-day retail prescriptions approaches those available through mail service, and represents a significant savings opportunity over savings available through multiple 30-day supplies. For specific pricing, please see PHARMACY -Proposed Fees. 28. Do you offer alternatives in the pharmacy program that can help control or reduce the plan costs? If so, please provide details and approximate savings for each feature. Advantage90 Our 90-Day at Retail program, Advantage90O, gives members taking maintenance medications a convenient alternative to mail-service without removing the cost-savings of mail-service. Advantage90 brings convenience to Kerr County members by providing choice between retail and mail to fill their medication. Advantage9() also saves Kerr County money by towering the cost of prescriptions through deeper discounts at more than 38,000 participating pharmacies. Page 5 of 13 MedMonitor® Retrospective Drug Utilization Review (RDUR) WHI's Retrospective Drug Utilization Review (RDUR) is an invaluable clinical tool that both protects members from potential adverse drug events and enhances their quality of care. MedMonitor offers the ability for WHI to integrate both Kerr County pharmacy data and medical carrier claims data. The ~, MedMonitor© RDUR program offers the means to prevent adverse drug events before they can become costly and dangerous issues. Integrating and monitoring prescription and medical histories help ensure safe, appropriate drug therapy. MedMonitor is an optional service provided by WHI. Our Senior Safe Prescribing program (part of MedMonitorO) is designed to identify and decrease utilization of potentially inappropriate medication use in seniors based on recommendations by a panel of experts in geriatric medicine. This program identifies seven therapeutic classes (25 medications) that are commonly used to treat the senior population. The goals of this program are to decrease the utilization of these inappropriate medications and prevent potential harm in the senior population. Care Management -Healthy Living (Disease Management) Walgreens Health Initiatives Care Management -Healthful LivingT"' is a multifaceted offering designed to help improve self-management of costly and prevalent chronic health conditions and create awin-win situa- tion for plan sponsors and members alike. Through patient education, our disease management program helps empower participating members to successfully manage their health condition, and thereby potentially improve their health, quality of life, productivity, and reduce overall healthcare costs. In addition, this pro- gram's wellness-focused offerings help healthy members stay well and manage the risk factors for disease. Voluntary Tablet Splitting Program In keeping with our commitment to provide quality, affordable prescription care, the WHI Voluntary Tablet ;,~,, Splitting Program has been designed to help clients and members manage the rising costs of prescription medications. Patients in a tablet splitting program save money by cutting a "double-strength" tablet in half to take their prescribed dose. While this voluntary program can be an excellent cost-control option for many members, WHI does not support mandatory tablet splitting programs. Mandatory programs may cause a patient's medication therapy to be disrupted due to delays in obtaining a new tablet splitting prescription, and would inappropriately require patients with dexterity or cognitive impairment to split tablets. Medication Therapy Management In another "high-tech, high-touch" approach embracing both technology and human interaction, Walgreens Health Initiatives has created a comprehensive new program designed to help improve patient outcomes and manage overall healthcare costs. The Walgreens Health Initiatives Medication Therapy Management (MTM) Program combines custom designed technology solutions, face-to-face pharmacist-patient interaction, and our in-house clinical care center. MTNI interventions, via one-on-one counseling, are designed to help patients understand and adhere to their medication regimen, and avoid inappropriate and potentially dangerous medications. Optimizing medication therapy in this way can increase patient care and decrease overall healthcare costs. Our MTM services, which have the flexibility to customize intervention type and volume per plan-specific parameters, include any or all of these components: appropriateness of therapy (AOT), inappropriate medications in the elderly (IMIE), medication adherence, and polypharmacy. Our extensive managed care and community pharmacy experience gives Walgreens Health Initiatives the unparalleled expertise necessary for optimizing both cost management and quality patient care through technology-based solutions such as the Walgreens Health Initiatives hITM Program. Page 6 of 13 Medication Management Programs WHI offers optional clinical prior authorizations through our sophisticated Medication Management offering. Medication Management programs are designed to improve patient outcomes while proactively saving critical healthcare dollars. These programs promote appropriate utilization of expensive and potentially wrr misprescribed or abused medications. The protocols we put in place are intended to save overall healthcare dollars by limiting inappropriate, and sometimes overutilization of medications. Highlights of the Medication Management Programs Include: • Therapy-Specific Design Based on your plan benefit criteria, members are informed of specific medications requiring prior authorization and are advised of the procedure to request clinical review. Example drug categories are obesity, migraine, and anti-fungals. • Clinical Pharmacist Analysis Our staff of clinically trained pharmacists manages the authorization process and works with the physician to promote the most appropriate, cost-effective therapy for your members. Our pharmacists review the clinical criteria and determine approval or denial based on the information obtained through the patient, physician, pharmacy and plan. This strategy takes away the uncertainty of administration at the point of sale, enforcing the parameters needed to fulfill the program exactly as specified. • Customized Quarterly Reports WHI is committed to documenting true savings results, thus our reports will document the number of approvals or denials, types of medication, and estimated cost savings for your plan. OI' course, this commitment extends to all areas of reporting, including the extensive standard management reports and the supplemental reporting package. Medication Management Program Options Kerr County can enroll in any combination of the following Medication Management programs: • Clinical Prior Authorization Programs -Identify expensive, high-impact, and potentially misprescribed and/or abused medications. • Step Care Therapy Programs -Generally require utilization of an effective first-line agent before a more expensive alternative may be covered/dispensed. • Appropriateness of Therapy Programs -Monitor drug quantities, age, and gender for appropriateness of therapy. • Clinical Override Programs -Provide medical-necessity alternatives for members seeking to obtain medications outside their standard prescription benefit design. Our Most Popular Medication Management Programs: • OTC Clarion -This program is designed to encourage the use of OTC non-sedating antihistamine (NSA) products before a prescription NSA is approved. Wheu based upon an estimated standard duration of therapy per year, anticipated savings from this program are. $3..36 per dollar invested. ~ • OTC Prilosec -This program is designed to encourage the use of OTC proton pump inhibitors (PPI) products before a prescription PPI is approved. When based upon arz esti~nated standard duration of therapy per year, anticipated savings from this program are $12.43 per dollar invested. Page 7 of 13 • Insomnia -This program is designed to ensures appropriate utilization of insomnia medications. Does not allow for chronic use unless medical condition or medication is causing the insomnia. Wlaen based upon an estimated standard duration of therapy per year, anticipated savings from this program are $8..5.5 per dollar invested. • LamisiUSporanox -This program is designed to allow treatment of nail fungus in high-risk patients ~, for developing infections. When based upon an estimated standard duration of therapy per year, anticipated savings from this program are $8.69 per dollar invested. • Migraine -This program is designed to ensure appropriate treatment (i.e. use of prophylactic therapy), utilization and dispensing quantities of migraine medications. It also prevents stockpiling. When based upon an estimated standard duration of therapy per year, anticipated savings from this program are $33.06 per dollar invested. WHI is committed to our clients; therefore, we will only recommend programs that appropriate for Kerr County's membership. 29. Please explain your Drug Utilization Review process for these programs: a. Prospective WHI offers a unique formulary management/therapeutic interchange program, designed to help our clients control their drug expenditures while providing enhanced patient care to their members. Our Informed PrescribingT"" program employs dedicated, specially trained pharmacy professionals who, according to specific plan design of Kerr County and established clinical criteria, identify those retail and mail service prescriptions appropriate for intervention activities. Programs include Brand-to- Generic interventions, Brand-to-Brand interchanges, and formulary management support. Informed Prescribing is included as part of our PBM offering. b. Concurrent Included as part of our PBM services is our Concurrent Drug Utilization Review (CDUR) program, ~ which is an effective tool in monitoring drug use to assure that it is appropriate, safe, and effective. CDUR identifies Drug/Drug interactions, duplication of therapy and over-utilization situations for Kerr County members in real time. WHI works directly with the pharmacy to block and adjust the medication as appropriate. c. Retrospective WHI's Retrospective Drug Utilization Review (RDUR), MedMonitor®, is an invaluable clinical tool that both protects members from potential adverse drug events and enhances their quality of care. MedMonitor offers the ability for WHI to integrate both the Kerr County pharmacy data and medical carrier claims data. The MedMonitor® RDUR program offers the means to prevent adverse drug events before they can become costly and dangerous issues. Integrating and monitoring prescription and medical histories help ensure safe, appropriate drug therapy. MedMonitor is an optional service provided by WHI. 30. Please submit a sample of your standard reporting package. Attach samples of your standard reporting package that is included in your quote. Please note if your paid claims numbers are based on paid or incurred claims figures. WHI has included a sample reporting package as an attachment. All reported figures are based on true paid claims. 31. Include in your response a PPI report, a specialty drug report, and a net cost per day for mail or retail report w/ specialty and acute meds removed. WHI has included a sample of its standard reporting package as an attachment. Detailed reports specific to certain therapeutic categories (i.e. PPI report) or cost metrics (i.e. cost per days supply) can be made available as an ad-hoc report. Page 8 of 13 32. How do you propose getting members to look at alternative brands that have generics available and do your manufacturer contracts preclude you from providing this type of information to members? WHI recognizes an effective generic substitution policy as one of the greatest cost savings opportunities available for our clients and their members. Our claim processing system automatically prompts the ~rrr pharmacist when a generic is available. At that time, the pharmacist can substitute the generic for the brand name drug, as permitted by law, plan design, clinical policy, and his or her professional judgment. At mail, it is the policy of Walgreens Alail Service to dispense a generic for a brand name drug whenever legally permissible and clinically sound. As an ancillary service, WHI can review utilization, identify members using multi-source brand drugs, and create targeted alert letters informing them of what generic alternatives are available. We can also create communication materials promoting the use of appropriate generics. Our "Go Generic" brochure provides the member simple, easy to understand facts revealing the importance of substituting brand name drugs with appropriate generics, as well as the advantages of using the mail pharmacy. Additionally members may also visit our website www.mywhi.com to find out if their prescription drug has a generic available. Our Informed PrescribingT"' program also assists in maximizing appropriate generic utilization. Along with monitoring and evaluating prescribing patterns; supporting pharmacy needs; providing medication adherence activities, and disease management initiatives; and consulting with members, prescribers, and pharmacies, these centers perform generic interventions when appropriate. Brand to Generic Program When a prescriber writes "Dispense as Written" on a prescription that has a safe and effective generic alternative, we will contact the prescriber to request that a generic substitution be allowed. If the prescriber agrees, the substitution is made. At our mail service Facility, the intervention takes place with ~,, the member's approval prior to dispensing the first fill. At retail locations, the intervention takes place with the member's approval after the initial fill, and for each fill thereafter. Our success rate with this intervention is over 90 percent. For combined DAW I and DAW 2 (member requires brand over generic) interventions, WHI currently has over a 65 percent success rate. WHI is not precluded from promoting any items. Since WHI is not arebate-driven PBN1, there are no such exclusions. This means WHI is able to design the program that best suits your members' needs. 33. What financial advantage would KERR COUNTY gain if we limited the pharmacy network to several large chains? Could exceptions be made in outlying areas? WHI believes that members should have choice in where/how they obtain their medications and that restricted networks prevent that member choice. however, if this is an option that Kerr County wants to consider, WHI would be willing to discuss this in further detail. 34. Is electronic billing available? Reports on line? Is an interactive website available? Can members compare pricing of drugs on line? Billing/Invoicing Currently WHI does not offer electronic billing. We invoice pharmacy claims twice each month. Administration fees are invoiced once per month. We strongly prefer payment be made via wire transfer to enable timely payment to participating pharmacies. For wire or AC'H payment, a fax or a-mail containing invoice numbers and amounts should be sent at the same time as the transfer to WHI. Page 9 of 13 Online Reporting All reports included in the standard reporting package are available online. Online reports are available on a rolling basis for the three previous reporting periods, with the former previous period archived online for one fir„ month. WHI's online reporting and query tools are designed to run from standard desktop computers via traditional Internet Service Providers. WHI will assign passwords and IDs to access our online reporting and eligibility tools, and our RxPort system. Website WHI has been providing Internet support since 2002. WHI provides a comprehensive and user-friendly web site that contains an array of toots to assist both members and clients alike. These toots include a quick and easy member registration page, member home page, plan-specific drug coverage and copay search tools, a formulary search, a detailed geographic pharmacy locator, an Rx History section, a place to order mail refills, prescription order status check, account summary searches, personal secure messaging mailbox, eligibility verification, temporary ID card printing, a health information library, a contacts resource and much more. Clients and members continue to be impressed with www.mywhi.com. In fact, 94 percent of all clients responding to our 2006 satisfaction survey rated it as "good to excellent" in terms of the site's usefulness and overall resources. WHI encourages Kerr County to visit our site, www.mywhi.com, using the following "test" user name and password. ~" :- User Name: whidemo26 Password: whidemo26 35. Will the PBM provide assistance with developing a communication piece? Yes. 36. Provide all materials used in marketing your product. Please see Attachments. 37. Do your administration fees include the following: a. Postage (in D below) For standard mail service prescription delivery, yes. For additional member materials mailed directly to members' homes, no. b. Claim forms Direct Member Reimbursement (DMR) claim forms (paper claim forms) are available at no charge. DMR claims are processed at $1.75 per claim. c. ID cards, (medicaUrx combo cards?) Yes. d. Mailing to participants homes No. Page 10 of 13 e. Participating provider directories N/A f. Customer service representatives specific to KERB COUNTY. No. Please note that customer service representatives are not designated only to Kerr County. g. Nlail order forms Yes. h. 1- 800 number to call center Yes. i. Standard report packages Yes. 38. Does your plan currently offer on-line access to claims and eligibility information for employees? Is there a separate charge for this to the plan? Yes. At no additional cost, WHI provides connectivity to our claim processing system to Entrust via the Internet to view eligibility, add/change/terminate eligibility, view adjudicated claims, and enter prior authorizations. Utilizing this tool provides complete control of member eligibility, eliminates paper additions and deletes, allows for online, real-time authorization of designated drugs, and provides access to member claim history and drug profiles. 39. Will any revenue be paid to a third party administrator for services, fees, disease state management or other vendor services by the PBM? Will all compensation to third parties be disclosed? Is an implementation allowance paid to the payor? If so, how much per member or head of household? No. ~- 40. Will you audit the pharmacy data? Specifically, as a payor, what independent source will audit claims? What are the fees associated with an independent audit? Yes. WHI's Drug utilization Review (DUR) is an effective tool in monitoring drug use to assure that it is appropriate, safe, and effective. Our online, real-time point-of-service UUR program monitors claim submissions across all pharmacies and prescribers, compares each claim with the active prescriptions of individual members, and sends "flags" back to the pharmacist should any drug interaction occur. Our DUR system adheres to the National Council for Prescription Drug Programs (NCPDP) DUR guidelines and monitors every prescription for numerous condition categories, including: drug/drug interactions, therapeutic duplication monitoring, overutilization, quantity over time edits, and maximum dose range edits. One of the most common occurrences involves Duplication of Therapy. For example, when a member is being treated for high blood pressure using ACE Inhibitors, it is not unusual for the prescriber to change products or doses. Our integrated online, real-time system alerts the pharmacist of a potential adverse outcome, and recommends counseling the member to discontinue the use of the previous prescription, which may or may not have been made clear at the prescribers office. In addition to rigorous concurrent edits, Walgreens Health Initiatives ensures network integrity through regularly conducted desk and onsite pharmacy audits. These audits are performed by PrudentRx, an independently owned company known for its advanced auditing and review capabilities. Every month, WHI sends claims to PrudentRx for review. These claims are then run against more than 90 proprietary algorithms established by PrudentRx. These algorithms identify potential audit opportunities such as quantity limit errors (too low or too high), prescription splitting by pharmacies, missing or inaccurate patient information, and many others. PrudentRx researches outliers and notifies WHI of specific claims that should be addressed. Following our internal review of PrudentRx recommendations, WHI charges back pharmacies as needed and credits our clients' accounts appropriately. Page 11 of 13 Walgreens Health Initiatives supplements its desk audit program with onsite visits to the pharmacies themselves. Pharmacies are selected based upon findings from our desk audit program, at random, or as a result of a member or client concern. Conducted by PrudentRx, these onsite audits are an opportunity to observe individual pharmacies, their practices and procedures, and ensure all contractual requirements are ~r being adhered to. They also have a sentinel effect, notifying all pharmacies in the network that Walgreens Health Initiatives intends to hold all stores to the highest of standards. During 2005, 45 percent of all network pharmacies had claims that were subjected to a desk audit; approximately 70 percent of our network pharmacies had claims that were desk audited in 2(106. Less than 1 percent underwent an onsite audit. WIII is amenable to independent audits by Kerr County as long as the selected auditor is not a competitor of WHI and we are provided a signed confidentiality agreement beforehand that is acceptable to WHI. The scope and timing of such an audit would be subject to mutual agreement and could include topics such as network discounts, eligibility, implementation, and rebate calculations. All information, records, and data pertaining to the processing and payment of prescription claims will remain the property of Walgreens health Initiatives. For business reasons, we discourage audits during the months of December or January. 41. Will you provide consultative modeling and forecasting annually? Yes. WHI offers Entrust access to standard management reports, quarterly trend reports, and our RxPort query tool to assist with consultative services. WHI uses a proprietary Insight modeling tool to analyze a client's claims data. Insight has the ability to re- adjudicate multitudes of claims, calculating cost impacts due to copay changes, drug class coverage additions or deletions, new pricing arrangements, as well as trend claims forward using growth and inflation. It also models the effects that our clinical programs could have on the individual client's claims, models changes in ter utilization and rebates caused by a change in formulary, and models the effects of a client's claims with the addition of new generics or other drugs to the marketplace. Insight is supported by a team of financial analysts who are able to create customized modeling based upon each client's individual needs. 42. Will atrue-up of guarantees be performed annually? If so, when can KERB COUNTY expect payment of true-ups above guarantees under transparency model? WHI is not offering any guarantees as part of this PBAI proposal. 43. Will the mail service provider provide to KERR COUNTY copies of their suppliers (wholesaler or manufacturer) invoices showing net invoice for medications? No. 44. Will your firm detail its total revenue from all sources for administering the KERR COUNTY pharmacy benefit plan and allow an independent audit by the KERR COUNTY? Yes. WHI is amenable to audits by Kerr County, as long as the selected auditor is not a competitor of WHI and we are provided a signed confidentiality agreement beforehand that is acceptable to WHI. The scope and timing of such an audit would be subject to mutual agreement and could include topics such as network discounts, eligibility, implementation, and rebate calculations. All information, records, and data pertaining to the processing and payment of prescription claims will remain the property r-f Walgreens Health Initiatives. For business reasons, we discourage audits during the months of December or January. Page 12 of 13 45. The 3 finalist will be required to make a presentation to KERR COUNTY and answer questions to fully explain the specifics of the program offered. Entrust will be able to attend finalist meetings to answer questions and to fully explain specifics to the pharmacy benefit program offered. 'ors' -16. Will your firm contractually guarantee that the amount you reimburse to pharmacy providers is the exact same amount that is billed to the plan sponsor:' No. WHI is proposing a traditional model through which some revenue is earned via the difference between "pay pharmacy" and "charge client" rates. Attach a sample draft of the PBM contract. A sample PBM contract is included as an attachment, however all PBNt services are contracted directly through Entrust. An additional PBM contract will not be necessary. Sri/` Page 13 of 13 ALGREENS HEALTH INITIATIVES (WHI) MANAGEMENT REPORTS err ~GQa "Healt~~tiues Standard Management Report Package Utilization Reports A. Executive Summary B. Client Group Summary II. Savings Reports A. Denied Claim Summary B. Generic Savings Summary III. Dr A. B. C. D. ug Reports Top 100 Drugs by Rx Top 100 Drugs by Plan Costs Top 10 Therapeutic Classes by Rx Top 10 Therapeutic Classes by Plan Costs IV. Top 25 Prescribers V. Phari~~acy Comparison VI. Member Reports A. DUR Summary ~. Walgreens Heal th Initiatives Executive Summary Report«: t,tt><, CLIENT ### Report Date: 01/29/2007 - - - --- Report Period: Dec 2006 llec 2UU6 -- -_ _ Total Retail 311 Retail 9U Combined Retail Mail Avg Eligible Members 1,03U Utilizing Members 282 251 29 265 28 Number of Rxs 657 546 40 586 71 Plan Cost $37,401.12 $21,140.23 $6,227.24 $27,367.47 $10,033.65 Average $56.93 $38.72 $155.68 $46.70 $141.32 Member Cost $14,227.65 $10,469.03 $856.99 $11,326.02 $2,9U1.63 Average $21.66 $19.17 $21.42 $1933 $40.87 Total Drng Cost $51,628.77 $31,609.26 $7,084.23 $38,693.49 $12,93528 Average $78.58 $57.89 $177.11 $66.03 $182.19 Plan Cost PMPM l PEPM $36.31 ! $66.55 $20.52 1 $37.62 $6.05 I $11.08 $26.57 I $48.70 $9.74 I $17.85 Avg Days Supply 34.4 23.4 90.1 28.0 87.5 Avg Utilizing Mbr Age 46.4 45.2 49.1 45.5 54.0 Avg Ingredient Cost $76.80 $SS 89 $175.11 $64.03 $182.19 Avg Dispensing Fee $1.78 $2.00 $2.00 $2,00 $0.00 Avg % Discount (AWP) 23.a% 22.6°k 19.2°k 21.9% 27.4Y<, Generic I °k of Rxs I % of Plan Cost 63.6% 1 24.3% 66.8% / 30.8°k 50.0% I 26.0°k 65.7 ! 29.7 46.5°k 1 9.5'Yr~ Avg ingr Cost $35.24 $30.30 - -- _ - $93.88 _ _ . $33.60 $54.33 MSB Wtth Generic Available °k of Rxs / % of Platt Cost 1.8% 1 2.7% 1.8% / 1.2°k 5.0% / 12.1 ~/c 2.0% l 3.7°k 0.0'~ ! 0.0'Y. Avg Ingr Cost $114.54 $54.16 $418.24 $I 14.84 $0.(Nl SSB °k of Rxs / ~o of Plan Cost 34.6% 1 73.0% 3 L3%r I 68.0°k 45.0°k / 61.9~k 32.3 l 66.6 53.5°k I 9Q5'#. Avg Ingr Cost $151.32 $1!0.62 $238.34 $122.79 ~ $293.2? Generic Efficiency 97.7% 97.9% 90.9% 97.5°k 100.0rY. Savings Analysis Submitteding Cost $65,883.24 $39,405.19 $8,665.47 $48,070.66 $17,812.58 Total Drug Ing Cost $50,456.77 $30,517.26 $7,004.23 $37,521.49 $12,935.28 'Dotal Savings $15,426.47 $8,887.93 $1,661.24 $10,549.17 $4,877.30 Average SavingslRx $23.45 $16.28 $4L53 $18.00 $68.69 Reports prepared by Walgreens Health Initiatives for the authorized use by our clients Page 1 of 2 Walgreens Health Initiatives Executive Summary CLIENT ### YTD 112006 - 12/211116 Total Avg Eligible Members 1,076 Utilizing Members 1,420 Number of Rxs 8,°55 Plan Cost $493,225.39 Average $56.34 Member Cost $153,338.91 Average $17.51 Total Dmg Cost $646,564.30 Average $73.85 Plan Cost PMPM 1 PEPM $38.22 I $70.28 $24,93 I Avg Days Supply 33.2 Avg Utilizing Mbr Age 46.1 Avg Ingredient Cost $71.54 Avg Dispensing Fee $2.31 Avg % Discount (AWP) 25.5% Generic % of Rxs / % of Plan Cost 62.0% / 23.6% 64.20k 1 Avg htgr Cosl $31.41 MSB Wuh Generic Available 90 of Rxs 1 % of Plan Cost 1.4% I 1.3% 1.3°9 ! Avg htgr Cost $83.66 12etail30 12etail 9U 9,0"12 1,578 7,548 485 $321,808.62 $67,470.79 $42.63 $139.12 $119,753.72 $8,846.114 $15.87 $18.24 $441,56234 $76,316.83 $58.50 $157.35 $45.85 $5.23 l $9.61 24.2 92.2 45.2 503 $56.09 $154.97 $2.41 $2.39 22.7% 37.0% 27.1 % 44.909 I 16.6% $27.21 $61.00 1.390 3.1% / 3.39c $7Q98 $177.66 Report #: U I W Report Date: 01/29/2007 Report Period: Dec 2W6 Combined Retail Mai 1,193 113 8,033 72'2 $389,279.41 $103,945.98 $48.46 $143.97 $128,599.76 $24,739.15 $16.01 $34.26 $517,879.17 $128,685.13 $64.47 $178.23 $30.16 / $55.47 $8.05 I $14.81 28.3 87.5 45.5 53.6 $62.06 $176.98 $2.41 $ L25 25.3% 26.6rY~ 63.1r9 1 25.3% 49.9% / 17?"k $28 66 $70.04 L4°9 ! 1.6% 0.8°k I 0 0'Y~ SSB 90 of Rxs 1 % of Plan Cost 36.7% I 75.%% 34.5°k / 71.6°k 52.0'9 1 80.1°k 35.5°9 1 Avg Ingr Cost $138.92 $109.34 $234.91 Generic Efficiency 98.6% 98.709 96.5% Savings Analysis Submitted Ing Cost Total Drug Ing Cost Total Savings Average Savings/Rx $841,150.44 $547,83937 $119,317.30 $667,156.67 $173,993.77 $626,304.30 $423,363.84 $75,159.83 $498,523.67 $127,780.63 $214,846.14 $124,475.53 $44,157.47 $168,633.00 $46,213.14 $24.54 $16.49 $91.05 $20.99 $64.01 Reports prepared by Walgreens Health Initiatives for the au[horirsd use by our clients $85.14 $55.71 73.1°9 49.3°k l 82.8'%. $120.43 $287.17 98.690 98.49 Page 2 of 2 Health initiatiVeS walgreens mart Client Group 5Um Dec X116 CLI~N~ ### iimB Nurnper °~ U-~ R~ El'tSlble ~~nbers X69 Mem~~ 81 ID 3~`1 ~'~~ 19~ A~IVEA 626 0 0 ~rou NaNe ApTI~Eg 2 13 a AC('lVE A RETIREEA 13 /'~~ A~T1vE 6 65 RETIREES 28~ RETIREE A 1,030 RETIREE B use by nut elie~tts Walgreens Health lniiratives [nr the authurit~ Reppj15 ptepared by ~IOIA Re~rt #. OU2912001 ReP°n pate'. Report Period'. pec 200b "'_ Avg AvBplan pp~M T C generic M~ogt Cost $2A!j3 E[(irkn 551.3y perk $2093 543.1y 91.6% 556 92 11.0° 5X1.13 5p.tl~ 911' SO.Op 61.3~a $0 ~ 55U.N9 00.00 55~ ~ 0.0`~ OMO 528 SI 100• 536.3 53.g~0 856.93 521.66 u~.1'~ 1 ~aa ~~c 59 6`1N b0 521,0311 5u 5667 KI ~~i m,~ ~ol.l CLIENT # ACTIVE A ACTIVE B RETIREE A RETIRE' ~. ns ~ealtb liiitiatlves w algre t Group Summary' Ghen i~ l}til'rimg N b,-ggibl^ embers McID~"s >II Grow Id 3g9 ACIIVEA 19'1 626 0 pCTIVEB 2 4 RETINA 13 RETIREES 2sa iUC Lei U101B Report#: p1R`)1?W1 ReQort Date', eriod' De` 2~ Report P DgC 2Ollb '~ Y ~.... pvg w~ Ylau ~ lnn Cost ,roID- Y Y~,M lau Cost $y 699 6U --'"'_/ Member generic Cost Cost $51,39 $2493 $21,03g71 9O Ceneric RtR~~e $2093 9160 $56.92 $43.1y $p (d ~RX 11.0~P lb9 $21.13 971° $p.OC $0.~ I $662. ~, 4'IS b1.3 OW 0.0~ $ $50,99 6Q99 $ p.0~7o $2831 $31,1.1 0 IOO,IYgo $36.31 53 ~~ $56.93 13 $2-,66 q'1.1eM Ith Initiatives for the authorl2ed ~ by onr clients ReP°~' prepared by Wa~Breeru -y~a I Walgreens Health Initiatives DenF.ed Claims Summary Savings Analysis Repo., #, 5,~, CLIENT ### Repotl Date: I /291?007 ReponPeriod: Uec?UUb Dec 21N16 Total Dollar Avg Saved Per Number of Claims Savings (AWP) qo Dollar Savings Claim Total Claims Submitted 832 DUE ENCOUNTERS 7 $3,926.37 Filled after coverage terminated 23 $1,796.58 2.7°h $78.1 I Non-matched cardholder id 14 $1,146.45 L7rYc $81.89 Pharmacy not with plan on date of service 2 $98.03 0.1% $49.02 Plan limitatiot>s exceeded 8 $5,459.48 7.7% $682.44 Prior authorization required 34 $8,702.54 11.7~C $255.96 ENROLLMENT Sl $17,203.08 20.7gC $212.38 NDC not covered 8 $3,762.99 5.4gc $470.37 DRUG NOT COVERED 8 $3,762.99 5.4°k $470.37 DUPLICATE CLAIM 0 $0.00 U.0°k $O.OC M/I Diagnosis code 3 $88.26 O.lak $29.42 M/l Graup number 6 $418.05 0.6'~ $69.68 PHARMACY SUBMITTED DATA 9 $506.31 0.8% $56.26 DURrejecterror 70 $12,513.13 16.0°k $178.76 PROCESSORIHOST 70 $12,513.13 16.O~k $178.76 MISCELLANEOUS U $O.OU 0.0~ $O.OU OTHER U $O.OG O.Ogc $0.00 Total Claims Denied Excl DUR 168 $33,985.51 32.7°k $202.29 Total Claims Denied 175 $37,91 L88 36.5% $216.64 Reports prepared by Walgreens Health hii[ia[ives for the authorized use by our clients Walgreens Health Initiatives Generic Drug Savings Summary CLIENT ### Dec 2006 Report #: S200 Report Date: 01!29/2007 Repot Period: Dec 2006 % of Total Copay % of Number of Rxs Rxs Total Plan Cost Avg Plan Cost Av Co ay Total Cost Multi Source Brands With Generic Available 12 1.8% $1,010.57 $84.21 $32.62 27.9% Generics 418 63.6°!0 $9,073.74 $2L71 $1537 41.5% Brand Without Generic Available 227 34.6% $27,316.81 $12034 $32.64 21.3°k Total For All Rxs 657 IOU.0°!o $37,401.12 $56.93 $21.66 27.6% Formulary Compliance 100.0% Estimated Savings With a 1 % Increase in Generic Rxs Per Month Plan $23139 Patient $4127 Estimated Savings Achieved through Generic Substitution Per Month Phut $26,127.78 Patient $7,209.78 Reports prepared by Walgreens Health Initiatives for the authorized use by our clients \. Walgreens Health Initiatives Top 100 Drugs by Rxs Report 7t: D3IX)A CLIENT ### Repan Date. u29r>uo7 Report Period: Drr 2006 Dec 21N16 Rank llrug Name '1'her Class Thera~peulic Class llescri lion D Type Number of Rxs UGliziog Members Avg llays Su I Avg QtylRx Plan Cust Avg Plau CostlRx % of"total Plan Cost 1 LIPITOR 65 LIPOTROPICS SSB 23 22 54.8 54.8 $2,930.65 $127.4? 7.8~f 2 TOPROL XL 76 OTHER CARDIOVASCULAR PREPS SSB 18 18 43.3 50.8 $511.56 $28.42 L4 ~Y 3 AZITHROMYCIN 25 ERYTHROMYCINS Generic 17 17 4.2 72 $422.78 $24.87 I I'/ 4 METFORMIN HCL 58 DIABETICTHERAPY Generic 16 16 37.5 90.0 $476.04 $?9.75 1.3'Y 5 AMOXICILLIN 22 PENICILLINS Generic IS 15 10.0 67.2 $O.UO $O.IH; UO'/~ 6 HYDROCODONE WlAfFTAMIN(1PHFN 40 NARCOTIC ANALGESICS Generic 14 13 15.8 64.3 $146.59 $10.47 0A~Y< 7 LEVOTHYROXINE SODIUM 55 THYROID PREPS Generic 14 14 42.9 42.9 $29.57 $2.11 U.I 'Y< 8 LISINOPRIL 71 OTHER HYPOTENSIVES Generic 14 14 47.1 46.1 $187.89 $13.12 OS °/<. 9 ALBUTEROL IS BRONCHIAL DILATORS Generic I I 10 25.1 17.0 $37.72 $ 3.4.1 0.1 'Y<. IU HYDROCHLOROTHIAZIDE 79 DIURETICS Generic II ll 46.4 49.1 $17.56 $L6C OAS% II VYTORIN 65 LIPOTROPICS SSB 10 lU 48.0 48.0 $1,101.69 $110.17 2.9'%. 12 ACTOS 58 DIABETIC THERAPY SSB 7 6 55.7 55.7 $2,037.99 $291.14 5.4 ~% 13 CEPHALEXIN 26 CEPHALOSPORINS Generic 7 7 8.6 52.9 $24.17 $3.45 0.1 '%. 14 CLONIDINE HCL 71 OTHER HYPOTENCIVES Generic 7 6 38.6 74.0 $QUO $0.(H; 11.0 ~% IS NORVASC 76 OTHER CARDIOVASCULAR PREPS SSB 7 7 64.3 70.7 $588.02 $84.1H1 I b'% 16 TRAZODONE HCL I I PSYCHOSTIMULANTS-ANTIDEPRESSANTS Generic 7 7 30.0 36.4 $O.UO $U.U(; Q0'% 17 ATENOLOL 76 OTHER CARDIOVASCULAR PREPS Generic 6 6 40.0 45.0 $0.00 $U.lx: U.0'% 18 BENZONATATE 16 COUGH PREPARATIONS/EXPECTORANTS Generic 6 6 10.0 30.0 $172.30 $28.72 11.5 19 CRESTOR 65 LIPOTROPICS SSB 6 6 SU.U 50.0 $611.60 $101.93 1.6 'Y 2U ESTRADIOL 61 ESTROGENS Generic 6 6 SU.U 50.0 $25.56 $426 Q I '% 21 FEXOFENADINE HCL 14 ANTIHISTAMINES Generic 6 6 45.0 55.0 $377.02 $62.84 I.0 ~% 22 FLOMAX 99 MISCELLANEOUS SSB 6 6 50.0 65.0 $65729 $109.55 1.8~% 23 FLUOXETINE HCL I I PSYCHOSTIMULANTS-ANTIDEPRESSANTS Generic 6 6 60.0 60.0 $289.10 $18.18 U 8'Y< 24 HYDROCODONE-ACETAMINOPHEN 4U NARCOTIC ANALGESICS Generic 6 6 8.5 55.3 $26.87 $4.48 U.I'% 25 SERTRALINEHCL II PSYCHOSTIMULANTS-ANTIDEPRESSANTS Generic 6 6 50.0 60.0 $703.16 $117.19 19'% 26 SINGULAIR IS BRONCHIAL DILATORS SSB 6 6 SO.U 50.0 $788.64 $131.44 2.1 ~%. 27 SULFAMETHOXAZOLE/fRIMETHOPI M 24 SULFONAMIDES Generic 6 6 2U.U 26.7 $0.110 $O.l)L 0.0 ~% Reports prepared by Walgreens Health Initiatives for the authorized use by oar clients I ~, Walgreens Health Initiatives Top 100 Drugs by Rxs Repun #: D3lN)A CLIENT ### Repun Da(r: ia9n_l>tn Repun Prriud: Der''?006 Dec 2(Nl6 Rank UrugName Ther Class TherapeulicClassDescri lion Dru 'Fy a Number otRxs Utilizing Members Avg Uays Su I Avg ty/Rx Plan Cost Avg Ylau CusUKx % uf'1'ulal YlanCost 28 HMO ~~~ arvaTF 22 PENICILLINS Generic 5 5 10.0 22.0 $291.49 $5830 0.8'% 29 CELEBREX 42 ANTIARTHRITICS SSB 5 5 42.0 66.0 $799.78 $159.96 2.1 'h 3U LEXAPRO II PSYCHOSTIMULANTS-ANTIDEPRESSANTS SSB 5 5 42.0 42.0 $354.07 $'70.81 U~~'h 31 NAPROXEN 42 ANTIARTHRITICS Generic 5 5 202 43.0 $4.32 $0.86 0.0 ~W. 32 PSEUDOVENT4W 16 COUGH PREPARATIONS/EXPECTORANTS Generic 5 S 15.0 30.0 $92.30 $18.46 U.2'R. 33 TRICOR 65 LIPOTROPICS S58 5 5 66.0 66.0 $898.38 $179.68 2A h 34 WARFARIN SODIUM 77 ANTICOAGULANTS Generic 5 4 30.0 33.0 $45.28 $9.UG 0.1 '% 35 ACETAMINOPHENW/CODEINE 40 NARCOTIC ANALGESICS Generic 4 4 18.5 83.8 $1.5C $(1.38 Q0'3 36 ALBUTEROL SULFATE IS BRONCHIAL DILATORS Generic 4 4 8.3 93.8 $I LIS $?99 O.U ~/ 37 AMBIEN 47 SEDATIVE NON-BARBITURATE SSB 4 4 25.0 25.0 $301.14 $7519 Q8'/ 38 CIPROFLOXACIN HCL 27 OTHER ANTIBIOTICS Generic 4 4 13.5 23.5 $13.46 $337 0.0 "/h 39 CYCLOBENZAPRINEHOL 08 MUSCLE RELAXAUTS Generic 4 4 19.8 52.5 $ I L20 $?.8C U.0 ~/< 40 FOSAMAX 99 MISCELLANEOUS SSB 4 4 55.8 8.0 $441.04 $IIU.'?b 1.27r. 41 GLIPIZIDEXL 58 DIABETIC THERAPY Generic 4 4 60.0 112.5 $105.0(1 $?G15 03'%. 42 IBUPROFEN 42 ANTIARTHRITICS Generic 4 5 20,0 70.3 $O U0 $U.IH; U,U'A 43 LISINOPRIL-HCTZ 7l OTHERHYPOTENS[VES Geueiic 4 4 30.0 37.5 $7208 $1927 U2'Y 44 NASONEX 19 TOPICAL NASAL ANDOTIC PREPARATIONS SSB 4 4 66.3 59.5 $877.76 $?19.4-1 ?.3 ~y, 45 NEXIUM 01 ANTI-ULCER PREFSlGASTROINTESTINAL PREPS SSB 4 4 45.0 45.0 $561.66 $14Q 42 I.5 <7 46 PROMETHAZINE WICODEINE 17 COLD AND COUGH PREPARATIONS Ceneric 4 4 9.3 225.C $3.65 5091 Q U ~Y 47 ALLOPURINOL 42 ANTIARTHRITICS Generic 3 3 3Q0 30.0 $0,00 $ILIH: U9 ~/. 48 AMPHETAMINE SALT COMBO 12 AMPHETAMINE PREPARATIONS Generic 3 2 30.0 60.0 $153.63 $51.21 U.4/ 49 ARMOUR THYROID 55 THYROID PREPS MSB 3 2 30.0 25.0 $0.00 $0.OC O.U '&~ SU LISINOPRIL 71 OTHERHYPOTENSIVES Generic 14 14 47.1 46.1 $187.89 $13.43 0.5 k, 51 CADUET 76 OTHER CARDIOVASCULAR PREPS SSB 2 2 30.0 3U.U $183.60 $91.80 0.5'X, 52 MERCAPTOPURINE 3U ANTINEOPLASTICS Generic I I 30.0 60.0 $183.44 $183.44 QS'X~ 53 FROVA 41 NON-NARCOTIC ANALGESICS SSB 1 I 3Q0 12.0 $18332 $18332 U.5°A, 54 ADDERALLXR l2 AMPHETAMINE PREPARATIONS SSB I I 60.0 60.0 $18L56 $181.56 U.5 'w 55 ASACOL 41 NON-NARCOTIC ANALGESICS SSB 1 I 30.0 180.C $180.67 $180.67 U.5'x 56 ZETIA 65 LIPOTROPICS SSB 3 3 30.0 30.0 $175.02 $5834 U5~& Reports prepared by Walgreens Health Initiatives for the authorized use by our cl Tents 2 Walgreens Hralth Initiatives Top 100 Drugs by Plan Cost Report #, D31X16 CLIENT ### Report Dale: lrnnzu~7 Report Period: Der 2006 Dec 21NI6 Rank llrug Name Ther Class Therapeutic Class Description llru 'type Number of Rxs Utilizing Members Avg llays Su ply Avg QtylRx Ylan Cust Avg Plan Cusdltx % ot''1'otal Ylan G'ost 57 RELPAX 41 NON-NARCOTIC ANALGESICS SSB I I 6.0 12.0 $172.78 $172.78 0.5"/~, 58 BENZONATATE 16 COUGH PREPARATIONS/EXPECTORANTS Generic 6 6 10.0 30.0 $172.30 $28.72 U.S "/k. 59 EPIPENIR. 18 ADRENERGICS SSB I 1 4.0 4.0 $163.24 $163.24 0.4y $130.119 03 Y. 68 PAROXETINEHCL II PSYCHOSTIMULANTS-ANTIDEPRESSANTS Generic 3 3 30.0 40.0 $129.20 $43.07 U.3'Y< 69 TOPAMAX 48 ANTICONVULSANTS SSB L 1 30.0 30.0 $124.98 $'12498 113 Y. 7U ACTOPLUSMET 58 DIABETIC THERAPY SSB I I 30.0 60.0 S124.49 $12449 U3~7c 71 LEVAQUIN 28 URINARY ANTIBACTERIALS SSB 2 2 7.5 7.5 $ 117.31 $18.68 U3 "/<~ 72 AVODART 99 MISCELLANEOUS SSB 2 2 3Q0 30.0 $117.20 $58.60 U.3'Y 73 BUPROPION HCL I I PSYCHOSTIMULANTS-ANTIDEPRESSANTS Generic 2 2 60.0 120.0 $112.26 $56.13 U.3 'Y. 74 NUVARING 63 SYSTEMIC CONTRACEPTIVES SSB 2 2 42.5 2.U $110.43 $55:!2 03~Y 75 ALLEGRA-D 12 HOUR 99 MISCELLANEOUS SSB 2 2 30.0 60.0 $II)y.60 $5480 0.3'Y 76 BUTALBITALICAFFIAPAP/CODEINE 40 NARCOTIC ANALGESICS Generic 1 I 20.0 IUU.O $106.20 $106.20 U3~Y: 77 SIMVASTATIN 65 LIPOTROPICS Generic I I 30.0 30.0 $IUS.IIy $IUS.U9 0.3~% 78 CLIPIZIDE XL 58 DIABETIC THERAFY Generic 4 4 6U.U 112.5 $I US.IXI $2625 U3 ~% 79 KARIVA 63 SYSTEMIC CONTRACEPTIVES Generic 2 2 56.0 56.0 $104.61 $52.31 0 f k 8U FENTANYL 40 NARCOTIC ANALGESICS Generic 1 I 30.0 10.0 $10236 $102.36 U_3'%. 81 PRAVASTATINSODIUM 65 LIPOTROPICS Generic 1 1 30.0 30.0 $102.07 $102.07 03~Y. 82 ENALAPRILMALEATE 71 OTHERHYPOTENS[VES Generic t I 90.0 180.0 $10167 $101.67 03~%. 83 RANITIDINE HCL 01 ANTI-ULCER PREPS/GASTROINTESTINAL PREPS Generic 2 2 60.0 120.0 $97.48 $48.74 U.3 ~Y. 84 BENICAR HCT 71 OTHER HYPOTENSIVES SSB 2 2 60.0 37.5 $95.72 $47 86 U3 ~y Reports prepared by Walgreens Health Initiatives tar the authorized use by our clienU 3 Wal reens ~ alth Initiatives g Top 100 Drugs by Plan Cost Repon #: D3IX16 CLIENT ### Repun Date u?9/2otn Report Period; Der 2006 Dec 2006 Rank llru Name '1'her Class Therapeutic Class Description Dru 'type Number of Rxs Utilizing Members Avgllays Su 1 Avg lylRx Ylan Cost AvgYlau CusuRx %uf'futal Ylan lust 85 WELLBUTRINXL Il PSYCHOSTIMULANTS-ANTIDEPRESSANTS MSB I I 30.0 30.0 $9298 $92.911 0.2'k. 86 AUGMENTIN XR 22 PENICILLINS SSB 1 1 10.0 4Q0 $92.86 ~y92.86 U.2 ~A 87 PSEUDOVENT4W 16 COUGHPREPARA'I'IONS/EXPECTORANTS Generic 5 S I5.0 3U.U $92.30 $18,46 U.2'ti 88 ACIPHEX 01 ANTI-ULCER PREPS/GASTROINTESTINAL PREPS SSB ] I 3U.U 30.0 $92.18 $92.18 02 ~%, 89 DEPAKOTE 48 ANTICONVULSAN"i5 5SB I I 30.0 90.0 $92.08 $92.08 U2 "/k. 90 PAXIL CR I I PSYCHOSTIMULANTS-ANTIDEPRESSANTS SSB 2 2 30.0 30.0 $91.63 $45.8'1 0 2 ~k- 91 DESMOPRESSIN ACETATE 64 OTHER HORMONES Generic 1 I 30.0 30.0 $91.43 $91.43 U.?'x 92 STRATTERA I I PSYCHOSTIMULANTS-ANTIDEPRESSANTS SSB I I 30.0 30.0 $89,22 $89.22 11.2 ~Y 93 TERAZOSIN HCL 71 OTHER HYPOTENSIVES Generic 3 3 SU.O 50.0 $87.00 $29.00 U.2'Y. '94 CEFUROXIME AXETIL 26 CEPHALOSPORINS Generic I I 10.0 20.0 $86.49 $86.49 U.3 7~ 95 AVELOX 28 URINARYANTIBACTERIALS S5B I I 10.0 IU.O $81.72 $81.72 Q2 %~ 96 AZATHIOPRINE 99 MISCELLANEOUS Generic I I 30.0 90.0 $81.27 $81.?7 0.2 ~Y 97 MICARDIS HCT 71 OTHER HYPOTENSIVES SSB I I 90A 90.0 $79.10 $79.1 U U.2 `Yo 98 DUAL 95 ALL OTHER DERMATOLOGICALS SSB I I 30.0 45.0 $7829 $7829 U.2 ~Y, 99 VIACRA 99 MISCELLANEOUS SSB 2 2 25A 8.0 $77.26 $38.63 U "1 ~%. IOU LISINOPRIL-HCTZ 71 OTHERHYPOTENSIVES Generic 4 4 30.0 37.5 $77.08 $1927 0,2Y- 't'otal for Top 1011 333 40.5 57.8 $33,955.02 $101.97 90.8 /° 'fatal Yor All 657 282 34.4 55.8 $37,401.12 X56.93 IUUA ' ludicates Multisource wiW NO generics Reports prepared by Walgreens Health Initiatives f'or the authorized use by oar clients 4 Walgreens Health Initiatives Tnp 10 Therapeutic Classes by Rxs Report#: D301A CLIENT ### Report Date: u29noo7 Dec 2006 Report Period: Dec 2006 WiHon'1'herapeuGc Chus % of Plan Utilizing UNll'M PNll'Nl Rank 'Thera alit Class # of Rxs Ylan Cost °k of Rxs Av Plan Cust % of Rxs Cost Members Cult Cost 1 2 3 65 LIPOTROPICS 55 $6,799.25 8.4% $123.62 70.9% 683% 48 $141.65 $6.60 LIPITOR 23 $2,930.65 3.5% $127.42 41.8NO 43.1% 22 $133.21 $2.85 VYTORIN 10 $1,101.69 1.5°k $110.17 182% 162 1U $IIQ17 $LU7 CRESTOR 6 $611.60 0.9% $101.93 10.9% 9.0% 6 $101.93 $059 76 OTHER CARDIOVASCULAR PREPS 51 $1,829.77 7.8°k $35.88 62.7°k 61.6% 48 $38.12 $1.78 TOPROL XL 19 $538.23 2.9% $28.33 37.3 29.4~i 19 $28.33 $0.52 NORVASC 7 $588.02 LIB $t#.W 13.7% 32.1% 7 $84.110 $0.57 ATENOLOL 6 $O.OU 0.9~ $0.00 11.8% 0.0%, 6 $U.UL' $U.OI; 11 1'SYCHOSTIMULANTS-ANTIDEPRESSANTS 44 $2,616.54 6.7°/° $59.47 43.2% 37.9°k 39 $67.09 $2.54 TRAZODONEHCL 7 SU.UO LI% $O.OC 15.9% U.0% 7 $O.UL' $U.l)L FLUOXETINE HCL 6 $289.10 0-9% $48.18 13.6% ] L0% 6 $48.18 $U?8 SERTRALINEHCL 6 $703.16 0.9% $117.19 13.6 26.9%n 6 $117.19 $Ob8 4 5 71 O'I'HERHYPOTENSIVRS 44 $1,056.52 6.7°h $24.01 56.8°!° 25.1°k 42 $25.16 $LU3 LISINOPRIL 14 $187.89 2.1'~ $13.42 31.8%O 17.8 14 $1342 $0.18 CLONIDINEHCL 7 $O.UO L1% $O.UO ]5.9%, U.U°k 6 $0.1>L' $O.IN; LISINOPRIL-HCTZ 4 $77.08 0.6°k $1927 9.1%O 7.3'10 4 $19.27 $OA7 58 DIABETIC'fHERAPY 4U $4,681.46 6.1% $117.04 67.5% 55.9% 23 $203.54 $4.55 METFORMIN HCL 16 $476.04 2.4% $29.75 40.0%O 10.2%, 16 $29.75 $Q4G ACTOS 7 $2,037.99 LI%O $291.14 17.5' 43.5 6 $339.67 $1.98 GLIPIZIDEXL 4 $105.00 U.6% $2625 IU.O% 2.2% 4 $2625 $U.IC Reports prepared by Walgreens Health Initiatives for the authorized use by our clients Walgreens Health Ini tiatives Tnp 10 Therapeutic Classes by Rxs Report#: D3 UTA CL IENT ### Report Dale: a? 9n_uU7 Del' 20116 Report Period: De c 2Ulw Within Therapeutic Class %ofNlan Utilizing UMYM NMNM Rank 'therapeutic Class q of Rxs Nlan Cost % of Rxs Av Nlan Cost % of Rxs Cost Members Cost Cost 6 4U NARCOTIC ANALGESICS 38 $915.63 5.8% $24.10 63.2% 19.1% 33 $27.75 $U.89 HYDROCODONEWlACETAMINOPHEN 14 $146.59 2.1%, $10.47 36.8%, 16.0 13 $11.28 $U.14 HYDROCODONE-ACETAMINOPHEN 6 $26.87 U.9%, $4.48 15.8% 2.9%, 6 $4.48 SQ03 ACETAMINGPHENWICODEINE 4 $LSU 0.6% $038 10.5% 0.2% 4 $038 $QOI; 7 15 BRONCHIAL DILATORS 28 $1,443.72 4.3% $51.56 75.U% 58.0°k 22 $65.62 $1.4U ALBUTEROL ll $37.72 1.7% $3.43 393% 2.6~ IU $3.77 $OIW SINGULAIR 6 $788.64 U.9°h $131.44 21.4% 54.6% 6 $131.44 $U 77 ALBUTEROLSULFATE 4 $1115 0.6% $2.79 14.3%, U.8%, 4 $2.79 $O.UI 8 22 PENICILLINS 26 $433.84 4.U°k $16.69 84.6% 67.2% 26 $16.69 $U.42 AMOXICILLIN IS $O.W 2.3%, $O.OC 57.7%, 0.0% 15 $0.111 $O.UC AMOXTR-POTASSIUMCLAVULANATE 5 $291.49 0.8'ib $58.30 192°k 67.2 5 $58.30 $U28 PENICILLIN V POTASSIUM 2 $O.OC 03°W $O.UI; 7.7% 0.0'~ 2 $O.IIU $O.UC y yy MISCELLANEOUS 26 $2,564.22 4.U% $98.62 46.2°k 47.4% 25 $IU2S7 $2.49 FLOMAX 6 $65729 0.9°k $109.55 23.1% 25.6' 6 $lU<).55 $U.64 FOSAMAX 4 $44LU4 U.6'9° $110.26 15.4°k 172°k 4 $IIU.26 $O.di AVODART 2 $117.20 U.3°k $58.W 7.7N, 4.6%O 2 $58.60 $U.II IU 42 AN'I'IARTHNITICS 21 $2,232.63 3.2% $1U6.32 66.7% 36A% 22 $1U1.48 $2.17 CELEBREX 5 $799.78 0.8% $159.96 23.8°k 35.8% 5 $159.96 $U.78 NAPROXEN 5 $4.32 U.8%a $0.86 23.8%, 0.2'~ 5 $U.86 $U.OC IBUPROFEN 4 $O.UL' 0.6~ $O.IX; 19.0°k U.0~ 5 $O.UI; $U.UC Total for Top 10 Therapeutic Classes 373 $24,573.58 56.8°h $65.88 Reports prepared by Walgreens Health Initiatives for the authorized use by ow' clieols 2 Walgreens Health Initiatives Top 10 Therapeutic Classes by Plan Cost Repot #: D3DI6 CLIENT ### Repnrl Date: Ir29nD07 Dec 21N16 Report Peritxi; Uec 2W6 Within Thera alit Class % of Plan % of Plan UGliziog UMPM YNH'NI Rank Thera eutic Class # of Rxs Plan Cost Cust Av Plan Cost % of Rxs Cost Members Cast Cost 1 2 65 LIPOTROPICS 55 $6,799.25 18.2% $123.62 69.1% 728% 48 $141.65 $6.60 LIPITOR 23 $2,930.65 7.8~ $127.42 4L8~ 43.1' 22 $133.21 $3.85 VYTORIN 10 $1,101.69 2.9°k $110.17 18.2% 16.2% IU $110.17 $1.07 TRICOR 5 $898.38 2.4% $179.68 9.1% 13.2% 5 $179.68 $0.87 58 DIABETICTHEBAPY 40 $4,681.46 12.5°k $117.04 27.5% 803°k 23 $203.54 $4.55 ALTOS 7 $2,037.99 5.4%O $291.14 17.SNo 43.5 6 $339.67 $1.98 HUMALOG I $922.06 2.5~ $922.06 2.5% 19.7 I $922.1)6 $1190 AVANDIA 3 $800.03 2.1 %O $266.68 7.S;b 17.1 2 $40U.1n $0.78 3 4 11 PSYCHOSI'IMULANTS•ANTIDEPRESSAN'I'S 44 $2,616.54 7.0% $59A7 298% 53.2% 39 $67.09 $2.54 SERTRALINEHCL 6 $703.16 1.9% $117.19 13.6%u 26.9% 6 $117.19 $0.68 LEXAPRO 5 $354.07 0.9% $70.61 11.4% 13.5% 5 $7Q81 $Q34 CYMBALTA 2 $333.K4 Q9°k $166.92 4.5°k 12.8% 2 $166.92 $Q32 99 MISCELLANEOUS 26 $2,564.22 6.9% $98.62 42.3% 59.8% 25 $102.57 $2.49 FLOMAX 6 $657.29 1.8~ $IOy.55 23.1% 25.6°k 6 $109.55 $0.64 FOSAMAX 4 $441.04 1.2%, $11026 15.4°6 I7.2%n 4 $110.26 $0.43 CYCLOSPORINE I $435.73 12% $435.73 3.8% 17.0% I $435.73 $0.42 5 42 AN'f1ARTHRI'fICS 21 $2,232.63 6.0°k $106.32 33.3°k 98.0% 22 $101.48 $2.17 ENBREL I $1,322.09 3.5'~ $1,322.09 4.8~ 592% I $1,322.f1y $L28 CELEBREX 5 $799.78 2.1% $159.96 23.8% 35.8% 5 $1595)6 $0.78 NABUMETONE I $65.00 02°k $65.00 4.8°k 29~, I $65.00 $O.U6 Reports prepared by Walgitiens Health Initiatives for [he authorized use by oo clients Walgreens Health Initiatives Top 10 Therapeutic Classes by Plan Cost Report#: D301B CLIENT ### Report Date: 1/29/2007 DCC 2~ Report Periuu~ Report Perial: Dec 2(IU6 Dec 2U06 Claims With DUR Edits # of Claims) Ingr Cost/ % of Total % of Total Paid Claims # of Claims) % of Total IngrCost/ °k of Total Denied Claims # of Claims/ Ingr Cost) % of Total % of Total Reversed Claims # of Claims/ lugr Oust/ °I° of Total rk of 'Ibtal Drug-Drug 115 $9,822.81 89 $7,801.76 17 $1,54033 9 `)i48U.72 12.7°Io 11.8% 77.4% 79.4% 14.8% 15.7% 7.8% 49% Duplicate Ingredients 40 $3,22920 25 $1,924.80 I I $713.82 4 $590.58 4.4% 3.9% 62.5°I° 59.6% 27.5% 22.1% 10.0% 18.3% Duplicate Therapy 83 $7,75933 60 $5,727.92 17 $1,420.85 6 $610.56 9.l% 93% 723% 73.8% 20.5% 18.3% 72% 79% Controlled Substance 0 $0.00 0 $O.OU 0 $0.00 0 $U.II(1 0.0% U.0% 0.0% 0.0% 0.0% 0.0°k 11.0% 0.0% Drug Geriatric 131 $7,21)4.15 114 $6,160.89 10 $772.90 7 $27036 14.4% 8.6% 87.0% 85.5% 7.6°I° 10.7% 53% 3.8r% Drug Pediatric 8 $906.52 6 $534.04 0 $0.00 2 $373.48 0.9% 1.1% 75.0% 58.9% 0.0% 0.0% 25.11% 41.1%, MinlMax Dose 68 $6,36725 44 $4,140.62 12 $1,229.19 12 $997.44 7.5% 7.6% 64.7°l0 65.0% 17.6% 19.3°Io 17.6°/v 15.7% Duration of Therapy 0 $0.1X1 0 $O.OU 0 $Q00 ll $U.0(1 0.0% 0.0°I° 0.0% 0.0°l0 0.0% 0.0% QO% O.llr% Drug Gender 1 $13.(X) 1 $13.00 0 $0.00 0 $U.I)0 0.1% 0.0°k I(~.0% 100.0% 0.0°Io 0.0% 0.0% U.U% Too Late Clinical 128 $ 11,320.81 112 $9,116.93 0 $0.00 16 $2,203.88 14.1% 13.6% 87.5% 80.5% QO°lo 0.0% 12.5% 19.5% Reports prepared by Walgreens Healih Initiatives For the authorized use by our clients Walgreens Health Initiatives Drug Utilization Review Report q: 5,t,, CLIENT ### Repnn Date: tn_vn_ooi Report Periutl: Dec 20l>V Dec 2006 Claims With DUR Edits Paid Claims Denied Claims Reversed Claims # of Claimsl Ingr CosU # of Claimsl Ltgr CosU # of Claims/ Ingr CosU # of Claims) ingr CusU °Io of Total % of Total % of Total % of Total °Io of Total °k of Total °k of Total % of 'Dotal All DUR Claims 492 $43,299.31 373 $29,632.57 70 $9,065.50 49 $4,601 24 54.1% 51.8% 75.8% 68.4% 14.2% 20.9°k 10.0% IQ6% Non DUR Claims 417 $40,242.25 284 $20,824.20 105 $18,074.60 28 $1,343.45 45.9% 482°I° 68.1% 51.7% 25.2% 44.9% 6.7% 33% Total Claims Submitted 909 $83,541.56 657 $50,456.77 175 $27,140.10 77 $5,944.69 100.0% 100.0% 72.3% 60.4% 19.3% 32.5% 8.5% 7.1 % Actual # of Eligible Members: 1,030 Number of Utilizing Members: 282 Because some claims may have received more than one DUR edit, the totals are adjusted to reflect the actual number of claims and dollars and to eliminate any duplication Reports prepared by Walgreens Health Initiatives for the authorized use by our clients 2 Walgreens Health Initiatives Drug Utilization Report -Summary Repast #: M6W CLIENT #### Report Data ou29r21xn Report Period: Dec 21X16 Oct 2006 • Dec 2006 Total Numberaf Utilizing Members 432 Number of Members Meeting I or More Selected Criteria's 38 Number of Rxs 445 Total Plan Cost $43,291.39 % of Total 8.8°k 23.0' 41.8% SELECTED Number of % of TuGrl ~° of Plan CA'T'EGORIES Members Members Number of Rxs 't'otal Yaid Cost I Members with Over 15 Rxs in either of the Previous 3 Months p 0,0°~ O $0 ~ O 0~# 2 Members with Over $150 in Rxs in either of the Previous 3 Months 9 2.I ~O IOC $20,190.25 195~Y~ 3 Members with Over 5 Rxs in the Same Therapeutic Class in the Previous 3 Months 20 4.6°k 264 $13,825.49 14.4Y~ 4 Members with Same Drug From Different Prescriber in the <'~~evious Mouth 4 0.9'~ SO $3,59LU4 3.5~Y~ 5 Members with 5 or Mare Prescribers in the Previous 3 Mouths 2 0.5~ 31 $3,230.45 3.1'& '^ Members may fall into more than one of the SELECTED CATEGORIES, but each member is represented only Duce in this count. Reports prepared by Walgreens Health Initiatives for the authorized use by our clients' I Healthlnitiatives CLIENT #### 4 Q 2006 'ZQ1a~~reerrGS, Healthlnitiatit~es ~_ CLIENT ### Quarterly Trend Report Executive Summary 4Q 2006 Paid Claims: Retail 128,309 Mail 7,750 Total Claims 136,059 Eligible Members 81,352 Retail Utilization 94.3 °Io Mail Utilization S.7 % Claim Costs: Total Cost $12,750,850 Plan Cast $10,890,095 Member Cost $1,860,755 Plan Pay % 85.4 % Member Pay °Io 14.6 °Io Drug Mix: Generic 59.6 °lo Avg Generic Cost $28.68 Multi-Source Brand 2.4 % Avg MSB Cost $98.44 Sin le-Source Brand 38.0 % Av SSB Cost $195.66 Average Claim Costs: Plan Commercial Avg Total Claim Cost -Retail $86.27 $69.34 Avg Total Claim Cost -Mail $216.95 $193.36 Avg Plan Cost -Retail $73.28 $53.47 Avg Plan Cost -Mail $191.98 $164.97 Avg Member Cost -Retail $12.99 $15.87 Avg Member Cost -Mail $24.97 $28.39 Avg Claims PMPY 6.57 10.28 Avg Plan PMPM Cost $44.62 $54.57 Av Member A e 38.5 49.5 ~. ~: Prescription Utilization CLIENT ### 4 Q 2005 1 Q 2001 2 Q 20116 3 Q 2006 4 Q 2006 ..'Quarterly Change 4 Q'2005 to 4 Q 2006 Change 12 Munt6 Total % ut Beaetit Paid Claims 1letail30 95,705 IU2,630 96,073 92,884 102,192 10.0 6.8% 393,779 75.1'% Itetai190 22,312 22,294 23,449 24,979 26,117 4.6% 17.1°k 96,839 185'/, Combined Ketail 118,017 124,924 l 19,522 117,863 128,309 8.9°k 8.7% 490,618 93,6. Mao 9,565 9,Ip2 8,617 8,021 7,7511 -3.4% - 19.0% 33,390 6.4~ti, Total 127,582 133,926 128, l39 125,884 136,059 8. I °l0 6.6%o 524,(X)8 #ot'EtigibleMembers 77,835 78,743 79,106 8Q006 81,352 1.7% 4.5% # of Utilizing Members Retai130 31,318 33,646 31,642 30,534 32,839 7.5% 4.9°k Retai190 12,016 12,2116 12,721 13,390 13,867 3.6% 15.4% Combined Retail 35,202 37,283 35,638 34,946 37,189 6.4% 5.60 Mail 4,284 4,045 3,796 3,561 3,413 -4.2% -20.3% Total 36,976 38,915 37,226 36,510 38,593 5.7°Io 4.4°Io f Total Yaid Claims f 8311 Paid Claims f Eligible Mbr ~ # Paid Claims • R90 Yaid Claims ~ R Paid Claims # of Members ~ P Utilizing Mbr •MYaidClaims ~. 91,.x, 120.W0 8~,~~1, 7~.~, I~.~ 60.(100 8Q,000 50,000 60.0011 40,0011 6 ~ ® v - ~ 30,000 40,000 20,OIX1 20,000 10,01)0 0 , . --- --- - -- ----- - ---- - --__ __ 0 ---- - - - 4Q 2W5 I Q 200b 2Q 2006 3Q 2006 4Q 2006 4Q 2005 I Q 2006 2Q 20lffi 3Q 2006 4~) 2000 Quarter Quarter aeWrls preyared by WalKreens Heallh Ildrlarives rur the aulhurued u,e by uur clienp Claim Costs CLIENT ### Quarterly 4Q 20p5 too Q 2006 ' 12 Month ~O uY 4 Q 2005 tQ 2006 2 Q 2006 3 Q 2006 4 Q 20A1 Change Change Tntal Benrtit 1'aW Cnst Retail 3U $5,486,923 $5,767,802 $5,772,138 $5,590,049 $6,105,596 9.2~/o ]1.3°k $23,235,585 482'~r Retai190 $3,983,466 $4,033,481 $4,368,064 $4,603,778 $4,963,880 7.8~c 24.6°k $17,969,203 37.3r7r CumbinedRetail $9,470,389 $9,801,284 $10,140,202 $10,193,827 $11,069,476 8.6°k 169°k $41,204,788 85SrYr. Mail $1,868,454 $1,820,525 $1,779,364 $1,730568 $1,681,374 -2.8~, -10.0Nc $7,011,831 14.5~/~ Total $11,338,843 $11,621,809 $11,919,566 $11,924,394 $12,750,850 6.9% 12.5% $48,216,619 Plan Cost Relai130 $4,491,140 $4,668,667 $4,726,498 $4,599,132 $5,054,760 9.9°k 12.5°k $19,049,056 46.7% Retai190 $3,458,280 $3,470,636 $3,777,143 $3,997,987 X4,347,468 8.T~ 25.7 $15,593,234 382°k Combined Retail $7,949,420 $8,139,302 $8,503,641 $8,597,119 $9,402,228 9.4°k 183 $34,642,290 85.0% Mail $1,632,152 $1,574,061 $1,549,171 $1,520,937 $1,487,867 -22°k -8.8~C $6,132,035 15.0°h Total $9,581,572 $9,713,363 $10,052,812 $IQI18,055 $10,890,095 7.6% 13.7% $40,774,325 Member Cwt Ketai130 $995,783 $1,099,136 $1,045,640 $990,917 $1,050,836 6.0'~ 5.5°k $4,186,529 56.3'x. Relai190 $525,186 $562,846 $590,921 $605,79] $616,411 1.8~ 17.4% $2,375,969 31.9~C CumbinedRetail $1,520,970 $1,661,981 $1,636,561 $1,596,708 $1,667,247 4.4% 9.6°k $6,562,498 882°k Mail $236,302 $246,464 $230,193 $209,631 $193,507 -7.7% -I8J1~ $879,796 11.8°k. Total $1,757,272 $1,908,446 $1,866,754 $1,806,339 $1,860,755 3.0% 5.9% $7,442,294 --- f'1'otal Cwt • R30 Total Cost __ -- --- - --- _ -- - f Total Ylan Cwt • R3U Ylan CwY Total Cost '~ RYO 1 utal Cwt ~- R Total Cwt Plan Cost '• R90 Ylan Cwt -¢ R Plan Cwt • M'I'otal Cwt • M Plan Cwl $14,ODQ,000 .. $12,000.(X10 - ___. -. $12,000,0W .~~ $10,(XX>,000 ~ _ $10.000,000 ~ ~ $B,OW,0011 $8,000.000 86,000,000 $6,WU,Wh ~_,~ ~~ ~~ ~4,ooo,lx>u $4,WO,WC $2,W0,W0' $2,000,1KX) SU - _ ._ - - - _ --._.... -- -- -- - __ ._- - -- ---- -- $0 - ___ _ ___ _ ____ . 4Q 2W5 IQ 2lH)6 2Q 2006 3Q 2(X16 4Q 2006 4Q 2W 5 I Q 2006 2Q 2006 3Q 2006 4(2 211116 Quarter Quarter aepmu preyared by Walgreeiu Heallh Inilulires lur the aulhurfaed use by uur clients Average Claim t;osts CLIENT ### 4 Q BIOS 1 Q 2006 2 Q2006 3 Q 2006 4 Q2066 Qu~tetty Chauge a Q zees to a Q 2006 Chhnge 12 Mopgr Average 'total Cust Ketail311 $57.33 $56.20 $60.08 $60.18 $59.75 -07°k 4.2°k $59.01 Ketai190 $178.53 $180.92 $186.28 $18431 $190.06 3.]k 6.5~ $185.56 CumbinedRetail $80.25 $78.46 $84.84 $86.49 $86.27 -0.3°/ 7.5°/, $83.99 Mail $195.34 $202.24 $206.49 $215.75 $216.95 Q6'k ILl% $21U.1lu Overall Average $88.87 $86.78 $93.02 $94.73 $93.72 - l .l °~ 5.4% $92.02 Plao Cwt Ketail3U $46.93 $45.49 $4920 $49.51 $49.46 -0.1°k 5.4°k $4837 Ketai190 $155.00 $155.68 $161.08 $160.05 $166.46 4.U°k 7.4% $16LU2 Combined Retail $67.36 $65.15 $71.15 $72.94 $73.28 0.5~; 8.8°k $7Q.61 Mail $170.64 $174.86 $179.78 $]89.62 $191.98 1.2'k 12.5% $183.65 Overall Average $75.10 $72.53 $78.45 $80.38 $80.04 -0.4% 6.6% $77.81 Member Cust Ketail3U $]0.40 $10.71 $10.88 $1Q67 $10.28 -3.6°k -1.2% $10.63 Ketail9U $23.54 $2525 $25.20 $24.25 $23.60 -2.7°iG U.3% $24.54 CumbinedRetail $12.89 $13.30 $13.69 $13.55 $1299 -4.1°k U.8% $13.38 Mail $24.70 $2738 $26.71 $26.14 $2497 -4.5% L1% $26.35 OverallAvera~e $13.77 $14.25 $14.57 $14.35 $13.68 -4.7°k -0.7% $140 ~-Overall Average •'I'Cf Tatal Cwt • Retai130 .f. Overall Average PC •-Plan Cost - Retail311 Total Cost •' total Cost Retai190 .~. Total Cwt-Retail Plan Cost • Wan Cost - Reta11911 ~- Pla n Cwt • Retail • ToWI Cwt • Mail • Plan Cwt -Mail $250 ~ - - __ -~ -- T--~i $180 ~."' $200 $160 $I4U $ISU $120 8100 $IW $8C $6C $50 $4 C $26 $0 -- --- --- ---- - $U - - ---- ---- - -- - - ------ ------ - 4Q 2005 I Q 2006 2Q 21106 3Q 2006 4Q 2006 4Q 2005 I Q 2006 2Q 2W6 3Q 20116 4Q 20116 Quarter Quarter aepulr preyuml by Welgreenr Health Inilialirn fur the umhurittd ore by uurr by uurclien~ Eligible Member Per Month Costs CLIENT ##~' Quarterly 4 Q 200510 4 Q 7AAG 12 Moath 4 Q 2005 1 Q 2086 2 Q 21106 3 Q 2tl06 4 Q2006 Cba~ Chauge Total 'Total CHSt Retail 3U $102.90 $105.14 $107.64 $107.08 5104.00 -2.990 1.19c $106A1 Retail 9U $60.82 $63.00 $66.95 $66.09 $70.81 4.09, 16.40k $67.26 CombiaedRetail $163.71 $166.14 $174.79 $175.17 $174.81 -02°h 6.6% $173.27 Mail $3.67 $5.00 $2.SU $3.16 $3.05 -3.9°h, -16.90k $3.42 Total $167.39 $173.14 $177.29 $178.34 $177.86 -03°k 6.3°Io $176.69 Plan COSt ReWi13U $77.11 $79.44 $82.16 $61.68 $79.64 -2.7°k 3.3'~ $60.76 ReWi190 $44.42 $46.36 $49.56 $50.66 $53.45 5.590 203% $50.05 CombinedRelail $121.53 $125.80 $]3].72 $132.54 $133.09 0.490 9.59, $130.84 Mail $3.06 $4.21 $].61 $2.SU $2.35 -5J90 23.090 $2.71 Total $124.59 $130.02 $l?3.53 $135.03 $135.44 U3~o 8.7°k $133.54 Member Cost ReWi13U $25.76 $25.70 $25.66 $25.20 $24.36 -3.3°,b -5.59c $2522 Retail 9U $16.40 $16.64 $17.39 $17.43 51736 -0.490 5.9~ $17.21 CombiaedRetail $4218 $42.34 $43.07 $42.63 $41.72 -2.19, -].190 $42.44 Mail $0.62 $0.79 $0.69 $0.66 $0.70 2.6'~ ]3.39c $0.71 Tutal $42.80 $43.12 $43.75 $4331 42.42 -2.0°k -0.9% $43.15 -- --- f'fotal Cost • Elig • Relail3U'I'C - Elig {'total PC • Elig } Retai130 PC • Elig Total Cost PMPM • Retai190 TC • Elig-O- Retail TC - Elig M il'I'C Eli Plan Cost PMPM • ReWilYO PC - Elig-k Retail PC - Elig • a • g • Mail PC - Elig $160.W _ --- - - ---- $140.W $160.W $120.W b140.W $IW.W $120.W $ I W.W $60.W $BO.W $60.W $60.W ~40.W $40.W $'20.00 $20.W $O W -- ~ -- • -___. - ---~----~ -~ , . - .--- - SO.UO - --_ _ __ _ _ _ _ -- -- f ----' __ _ _ _ 4Q 2W5 1 Q 2006 2Q 2W6 3Q 2006 4Q 2W6 d(~ 2005 IQ 2006 2Q 2W6 3Q 2W6 4Q 2W6 Quarter Quarter aeiwrtv prepurvvt by Welgreero Hrallh INllalivn ILr the eWhurixeJ ine by wr dknu Utilization Demographics CLIENT ### 4 Q 2005 1`Q 2006 2 Q 2006 3 Q 2006 4 Q 2UU6 Average Member Age Retai130 46.10 2630 27.03 23.84 20.42 Retail 90 63.60 24.80 24.37 23.25 22.97 Combined Retail 463 26.3 27.0 23.8 2U.4 Mail 70.6 -U.1 14.3 33.3 43.9 Overall Average 46.5 26.3 27.0 23.8 20.4 Average Days supply Retail 30 23.00 19.80 20.51 19.84 18.50 Retail 90 90.00 90.00 90.43 89.96 90.15 Combined Retail 23.4 19.9 20.6 2U.0 18.6 Mail 87.4 29.5 30.0 8.7 18.4 Avera e Da s Su l ^Retai"°-DaysSapply Avera e Mem ~°Ve'a'-A"~• "~r b A g y y pp . Refai190 -Days Supply g er ge . Retail3U • Age ®Retail - llays Supply . Retail9U -Age Days ®Mail - Da s Su I Y PP Y .Retail -Age _ Age ~0(r ®Mad -Age 9(} 94 8lF 8U 7U 74 6U 60 5U 5U 4U 4(} 3U- 3U 20 2 10 I U - . - _ ~_ 4Q 2005 I Q 2006 2Q 2006 3Q 2006 4Q 2006 4Q 2005 I Q 2006 2Q 2006 3Q 20U6 4Q 2000 Quarter Quarter aepurU prepared by Walgreeus Hrallh lidtialires fur the audturized use by uur rlien6 Drug Utilization CLIENT ### 4Q?A05 LQ21106 2Q 2006 3Q211A6 4Q280f+ 12MadhTotal Generic• % of Rxs Av Coat % of Rxe A Cost % d' Rxa Av .Coat % of R>es Av . C~ % of Reis Av Coet '9o d Rxs Av Cast Retail 311 69.3% $16.33 71).2% $15.52 70.5% $15.911 73.5% $1634 75.7% $16.59 73.0% $16.18 Retai190 76.0% $46.96 80.2% $48.44 78.1% $47.73 81 ?% $49.11 96.4% $60.90 84.8% $5266 Combined Relail 69.3% $16.53 70.2% $15.58 70.5% $15.96 73.5% $16.41 75.7% $16.67 73.0% $16.25 Mail 63.5% $68.33 0.0% $0.00 0.0% $0.00 28.6% $9,15 O.U% $0.00 0.3% $9.15 Total 69.3e1o $16.94 70.8% $15.58 70.5% $15.96 73.5% $16.41 759% $16.67 73.1% $16.25 Multi-Source Retai130 1.6% $34.43 08% $38.89 Q8% $45.30 L5% $88.2? 1.1%a $94.67 LI% $76.79 Retail9U 2.0% $61.08 2.2%~ $54.26 2.4% $5435 3.7% $130.63 1.6% $81,1U 2.5% $91.18 Combined Retail 1.6% $34.63 0.8% $38.95 0.8% $4535 LS% $88.40 l.l% $94.65 Ll% $76.85 Mail I.I% $75.41 0.0% $0.00 U.0% $0.00 0.0% $O.OU 0.0% $0.00 0.0% $0.00 Total 1.6% $34.88 0.0% $0.(10 0.8% $45.35 LS% $88.40 11% $94.65 0.9°Io $83.58 Sing(e•Sourre Retail3U 2y?% $95.21 29.0% $11021 28.8% $114.14 25.0% $118.71 23.2% $121.37 26.0% $116.55 Retai190 22.1% $200.93 17b% $171.90 19.5% $195.32 15.1% $190.39 2A% $374.57 12.7% $195.39 Combined Retail 29.1% $95.68 29.0% $110.26 28.7% $114.23 25.0% $118.78 23.2% $121,40 26.0% $116.61 Mail 35.4% $239.66 100.0% $1,102.50 100.0% $1,109.76 71.4% $1,808.82 100.0% $1,645.30 99.7% $1,116.83 Total 292% $97.19 29.2% $1I L92 28.7% $114.26 25.0% $118.81 23.2% $121.43 26.0% $117.01 -Gen 70 - Total -¢ Gen °k -Retail Generic Utilization Dru Utiliz ti ~-Generics • Gen % - ReWil30 ~• Ce n % • ReWi190 g a on • MulliSource G¢Ile[IC % +Cen % -Mail tkUCR7tS ~-Single-Source IWY< -. - _. -... I,6O0,000 - - WH 1,400.000 80H ~~ I;?OO,OW 70H (~9r i I,000,WO SOH SW,WO 40H 6110.000 30H 4ao•Wa 20H . IOH 2OU,OW OH - - -- - --- - - - ~ -- - -- 0 - -- --- --- 4Q 2W5 IQ 2000 2Q 2006 3Q 2006 4Q 21)06 4Q 2WS IQ?006 2Q 2006 3Q 2006 4Q 2006 Quarter Quarter agrorb N~gwrcd by Wali;rmnr amllh Iniluli.er Ibr Ihr andrurued one by our limb DAW Usage for Multi-source Brands CLIENT ### L' 4`Q 2003' 1 Q 2606 2 Q 21106 3'Q'2006 4 Q 200(1 UAW 1% Retail 30 12.0% 12.0% 14.0% 16.0% 19.U °k Relai190 279% 5.0% 10.0% 6.0% 14.U% Combined Retail 12.0°h 12.0% 149% 16.0% 19.U% Mail 52.0% 09% 0.0% 0.0% U.U% Overall Average ]2.3%0 12.0% 14.0% 16.0% 19.0°/0 UAW 2% Retai130 28.0% 22.0% 21.0% 34.0% 36.0% Retail 911 56.0% 68.0°k 42.0% 12.0% 21A% Combined Retail 29.0% 22.0% 2L0% 34.0% 36.U% Mail 28.0% 09% QO% 0.0% U.U%a Overall Avera a 29.0% 22.0°Io 21.0% 34.0°/0 36.0°l0 ___ • Retai130 -DAW 1 • Retad311- llA W? I DAW 1 Breakdown •.Retail911-UAWI DAW 2 Breakdown •Retail911-llAW2 ' ~ Retail -UAW 1 ~ Retail - llAW 2 • Mail -UAWI • Mail - UAW2 9U% 9U°k SO°h 80°k 7U°h 7U% 6U°k 60% SU°k SU°k 40 ~' 4U% 3U°k 30°h '-~ 20'~ I U°~ 10°k °k U - ------- 4Q 2l)US IQ?006 2Q 21N)6 3Q 2196 4Q 2006 4Q 2005 IQ 2006 2Q 2006 3Q?W6 4Q 20116 Quarter Quarter aepurls prepared by Walgree~s Hrdllh Inilialivesfur the authorized uxe by our clients D~xCta~s mement geUort ~, t2 Ntoutu • qu - germ T~ Direct Me`Y'bereL~ENT ~~ 3Q t,2a 2R 121 ~Q 2 ~~45.53 uu 4Q 1~~ 8132. $22,~a.Nl $5.U0 11.5Q 320 ~~ ~ -~ ~~2.'12 139 $225.53 $143.55 ~2. , ~~3.(~1 $5,~~'S~ ~oq~txs ~~,y8a.10 ~j4$.5$ ~g3b.l'1 ~O~ti ~y,952.t~ $8, 4 63 M~'~ti ev~t 21 , ~~.721.01 ~10,03~.0~ ~otal~ pVan Cosh $68,5b3.18 Total Cost # of DNiR gxs $~~,~ $60,~ 2 20t16 ZQ~20116 34 °°"_ 2W6 ~ . Q~W4 7Q Quarter ~,../ l,'~' $50,~ 1,2tA'' $40.~ Cpgt 1,0~' $3U.OW 80C # 01 $20,~ 6tw $10,1 _ ~tltx~ _ ~ ~Q Z~ ~ . 3Q'~' .,~ 4tN `'_~ ~ 1Q21WJ6 ~ru N~uu INiuliven Yor tlx ~uthudrwA ~ by w`r c6erd` uroiuu VrePgrrd by WnIRr CLIENT ` #### Top Drugs Dispensed by Rxs -Mail 4Q 2006 Sorted by Ras T '(lass. Farmaluy 71er doPRxs Total Cod '% of Puts! Rxs % ut'1'otal Oust GENO'fROPIN Single-Source OTHER HORMONES ? B $38,388 30.77 ~, 38 b8 `Y NU'IROPIN Single-Source OTHER HORMONES 6 $38,W7 33.U8'~ 38.7v ~y< NU'fROPIN AQ Single-Source OTHER HORMONES 5 $15,313 1923'4, 15.43 NORllI'fROPIN NORllIFLEX Single-Source GTHER HORMONES 2 3 $7,131 11.54'Y~ 7.18 `Y~~ AllDERALL XR Single-Source AMPHETAMINE PREPARA'f1ONS 2 I $?88 3.85'x, U29 ~Y, AMPHE'1'AMINESAL'I'COMBO Generic AMPHETAMINEPREPARA'I'IONS I I $lUU 3.85% U.IU~Y, BD INSULIN PEN NEEDLE OF SHORT Single-Sow~ce MEDICAL SUPPLIES 2 I $?5 3.85' U.U3'Y SINGLE. USE SWAB Single-Source GENERAL. ANTIBAC'l'HRIALSAND ANTISEPTICS 3 I $2 3.85'Y l1.UU'Y Total 26 $99255 11N1.U% IUU.U% Reports prepared by Walgreens Health luidadvn rur the aulhurieed use by our alien[, CLIENT ### Top Drugs Dispensed by Total Cost -Mail 4Q 2006 ~. Sorted by Cost D Dr Thers ikClass Fermuistry 15e< potltu ToWCost 96 of'1'uWl Rxs ~, of TuWI Ctrst GENOTROPIN Single-Source OTHER HORMONES 2 8 $38,388 30.77'w 38.68'% NUTROPIN Single-Source OTHER HORMONES 2 6 $38,(107 23.08'&, 38.?9'R. NUTROPINAQ Single-Source OTHER HORMONES 2 5 $15,313 1y23'Y~ 15.43'k. NORDITROPINNORDIFLEX Single-Source OTHER HORMONES 2 3 $7,131 11.54'w 7.18'R~ ADDERALL XR Single-Source AMPHETAMINE PREPARATIONS 2 l $288 3.R5 ti, U.29'h AMPHETAMWESALTCOMBO Generic AMPHETAMWEPREPARATIONS 1 I $IUO t.85 h~ U.10'h~ BD INSULIN PEN NEEDLE OF SHORT Single-Source MEDICAL SUPPLIES 2 I $25 3.85 "l0 0 U3'ti- SINGLE USE SWAB Single-Source GENERAL ANTIBACTERIALS AND ANTISEPTICS 3 I $2 3.85'k U OU'k~ Total 26 $99255 111(1.0% IUU.U°Io Repurb prepared by Walkreens Neallh Inhiatirn t'ur the authurixed use by uur clien4r l CLIENT ### Top Drugs Dispensed by Rxs -Retail 4D 2006 Sorted by Rxs D T Thera tk Class )!brmalary Tier Y ~ Rxs Total Cost % ot'fotal Rxs % uC'!'otal Cost AMOXICILLIN Generic PENICILLINS I 867 $5,558 5.33'ti, 0.60'%~ CONCERTA Single-Source CVS STIMULANTS 2 559 $59,617 3.44'%. G.46 h~ AZITHROMYCIN Generic ERYTHROMYCINS I 549 $20,383 3,37'k, 3.2J %. AMOX TR-POTASSIUM CLAVULANATE Generic PENICILLINS I 483 $24,968 2.97'w 3.71 '%~ ALBUTEROL Generic BRONCHIAL DILATORS 1 483 $10,002 297'% LllB'x~ ALBUTEROL SULFATE Generic BRONCHIAL DILATORS 1 48C $9,194 3 `15 % L00'h ADDERALL XR Single-Source A;vIPHETAMINE PREPARATIONS 2 382 $40,685 2.35'%, 4.41 '% SINGULAIR Single-Source BRONCHIAL DILATORS 2 382 X35,470 2.35'%v 3.85'x, CLONIDINE HCL Generic OTHER HYPOTENSIVES 1 379 $2,368 2.33'k U?6 /~ IBUPROFEN Generic ANTIARTHRITICS I 339 $2,003 2.08 'R, U.22'x AMOXICILLIN TRIHYDRATE Generic PENICILLINS I 308 $3,805 1.89 "/~~ 0.41 LORATADINE Generic ANTIHISTAMINES I 297 $3,321 1.83'%, 0.36'/, CEPHALEXIN Generic CEPHALOSPORINS I 288 $5,368 1.77 W 0.58'%, PULMICORT Single-Source GLUCOCORTICOIDS 2 261 $51,990 1.60 h• 5 64'x. OMNICEF Single-Source CEPHALOSPORINS 2 237 $18,82a 1.46'%, 2.04 %• NYSTATIN Generic FUNGICIDES I 205 $1,955 I.26'%~ 0.21'%• FLUTICASONEPROPIONATE Generic TOPICAL NASALANDOTICPREPARATIONS 1 2UI $12,5?0 1.24'&- Lib' ADVAIRDISKUS Single-Source BRONCHIAL DILATORS 2 197 $31,313 1.21 'W 3.40'x DEPAKOTEER Single-Source ANTICONVULSANTS 2 19C $18,975 1.17'%. 2.06'%, CERON-DM Generic COLD AND COUGH PREPARATIONS ] 176 y5,910 1.08'% U.64'x SULFAMETHOXAZOLE/fR1METHOPRIM Generic SULFONAMIDES I 169 $2,085 L04'x. 0.23 `h GUANFACINEHCL Generic OTHERHYPOTENSIVES I 163 $4,778 I,UO'W 0.52'x. PREDNISOLONE Generic GLUCOCORTICOIDS I 162 $1,848 1011'k U20'%~ ELOVENTHFA Single-Source GLUCOCORTICOIDS 2 146 $14,266 0,901- 1.55'x, SYNAGIS Single-Source ANTIVIRALS 2 143 $194,903 11.88'k~ 21.13 °k- Total 8,046 $582,135 49.5% 63.1% aepuris prepared by Welgreeiu Health Initiadres 1'ur the a Wwrixed use by uur clients CILENT ### Top Urugs Dispensed by Total Cost -Retail 4D 2006 Sorted by Cost Dr Dr T Then tlrClass Fertoulary Trer Mofl2ss TotelCost % of 7'utal Rxs °k of'Ibtul Cult SYNAGIS Single-Source ANTIVIRALS 2 143 $194,903 Q88 tY~ 21.13 tY~ CONCERTA Single-Source CNS STIMULANTS 2 559 $59,617 3.44 ~% 6.46 %- PULMICORT Single-Source GLUCOCORTICOIDS 2 261 $51,990 1.60 ~Y0 5 64'Yo ADDERALL XR Single-Source AMPHETAMINE PREPARATIONS 2 382 $40,685 2.35'Y d.41 'Y< SINGULAIR Single-Source BRONCHIAL DILATORS 2 382 $35,470 2.35'Y0 3.85'Y0 ADVAIR DISKUS Single-Suurce BRONCHIAL DILATORS 2 197 $31,343 121 '~, 3.40 ~Y~ AMOXTR-POTASSIUMCLAVULANATE Generic PENICILLINS I 483 $24,968 2.97°w 3.71'%, AZITHROMYCIN Generic ERYTHROMYCINS 1 549 $20,383 3.37' 221'l~ DEPAKOTE ER Single-Source ANTICONVULSANTS 2 19C $18,975 1.17 °/u 2.06'/. OMNICEF Single-Source CEPHALOSPORINS 2 237 $18,823 1.44 °k 2 U4'w FLOVENTHFA Single-Source GLUCOCORTICOIDS 2 ]46 $14,266 U9U°k. I ~5'R, FLU'CICASONE PROPIONATE Generic TOPICAL NASAL AND OTIC PREPARATIONS I 201 $12,520 124 °w 1.36'%u DESMOPRESSIN ACETATE Generic OTHER HORMONES 1 71 $12,340 0.44 "k 13d w ABILIFY Single-Source PSYCHOSTIMULANTS-ANTIDEPRESSANTS 2 31 $11,767 U.19~Y0 L28'% TOPAMAX Single-Source ANTICONVULSANTS 2 48 $10,773 U.30t~ 1.17'ti, ALBUTEROL Generic BRONCHIAL DILATORS I 483 $10,002 297 Y0 1 US'h ALBUTEROL SULFATE Generic BRONCHIAL DILATORS I 48C $9,194 2.95'Y0 LUO %< STRATTERA Single-Source PSYCHOSTIMULANTS-ANTIDEPRESSANTS 2 68 $8,572 0.42 ~Y- Q93'Y- PULMOZYME Single-Source MISCELLANEOUS 2 3 $7,656 UA2'Y<, U 83'%~ SEROQUEL Single-Suurce ATARACTICS-TRANQUILIZERS 2 41 $7,361 025 ~Y0 U.SU'Y METADATE CD Single-Sow'ce CNS STIMULANTS 2 95 $7,222 0.58 ~Y, 0.78'Yo RISPERDAL Single-Suurce ATARACTICS-TRANQUILIZERS 2 36 $b,734 0.22 °w 0.73'/0 MINOCYCLINEHCL Generic TETRACYCLINES 1 89 $6,570 0.55'h, 0.71'Y- PROGRAF Single-Source MISCELLANEOUS 2 1U $6,314 O.U6~k U.68'/~ DEPAKOTE Single-Source ANTICONVULSANTS 2 71 $6,277 0.44'W 0,68% Total 5256 $634723 32.3% 68.8°/a ReNurls yrepared by Walgreetu Health Initiatives I'ur the authorized use by our cnenU Formulary Analysis CLIENT ### 4 Q 21185 1 Q 2Q06 2 Q 2006 3 Q 2UOd 4 Q 20@b 12 Month Total % of Rxs Av Cost. % of 12as A .Cad % of Ras Av Coat % of Rrs A Coat ~O of Rxs Ar Cost % of Rxs Avg.Cost l - Cenerie Urugs Retai130 70.3% $2LU3 70.1% $20.64 68.7% $21.09 70.8°c $?1.36 72.9% $21.86 70.6% $?I ?2 Retai190 100.0°k $47.1)4 lOU.IWIo $3.91 O.U% $0.00 0.0'k $O.W U.0% $O.OU 25.0% $3.91 Combined Retail 703 $2LU3 70.1% $20.64 68.7% $21.09 70.8°k $21,36 72.9% $21.tW 70.6% $?I ?2 Mail U.0°k $0.00 U.0% $0.00 25.0% $523.72 7.1°k $99.76 3.8% $99.76 8.f)uk $31L74 Total 70.3% $21.03 70.1% $20.64 68.7°k $21.18 70.8% $2136 72.8% $21.87 70.6°10 $2L25 2-Preferred Retail 3U 253°Ic $143.50 24.5°k $186.93 25.5% $126.42 23.8% $120.45 22.5% $170.25 24.1% $152.67 Relail9U 0.0% $0.00 0.0% $Q.00 0.0°k $0.00 50.0% $653.73 f00.U% X982.12 50.0% $817.93 Combined Retail 25.3% $143.50 24.5% $186.93 2.5.5% $126.42 23.8% $120.60 225% $170.47 24.1'k $152,76 Mail 100.0% $3,946.59 100.0°k $5,315.10 75.0°k $?,856.79 78b% $4,033.63 92.3% X4,131.37 86.Uh $3,983.57 Total 25.3% $149.80 24.5% $189.17 25.5% $130.44 23.9% $132.72 22.6% $196.25 24.1% $163.13 J- Non•Preferred Retail 3U 4.4%i $37.05 5.4% $44.77 5.8% $46.07 5.4% $44.10 4.6% $52.30 5.3°k $46.58 Retai190 0.0°k $0.011 U.0% $0.00 U.U°k $0.00 50.0% $55.91 0.0% $0.00 25.0% $55.91 CombiuedRetail 4.4% $37.05 5.4% $44.77 5.8~ $46.07 5.4% $44,11 4.6% $52.30 53°k $4b.59 Mail 0.0%c $0.011 QU% $0.011 U.U% $0.00 14.3% $2.68 3.8% $2.41 6.U°k $2.59 Total 4.4% $37.05 5.4% $44.77 5.8% $46.07 5.4°10 $44.01 4.6% $52.24 5.3°I0 $46.55 f'l'ier l kxs f'l'ier I kx % Rx Count b y Tier ~.;.'fier z kxx Utilization % by Tier ~-'tier 2 kx % # RXS •'fier 3 Nxs % RXS •'1'ier 3 kx % 14,D00 100 90 12,DDO 80% 10,000 70% i - '~ -' 8,000 ~~0 50% 6,000 40°k 4,000 __. __ .-,. _ - .~ - A------ -.~____ 20 2,000 10% 0 - _ _ _ -- --- _ _ _- _ - -- -- 0% --- _ --- - ------.. --- --- _ _ _ --- -- - -- ... _ 4Q 2005 IQ 2W6 ?Q 2006 3Q 20D6 4Q?U06 4Q 2005 I Q 2W6 2Q 20f~ 3Q 2W6 4Q 2006 QUBCter Quarter aepurls preiwred by Walgrenu Hwl[h Initiatives fur the aulhuriuvl use by uur [Bents CLIENT ~## Top Specialty Drugs by Total Cost 4Q 2006 Dr Dear F~m,turcy Tier ` ~ai13t-Ras Ret~il9wf Ras ca Retail Rai MA1 Rxs Total Cost ~ uv ltxs ~ ar TWaI Cust SYNAGIS Single-Source RESPIRATORY SYNCI'17AL VIRUS 2 143 0 143 U $194,90297 85.1? Y~ 64.67 'Y GENO'I'RONIN Single-Sowce GROWTH HORMONE 2 U U U 8 538,388.31 4.76'ti~ I:'.74 ~/ NUTROPIN Single-Source GROWTH HORMONE 2 U 0 U 6 538,007.1? 357 "k I ~ 61 ~% NU'I'ROPIN AQ Single-Source GROWTH HORMONE 2 0 U 0 5 515,313.46 '.98 °h~ 5 08'#, PULMOZYME Single-Source CYSTIC FIBROSIS ? 3 0 3 0 57,656 I I 1.79 ~k ?.54'% NOR01'I'ROPINNORDIFLEX Single-Source GROW'fHHORMONE Z 0 U U 3 57,130.91 L19%, 2.i7'Y, Total 146 0 146 22 $301,399 lA3 % 29.50 % Cost All D T S Top SpeeiaUy ~ at AY Plan Cast $1,021.011 $301,399 29.52 % Member Cast $730 $0 0.00 % Total Cwt 51,021,741 5301,399 29.50 °/G Total Rxs 16,296 168 LU3 ~O RxPort Query Tool ~--- ~~ ~,~, r_ File Edik View Favorites Tools Help Cy back • ~- ~• ~ ~ ~' lse.~'d1 ~1=avorikes Mega I' .[- ~ ~ ;. Add-es9 htkp; jjwu~w,reports,whphi,comjwijbinjiswi,dlljWIGeneratorjwigeneratorjgeneratorjExecuteWIS?sWIS=DeFaultWebPanelFrame&ci~ ~Go I, Links 411'..x' Y ~~ Clientl Group a~ Drug o-~ Patient ~}~ Plan a~ Pharmacy p-~ Prescriber a~ Date i0-I~ Measures G~i:IJR1611it6 end ~ ~__~__~-- ~'~ ~4dJu~1>~~t1~1 R~t~ E3~~~ 'l~t~;.~nd'9t3NQ3 ` ;. Dra.~ Qb;ects frr~m tAe list arld Aron t,~em here. et bo,wl,app,WebIRpplekstarted____ _____.__ .---__.--- - -_.__-- ----_------_- ---__-.. `l__.'~~ ~~___~)~~!ternet -- - - . - ..---~- ~ ~,~ Go pefauik"~ebRanelfram ...- r~~ °~~ View ~~° ` 5earcti Eavantes e~rator~Exec _.. ~ ~ , ' , . ~- ,~, . ~ p~ ~`~ iy IGer+erakor~ _ ~nerakar~9 .. c~ back , camt -- ~ ~ ': ~,~ patiera onr C'u~omer Care Center at 1-st16-345-1985 to advl~e. Simply mail your original prescription and this form along with your credit card information or check made payable to: Walgreens Mail Service, P.O. Box 29061, Phoenix, AZ 85038-9061 Customer Care Center: 1-800-345-1985 (TTY for hearing impaired: 1-800-573-1833) Refills by Phone: 1-800-RX-REFILL (1-800-797-3345) (en espanol: 1-800-778-5427) Internet: www.walgreensmail.com ~~i~~~t. Health In~tratw>~s To get the most for your money, use generic medications whenever possible. And to help ensure the safety and effectiveness of your medication therapy, present your insurance card with each fill. Then our drug utilization review program can help prevent medication-related issues, such as dangerous drug interactions and other medication issues. By "going generic" you can save money without compromising quality. The U.S. Food and Drug Administration requires generics to be as safe and effective as their brand-name counterparts. With generic prices on average 30 to 80 percent less than their brand-name counterparts, your choice of generics can help keep your insurance premiums low and benefits high. In fact, more than half of all prescriptions in the United States are now filled with generic medications. Your doctor may choose to prescribe a generic for you, or, if he or she recommends a brand name, you can ask if a generic is available. You probably have heard of a limited number of generics which have become available recently at a low price for a typical 30-day supply at certain retailers. If you elect to have your prescription filled for one of these specific generic medications at one of the retailers in our network, our claims system will compare their cash price to our rate, and charge you the lower of the two. This means that, if their price represents a better value, that is what you would pay. Protecting Your Safety Presenting your insurance card with each fill is important. This allows us to monitor your medication usage via our drug utilization review system, and we can help make sure that you receive safe and appropriate medication therapy. Our drug utilization review program integrates and monitors prescription and medical history (when available), in order to prevent adverse drug events and other medication-related issues such as dangerous drug interactions. We alert your doctor to potential drug-related problems, which enables him or her to make more informed decisions regarding treatment options. Your prescription benefit is about more than just price. Equally valuable are these behind-the-scenes services that help ensure that you are getting the best possible medication therapy. So be sure to present your card each time you get a prescription filled and take advantage of these important features of your prescription benefit. For more information, contact the Walgreens Customer Care Center at 800-207-2568 or visit mywhi.com. ~ 2006 Walgreens Health Initiatives, Inc., a wholly owned subsidiary of Walgrecn Co. 411 rights reserved. PBM>332-1206 °tir.r t~~! Health Initiatives Healthcare costs continue to rise year aReryear-including prescription costs. While you can't always control what you must spend on healthcare, you can take charge of your prescription copay. That's because your prescription benefit plan uses athree-tier copay design that is categorized into three payment levels-allowing you to choose what you pay. Preferred Medication List The Walgreens Health Initiatives Preferred Medication List (PML)-chosen by a committee of doctors and pharmacists-is used by your plan. You choose (pending your doctor's approval) whether to use a more expensive brand-name medication or an equally effective-but less expensive-preferred-brand or generic* alternative. All medications listed have been approved by the United States Food and Drug Administration. Review the PML with your doctor and ask if he or she can substitute apreferred-brand or generic alternative for any of the medications you currently take or are being prescribed. You or your doctor can quickly access the Preferred Medication List at www mywhi.com. Register on our web site to find out if your medication is covered by your plan, look up copays, and research generic and brand-name alternatives. ' A generic medication is a chemically identical version of a brand-name containing the same amounts of the same active ingredients and is approved by the FD,~1 as being sate and et}ective. Tiers Made Easy Understanding your three-tier plan can help you save valuable healthcare dollars. Following are the differences among the three tiers: 15t Tier-Lowest Copay Most generic medications are in the 1"tier. Generally, these are the least expensive and the most cost-effective for both you and your plan sponsor. ©2004 Walgreens Health Initiatives, Inc. PBM1011-1104 2"d "Tier-Middle Copay A 2"d-tier medication is a brand-Warne drug- referred to as apreferred-brand-that either does not have a generic equivalent or may be a less- expensive, but equally effective, alternative to its 3`d-tier counterpart. 3`~ Tier-Highest Copay A 3`d-tier medication is a brand-name drug- referred to as a nonpreferred brand-that has either a generic or 2"d-tier alternative available. Generally, these are the most expensive for both you and your plan sponsor. For more information, call 1-800-207-2568, e-mail whi.info@walgreens.com, or visit us at www.mywhi.com. ;4LGREENS HEALTH PHARMACY (WH/) ETWORK LISTING ~r ~J Health Initiatives The Walgreens Health Initiatives network consists of more than 60,000 participating chain and independent pharmacies nationwide. Following is a list of some of our network pharmacies. This list is subject to change. For the most up-to-date, complete list of participating pharmacies, please visit mywhi.com. A&P* Accredo Health Group Acme* Albertsons* Arrow Phazmary and Nutrition Center* Aurora Pharmary* Bartell Drugs Bashas'* Bi-Lo Bi-Mart BJ's Pharmacy" Brooks Phazmary* Brookshire Brother's Phazmary* Brookshire's Bruno's Buehler's* City Mazket* Coborn's Pharmacy Costco Cub Foods* CVS Phazmary* CVS ProCaze* Dillons* Discount Drug Mart* Dominick's* Drug Fair DrugTown* Duane Reade* Eckerd* Fagen Phazmary* Fairview Pharmacy Familymeds* Farm Fresh Fazmer Jack* Food 4 Less* Food City* Food Lion Fnod World Fred Meyer* Fred's Pharmacy Fruth Pharmacy Fry's* Giant Eagle* Giant Pharmacy Hannaford Happy Harry's Hazris Teeter* Health Partners H-E-B Pharmacy Homeland Pharmacy Hy-Vee* [ngles Pharmacy Integrity Healthcare Services Kash N Kerry* Kerr Drug King Soopers* Kinney Drugs Kmart* Kroger* Longs Drugs* Mares Pharmacy Mazsh Drug* Martin's May's Drug Stores Medic Discount Drug Medicap Pharmary* Medicine Shoppe* Meijer* Navazro Discotnt Pharmary* NCS Heahhcare NeighborCare Option Care Osco Drug* Pamida Pharmacy Pathmark Pharmacy PharMerica Price Chopper* Publix* QFC* Raley's Ralphs* Randalls* Rite Aid* Safeway* Sam's Club* Save Mart* Sav-on Drugs* Schnucks* Shaw's/Osco Pharmary* Shop 'n Save* ShopKo* Shoppers Phazmary* ShopRite Smith's Food &Drug* Smith's Phazmary* Snyders Drug Stores Sourhern Family Market Statscript Pharmacy Stop & Shop Super 1 Super D Super Fresh Tazget* The Phazm* Thrifty White* Tom Thumb* Tops Ukrop's United Drugs United Phazmary* USA Drug Vencare Pharmacy Vons* Waldbaum's* Walgreens* Wal-Mart* Wegmans Weis Pharmacy White Drug* Winn-Dixie* "These pharmacies also participate in our Advan[age90" program. This program allows you to obtain a 90-day supply of maintenance medication at select retail locations. ©2006 Walgreens Health Initiatives, Inc., a wholly owned subsidiary of Walgreen Co. All rights reserved. PBM2231-0906 ALGREENS HEALTH INITIATIVES (WHI) PREFERRED MEDICATI ~r L([ll~:~/Y~~il~/1. Kealth Inataataves You can make the most of your pharmacy benefit plan and control your prescription medication costs by using this Preferred Medication List. Be sure to share this list with your doctor to select cost-effective medications that are clinically appropriate to treat your condition or maintain your health. This Preferred Medication List (PML) was developed by Walgreens Health Initiatives, your plan sponsor's pharmacy benefit manager, under the direction of a committee of physicians and pharmacists. All medications on this list are preferred by your plan. Understanding Your Tiered copays Your pharmacy benefit plan offers three categories- or tiers-of drugs that determine your costs (copays) • Therapeutic categories are listed alphabetically in all UPPERCASE letters in black boxes. Therapeutic classes in each category are printed in gray boxes. • Types of medications in each class are printed in italics. • Generic medications are listed in lowercase letters below the word generic. • Preferred medications are listed in UPPERCASE letters below the word BRAND. • If a medication is used to treat more than one condition, it will be listed under only one category. Check different 1" tier: Generics. Generics contain the same active ingredient as their brand-name equivalents and offer the same effectiveness and safety. Generics generally have the lowest copay. 2"~ tier: Preferred. Medications in this tier have been selected by your pharmacy benefit plan as preferred brand drugs. These drugs have higher copays than generics but are less costly than nonpreferred medications on the third tier. 3`d tier: Nonpreferred. Because they have a generic version or a second-tier alternative available, nonpreferred medica- tions have the highest copays and are not listed on the PML. How to Use This Guide Whenever possible, have your doctor consult this guide for the lowest cost brand-name and generic medications available for your therapy. Some tips to keep in mind when using this guide: categories for your medication. Al! medications on the 1'ML have been approved by the Food and Drug Administration (FDA). Additional Information Due to space limitations, not all medications are listed in this PML. Medication coverage and copays may vary Erom plan to plan. For more information specific to your plan, register on mywhi.com and click on Check Drug Coverage/copay to verify coverage. You can also access the alphabetical version at the above web site. Please note: The PML is subject to change without notice. Call Us With Questions For assistance, please call the VGalgreens Health Initiatives Customer Care Center toll free at 800-207-2568. C56619A-0607 ''`rrr~ `'~1r~ Walgreens Health Initiatives 2007 Preferred Medication List Effective June 15, 2007 Bronchial Dilators ep neric albuterol albuterol HFA [ProAir HFA] ipratropium bromide theophylline anhydrous B@A~III ALUPENTINHALER ATROVENT HFA ATROVENTINHALER COMBIVENT FORADIL SEREVENT DISKUS SPIRIVA UNIPHYL i~lfor snd Bkicee~lNc~rJd at10t~ BRAND ADVAIR DISKUS Costero~lnhaNd tl0tls BRAND ASMANEX FLOVENT HFA PULMICORT RESPULES PULMICORT TURBUHALER QVAR iLeu R+elaeptor An1ag©n~fs BRAND SINGULAIR e~;:1,~tabers. ~. ep neric cromolyn nebulized solution BRAND INTAL INHALER AM!lunga! Agents e4 neric fluconazole itraconazole ketoconazole oral nystatin terconazole BRAND GRIS-PEG LAMISIL TABLET VFEND Antimalarial Agents ea neric hydroxychloroquine mefloquine quinine sulfate BRAND MALARONE An~aras~lc and An>6~rot~oal Agents eg neric mebendazole metronidazole permethrin BRAND OVIDE Antlviirsls ep neric acyclovir Cytomegalovirus e4 neric ganciclovir BRAND VALCYTE Herpes BRAND FAMVIR VALTREX t-absporins 1 S~ Generation ea neric cefadroxil cephalexin 2^d Generation eg neric cefaclo~ cefprozil cefuroxime 3~ Generation BRAND OMNICEF lntraregina! Antlblotlcs BRAND METROGEL-VAGINAL GEL Mecrolldes eq neric azithromycin clarithromycin clarithromycin ER erythromycin oral Nitro/uran Derivatives eo neric nitrofurantoin macrocrystals Penicillins eg neric amoxicillin [TrimoxJ amoxicillin trihydrate/ potassium clavulanate ampicillin dicloxacillin penicillin V potassium BRAND AUGMENTIN XR QuMobnes eg neric ciprofloxacin ofloxacin BRAN D AVELOX SuNbnemld~ eg neric sulfamethoxazole/ trimethoprim (Sulfatrim] BRAND GANTRISIN Tetracycf/nes eg neric doxycycline minocycline tetracycline Tuberculosis Agents eq neric isoniazid rifampin nlOtt3 Arrt~iot>cs eg neric clindamycin oral trimethoprim Ar~coagubnts eQ neric warfarin [Jantoven] BRAND COUMADIN Platelet Inhibitors eo neric cilostazol dipyridamole pentoxifylline ER BRAND PLAVIX .Miscellaneous eo neric anagrelide BRAND MEPHYTON All oral agents under this class are on the PML, if FDA approved. •~ • Bbod Piress~t Afs ACE Inhibitors eg neric benazepril captopril enalapril fosinopril lisinopril moexipril quinapril trandolapril BRAND ALTACE ACE Inhibitor Combinations eq neric benazeprillhctz captopril/hctz erialaprillhciz fosinoprillhctz lisinoprillhctz moexipriflhctz quinaprillhctz [Quinaretic] BRAND LOTREL Angiotensin Receptor Blockers (ARBs) BRAND AVAPRO BENICAR COZAAR Angiotensin Receptor Blocker (ARBs) Combinations BRAND AVALIDE BENICAR HCT HYZAAR Medication Categories Guide Page 2 Beta-Blockers eg neric acebutolol atenolol bisoprolol labetalol metoprolol metoprolol succinate ER 25mg tablet nadolol pindolol propranolol propranolol LA sotalol BRAND COREG INNOPRAN XL TOPROLXL Blood Pressure Agents- Combinations eneric atenolollch lorthalidone bisoprolol/hctz metoprolollhctz Calcium Channel Blockers eQ neric diltiazem diltiazem ER [Cartia XT, Dilt XR, Diltia XT, Taztia XT] felodipine ER isradipine nifedipine ER [Afeditab CR, Nifediac CC, Nifedical XLJ verapamil verapamil ER BRAND NORVASC Central Nervous System Agents eq neric clonidine guanfacine hydralazine methyldopa BRAND CATAPRES-TTS '' Vasodilators eg neric isosorbide dinitrate isosorbide mononitrate ER nitroglycerin [Minitran, Nitroquick, Nitrostat, Nitrotab] Generic medications are sometimes given specific names by their manufacturers for ease of reference. These are listed in brackets after the generic name. ~r Walgreens Health Initiatives 2007 Preferred Medication List Effective June 15, 2007 Cholesterol Agents Cholesterol Binding Agents e cholestyramine BRAND WELCHOL Cholesterol Reducing Agents-Combination BRAND VYTORIN Cholesterol Reducing Agents-Miscellaneous ep neric gemfibrozil BRAND ANTARA N IASPAN TRICOR ZETIA Cholesterol Reducing Agents-Statins eQ neric lovastatin pravastatin simvastatin BRAND CRESTOR LIPITOR OJbO~CS Loop ea neric bumetanide furosemide torsemide Potassium Sparing eg neric amiloride spironolactone Potassium Sparing Combinations ea neric amiloridelhctz spironolactone/hctz triamterene/hctz Thiazides eg neric chlorthalidone hydrochlorothiazide indapamide metolazone Miscellaneous eq neric acetazolamide Heart Rhythm StabUlzers ep neric amiodarone [Pacerone] Digitalis Glycosides eg neric digoxin [Digitek] BRAND LANOXICAPS LANOXIN 1~$f.'@llaneotlS BRAND CADUET RANEXA ARNf BRAND ARICEPT EXELON NAMENDA RAZADYNE RAZADYNE ER Ana/Qeaks Narcotics e4 nenc acetaminophen lcodeine butalb ita Ilcaffeinel acetaminophenlcodein e fentanyl transdermal hydrocodonel acetaminophen h yd rocod oneli bu p rote n hydromorphone meperidine morphine sulfate ER oxycodone oxycodonelacetami nophe n [Endocet, Roxicet tablet] propoxyphenel acetaminophen BRAN D OXYCONTIN Non-Narcotics (NSAIDs) e diclofenac diflunisal etodolac flurbiprofen ibuprofen indomethacin ketorolac meloxicam nabumetone naproxen naproxen sodium oxaprozin piroxicam salsalate sulindac Non-Narcotic Agents- Aspirin Containing e4 neric butalbital compound Non-Narcotic Agents- Other eg nenc butalbitallacetaminophenl caffeine Miscellaneous ea neric tramadol tra madollaceta minophen AMtitnxlsty Agents eo neric alprazolam alprazolam XR buspirone clorazepate diazepam lorazepam oxazepam AnticonvulsentS eg neric carbamazepine clonazepam gabapentin phenobarbital phenytoin ER primidone valproic acid zonisamide BRAND CARBATROL DEPAKENE DEPAKOTE DEPAKOTE ER DIASTAT DILANTIN GABITRIL KEPPRA LAMICTAL LYRICA PHENYTEK TEGRETOL TEGRETOLXR TOPAMAX TRILEPTAL Anal~igarestantf Alpha-2 Receptor Antagonist eq neric mirtazapine mirtazapine soltab NDRI eneric bupropion bupropion ER SARI eneric nefazodone trazodone SNRI eg neric venlafaxine BRAND CYMBALTA EFFEXOR XR SSRI eg neric citalopram fluoxetine fluvoxamine paroxetine sertraline BRAND LEXAPRO TCA e4 neric amitriptyline desipramine doxepin imipramine nortnptyline Miscellaneous BRAND SYMBYAX Mtlpatldnaontsm Agents Anticholinergic eg neric amantadine benztropine tnhexyphenidyl Miscellaneous ea neric carbidopa/levodopa sefegiline BRAN D COMTAN MIRAPEX REQUIP STALEVO Medication Categories Guide Page 3 Antfpsychofics eo neric clozapine haloperidol BRAND ABILIFY GEODON RISPERDAL SEROQU EL ZYPREXA ZYPREXA ZYDIS At~f-~Oll DeIFJCIt Hythr~j- Eraler . - ~~ e amphetamine mixed salts methylphenidate [Methylin] methylphenidate ER [Methylin ER] BRAND ADDERALLXR CONCERTA METADATE CD STRATTERA B~ol1f/Igents eg neric lithium carbonate lithium carbonate ER BRAND ESKALITH CR LITHOBID iitlne Agents BRAND IMITREX MAXALT MAXALT MLT RELPAX ZOMIG ZOMIG ZMT Steep Afds ep neric estazolam flurazepam hydroxyzine temazepam triazolam BRAND AMBIEN AMBIEN CR SONATA Generic medications are sometimes given specific names by their manufacturers for ease of reference. These are listed in brackets after the generic name. ~-° ~rrr' Walgreens Health Initiatives 2007 Preferred Medication List Effective June 15, 2007 Antiallergy- Antlhlstamine Preparations eg neric fexofenadine t~h Md rLbld t>l!OnS eg neric benzonatate dextromethorphanl promethazine [Promethazine with DM] dextromethorphanl pseudoephedrinel brompheniramine [Cardec DM) guaifenesin guaifenesinlcodeine (Cheratussin AC, Mytussin AC] gua ifenesinldextromethor- phanlpseudoephed tine [Giltuss TR) g uaifenesinlpseudoe- phedrine ER [Guaifen PSE, Guaifenex PSE, Pseudovent400] hydrocodone compound hydrocodonelg uaifenesin phenylephri nelcodei ne/ promethazine [Promethazine VC with codeine] phenylephrinelhydtocodone phenylephrinelhyd rocodone/ chlorpheniramine [H-C Tussive, Histinex HC] promethazinelcod eine pseudoephedrinel chlorpheniramine [De-Congestine TR] AntrtRt,k A~elcls- t?fal eg_neric glimepiride glipizide glipizide ER glipizidelmetformin glyburide glyburide/metformin glyburide micronized metformin metformin ER BRAND ACTOPUJS (vIET ACTOS AVANDANIET AVANDARYL AVANDIA DUETACT PRANDIN PRECOSE STARLIX BiOOd.SefEBr BRAND ACCU-CHEK [Active, Advantage Comfort Curve, Aviva, Compact] ONE TOUCH [Basic, FastTake, OneTouch II, Profile, SureStep, Ultra] 8b~i` ,~rw'w~stnD BRAND GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT ~)ftl~l3 BRAND APIDRA BYETTA EXUBERA HUMALOG HUMALOG MIX 50150 HUMALOG MIX 75125 HUMULIN 50150 HUMULIN 70130 HUMULIN L HUMULIN N HUMULIN R HUMULIN U I_ANTUS LEVEMIR NOVOLIN 70/30 NOVOLIN INNOLET 70/30 NOVOLIN INNOLET N NOVOLIN L NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX 70/30 NOVOPEN SYMLIN Allergy Agents and Antfhistamfnes-Eye e4 neric cromolyn ketotifen BRAN D ALAMAST OPTIVAR ANrFee~y Agents-Nose eneric flunisolide fluticasone BRAND NASONEX Afotks-Ear BRAND FLOXIN OTIC Mfi~iodcs--Ej/e eo neric erythromycin gentamicin [Gentak] neomycinlpolymyxin BI bacitracin ointment neomycinlpolymyxin BI gramicidin solution ofloxacin 0.3% solution polymyxin Bltrimethoprim sulfacetamide tobramycin BRAN D QUIXIN TOBRADEX VIGAMOX ZYMAR NDSe BRAND ASTELIN .Anti-hry Agltit8-Ey@ ea neric neomycinlpolymyxin BI dexamethasone prednisolone 1%drops BRAN D ACULAR ACULAR LS ALREX LOTEMAX VOLTAREN OPHTHALMIC Glaucoma Agents eq neric brimonidine tartrate levobunolol pilocarpine timolol maleate BRAND ALPHAGAN P BETIMOL COSOPT LUMIGAN TRUSOPT XALATAN Noseand EarTopkal Pnpsratla ea neric acetic acidlhydrocortisone [Acetasol HC] antipyrinelbenzocaine [A!B Otic] Mlscelpneoers e4 neric atropine 1 % ophthalmic drops An>t~pasfiodks e4 neric dicyclomine hyoscyamine sulfate ChrehtC MtNerrna~Dfy Bo'rMel iT318Wde/3 eg neric mesalamine BRAND ACACOL CANASA COLAZAL ENTOCORT EC PENTASA Diarrhea Treatments eg neric diphenoxylatelatropine (Lonox] Medication Categories Guide Page 4 Gastric Acid Secretion Reducers and Ulcer Therapy eq neric cimetidine famotidine misoprostol nizatidine omeprazole ranitidine tablet sucralfate BRAND PREVACID PREVACID NAPRAPAC PREVPAC "Al~i~ltjl St~R@liAts eg neric metoclopramide La~ratiYes eq neric lactulose [Enulose] polyethylene glycol 3350 [Glycolax] polyethylene glycol 33501 electrolyte solution BRAND NULYTELY VISICOL Nausea Agents ep neric meclizine ondansetron ondansetron ODT prochlorperazine promethazine trimethobenzamide BRAND EMEND Pancfestk Enzymes ep neric pancreatic enryme preparation BRAND CREON ENZYMAX KU-ZYME KU-ZYME HP PANCREASE MT PANCRECARB ULTRASE VIOKASE MfscelNneous eq neric sulfasalazine [Sulfazine EC] ursodiol Generic medications are sometimes given specific names by their manufacturers for ease of reference. These are listed in brackets after the generic name. ''fir' Walgreens Health Initiatives 2007 Preferred Medication List Effective June 15, 2007 All medications used for the treatment of HIV are on the PML, if FDA approved. AnildiureGc and Vasopressor Hormones eg neric desmopressin Contraceptives Intravaginal BRAND NUVARING Oral-Monophasic eg neric ethinyl estradiol/desogestrel [Apri] ethinyl estradiollethynodiol [ZoviaJ ethinyl estradiolllevonor- gestrel [Aviane, Lessina, Levora, Lutera, Portia] ethinyl estradiollnorethin- drone [Microgestin, Necon, Nortrel] ethinyl estradiol/norethin- droneliron [June) FE, Microgestin FE] ethinyl estradiollnorgesti- mate [Sprintec 28] ethinyl estradiollnorgestrel [Cryselle, Low-Ogestrel, OgesVelj BRAND YASMIN 28 YAZ Oral-Biphasic eg neric ethinyl estradiolldesogestrel [Kariva] ethinyl estradiol) norethindrone [Necon] Oral-Triphasic eg neric ethinyl estradiol) desogestrel [Velivet 28] ethinyl estradiol/ levonorgestrel [Enpresse, Trivora-28) ethinyl estradiol) norethindrone [Aranelle, Nortrel 71717] ethinyl estradiol) norgestimate [friNessa, Tri-Sprintec] BRAND ESTROSTEP FE Ora~Progestin eo neric norethindrone [Camila, Errin Nora-BE] Orad-Other BRAND PLAN B Estrogenk Agents and Comblmatfons eg neric estradiol patch [Alora] estradiol tablet [Gynodiol] estropipate BRAND ACTIVELLA CENESTIN COMBIPATCH ESTRACE CREAM ESTRATEST [Syntest DS) ESTRATEST HS [Syntest HS] ESTRING FEMHRT FEMRING MEN EST PREFEST PREMARIN PREMARIN VAGINAL PREMPHASE PREMPRO VIVELLE VIVELLE-DOT Gkcocortlcoids eg neric dexamethasone fludrocortisone hydrocortisone methylprednisolone prednisolone 15mg/5ml syrup prednisone a~ AgeMs BRAND BONIVA TABLET EVISTA FOSAMAX FOSAMAX PLUS D FrogestJns eq neric medroxyprogesterone T° BRAND ANDROGEL Thyroid Hormones eg neric levothyroxine sodium [Levothroid, levoxyl] methimazole propylthiouracil BRAND ARMOUR THYROID CYTOMEL SYNTHROID THYROLAR Mktceli~-neous e9 neric bromocriptine cabergoline All oral immunosuppressant agents under this class are on the PML, if FDA approved. Ar!lIe eg neric leflunomide Cyclooxygenase (COX-2) Inhibitors BRAND CELEBREX Gout Agents e4 neric allopurinol colchicine probenecid MuscJle Relaxants eg neric baclofen carisoprodol chlorzoxazone cyclobenzaprine dantrolene methocarbamol orphenadrine tizanidine A1~Ceaan@otlS e4 neric methotrexate Medication Categories Guide Page 5 Antivirals Acne Agents-Oral eg neric isotretinoin [Amnesteem, ClaravisJ Acne and Vltam~ A Agents-Topical eg neric tretinoin BRAND AZELEX DIFFERIN RETIN-A MICRO Rosacea Agents ea neric metronidazole topical cream, lotion BRAND FINACEA METROGEL NORITATE AntJbioNcs eg_neric clindamycin topical erythromycinlbenzoyl peroxide gel erythromycin topical mupirocin silver sulfadiazine [SSD] Amti>fUngals eg_neric ciclopirox topical clotri mazolelbeta me thasone econazole nitrate ketoconazole topical nystatin powder nystatinltria mci nolone BRAND LOPROX GEL, LOTION, SHAMPOO An>~eaplastks and hmrnanosuppressants BRAND ALDARA CARAC EFUDEX CREAM ELIDEL PROTOPIC SOLARAZE BRAND ZOVIRAX 5% OINTivIENT Corticosterolds Listed by potency: Group I is most potent; Group IV is least potent. Group 1 eg neric betamethasone dipropionate augmented 0.05% ointment clobetasol 0.05% cream, gel, ointment, solution Group II eg neric betamethasone dipropionate 0.05% cream, lotion, ointment desoximetasone 0.25% cream, ointment fluocinonide 0.05% cream, gel, ointment, solution Viamcinolone 0.5% cream, ointment Group III eg neric betamethasone valerate 0.1 % cream, lotion, ointment hydrocortisone valerate 0.2% cream, ointment mometasone furoate 0.1% ointment, solution triamcinolone 0.025% cream, lotion, ointment triamcinolone 0.1% cream, lotion, ointment BRP,ND DIPROLENE LOTION Group IV eg neric desonide 0.05% cream, lotion, ointment fluocinolone 0.01 % solution hydrocortisone 1% cream hydrocortisone 2.5% cream, lotion, ointment MtTtCe/~nA0ft8 BRAND REGRANEX Anf~soriatk Agents BRAND DOVONEX TAZORAC Generic medications are sometimes given specific names by their manufacturers for ease of reference. These are listed in brackets after the generic name. Walgreens Health Initiatives 2007 Preferred Medication List Effective June 15, 2007 `~.r Benign Prostatic Hype-trophy Alpha Blockers eg neric doxazosin terazosin BRAND FLOMAX Voiding Agents eq neric bethanechol oxybutynin oxybutynin ER BRAND DETROL DETROL LA ENABLEX VESICARE 5-Alpha Reductase Inhibitors e4 neric finasteride BRAND AVODART itll-inarypN IitTQdlfle~s ,,~. ea neric potassium citrate ER iMrn-ry Trnct Aneatltl~tlcs and Atlral~esks ea neric phenazopyridine BRAND ELMIRON All generic prenatal vitamins are on the PML. Efecttolyte cements eq neric potassium chloride ER [Klor-Con] E~tCakrl©lirb! 3tabNkera BRAND PHOSLO RENAGEL Andalle-glc and Anaphylaxis BRAND EPIPEN EPIPEN JR [k~r11/9ub-- $ti'$ Sy»drome eo neric pilocarpine tablet BRAND EVOXAC BRAND GASTROCROM 1/gNnli f3rsY~ eg neric pyridostigmine BRAND MESTINON SYRUP MESTINON TIMESPAN Coverage may vary by plans andlor pharmacies. Register on mywhi.com and click on Check Drug Coverage/ Copay to verify your coverage. A~Iotks BRAND TUBI Anr~hQtgQpltNk Factors BRAND HUMATE RECOMBINATE Mt--nmad~ry and WG4RDs BRAND ENBREL HUMIRA KINERET As~rRlnsonb~ea BRAND APOKYN Blood Cell Stimulators Red Blood Cells BRAND EPOGEN PROCRIT White Blood Cells BRAND NEUPOGEN EnZylneS BRAND ALDURAZYME CEREZYME PULMOZYME C'~C1Wfh HneS BRAND GENOTROPIN HUMATROPE NORDITROPIN NUTROPIN NUTROPIN AO SAIZEN SEROSTIM Other Hormones eg neric octreotide BRAND SANDOSTATIN LAR lrt And;d /-gents n1 BRAND FRAGMIN LOVENOX H6~at1;dS TFlBitlttBnt AQlnEs Hepatitis B BRAND EPIVIR-HBV HEPSERA Hepatitis C e4 neric ribavirin BRAND INFERGEN PEGASYS PEG-INTRON Immunomodulators BRAND INTRON A ROFERON-A Medication Categories Guide Page 6 Multiple Sclerosis Agents BRAND AVONEX BETASERON COPAXONE REBIF Psoriasis BRAND AMEVIVE RAPTIVA s~ -~ BRAND FORTEO Alneoua BRAND ACTIMMUNE LUPRON DEPOT SYNAGIS Generic medications are sometimes given specific names by their manufacturers for ease of reference. These are listed in brackets after the generic name. Drug names are the property of their respective owners. HEALTH BENEFIT PLAN PROPOSAL KERR COUNTY TINANCIALS Bid Spread Sheet Self-Funded Welfare Plan Stop-Loss Proposal Comparison Durance Carrier American National American National American National P an Option Current Benefits Alternate 1 Alternate 2 Setup Fee *: $ l ,500 $1,500 $1.500 Renewal Fee $3,000 $3,000 $3.000 Run-In/Run-Out: Administration Fee See Below See Below See Below Estimated run out claim liabililty N/A N/A N/A Specific Lifetime Maximum 950,000 950,000 950,000 Aggregate Plan Year Annual Maximum 1,000,000 1,000,000 1,000,000 * Note: These rates are not included in totals below. STOP-LOSS BASIS Current Benefits Alternate 1 Alternate 2 Number of Employees: 243 243 243 Number of Spouse Only 21 21 2l Number of Child(ren) only 31 3 l 3 l Number of Family Units 26 26 26 Number of Dependent Units: 78 78 78 Specific Deductible: $50,000 $50,000 $50,000 Specific Contract: l5/ 12 15/ l2 l5/ 12 Specific Contract Includes Medical & Rx Medical & Rx Medical & Rx Aggregate Contract: l5/ 12 15/ l2 l5/ 12 Maximum Aggregate Run In $236,288 $236,288 $236,288 A e ate Contract Includes Medical & Rx Medical & Rx Medical & Rx MONTHLY FIXED COSTS Current Benefits Alternate I Alternate 2 ~~ fic Premium ErTloyee: $59.16 $59. l6 $59.16 Employee and Spouse $136.07 $ l 36.07 $136.07 Employee and Child(ren) $ 136.07 $ 136.07 $ l 36.07 Dependent Unit: $76.91 $76.91 $76.91 Employee & Family: $ 136.07 $ l 36.07 $136.07 Composite: $83.85 $83.85 $83.85 Aggregate Premium Composite: $4.93 $4.93 $4.93 Monthly Cap N/A N/A N/A Administration( all fees per unit per month) Claims Cost Per Employee : $17.25 $17.25 $ l 7.25 Claims Cost Per Dependent : $0.00 $0.00 $0.00 Utilization Review per EE $2.25 $2.25 $2.25 PPO Network Per EE: $4.50 $4.50 $4.50 Rx Program Fees(Describe) N/A N/A N/A COBRA per EE $1.95 $1.95 $1.95 HIPAA Per EE Included In COBRA Included In COBRA Included In COBRA Cafeteria Plan FSA Account Per Participant $5.00 $5.00 $5.00 Child Care Per Participant $5.00 $5.00 $5.00 Debit card expense N/A N/A N/A Start up expense $350.00 $350.00 $350.00 Other Cafeteria Plan Fees: (Plan Document Fee) $500.00 $500.00 $500.00 HT' ~ ~up expense N/A N/A N/A Per Account Fee N/A N/A N/A Debit card expense N/A N/A N/A Other HRA Plan fees: See Below See Below See Below Wellness Plan Cost Requires ER Description Requires ER Description Requires ER Description Disease Management * Requires ER Description Requires ER Description Requires ER Description Dental Dental Admin Fee per EE/l~Ith Included Included Included Dental Admin Fee per Dep/Mth Included Included Included Dental Network Access Fee N/A N/A N/A Positive Pay Banking System N/A N/A N/A R- ~ker Fee: ltal Per Employee: Not Included Not Included Not Included Total Per Dependent Unit: Not Included blot Included Not Included Total Per Famil Unit: Not Included Not Included Not Included AGGREGATE FACTORS Current Benefits Alternate 1 Alternate 2 Employee Only: $438. l5 $41 1.86 $398.72 Dependent Unit: $438. l6 $41 1.87 $398.73 Family: $876.31 $823.73 $797.44 Com osite: $578.80 $544.07 $526.7 t OPTIONAL BEHAVIORAL HEALTH CARVE-OUT Current Benefits Alternate 1 Alternate 2 Employee Only: $0.00 $6.23 $6.23 Dependent Unit: $0.00 $6.23 $6.23 Family: $0.00 $ l 2.46 $12.46 Attachment Points Monthly: $140,646.93 $134,207.94 $129,988.54 Annual $1,687,763.16 $1,610,495.33 $1,559,862.44 Com osite: TOTAL ANNUAL COSTS Current Benefits Alternate 1 Alternate 2 Stop Loss Premium $244,498.32 $244,498.32 $244,498.32 Aggregate Premium $14,375.88 $14,375.88 $14,375.88 Administration $55,987.20 $55,987.20 $55,987.20 Administration as % of Maximum Annual Cost 2.77% 2.88% 2.96% UR, PPO, Rae, Broker, and all other $19,683.00 $19,683.00 $19,683.00 Current Benefits Alternate 1 Alternate 2 T 'Fixed $334,544.40 $334,544.40 $334,544.40 Icted: $1,684,754.93 $1,622,940.66 $1,582,434.35 Maximum: $2,022,307.56 $1,945,039.73 $1,894,406.84 Current Benefits Alternate 1 Alternate 2 Total Fixed Increase in Cost as percent of current Expected Maximum -9.43% -9.43% -9.43% 3.96% 0.15% -2.35% 4.60% 0.61 % -2.01 % Notes: * (Please refer to the proposal terms & conditions for standard administration & policy contingencies) The plum nwc incur eapensee' involved with the prnce.csing uj'cl~ims pucments that will not he cuneidered eligible jar reintburrenrent under the reinsurance agreement. Charges that muv be eligible. upon currier approval, include fees invah~ed in the subrogation of cluint.c, 30% of negotiated savings for nut-uf network eharge.e, 30% of savings jor in-network charges' negotiated below the contractual PPO discount untaunt, and Cuse Management Fees. if u drug curd progrunt is cho.+'en, the drug claims ARE /ARE NOT included in the u,ggregute stop Loss coverage.... Adminia'trution fees charged be the drug curd vendor are mn included Gtargee that .4RE NOT considered eligible jnr reintburcement under the reinsurance contract include. but ore not limited to, u fee oj'$4.95 per trmtsuctiun us outlined on dte numthlr MPRl4 Cluint.c Activin' Reports. It is important to review the udmirtieTrution sen~ice agreement provided he Entrust in order to have u complete understanding of all udministrutive e.epenses' prior to Cite plum effective dote. ~~ TERMS CONDITIONS Proposal Terms and Conditions l . No agent and/or consultant have the authority to bind coverage or modify this proposal No coverage will be placed into effect until final approval has been issued and accepted in writing by the carrier. Issued rates and factors will base upon the actual final enrollment. 2. All stop-loss rates and factors require a minimum participation of 75% of all eligible employees. Some carriers may require a minimum participation requirement for eligible dependents. You must refer to the policy for actual provisions regarding enrollment participation. 3. All stop-loss quotes are subject to revision (both specific and aggregate coverage's) based upon review of actual claims experience up to the effective date of coverage, if claims experience was submitted and used as a basis for quotation. This includes, but is not limited to, large dollar claims and average monthly claims during the course of the immediate 12-months (or ?4-months) preceding the plan effective date. 4. All annualized costs and factors are estimated based upon census data provided with the quote request (claims experience, if applicable) plus a prognosis and diagnosis of all claimants that had or are expected to have claims over 50% of the requested specific attachment point. An Attending Physicians Statement may be required on any potential specific claims. 5. All Stop Loss rates and factors are contingent upon review of final enrollment. A 10% change in enrollment or other material changes in enrollment demographics may necessitate a change in rates and factors. 6. No Stop Loss coverage is in force until all required materials (indicated in the carrier's quote) have been submitted, and an approved Plan Document has been forwarded to the carrier within 60 days of the plan effective date. Coverage will not be issued without the funds indicated in the binder allocation provided by the TPA. 7. If a drug card program is chosen, the drug claims ARE /ARE NOT included in the aggregate stop loss coverage.... Administration fees charged by the drug card vendor are not included. 8. If a Preferred Provider Network (PPO) has been selected, the carrier has the right to consider claims eligible for payment based on the discounts being provided. Reimbursements for claims incurred by out-of-network providers will be limited to the usual and customary allowances as indicated in the plan document and/or policy. 9. The plan may incur expenses involved with the processing of claims payments that will not be considered eligible for reimbursement under the reinsurance agreement. Charges that may be eligible, upon carrier approval, include fees involved in the subrogation of claims, 30% of negotiated savings for out-of-network charges, 30% of savings for in-network charges negotiated below the contractual PPO discount amount, and Case Management Fees. Charges that ARE NOT considered eligible for reimbursement under the reinsurance contract include, but are not limited to, a fee of $4.95 per transaction as outlined on the monthly MPR14 Claims Activity Reports. It is important to review the administration service agreement provided by Entrust in order to have a complete understanding of all administrative expenses prior to the plan effective date. 10. All claims must be paid (funded and checks issued) prior to the end of the current Plan Year in order to be eligible for reimbursement by the carrier, regardless of any plan provisions regarding aggregate accommodation or specific advance. Provisions may vary by stop-loss carrier. Please refer to your reinsurance contract for a complete understanding of the policy prior to acceptance. 11. Subject to the above, the aggregate and specific rates and factors are Quaranteed for a period of 12 months. However, the minimum attachment point is established by each carrier. The aggregate attachment point minimum is usually calculated as 100~Ic of the first month's census, times the factors. times l2. The exact minimum aggregate will be provided in the carrier's proposal. application and master contract. l2. All coverage is offered on a "No Loss / No Gain" basis. This means that Entrust will give full credit for deductibles and amounts credited towards any out-of-pocket maximum satisfied under the prior plan based on presentation of an acceptable copy of the prior carrier's Explanation of Benefits. 13. If your group is participating in the Capitated Generic Drug Program, the following terms will apply to your plan: Generic drugs for each plan participant will not count against the Spec or Agg for the first $5,000 in charges. Once the $5,000 maximum has been reached by a participant, that person's generic RX claims will begin to apply to the specific and aggregate. 14. This is a tentative proposal based on the information furnished in your request and does not constitute an offer to bind excess loss reinsurance without full agreement of all quoted contingencies, contracts and policy considerations. 15. Rates cannot be finalized until carrier has received all l2-months of claims from the current plan year. 16. Final Rates and Factors are subject to review and acceptance of Disclosure Statement completed by Employer/TPA and UR Company. 17. Quotes are based on the Current Plan of Benefits and any Options Shown in the Financial and Benefit Section of the Proposal. 18. Higher Specitic Deductible(s) may apply after receiptlreview of the APS and/or Large Case Management Report for named individuals. If used, the additional specific deductible amounts will not be eligible under the aggregate. Receipt/Review of Current Diagnosis, Prognosis, APS and Case Management Reports on: All claimants projected to have expenses in excess of $25,000. All claimants currently pregnant indicating the expected due dates. Employee w/Breast Cancer. 19. Plan management expense includes the base Entrust administration fee of $17.25 per employee per month. Additionally, Entrust has included a fee of $ L95 per employee per month for complete COBRA/HIPAA/Medicare Part D Administration, $4.50 per employee per month for access to the Texas True Choice Network, and $2.25 per employee per month for Medical Helpline (24-Hour Nurse Triage and Fre-certification/Utilization Review. 20. Included in the maximum claims funding amount illustrated are the medical and prescription drug aggregate factors provided by the stop-loss carrier. Included in the Family Monthly Deductible (FMD) options is $6.23 per employee and $12.46 per employee covering dependents each month payable to CIGNA Behavioral Health Services for carving out pre-paid Behavioral Health Services. 21. This quote assumes no participants with potentially high risk diagnosis as defined in American National's Disclosure Statement. UMMARY ANALYSIS Kerr ~ unty Self-Funded Proposal w/Stop-Loss Protection Proposed Plan Et'Pective Date: January 1, 2UU8 (based on d1e Quoted Enrullment a~~ provided irr the Reyimst}urYropw~ul) Mutual of Omaha Premium $266,661 Plan Management $97,453 Expected Claims $1,358,975 Projected Reserve $204,966 $500 FMD 90/60 $258,874 $75,670 $ l ,323,646 $286,858 N[aximum Plan Cost $1,928,055 $1,945,049 Cost-Savings Percentage Nl~ -0.88'0 Expected Plan Cost $1,723,089 $1,658,[90 Cost-Savings Percentage NlA 3,77% Comparison ag Curare>~t Pla>~ & Rect-~nded:Option far Consideration Mutaai of Omaha $500 E'MD 90!64 S3~AOQ,004 $1Sga9UQ $lAU4,A~4 Sk ^t'reimiam ^PlanMaaagenceut Kerr County -Revised Self-Funded PresenLxlsRecommentlauon Page 11!1212007 ^ExperfedCtatms ~PrujectedBesorve -~_ __~_~ ENTRUST' ~w~ Page i of 5 Kerr ~ ~unty Self-Funded Proposal w/Stop-Loss Protection Proposed Plan Eft'ective Date: January 1, 2008 (Bused un the Quoted I;lu'nllment us ~nzn~ided in the Request fi,r Yroposul) Current Plan $500 FMD 90160 Premium $258,874 $258,874 Plan Management $75,670 $75,670 Expected Claims $1,381,178 $1,323,646 Projected Reserve $306,585 $286,858 $1,000 FMD 100160 $258,874 $75,670 $ I ,282,877 $276,995 Maximum Plan Cost $2,02?,308 $1,945,049 $1,894,416 Expected Plan Cost $1,715,722 $1,658,190 $1,617,421 -- Campalrisan of Annualized Casfs far Prap~sed Benle~It Plan tlptians ssao 9ar~ ~~~ ---~ ,~ ENTRUST' ,>~.xe.ao.~ p.a~wxx. Kerr County ~ Revised Sell-Funded Present.xlsOptionCompurison 11/1212007 Page 2 of 5 s~ st,oea~oo pie s~ •tu~ Plea Maaageme~ ME~ecoed Ctwims ~ctpa ~s :..~ AILL,D FINANCIAL Kerr unty Detailed Financial Breakdown & Plan Option Parameters Proposed Plan Effective llate: January i, 2008 18u.veJ on dte Quoted Enruilrnerrt us provided iu the Neyuear /ire Propwull Quote Parameters Currier Aurx ricun Nmioiwl Specific Level $SQ(~D SpeeiticConuactTemt 1511? Aggregating Specific NIA Lacer NIA Aggregate ContractTemr 15112 Aggregate Covers Medical & Rx Aggregate Run-[n Limit $236,288 Temtinal Liability Nut Included MinClaiuuAttachment $1,687,763.16 Implementation & Annual Plan Costs Implerr>zntation Fee: $1,5W.(!U Annual Plan Cult: $3.Ul1U.l1U Multimedia Fee IOptiotwq: $O.OU Fixed Cost Breakdown Premium Expense: Employee Only: $64.09 Employee & Spouse: $141.(10 Employee & Child(ren): $141.00 Employee & Family: $141.00 Plan Management Expense: Employee Only: $'5.95 Employee & Spouse: $?5.95 Employee & Child(ren): $?5.95 Employee & Family: $25.95 Current Plan Total Quoted Enrollment: Enrollment Breakdown: Employee Count: 243 Employee Only: 165 Dependent Comet 78 Employee & Spouse: 21 Employee & Child(ren): 3I Member Count: 425 Employee & Family: 26 MontWy Expense Breakdown Expected Claims ^ Premium 6xpense~ <•PlauManagemetu ^ProjectedReserves Benefit Smmnary Neiwurk Non-Network Deductible $I,UW $'2,000 lkductible Applies Calendar Yta r Urduciible CoinstamweLinlil "D1U,1111U $IU,000 SingIe00P $1,000 $3,000 Family OOP $3,lHlU ~'S9,llU0 Oda Visit Copay $3U uulx of N/A pcr visit Specialist Copay $3U nwx of N/A per eivit DXLCupay D&C uwxuf NIA pervisil Urgem Cure Copay D&C uwx oY N/A per risil Ivr~ergency Room Copay D&C' uwx ul NlA per oi.;ii Cet>eric kx 13raud Tier I I1 Brarul'I'ier 121 $IU $2U $15 Claims Cost Breakdown Maximwn Claims: Employee Only: X438.15 Employee ~ Spouse: X876.31 Employee & Child(ren): $876.31 Employee & Family: $876.31 Expected Claims: Employee Only: $35856 Employee & Spouse: x717.13 Employee & Child(ren1: $717 13 Employee & Family: `6717.13 Expected Fundin>; Rate: Minimum Funding Rate: Maximum Funding Rate: Employee Only $448.60 EmployeelSpouse $884.08 EmployeelChild(ren) $884.08 Full Family $884.08 Monthly Total $142,976.84 Kerr County -Revised Selt-Funded Presenl.xlsFnanciel 1 Employee Only $90.04 Employee/Spouse $166.95 EmployeelChild(ren) $166.95 Full Family $ (66.95 Monthly Total 11117J2007 $27,878.70 Employee~Only $538.Ir1 EmpluyeelSpou,e ~ I ,U43't, EnlFloyee/Child(ren) X1.1143?6 Full F:uniiy y,l,ll43?6 Almtfhly'fotal $168,525.63 ENTRUST' r~..w.~~._,,. Paya3W5 Kerr unty Detailed Financial Breakdown & Plan Option Parameters Proposed Plan En'ective llate: January 1, 21108 (Based un the Quored @'aru!lulent as provided in dte Reyues! fur Proposal) Quote Parameters --_ Carzier Alrerican Natimwl Specific Level 55D,0(X) Specific Conuact Tenn 1511? Aggregating Specific N1A Laser N1A Aggregate Contract Term l5/12 Aggregate Covers Medical & Rx Aggregate Run-In Limit $?36,288 'Terminal Liability Notlrxluded MinClainuAttachment $1,610,504?4 Implementation & Annual Plan Costs In>plen>emation Fee: $1,500.00 Annual Plan Cost: $ 1,000.(X1 Multimedia Fee IDptiotraq: $O.f)D $500 FMD 90160 Total Quoted Enrollment: Enrollment Breakdown: Employee Count: ?43 Employee Only: 165 Dependent CounC 78 Employee & Spouse: 21 Employee & Child(ren): 31 Member Count: 425 Employee & Family: 26 M011t~1~~ Expense BrOwtl 11ExpectedClaims ^PnKnimmExpettce' 1PlanManagemenl ^YrojectedReserves Benefit Summary Nelwurk Nuu-Network Deductible $100 $j6U Deductible Applies I auilly h1aubl y Urduaiblc Coilurumue 90'Y 60°k~ Cuiresuralxx Limit $10,(100 $10,000 SiugIe00P $1,0(X1 $4,000 Namily00P $Il1lX) ~$4.OlAl Office VisitCapay $30 umxul N1A Perri>i1 SpecialislCopay $3ll n4ia ul N/A per visit DXL Copay U&C umx ul NlA per visit Urgem Care Copay D&C uwx ul N!A prr via~it &t>rrgelxy Ruom Copay U&C uwx ul N/A per visit (ICllerle RX nCHlld I Itf (11 Brand I ler (~) $10 ~!~ 30'%. Fixed Cost Breakdown Premium Expense: Employee Only: $64.09 Employee & Spouse: $141.00 Employee & Child(ren): $141.00 Employee & Family: $14L00 Ylan Management Expense: Employee Only: $25.95 Employee & Spouse: $?5.95 Employee & Child(ren): $?5.95 Employee & Family: $?5.95 Expected Funding Rate: Employee Only $433.66 Employee/Spouse $854:? I EmployeelChildlren) $854.21 Full Family $854,21 Monthly Total $138,182.54 Ken County - Revisetl SelbFuntletl PresenLxlsFinancial 2 Minimum Funding Rate: Employee Only $90.04 EmployeelSpouse $166.95 Employee/Child(ren) $166.95 Full Family $166.95 Monthly Total 11/122007 $27,878.70 Claims Cust Breakdown Maximum Claims: Employee Only: $418.09 Employee & Spouse: $83620 Employee & ChildlrenP $83620 Employee & Family: $8.1620 Expected Claiws: Employee Only: $343.6? Employee ~ Spouse: $68726 Employee & Childp~en): $687.?b Employee ~ Family: $68726 !1laxinuun Fundutl; Rate: Emplo~~ee Only ~_~~~ ~.-.~.'~SIIK.13 EmplDyeelSpouse $ LOU3.15 EmplDyeelChildl re6) $1,11113.1 i Full Family $1,003.15 !1~Ionlhly Total $162,087.39 ENT$U~T' ~w~~ Paye 4 ut 5 ~' Kerr runty Detailed Financial Breakdown & Plan Option Parameters Proposed Plan Effective llate: January 1, 2008 I Based un the Quoted Enrollment ua provided in the ReyuestJorYrnpova!) Quote 1'~arameters Cartier Atcerican Naliot>al Specific Level $50,(x)0 Specific Contract Term 15113 Aggregating Specific NlA Laser NIA AggregaleConnact"I'emt 15112 Aggregate Covers Medical Y. Rx Aggregate Run-In Lirnit $236,288 Terminal Liability Not I~luded Min ClaimsAttachnxnt $1,559,871.35 Implementation .~ Annual Ptan Costs Implementation Fee: $ 1,500.00 Amrual Plan Cost: $3,0(X).00 Multirrcdia Fee (Optional): $O.W Fixed Cost Breakdown Premium Expense: Employee Only: $64.09 Employee & Spouse: $141.00 Employee & Child(ren): $141.00 Employee & Family: $141.00 Plan Management Expense: Employee Only: $25.95 Employee & Spouse: $25.95 Employee & Child(ren): $25.95 Employee & Family: $25.95 Expected Funding Rate: Employee Only $423.08 EmployeelSpouse $833.04 EmployeelChild(ren) $833.04 Full Family $833.04 Monthly Total $134,785.10 Kerr County - RemseO Self-Funtletl PresenlxlsFnancial a $1,000 FMD 100/60 Total Quoted Enrollment: Enrollment Breakdown Employee Count: 243 Employee Only; 165 Dependent Count: 78 Employee ~ Spouse: 21 Employee & Child(ren): 31 Member Count: 425 Employee & Family: 26 lViollthly Expense Breakdown ^ExpectedClairm ^PremiumExpense ^Plan Management ^ Projected Rexrves Minimum Funding Rate: Employee Only $90.04 EmployeelSpouse $166.95 EmployeelChild(ren) $166.95 Full Family $ 166.95 Monthly Total 11I1Z2007 $27,875.70 Deductible Deductible Applies CoiluuraiKe Cbimurance Limit Single OOP Fanuly OOP OtLice Visit Copay Specialist Copay DXL Copay Urgeiu Care Copuy Enterget>ty Room Copuy Getteric Rx $10 Benefit Summary Neiwurk Nuu-Neiwurk $ LUUO $ I .UUU Irowily Mundd y Deductible IOU Y- 60"L $10,0(X) ~lolx)u $u $4,ua1 8U $4,000 1'he Fast $100 of kuutiue Medical ]:xpeuses IWclb~ezalllluessl are covered at 1 UOY~, thru Deductible Applies tiraud'I'ier 1 I I lir:md'I'irr IZ) 3U`Y 30 Claims Cost Breakdown Maximum Claims: Employee Only: 8404.95 Employee & Spouse: $8119.91 Employee & Child(ren): $809.91 Employee & Family: 88119.91 Expected Claims: Employee Only; $ 313 U4 Employee & Spouse: 8666.09 Employee & Child(reN: $666.09 Employee & Family: 5666.09 Maximum Funding Rate: Employee Unly ..._ $-1y~4.tltl l;mployeelSpouse `~r176.n6 Employee/Child(renl `h976.86 Full Family $97h.86 Monthly Total $17,567.95 ENTRUST' Pays 5 of 5 HEALTH BENEFIT PLAN PROPOSAL KERR COUNTY BENEFITS CURRENT 'ENEFITS Deductible Individual Deductible For Preferred Providers: $1,000 of Expense incurred by You and each of Your dependents for Covered Services of Preferred Providers. The Covered Person must satisfy the Individual Deductible once each Calendar Year. For Other Providers: $2,000 of Expense incurred by You and each of Your dependents for Covered Services of Other Providers. The Covered Person must satisfy the Individual Deductible once each Calendar Year. Family Deductible For Preferred Providers: After $3,000 of Expense has been incurred by You and Your dependents for Covered Services of a Preferred Provider during a Calendar Year, no other Individual Deductible requirement shall apply. For Other Providers: After $6,000 of Expense has been incurred by You and Your dependents for Covered Services of an Other Provider during a Calendar Year, no other Individual Deductible requirement shall apply. NOTE: The same Expense may be used to satisfy the Deductible for Preferred Providers and Other Providers. Exceptions (a) Waiver of the Deductible: The Deductible is waived for Covered Services in connection with: (1) a Preferred Provider's services for Routine Health Care Services (for Covered Persons age 18 or older); (2) a Preferred Provider's services for a Routine Mammography; (3) a Preferred Provider's services for Preventive Health Care (for dependent children through age 17); (4) a Preferred Provider's services for Childhood Immunization for eligible dependent children through age six; (5) ambulance services; (6) a Preferred Provider's services for Independent Radiology and Pathology Center services; (7) services for covered Counseling and Bereavement services; (8) services for covered Bassinet, Nursery and Well Newborn Delivery Hospital Services; . (9) a Preferred Provider's services for laboratory services; and (10) services for Routine Vision Care. (b) Copayments and/or Coinsurance percentage which the Covered Person pays will not be used to Deductible means the amount payable for Covered Services by the Covered Person each Calendar Year before benefits are payable by the Plan. 3l Percenta a Pa able All Covered Services shown in the Major Medical Benefits provision and not listed elsewhere in this Schedule will be payable as follows: For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense which You and Your dependents incur for Covered Services of Preferred Providers (and the Covered Person pays 10%) until the Out-of-Pocket Limit is reached. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense which You and Your dependents incur for Covered Services of Other Providers (and the Covered Person pays 30%) until the Out-of-Pocket Limit is reached. Out-of-Pocket Limit Individual Out-of-Pocket Limit For Preferred Providers: After the Out-of-Pocket Expense by one Covered Person reaches $2,000, the Plan will pay 100% of the Expense for Covered Services of Preferred Providers incurred by such person during the rest of the Calendar Year. For Other Providers: After the Out-of-Pocket Expense by one Covered Person reaches $5,004, the Plan will pay 100% of the Expense for Covered Services of Other Providers incurred by such person during the rest of the Calendar Year. Family Out-of-Pocket Limit For Preferred Providers: After the Out-of-Pocket Expense by You and Your dependents combined reaches $6,000, the Plan will pay 100% of the Expense which You and Your dependents incur for Covered Services of Preferred. Providers incurred by such persons during the rest of the Calendar Year. For Other Providers: After the Out-of-Pocket Expense by You and Your dependents combined reaches $15,000, the Plan will pay l 00% of the Expense which You and Your dependents incur for Covered Services of Other Providers incurred for such persons during the rest of the Calendar Year. NOTE: The same Out-of-Pocket Expense ~~nay be used to satisfy the Out-of-Pocket Limit for both Preferred Providers and Other Providers. Exceptions Expense for the following will not be used to satisfy the individual or Family Out-of-Pocket Limit and will not be paid at 100% after the Individual or Family Out-of-Pocket Limit is reached: (a) any Copayment which a Covered Person must pay; enta an ervous Disorders; (c) any amount which the Covered Person must pay as a result of failure to comply with the Utilization Management Provisions; and °~r- 32 (d) Organ(s) Tissue Transplant services performed by a Preferred Provider or Other Provider who ,,,~ does not participate in United's MSN. Out-of-Pocket Expense means Expense which the Covered Person incurs for Covered Services provided during the Calendar Year and must pay: (a) as Coinsurance; and (b) as Deductibles, except for Covered Services that apply to the Deductible, but do not apply toward the Out-of-Pocket Expense. NOTE: Any Expense incurred for anon-covered service does not apply to the Out-of-Pocket Limit. Maximum Maximum Benefits under the Plan $1,000,000 is the maximum amount of benefits payable under the Plan for Covered Services of Preferred Providers and Other Providers combined for treatment of all Injuries and Sicknesses of each Covered Person (the "Maximum"). NOTE: The same Expense will be used to accumulate toward both the Preferred Provider and Other Provider Maximum. Benefits are payable only for Expense incurred while You and Your dependents are covered under the Plan. '` Exception The Maximum benefits payable under the Plan will be reduced by the amount of benefits immediately preceding this coverage that have been paid or that are payable under the group health plan (whether insured or self-insured) currently maintained by Us and through which You are currently covered. Allergy Injections For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services. NOTE: Benefits for Covered Services incurred for allergy injections and allergy serum provided in and billed by a Physician's office are payable under this section of this Schedule. Ambulance Services or re erre Providers: The Plan will pay 80% of the Expense incurred for Covered Services by a professional ambulance service. For Other Providers: The Plan will pay 80% of the Expense incurred for Covered Services by a professional ambulance service. 33 ~„ Bassinet, Nursery and Well Newborn Delivery Services Well Newborn Covered Hospital Services The Plan will pay benefits for the Expense incurred by a Covered Person who is a well newborn dependent child for bassinet or nursery charges in the same manner as any other covered Hospital Confinement service. No Deductible will apply. Covered Physician Services Expense for Physician services incurred by such child during the Hospital Confinement will be payable same as any other Sickness as shown under the Physician Services section of this Schedule. Sick Newborn Covered Hospital and Physician Services Benefits for Expense incurred by a covered sick newborn will be payable same as any other Sickness. Chemical Dependency Benefits Refer to the Chemical Dependency Benefits shown in the Major Medical Benefits section of this Booklet. ~" Childhood Immunization Services (For Dependent Children through ale six) Maximum Immunization Benefit For Preferred Providers: The Plan will pay 100% of the Expense incurred for Covered Services received for Childhood Immunizations. For Other Providers: After the applicable Deductible for Other Providers is satisfed, the Plan will pay 70% of the Expense incurred for Covered Services received for Childhood Immunizations. NOTE: Immunizations for dependent children age 7 through 17 are payable under the Preventive Health Care Services (For Dependent Children through age 17) section of this Schedule. Dental Services Due To a Dental Injury The Plan will pay benefits for Expenses incurred for dental procedures, including, but not li~~nited to crowns, bridges, orthodontia, due to a Dental Injury as follows: For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will nav 90% of the Expense incurred frn• C:evered ~PrviePC nrnvirlPrl b; a Phy sician er I2entist fer a Dental Injury. For Other Providers: In the same manner as for Preferred Providers. 34 NOTE: Dental exams received in the office and any associated dental x-rays are payable under the Physician Services Office Visit Copayment. All other dental procedures are payable under this section of the Schedule. Durable Medical Equipment For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services received for Durable Medical Equipment each Calendar Year. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for Durable Medical Equipment each Calendar Year. Maximum Durable Medical Equipment Benefit The Maximum Durable Medical Equipment Benefit for Other Providers will not exceed $5,000 while You and Your dependents are covered under the Plan. High End Radiolog,~ For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services received for High End Radiology performed on an outpatient basis. `'~'~ For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for High End Radiology performed on an outpatient basis. High End Radiology means a magnetic resonance imaging (MRIs}, magnetic resonance angiogram (MRAs), computerized tomography scan (CT Scans}, positron emission tomography scan (PET Scans), single photon emission computed tomography scan (SPELT Scans), ultrasounds and other nuclear radiology. NOTE: Benefits for High End Radiology tests performed in a Physician's office, Independent Radiology and Pathology Center, Outpatient Facility and Emergency Room will be payable under this section of the Schedule. Home Health Care Services Each Visit Payment For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Home Health Care visits. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred, up to a Maximum Allowable Amount of $55 for each visit. err 35 Maximum Number of Visits ~'" The Maximum Number of Visits for which benefits are payable each Calendar Year will not exceed 100 for Preferred Providers and Other Providers combined each Calendar Year. Maximum Allowable Amount means the total charge considered for Covered Services before the applicable Deductible and Coinsurance amounts are applied. In cases where the Usual and Customary Charge is less than the Maximum Allowable Amount, the Usual and Customary Charge would apply. Hospice Care Services (inpatient and outpatient) Inpatient For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for inpatient Hospice Care. Inpatient Daily Limit: The daily room charge of the Hospice Care Facility or other facility where the Covered Person is confined. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred, up to a Maximum Allowable Amount of $55 per day. Outpatient For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services received for Hospice Care. ~"" For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred, up to a Maximum Allowable Amount of $55 for each visit. Inpatient and Outpatient Daily Limit For Other Providers: The Inpatient and Outpatient Daily Limit will not exceed a combined Maximum Allowable Amount of $55. Maximum Number of Days and Visits The combined Maximum Number of Days and Visits for which benefits are payable will not exceed l 85 for Preferred Providers and Other Providers combined. Covered Counseling and Bereavement Services Maximum Counseling Benefit The Plan will pay 100%, up to $500 for all members of the Covered Person's Immediate Family combined. Maximum Bereavement Counseling Benefit The Plan will pay 100%, up to $250 for all members of the Covered Person's Immediate Family combined. 36 IVTaximum Allowable Amount means the total charge considered for Covered Services before the ;~,, applicable Deductible and Coinsurance amounts are applied. In cases where the Usual and Customary Charge is less than the Maximum Allowable Amount, the Usual and Customary Charge would apply. Hospital Confinement Facility Services For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services received for each Hospital Confinement. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for each Hospital Confinement. Room Limit Semiprivate Room: The semiprivate room charge of the Hospital where the Covered Person is confined. Ward Accommodation: The ward accommodation charge of the Hospital where the Covered Person is confined. Private Room: The average semiprivate room charge of the Hospital where the Covered Person is confined. If the Hospital/facility only has private rooms, the private room rate will be allowed. Intensive Care Unit/Cardiac Care Unit: The intensive care unit/cardiac care unit charge of the Hospital where the Covered Person is confined. Hospital Emergency Room Facility Services ~wr~' Covered Hospital Services For Preferred Providers: After a $50 per visit Copayment and the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services provided by a Hospital Emergency Room. For Other Providers: After a $50 per visit Copayment and the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services provided by a Hospital Emergency Room. NOTE: The Emergency Room Copayment is waived if the emergency room treatment is immediately followed by Hospital Confinement. NOTE: Benefits for High End Radiology tests performed in the Emergency Room and billed by the Hospital will be payable as outlined under the High End Radiology section of the Schedule. NOTE: Emergency Room Physician, x-ray and laboratory services that are billed separate from the Hospital services will be payable as outlined in the applicable Physician sections of the Schedule or Independent Radiology and Pathology Center Services sections of the Schedule. Independent Radiology and Pathology Center Services For Preferred Providers: The Plan will pay 90% of the Expense incurred for Covered Services provided by an Independent Radiology and Pathology Center. 37 For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay ;,~, 70% of the Expense incurred for Covered Services provided by an Independent Radiology and Pathology Center. NOTE: Any Expense incurred for High End Radiology and Routine Mammography performed at and billed by an Independent Radiology and Pathology Center will be payable under the High End Radiology or Routine Mammography Services sections of this Schedule. Independent Radiology and Pathology Center means a freestanding facility offering radiology and pathology service which: (a) is not part of a Hospital; and (b) is licensed by the proper authority in the jurisdiction in which it is located. Inpatient Rehabilitation Facility Services For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services received for inpatient rehabilitation therapy each Calendar Year. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for inpatient rehabilitation therapy each Calendar Year. Maximum Inpatient Rehabilitation Facility Benefits The Maximum Number of Days Payable for Preferred Providers and Other Providers combined will not exceed 60 days each Calendar Year. Mental and Nervous Disorders Benefits Maximum Inpatient Benefit (for Hospital Confinement) Covered Hospital Services For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred. All Other Covered Services For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan y only during the period of time that benefits for the Hospital Confinement are payable. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred each Calendar Year. Benefits for visits by a Physician are payable only ~,,, during the period of time that benefits for the Hospital Confinement are payable. 38 Maximum Inpatient Benefits for Preferred Providers and Ot11er Providers combined will not be payable for more than 30 days each Calendar Year. Benefits will not be payable for more than 60 days while You and Your dependents are covered under the Plan. Maximum Outpatient Benefit For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 50% of the Expense incurred each Calendar Year. The Maximum Allowable Amount for an Outpatient Treatment visit is $70. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 50% of the Expense incurred each Calendar Year. The Maximum Allowable Amount for an Outpatient Treatment visit is $70. Maximum Allowable Amount means the total charge considered for Covered Services before the applicable Deductible and Coinsurance amaunts are applied. In cases where the Usual and Customary Charge is less than the Maximum Allowable Amount, the Usual and Customary Charge would apply. Other Covered Services For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Other Covered Services not listed elsewhere in this Schedule. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Other Covered Services not listed elsewhere in this Schedule. __ Outpatient Facility Services For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services provided in an Outpatient Facility. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services provided in an Outpatient Facility. NOTE: Benefits for High End Radiology, Routine Mammography and Outpatient Therapy services performed in and billed by an Outpatient Facility will be payable as outlined under the High End Radiology, Routine Mammography Services and Outpatient Therapy Services sections of this Schedule. Outpatient Facility means a facility providing nonemergency services other than an Independent Radiology and Pathology Center, Urgent Care Center or Hospital Emergency Room. Outpatient Prescription Drub Benefits If a Participating Retail Pharmacy is used For Diabetic Supplies $5 for each Diabetic Supply which is included on the Drug Formulary 39 $3~ for each Diabetic Supply which is not included on the Drug Formulary `'~"''" For Covered Drugs (other than Diabetic Supplies) ~- $10 for each prescription or refill for a Generic Drug $20 for each prescription or refill for a Brand Name Drug which is included on the Drug Formulary $35 for each prescription or refill for a Brand Name Drug which is not included on the Drug Formulary If You or Your dependents are required to make a Copayment (not based on a percentage of charges) in order to receive a covered Prescription Drug or supply, You or Your dependent will pay the lower of: (a) the Copayment; or (b) the pharmacy's charge. For purposes of this provision, "pharmacy's charge" means the price or fee that would be charged by the pharmacy to You or Your dependent for a Prescription Drug or supply in a cash transaction on the date the Prescription Drug or supply is furnished or dispensed. If aNon-Participating Retail Pharmacy is used For Covered Drugs 50% of the Expense incurred for each prescription or refill or each Diabetic Supply If a Participating Prescription-by-Mail (Mail Order) Pharmacy is used For Diabetic Supplies $10 for each Diabetic Supply which is included on the Drug Formulary $70 for each Diabetic Supply which is not included on the Drug Formulary For Covered Drugs (other than Diabetic Supplies) $20 for each prescription or refill for a Generic Drug $40 for each prescription or refill for a Brand Name Drug which is included on the Drug Formulary $70 for each prescription or refill for a Brand Name Drug which is not included on the Drug Formulary Outpatient Therapy Services will pay 90% of the Expense incurred for Covered Services received for outpatient therapy visits. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for outpatient therapy visits. 40 Maximum Number of Outpatient Therapy Visits ~"'"' For Preferred Providers and Other Providers combined: Physical Therapy and Occupational Therapy: 60 visits each Calendar Year for Physical Therapy and Occupational Therapy combined Speech Therapy: 30 visits each Calendar Year NOTE: Physical Therapy includes Aquatic Therapy and Osteopathic Manipulative treatment. NOTE: Benefits will be payable for Expense incurred for outpatient therapy, including physical, occupational, speech, cardiac rehabilitation and pulmonary rehabilitation performed in a Physician's office, an Outpatient Facility or received during a Covered Home Health Care Visit. Physical, Occupational and Speech Therapies are subject to the Maximum Number of Outpatient Therapy Visits. Physician Office Services For Covered Services received in a Physician's office: For Preferred Providers only: After the applicable office visit Copayment for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services received in a Physician's office subject to the Conditions that follow. ~ Office Visit Copayment: $30 For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received in a Physician's office. Conditions of Preferred Provider Office Services 1. Any Deductible shown in the Schedule will not apply. 2. These Conditions apply to services received in the Physician's office, including but not limited to: (a) services other than surgery: (1) office visits, including the initial office visit for the diagnosis of pregnancy; (2) consultation; (3) ophthalmology exam (excluding Routine Vision Care and refractions); and (4) Medical Emergency office visits; (b) injections (excluding allergy injections and Specialty Drugs and Medicines); (c) allergy testing; (d) radiation therapy; and (e) x-ray services. 41 NOTE: For Preferred Providers only: After the applicable Office Visit Copayment is satisfied, the Plan ~""' will pay 100% of the Expense incurred for laboratory services (excluding other High End Radiology, such as MRIs, CT scans, PET scans, SPECT scans, ultrasounds, arteriograms and other nuclear medical scans). These conditions do not apply to: (a) services performed by an Other Provider; (b) office surgery; (c) supplies provided by the Physician; (d) drugs supplied by the Physician; (e) outpatient therapy; (f) treatment for Mental and Nervous Disorders; (g) Spinal Treatment (nonsurgical); (h) Allergy Injections; (i) Specialty Drugs and Medicines; (j) Routine Vision Care; (k) High End Radiology; and ~,r (l) subsequent office visits for maternity services, including prenatal and postnatal care, after the initial diagnosis of pregnancy. NOTE : An office visit Copayment will apply to each Physician bill received. NOTE: X-ray and laboratory tests that are performed outside the Physician's office or that are sent outside of the Physician's office for interpretation are payable under the Independent Radiology and Pathology Center Services, High End Radiology or Outpatient Facility Benefit as shown in the Schedule, depending on the type of service and where it is performed. Physician Services for Inpatient Surgery For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services provided by a Physician for inpatient surgery. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services provided by a Physician for inpatient surgery. Covered Physician surgical services are for the professional fees for surgical services provided by a Physician, including the services of an assisting surgeon. 42 Physician Services for Outpatient Sur~ery For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services provided by a Physician for outpatient surgery. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services provided by a Physician for outpatient surgery. Covered Physician surgical services are for the professional fees for surgical services provided by a Physician, including the services of an assisting surgeon. NOTE: Outpatient surgery includes surgical procedures performed in a Physician's office or in an outpatient facility. Physician Nonsurgical Inpatient and Outpatient Services For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services provided by a Physician for nonsurgical inpatient and outpatient services. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services provided by a Physician for nonsurgical inpatient and outpatient services. Covered Physician nonsurgical services are for the professional fees related to medical care (other than surgery) received in a Hospital, Skilled Nursing Facility, inpatient rehabilitation facility and Outpatient Facility. Physician Services for Maternity Including Prenatal and Postnatal Care For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services provided by a Physician for maternity services for prenatal and postnatal care. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services provided by a Physician for maternity services for prenatal and postnatal care. Preventive Health Care Services (For Dependent Children through age 17) For Preferred Providers: The Plan will pay 100% of the Expense incurred for Covered Services received for preventive health care, up to $200 each Calendar Year. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for preventive health care, up to $200 each Calendar Year. 43 Maximum Preventive Benefit '"~'~'"' The maximum for which benefits are payable will not exceed $200 for Preferred Providers and Other Providers combined each Calendar Year. Prosthetics For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services received for prosthetics each Calendar Year. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for prosthetics each Calendar Year. Maximum Prosthetic Benefit The Maximum Prosthetic Benefit for Other Providers will not exceed $5,000 while You and Your dependents are covered under the Plan. Qualified Organ(s)/Tissue Transplant Services Maximum Recipient Benefit For United's Medical Specialty Network Providers (MSN): After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 80% of the Expense incurred for Covered Services received for Qualified Organ(s)/Tissue Transplant services. '~"` NOTE: Transplant services provided by a Preferred Provider or Other Provider are not covered under the Plan. Maximum Donor Benefit For each Transplant Surgery performed the Plan will pay: Medical Specialty Network Providers: Donor benefits at 100%, up to $25,000 Preferred Providers: None Other Providers: None Medical Specialty Network Option (MSN) United offers an optional program for Organ(s)/Tissue transplants called the Medical Specialty Network. United's MSN consists of certain providers throughout the United States with whom United has contracted or made arrangements with to provide Organ(s)/Tissue Transplants. United will work with You and Your Physician to determine which of the MSN providers is available for Your or Your dependent's type of transplant. If a Qualified Organ/Tissue Transplant is Medically Necessary and performed at a MSN, You may be eligible for benefits related to Expenses for travel, lodging and meals for the transplant Recipient and one family member or Caregiver. may also assist You and one family member or Caregiver with travel ~'' and lodging arrangements. 44 Exceptions ~'`` (a) If You or Your dependent do not use United's MSN, any benefits under the MSN Option will not apply. (b) Cornea transplants will be paid the same as any other Covered Service and are not eligible for benefits under the MSN Option. __ Routine Health Care Services (For Covered Persons age 18 or older) For Preferred Providers: The Plan will pay l00% of the Expense incurred for Covered Services received for Routine Health Care Services, up to $200 each Calendar Year. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services received for Routine Health Care Services, up to $200 each Calendar Year. Maximum Routine Benefit The maximum for which benefits are payable will not exceed $200 for Preferred Providers and Other Providers combined each Calendar Year. Routine Mammography Services Maximum Routine Mammography Benefit °~r For Preferred Providers: The Plan will pay 100% of the Expense incurred for Coveted Services. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services. Skilled Nursing Facility Services Room Limit For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred each Calendar Year for the daily room charges of the Skilled Nursing Facility where the Covered Person is confined. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred each Calendar Year for the daily room charges of the Skilled Nursing Facility where the Covered Person is confined, up to a Maximum Allowable Amount of $200 per day. Maximum Number of Days The Maximum Number of Days payable for Preferred Providers and Other Providers comhined ~x~ill no exceed 100 days each Calendar Year. Maximum Allowable Amount means the total charge considered for Covered Services before the applicable Deductible and Coinsurance amounts are applied. In cases where the Usual and Customary ~, Charge is less than the Maximum Allowable Amount, the Usual and Customary Charge would apply. 45 ~r Specialty Drugs and Medicines Benefits for covered Specialty Drugs and Medicines supplied by Preferred Providers or Other Providers (excluding Specialty Pharmacy Providers) in a Physician's office or clinic or in a home health care setting are payable under this section of the Schedule. NOTE: Benefits for covered Specialty Drugs and Medicines supplied through a Specialty Provider (at a retail pharmacy) are payable under the Outpatient Prescription Drug Benefits section of this Schedule. For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense which You and Your dependent incurred for Specialty Drugs and Medicines provided by Preferred Providers. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense which You and Your dependent incurred for Specialty Drugs and Medicines provided by Other Providers. Specialty Drugs and Medicines means injectable drugs or medicines for the ongoing treatment of a chronic condition. NOTE: Benefits for Specialty Drugs and Medicines received in a Hospital setting are payable under the Hospital Confinement Facility Services or Outpatient Facility Services sections of the Schedule. ~ Spinal Treatment (nonsurgical) Services Maximum Spinal Treatment (nonsurgical) Benefit For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, the Plan will pay 90% of the Expense incurred for Covered Services for nonsurgical Spinal Treatment provided by a Preferred Provider, but not to exceed a maximum of 30 visits each Calendar Year. For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay 70% of the Expense incurred for Covered Services for nonsurgical Spinal Treatment by an Other Provider, but not to exceed a maximum of 30 visits each Calendar Year. The combined maximum number of visits for which benefits are payable will not exceed 30 visits for Preferred Providers and Other Providers combined each Calendar Year. NOTE: Benefits for any Physical or Occupational Therapy performed during the same visit as the Spinal Treatment (non-surgical) Services, will be payable under the Outpatient Therapy section of the Schedule. r~en are en er erv~ces For Preferred Providers: After the applicable Deductible for Preferred Providers is satisfied, tl~e Plar- will pay 90% of the Expense incurred for Covered Services provided in an Urgent Care Center. 46 For Other Providers: After the applicable Deductible for Other Providers is satisfied, the Plan will pay ~,,, 70% of the Expense incurred for Covered Services provided in an Urgent Care Center. Urgent Care Center means afree-standing facility offering ambulatory medical service, which: (a) is not part of a Hospital; and (b) is licensed by the proper authority in the jurisdiction in which it is located. Routine Vision Care Covered Vision Exam Services For Preferred Providers: The Plan will pay 100% of the Expense incurred for Covered Services received for a vision exam, up to a Maximum Allowable Amount of $60 each Calendar Year. For Other Providers: The Plan will pay 70% of the Expense incurred, for Covered Services received for a vision exam, up to a Maximum Allowable Amount of $60 each Calendar Year. Vision Exam Services means an eye examination to test the health of ones eyesight, including a refraction which is an assessment of the need for corrective lenses. This does not include fees for the fitting of contact lenses. Maximum Number of Visits The number of vision exams for which benefits are payable will not exceed one each Calendar Year for Preferred Providers and Other Providers combined. Maximum Allowable Amount means the total charge considered for Covered Services before the applicable Deductible and Coinsurance amounts are applied. In cases where the Usual and Customary Charge is less than the Maximum Allowable Amount, the Usual and Customary Charge would apply. 47 DEDUCTIBLE CONCEPT "A New Deductible Concept -Now 30 Years Old" Whv should an employer or an employee be concerned about how a deductible works? Because an appropriate deductible provision can help control current and future costs of a healthcare benefit plan, while an inappropriate deductible provision can drastically alter employee/patient opinion as to the plan's efficacy act as a catalyst to increase utilization, and create dissatisfaction. The original intent of having a deductible provision in a Medical Plan was to accomplish three objectives: • Eliminate the high administrative costs inherent in the handling of bud~etable claims -claims that a patient must recognize as part of their daily cost of living. • Patient involvement in the economics of purchasing healthcare services in a way that is budQetable - not to be perceived as a punishment -but as a way to maintain patient accountability and control unnecessary utilization. • Assure that the medical plan reimburses unexpected, therefore, unbudQetable, healthcare expenses - not expenses that could and should be worked into the family's bu yet. For most American families, it is impossible to budget on an annual basis. Monthly evaluation of expenses is routine; e.g. car payments, rent or mortgage payments, credit card payments, etc. A monthly timeframe simplifies the task of planning how much money may or may not be left after the paychecks are cashed. Most people relate to "monthly cash flow". Then, why do insurance plans contain deductible provisions that require budgeting annually by each family member instead of monthly for the entire covered family? In the 1960's, when the concept of Catastrophic Major Medical coverage became an integral part of a hospitaUsurgical benefit, the $100 Calendar Year Deductible per person rapidly became the norm. Times were different! A $100 Deductible per person represented an investment of more than one week's gross income for the average American family. With a maximum of 3 deductibles ($300) in a family unit, the American family was very definitely financially involved in the economics of their own healthcare. As time and inflation marched on, the cost of healthcare grew at more than double the rate of inflation. Family incomes also increased, but at a much lower rate. Budgets for living expenses required adjustments; i.e. higher rent, bigger car payments, growing credit card debt, etc. Many American businesses prospered during those years; and as health insurance rates soared, businesses "bit the bullet" and absorbed the increases. There was little proportional shifting of risk to the patient's family budget. This inertia left the $100 Calendar Year Deductible unchanged way beyond its logical, useful lifetime. Medical costs soared. Employer health plans absorbed a disproportionate share of the increase. Patient financial involvement in his or her own healthcare expenses lessened, further distancing the patient from economic reality. Since there was little economic incentive to "shop" patients did not question costs and/or procedures. Utilization of healthcare services took off! Then, beginning in the mid 1980's, the American economy went into a recessionary cycle. Businesses now faced the necessity of radically adjusting and controlling expenditures; their benefit plans ranked among the top major expense categories. Raising deductibles to a logical level in order to bring healthcare economics back into proper perspective meant increasing the prolific $100 Calendar Year Deductible per person to $500, or even $1,000. A patient could face having to write a large check to have medical tests, surgery, or hospitalization and; most likely, the required funds would be unavailable. Also, since a high deductible is perceived as punitive, it tended to fuel excessive utilization. Once that "high" deductible had been satisfied, the patient had the balance of the calendar year to over-utilize services without impediment. People instinctively seek a return on investment -getting the most from a plan. What they don't realize is this action increases claims, creating a need for greater premiums to cover the risk - a vicious circle! "Managed Care" appeared to be the only answer in the early 1990's. With the approval of government; insurance companies, HMO's, and benefit consultants decided that our healthcare system would be best served by healthcare usurping decision-making from the physician/patients. "Managed care" organizations, decided what "was" and "was not" necessary treatment. For a few years, plan participants and physicians "went with the flow", but then came the lawyers, lawsuits and the media. The American psyche does not give in easily to a system that hampers the right to choose. In the late 1970's Entrust's senior management was experimenting with a more realistic deductible approach -one that accomplished the original three objectives called for in a deductible provision. This deductible was logical, even though tooling up for implementation required major redevelopment of claim software, as well as, mobilizing a paradigm shift in traditional industry sentiment. Stop-loss carriers, reinsurers, underwriters, and consultants had to reinvent their software and think "outside of the box". The Family Monthly Deductible (Another Creative Concept by Entrust) The benefit industry was content with raising rates and deductibles or eliminating freedoms. Pursuing a different, logical alternative was too enterprising. Why not create and promote a deductible provision that enabled a covered family unit to budget for their share of their covered medical expenses incurred in a Calendar Month? It would accomplish the following: • The covered family (one or more covered persons) could pre-determine, budget for and; therefore, assume a realistic; yet, meaningful amount of economic liability during a familiar budgetary timeframe (monthly) that represented a maximum deductible liability for al[ members of the family unit. • The family monthly deductible dollar amount could be much lower -less punitive -than that required with a calendar year accumulation provision, while better accomplishing the healthcare consumer accountability objective. • Since satisfaction of a Family Monthly Deductible (FMD) the lower dollar deductible would only last for a single calendar month, the ability to overutilize services unnecessarily in order to reap that "return on investment" is reduced to a monthly time frame -making patients better and smarter shopper/consumers of healthcare services throughout the year. • The Family Monthly Deductible (FMD) is not cumulative; therefore no medical expenses - no deductible. For example, if an individual plan participant and/or family members incur medical services only in the month of March; their deductible liability is for that one month. • A $100 Family Monthly Deductible (FMD) works to reduce claims utilization in a benefit plan similar to a $500 Calendar Year Deductible per person (CYD) - a $150 FMD equates to a $900 CYD - a $200 FMD equates to a $1,200 CYD. • Routine maternity claims are usually subject to only one Family Monthly Deductible (FMD) exposure because maternity claims are incurred at the time of delivery. When Entrust management began suggesting and implementing the Family Monthly Deductible (FMD) into benefit plans; employees had a greater appreciation and understanding of the concept than employer decision-makers. To higher level management or higher income earners, $500 to $1,000 or more isn't a big deal - to the average family it can be a significant barrier to appreciation and acceptance. Over the past 30 years, with more than 2,000 case-years of experience, the Family Monthly Deductible (FMD) has been a valuable tool, enabling plans to optimize the balance between cost of coverage and value to the plan participant. The Family Monthly Deductible (FMD) should be an integral part of any ENTRUST HEAD BENEFIT PLAN. ALreeNare $500 FMD 90/60 ENEFI TS $500 FAMILY MONTHLY DEDUCTIBLE -SUMMARY OF BENEFITS ROUTINE MEDICAL EXPENSES • In Patient Services 90~Io after Deductible 60~1o after Deductible • Out Patient Services 90°Io after Deductible 60°lo after Deductible • Emergency Room Visit 90% after Deductible 60% after Deductible HOSPITAL SERVICES IN NETWORK OUT OF NETWORK • Office Visit $30 Copay 60% after Deductible • Specialist Office Visit $30 Copay 60% after Deductible • Diagnostic X-Ray and Lab 90°Io after Deductible 60~Io after Deductible • Urgent Care Facility Visit 90°Io after Deductible 60% after Deductible DEDUCTIBLE (FAMILY MONTHLY DEDUCTIBLE) • Per Covered Family Per Calendar Month $500 FMD (Limited to $3,000 in deductible exposure) OUT-OF-POCKET (Does not include Deductibles or Copays) • Per Covered Family Per Plan Year $1,000 $4,000 OTHER MEDICAL SERVICES • All other medical services 90~1~ after Deductible 60% after Deductible MEDICAL HELPLINE (ASK - A -NURSE) Registered Nurses are available 24 hours a day, 365 days a year, to answer your healthcare questions and offer advice of various treatment options and cost ... AVAILABLE AT NO ADDITIONAL COST TO YOU! EMPLOYEE ASSISTANCE PROGRAM (CIGNA BEHAVIORAL HEALTH) 5 Free Visits per Emotional Situation MENTAL AND NERVOUS (CIGNA BEHAVIORAL HEALTH) • Inpatient (Maximum of 25 days per plan year) • Outpatient (Maximum of 20 visits per plan year) o Individual Therapy o Group Therapy PRESCRIPTION DRUGS • Generic • Brand Name 80% N/A $20 Copay N/A $10 Copay N/A $ l0 Copay fora 30-Day Supply 30°Io Copay fora 30-Day Supply LIFETIME MAXIMUM BENEFIT $I,ooo,ooo ALTERNATE $'I,000 FMD 100/60 ENEFITS ~s-" $1,000 FAMILY MONTHLY DEDUCTIBLE -SUMMARY OF BENEFITS IN NETWORK ROUTINE MEDICAL EXPENSES • Office Visit • Specialist Office Visit • Diagnostic X-Ray and Lab • Urgent Care Facility V isit HOSPITAL SERVICES OUT OF NETWORK The First $500 of Routine Medical Expenses are covered at 100%, then Deductible Applies • [n Patient Services l00% after Deductible 60% after Deductible • Out Patient Services l00% after Deductible 60% after Deductible • Emergency Room Visit l00% after Deductible 60% after Deductible DEDUCTIBLE (FAMILY MONTHLY DEDUCTIBLE) • Per Covered Family Per Calendar Month $1,000 FMD (Limited to $4,000 in deductible exposure) OUT-OF-POCKET (Does not include Deductibles or Copays) • Per Covered Family Per Plan Year $0,000 OTHER MEDICAL SERVICES • All other medical services l00% after Deductible $4,000 60% after Deductible MEDICAL HELPLINE (ASK - A -NURSE) Registered Nurses are available 24 hours a day, 365 days a year, to answer your healthcare questions and offer advice of various treatment options and cost ... AVAILABLE AT NO ADDITIONAL COST TO YOU! EMPLOYEE ASSISTANCE PROGRAM (CIGNA BEHAVIORAL HEALTH) 5 Free Visits per Emotional Situation MENTAL AND NERVOUS (CIGNA BEHAVIORAL HEALTH) • Inpatient (Maximum of 25 days per plan year) • Outpatient (Maximum of 20 visits per plan year) o Individual Therapy o Group Therapy PRESCRIPTION DRUGS • Generic • Brand Name 80% N/A $20 Copay N/A $10 Copay N/A $ l0 Copay fora 30-Day Supply 30% Copay fora 30-Day Supply LIFETIME MAXIMUM BENEFIT $I,ooo,ooo ENTRUST" Report Summary Claims Related Reports ~''' # of Report Name of Report Frequency Standard Delivered Fee Ad Hoc Upon Request MPR18 B Claims Summary Monthly Standard 15th Included This report can also be generated quarterly or annually. MPR14 Transaction Register Monthly Standard 15th Included This report can also be generated quarterly or annually. NPR03 Pend Report Monthly Standard 15th Included NPR03A System Pend Report Monthly Standard 15th Included RSR01 Subscriber Report 10 Month Review Standard Upon Request Included RSR04 Eligibility Report 10 Month Review Standard Upon Request Included MPR50 Service Analysis Report 10 Month Review Standard Upon Request Included MGR11 Lag Report 10 Month Review Standard Upon Request Included MPR51C Paid Claims Analysis Upon Request Standard Upon Request Included MPR20A,B,C & D Plan Analysis by Member Location Upon Request Standard Upon Request Included MGR01 Claims Paid by Age & Sex of Upon Request Standard Upon Request Included Claimant MGR02 Outpatient Utilization by Top 25 10 Month Review Ad Hoc Upon Request Included Diagnoses MGR03 Inpatient Utilization 10 Month Review Ad Hoc Upon Request Included MGR04 Inpatient Utilization by Top 25 10 Month Review Ad Hoc Upon Request Included Diagnoses MGR05 Mental Health & Substance Abuse 10 Month Review Ad Hoc Upon Request Included Utilization by Diagnoses MGR06 Top 25 Hospitals by Number of 10 Month Review Ad Hoc Upon Request Included Admits AH100 Summary & Detail of Plans 10 Month Review Ad Hoc Upon Request Included YPR02 A&B Top Fifty Providers 10 Month Review Standard At Review Included AH101 Historical Claim Analysis 10 Month Review Ad Hoc At Review Included AH102 PPO Savings Pie Chart 10 Month Review Ad Hoc At Review Included AH103 Aggregate Report 10 Month Review Ad Hoc At Review Included AH104. Aggregate Claims History 10 Month Review Ad Hoc At Review Included AH105 Top Provider Reports 10 Month Review Ad Hoc At Review Included AH106 Claims By Member Reports 10 Month Review Ad Hoc At Review Included AH107 Turnaround Time Reports 10 Month Review Ad Hoc At Review Included Custom Custom Predictive Modeling Upon Request Ad Hoc Upon Request TBD Trust Accounting Reports ~+'' # of Report Name of Report Frequency Standard Delivered Fee TA101 Income & Balance Sheet Monthly Standard By the 15th Included TA102 Bank Reconciliation Report Monthly Standard By the 15th Included TA103 Payment Register Monthly Standard By the 15th Included TA104 Receipt Register Monthly Standard By the 15th Included CLAIMS UTILIZATION REPORT Sample Company Claim Utilization Summary February 1, 2007 through October 31, 2007 Participating Non-participating Capitated Total PPO Service Description Providers Providers Cost Cost Savings In Patient Services $56,564 $0 NIA $56,564 24.58% Out Patient Services $30,567 $1,723 NIA $32,290 18.89°Jo Surgery/Anesthesia $13,063 $1,064 NIA $14,127 30.92% Diagnostic, X-Ray & Lab $37,297 $285 $0 $37,582 28.75% Physician Services $12,497 $191 NIA $12,688 18.63% Therapeutic Services $3,726 $5,766 NIA $9,492 19.10% Behavioral Health $0 $0 $5,495 $5,495 OAO% Dental NIA $0 $0 $0 N/A Wellness $6,498 $146 N/A $6,644 28.81% Prescription Services NIA $0 $46,428 $46,428 N1A Vision $0 $0 $0 $0 OAO% Cost Containment NIA $5,835 N/A $5,835 N/A Other $0 $0 NIA $0 O.OU% TOTAL $160,212 $15,011 $51,923 $227,146 24.79% Sample Company Paid Claims by Type [n Patient Services Out Patient Services Surgery/Anesthesia Diagnostic, X-Ray & Lat Physician Services Therapeutic Services Behavioral Health Dental Wellness Prescription Services Vision Cast Containment Other Amount Paid Pct of Total $56,564 24.90% $32,290 14.22% $14,127 6.22% $37,582 16.55% $12,688 5.59% $9,492 4. ] 8% $5,495 2.42% $0 0.00°/0 $6,644 293% $46,428 20.44% $0 0.00% $5,835 2.57% $0 0.00% GGREGATE REPORT 200,000 Is0;00o 100,000 ~0,aoo Mark"/ Frk~1Yl Mai~fF7 Iacl!mtmPoiat 27,0 55600 ~~__ _ _ , ~>460 z~~te (~vns17,257 , _. _ ..,- .. ~, Apr-07 A9ay-07 JwrO'7 Jui-0'] Aag-~/ Apc-07 A9ay-OT JwaO't 1ub07 Aug,07 83,440 ~ 66,720 53,096' 111.2oD... _ 88,960 88,153 _.. 139,0011 111;200 107,634 l668ou 133,440 148,121 194,599 ISS,68~1` !3'!,403 ^Attachn~ttPoink C1Exzpected~ladtps rAg~regateClainB ~ . 177,919. ~ 204;159 -~ ,,22~;' -.' 168,44I ' 201~56T' 216;79! ~~~~ ~Qt~l~ity Medt~l a~ ~ Aregat~ ~~ PPO SAVINGS ~0 ~i5 '4&01 BSI °bOZ ~4Z °b0£ %5£ ~I;fy ca!~~ ~q ~~ Odd ~~,~a~o~ alaw~s C Sample Company PPO Util3za~on