It 031D COMMISSIONERS' COURT WORKSHOP AGENDA WEDNESDAY, NOVEMBER 3, 2010, 9:00 A.M. COMMISSIONERS' COURTROOM KERR COUNTY COURTHOUSE KERRVILLE, TEXAS 78028 THIS NOTICE IS POSTED PURSUANT TO THE TEXAS OPEN MEETINGS ACT. (TITLE 5, CHAPTER 551, GOVERNMENT CODE AND TITLE 5, CHAPTER 552, GOVERNMENT CODE.) This Commissioners' Court will hold a workshop at 9:00 A.M., Wednesday, November 3, 2010, in the Kerr County Commissioners' Courtroom, Kerr County Courthouse. Review and discuss employee health benefits and insurance. Fueaa?g� .Ara IBEX r,.n.so / 6 REPEL co. cum moo on 0 oil r Y Y F. Y Y Y Y Y N Z m m O u > ' > > > ' > ' > > > ' wg E E m m a ¢ 0 0 a v v `v ` ` > `v a a T T � 3 0 0 a a a a a a Q a a 0c c I- u- �! O o a 0 0 0 0 0 o 0 0 0 0 0 0 a 0 i t 0000 G O ... 2 m m m m m v m 1 � O O ce c c c r c 0 �' in c I O n u v O '° f0 V• u in u* w w a +n vv a s w LL 0 0 0 N z Z ■ Z. ...7 a 0 0 C: c a 7 0 0 0 0 0 0 1 7 00 o tt 02: J 0 0 O v1 Ln ' t/? W in. in. in F v T> T> T T o T >. 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Y Physician 203589445 BALL,MARK,MSPT TX 78624 Y Medical Y Physician 303905134 WATTS,LISA,M,PSYD TX 78028 Y UBH i Y Physician 752990526 STARCK,TOMY,MD TX 78256 Y Medical P Y Physician 742938811 REIFENBERG,LILANE,J TX 78006 N Medical N Physician 202148889 ORTIZ,GABRIEL,MD TX 78216 Y Medical Y Physician 741895118 MAYBEN,JENNIFER,K,MD TX 78624 Y Medical E Y Physician 742215169 SMITH,J,M,III,MD TX 78201 Y Medical I N Physician 742654134 ROCKWOOD,ANDREW,P TX 78624 Y Medical ',I Y Physician 741763675 HALLBAUER,GREGG,M,DO TX 77304 Y Medical Y Physician 742743906 DAVIS,LARRY,R,MD TX 78229 Y Medical V Y Physician 742464483 WAGNER,RANDALL,L,DDS TX 78028 N NotConsidered N Physician 743003947 BROWN,MARVIN,R,MD TX 78299 Y Medical Y Physician 742726528 MACHELL,CHARLES,H,MD TX 78229 Y Medical Y Physician 200455910 ANDEREGG,HEATHER,N,OD TX 78028 Y Medical Y Physician 562398084 GARCIA,RAMON,A,MD TX 78624 Y Medical i. Y Physician 900120192 SCHMIDT,DAVID,R,MD TX 78240 Y Medical I . 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Y Physician 742379769 RECTOR,WILLIAM,MD TX 78028 N Medical Y Physician 205869560 CORNETT,KAREN,G,MD TX 78013 Y Medical Y Physician 742104444 KERRVILLE PHYSICAL THERAPY TX 78028 N Medical Y Physician 742380838 BROCKWAY,BRUCE,A,MD TX 78229 Y Medical Y Physician 201685373 BABCOCK,CHAD,MD TX 78738 Y Medical Y Physician 752485366 GILLETTE,PAUL,C,MD TX 76201 Y Medical Y Physician 638501337 MINA,MAGED,M,MD TX 78258 Y Medical ': Y Physician 680569591 BLAKER,BRANDON,OD TX 78028 Y Medical ' Y Physician 742726528 ROMAN GONZALEZ,JAVIER,MD TX 78229 Y Medical Y Physician 742728787 EVANS,CARL,R,MD TX 78624 Y Medical Y Physician 742938811 SHROYER,STEVEN,MD TX 78229 N Medical N Physician 742945079 SPENCE,KELLY,A TX 78229 Y Medical Y Physician 900120192 ALLEN,MARQUE,A,DPM TX 78240 Y Medical . 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N Physician 262708683 SUMRALL,ZACH,T,DC TX 78028 N Medical N Physician 742938811 SALDIVAR,PRISCILLA,MD TX 78006 N Medical N Physician 742804555 WILLIAMS,BRIAN,K,MD TX 78028 N Medical, N Physician 020738450 CAULFIELD,CHRISTOPHER,T,MD TX 78006 Y Medical Y Physician 200773806 PILCHER,JOHN,A,JR,MD TX 78299 Y Medical Y Physician 742867618 JACKSON,GREGORY,M,MD TX 78212 Y Medical Y Physician 752473418 CARENOW TX 75013 Y Medical ! Y Physician 460218195 MCCULLOUGH,KEVIN,L,OD TX 78028 N Medical ' Y Physician 742109824 KIBEL,LIANE,B,MD TX 78731 Y Medical . Y Physician 742782325 DICE,YUHOE,G,MD TX 78006 Y Medical i Y Physician 760522391 RANEY,RANCE,W,MD TX 77380 Y Medical Y Physician 742503534 GURWITZ,GREGG,S,MD TX 78258 Y Medical Y Physician 742112082 WHEATLEY,KENNETH,K,JR,MD TX 78028 N Medical , N Physician 742593443 WICKWARE,CHARLES,A,DC TX 78028 Y NotConsidered Y Ph sician 743005527 DICKEY,MICHAEL,W,MD TX 78654 Y Medical 'i Y Physician 741985385 ! 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Y Physician 204311599 PENA,BENNY,OD TX 78028 N Medical ' i Y Physician 742371110 MARTINEZ,ALBERTO,N,MD TX 76849 Y Medical I Y Physician 742447500 TRIANA,JOSE,F TX 78229 Y Medical .,, Y Physician 201258661 MUELLER,CHERYL,MD TX 78240 Y Medical Y Physician 742082653 GALLAGHER,KEVIN,M,DO TX 78028 Y Medical Y Physician 460501947 THOMAS,AZREENA,MD TX 78229 Y Medical Y Physician 830398176 REYES,JOSE,MD TX 78293 N Medical Y Physician 262708683 PEDERSON,CORINNE,M,DC TX 78028 Y Medical 1 Y Physician 741654878 VARDIMAN,ARNOLD,B,MD TX 78258 Y Medical Y Physician 161751617 KEMPF,KEVIN,MD TX 78258 Y Medical Y Physician 742896068 GILLEY,JAMES,S,MD TX 78229 Y Medical ',I Y Physician 751598794 HARVEY,PATRICIA,L,MD TX 79601 N Medical N Physician 742730350 FINDLEY,MICHAEL,S TX 76705 Y Medical ' Y Physician 742728787 ADDINGTON,SHARI,L,MD TX 78028 N Medical k Y Physician 040468970 SIRIANNI,JEFFREY,G,MA TX 78028 Y NoMatch Y Physician 742945079 GARZA,SUZANNA,P,MD TX 78229 Y Medical '; Y Physician 200376970 BENSON,AMY,MD TX 78201 N Medical N Physician 680569591 BLAKER,BRANDON,OD TX 78624 Y Medical Y Physician 742904649 WYNNE,SUSAN,K,MD TX 78028 Y NotConsidered Y Physician 202280943 MELO,JAIRO,A,MD TX 78240 Y Medical Y Physician 742726528 ROMAN GONZALEZ,JAVIER,MD TX 78624 Y Medical Y Page7of9 r *- ( 4) i ! e - a s ; ami , y „ p - = N — MAW �i * r i �� . tA 1 �� to At t t y F� N i S !I� � f r , a 0 = V � - 3 4 i � r P4hi 1 i 6 i i ft1.3� a 2Sd: q r ' y , ( ° ' `� g ..,, ' ervi e i ; i et iti ^. 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"itta 1,`s°,fI ' _ --*fr Aifilli A ' `l n '} i r ' Ste er,� N *rJ Y1a(th yp ∎ NatWUr Physician 741671142 BOYS,GREGORY,J,MD TX 78229 Y Medical Y Physician 741586031 HEIM HALL,JOSEFINE,M,MD TX 78229 Y Medical Y Physician 741586031 MCGUFF,HOWARD,DDS TX 78229 Y Medical Y Physician 742112082 DELTORO,JANETH,RNC TX 78028 N Medical N Physician 742231775 SALINAS,CARL,MD TX 78249 Y Medical N Physician 743012944 ROUSE,LISA,A,MD TX 78028 Y Medical Y Physician 270024986 CUMBER,SALIMAH,F,MD TX 77055 Y Medical Y Physician 742880684 MURRAY,ROBERT,R,MD TX 78624 Y Medical Y Physician 742880684 PRUNEDA,JOE,N,MD TX 78624 Y Medical Y Physician 710996116 MCAULIFFE,MARY,E,NP TX 78028 Y Medical N Physician 741917555 MAYS,SHELIA,A,FNPC TX 78028 Y Medical Y Physician 742721268 MCDONALD,VANCE,A,JR,RPT TX 78624 Y Medical 'I Y Physician 311651314 EBI MEDICAL SYSTEM TX 78205 Y Medical N Physician 742726528 JAVIER,R GONZALEZ,MD TX 78028 Y Medical : : N Physician 742072186 DEWITT,CAROLINE,C,MD TX 78229 Y Medical ;' Y Physician 760010407 TUERO,ENRIQUE,I,MD TX 77555 Y Medical Y Physician 742112082 GODSEY,JILL,A,APN CNS TX 78028 N Medical N Physician 680569591 BLAKER,SHELLY,OD TX 78624 Y Medical Y Physician 742231775 MOORE,BENJAMIN,H,MD TX 78130 Y Medical Y Physician 742978885 FONTENOT,MICHAEL,S,MD TX 78028 Y Medical ! Y Physician 262788143 HUSSAIN,AKHTAR,MD TX 78028 N Medical ? N Physician 742999988 MORRIS,DONALD,C,JR,MD TX 78029 Y Medical Y Physician 202148889 ORTIZ,GABRIEL,MD TX 78221 Y Medical Y Physician 742782325 DICE,YUHOE,G,MD TX 78229 Y Medical Y Physician 742880684 WILLIAMS,GAYLE,R,MD TX 78028 Y Medical N Physician 710996116 MCAULIFFE,MARY,E,NP TX 78028 N Medical N Physician 742815026 WILLIAMS,EDMUND,P,MD TX 78232 Y UBH Y Physician 741671142 HENDRICK,ERIC,P,MD TX 78229 Y Medical Y Physician 751393557 JUBAY,FELIPE,L,MD TX 79035 Y Medical Y Physician 742922218 AVERYT,JOHN,MD TX 78229 Y Medical I, Y Physician 742721268 SCHNEIDER,KELLY,D,PT TX 78028 Y Medical ' Y Physician 742896068 GRANATO,MICHAEL,P,MD TX 78229 Y Medical :' Y Physician 742896068 ESCOBAR,BEATRIZ,E,MD TX 78229 Y Medical I Y Physician 742896068 BENEDIKT,RICHARD,A,MD TX 78229 Y Medical '! Y Physician 820540404 CHERN,PEGGY,L TX 78746 Y Medical f Y Physician 742231775 STORK,DONALD,E,MD TX 78257 Y Medical ! N Physician 742668497 SILMAN,JOHN,B,MD TX 78028 Y Medical Y Physician 741775525 RANDALL,CHARLES,W TX 78624 Y Medical `d Y Physician 203360918 VIRTUOX INC FL 33076 N Medical N Physician 200600718 DURA MEDIC LLC TX 78006 N Medical N Physician 952542635 STEVENSON INDUSTRIES INC CA 93065 N NotConsidered N Physician 742231775 HOLT,RICHARD,L,DO TX 78130 Y Medical Y Physician 741742582 MAVERICK,KENNETH,MD TX 78229 Y Medical Y Physician 742939835 HUFF,JOHN,P,MD TX 78006 Y Medical Y Physician 742109824 TRENTIN,ANN,M,MD TX 78731 Y - Medical Y Physician 205456094 SMITH,MICHAEL,J,MD TX 78006 Y Medical ( Y Physician 203151835 MCKENZIE,HEATHER,A,MD TX 78229 Y Medical Y Physician 752646477 MCCARTY,JACK,E,DO TX 79416 Y Medical Y Physician 840611484 LAB CORP OF AMERICA TX 78213 Y Medical ! Y Physician 262046652 MAYS,SHEILA,NP TX 78028 Y Medical Y Physician 742764739 COX,BRYAN,M,MD TX 78229 Y Medical Y Physician 741895118 KEESE,LORETTA,L,PA TX 78624 Y Medical N Physician 743008107 WALTON,MARTHA,A,MD TX 78624 Y Medical Y Physician 742759858 GRADY,MICHAEL,J,MD TX 78666 Y Medical i Y Physician 742574229 NOLAND,ROBERT,E,JR,MD TX 78006 Y Medical N Physician 020738450 FOWLER,BRIAN,L,MD TX 78006 Y Medical Y Physician 742112082 DERK,FRANCIS,F TX 78028 N Medical N Physician 593581288 IBRAHIM,BADR,A TX 78229 Y Medical Y Page8of9 f 41 ,, {av" • - Sai .� i a i t ° I 'V � : r� a ,; , r'„,'°? [ m [ ; a : 4 , ,sv llr p . h' ?.. } l a a a c 4' 1 y o».} € ( ,' � r ' a , � , f +b 'P , xi . 1 a� k � i @ . i " F as ' aka i ` - , a. i... a , ,%• }l G ., i . i i� ��a 'i yp a m I,, - , yyyyy����9 .4 a� mow,. 't°:..' Physician 262708683 - UMRALL,ZACH,T,DC TX 8028 Y Medical Y Physician 742339572 ENENDEZ,CARLOS,E,MD TX 8028 N NoMatch N Physician 742896068 • NE,MICHAEL,J,MD TX 8240 Y Medical Y Physician 742938281 ARZA VALE,ARNULFO,R,MD TX 8240 Y Medical Y Physician 742498008 ACKSON,RONALD,E,DC TX 8028 N NotConsidered N Physician 200376970 TORRES,ERNESTO,MD TX 8201 N Medical N Physician 742503534 IRSCH,DAVID,M,DO TX 8229 Y Medical Y Physician 522165554 ' JO LLC CA •0051 Y Medical Y Physician 742899823 OCAY,PAUL,H,MD TX 8028 Y Medical Y Physician 741671142 • NDERSEN,GARRETT,K,MD TX 8006 Y Medical Y Physician 741671142 IBBETTS,TODD,A,MD TX 8229 Y Medical Y Physician 742880684 :ISHOP,WILLIAM,E,MD TX 8013 Y Medical Y Physician 680541185 OHN,JOSEPH,M,MD TX 8624 Y Medical Y Physician 751731116 ANNON,JOE,R,MD TX 9601 N NoMatch Y Physician 900120192 • LLEN,MARQUE,A,DPM LA 0470 Y Medical +, Y Physician 752496714 DUKE CHIROPRACTIC TX 8028 N NotConsidered N Physician 760382012 SIMONSEN,RANDALL,L,MD TX '8332 N Medical N Physician 742112082 HOWELL,TODD,R,MD TX '8028 N Medical N Physician 742112082 COTT,DEBORAH,D,MD TX '8028 N Medical N Physician 752530066 • MERIPATH TX 5244 Y Medical N Physician 742541959 ERIWETHER,J,C,MD TX 8028 N Medical Y Physician 742922218 •ETERS,MARGARET,A,MD TX 8240 Y Medical Y Physician 742990878 ELA,VICTOR,D,MD TX 8006 Y Medical 'i Y Physician 742880684 •ECTOR,WILLIAM,MD TX 8624 Y Medical Y Physician 741671142 :ROWNE,F,S,MD TX 8229 Y Medical Y Physician 742498008 ACKSON,RONALD,E,DC TX 8028 Y NotConsidered N Physician 741671142 HETTY,ASHWIN,K,MD TX 8229 Y Medical ! Y Physician 741671142 II UNLAP,JOEL,A,MD TX 8229 Y Medical G Y Physician 742880684 •RUNEDA,JOE,N,MD TX 8028 N Medical Y Physician 200376970 ' AEHLER,ROBERT,W,MD TX 8201 N Medical N Physician 200376970 :AILEY,AARON,S,MD TX 8201 N Medical N Ph sician 200376970 s IT • - . W NoY in TX 8201 N Medical 'I' N Physician 200376970 CHANDLER,ROBERT,C,MD TX 78201 N Medical N Physician 741671142 PRABHAKAR,HIMA,B,MD TX 78229 Y Medical !' Y Physician 741671142 THAGGARD,ALVIN,III,MD TX 78006 Y Medical ' Y Physician 742817522 QURESHI,USMAN,MD TX 78332 Y Medical Y Physician 741671142 THOMAS,JOHN,W TX 78229 Y Medical Y Physician 741165572 WATSON,JON,T,MD TX 78332 Y Medical N Physician 742886173 HAUSENFLUK,LINDA,MD TX 78205 Y Medical ? Y Physician 742730328 MCGEHEE,JARRETT,T,MD TX 78229 N Medical Y Physician 742730328 RIVAS,PEDRO,A,MD TX 78229 N Medical Y Physician 741917555 SPROUSE,DAVID,R,MD TX 78028 N Medical Y Physician 205589008 COLGIN,MURRAY,M TX 78028 N Medical Y Physician 741619182 LEDET,SUZANNE,C,MD TX 78759 Y Medical Y Physician 020738450 DUNN,BRYAN,M,MD TX 78006 Y Medical Y Physician 742978885 FONTENOT,MICHAEL,S,MD TX 78028 N Medical Y Physician 710996116 JOHNSON,RICHARD,B,MD TX 78029 Y Medical Y 428 419 80 88 508 508 82.48% Page 9 of 9 10/28/2010 09:59 • • - PAGE 01/02 CLINICAL PAI HOLU4Y LABORATORIES ' P.O. SOX 141009 AUSTIN, TX 78714 - 1669 13y providing a check as ymept. you authorize as to use informati from 'your our check to make a Ar is ssC1,5 atennSSlLe - aces your e i rocc your check l7 clectromC.ilty. soon will 0py eing..p as l zczt ray y after o ek fer at ouoa receive 1 copy �Gk from your n 'Inan ltclal institution, N STATEMENT RETAINTNIS COPY FOR YOUR TAX RECORDS PATIENT NAME ACCOUNT NUMDER RERUSSTING PHYSICIAN! • DATE OF PROCEDURE SERVICE DESCRIPTION CREDITS CHARGES SERVICE - R _, 05/21/10 36415 PHLEBOTOMY FEE — SINGLE • 5.25 05/21/10 80053 COMPREHENSIVE METAROT,TC PANFT, 78.25 . 05/21/10 80061 LIPID PANEL 90.75 05/21/10 82248' BILIRUBIN, DIRECT 10.39 05/21/10 8g2Z607' VITAMIN B -12 140.25 05/21/10 82746. FOLIC ACID 131.50 05/21/10 .8309 HOMOCYSTEINE • 173.00 05/21/10 85652 SEDIMENTATION RATE . 31.50 05/21/10 86038 • ANA 115.00 05/21/10 86039 REFLEXED ANA TITER 134.25 05/21/10 83921 -90 METHYLMALONIC ACID 244.75 . 09/20/10 • PI1 NOT APPROVED — 370.48 09/20/10 PI1 PAYMENT — 85.91 INSURANCE WAS UNABLE TO IDENTIFY THE INSURED /PATIENT WITH THE INFORMATION ON FILE. PLEASE USE THE .BACK OF THIS STATEMENT TO RESUBMIT YOUR CURRENT INSURANCE INFORMATION —THANK YOU . INITIAL STATEMENT THIS STATEMENT REFLECTS LAB TESTS THAT YOUR•PHYSICIRN ORDERED ON YOUR RFHALF...PLEASE REMIT PAYMENT OR INSURANCE INFO WITHIN: 30 DAYS. WWW.CPLLABS.COM . DIRECT R 1 IMCt INOI IIRIFC rn, CLINICAL PATHOLOGY L48ORATORIES. INC. PAY ONLIfgE ct W W W.CPLLABS.COM TOTAL AMOUNT P.O. BOX 141669 a s 1111 ' °'- PAYMENT DUE ON RECEIPT ONTINUED AUSTIN, TX 78714-1569 TEL (512) 573.7690 1 1 ]I 1191111 • IAX 1U. NO. 14-'/,564159 OLJT OF AUSTIN! 1.BOD all - P pi D ACN AND RECUR PORTION WITH Yam PAYMENT IN ENCLOSlo ENVELOPE -� L 0 Please chock box II aodreas below is incorroht nr Insurance InfarmaliM has changed, and indicate MAKE CHECKS PAYABLE TO: chanassl IF PAYING BY VISA, MASTERCARD, AMERICAN EXPRESS UR ORRSIVEK, COMPLETE BELOW CLINICAL PATHOLOGY Ei M 0TDRCnRD 0 IX "- 1110 LABORATORIES CARD NUMBER MUST INOLUOEa DIGIT P.O, BOX 141009 ccCUnRY COM WHOM DACK OF CARD AUSTIN, TX 96714 -1669 SIGNATURE EXPIRAr1ON rAts AMOUNT. RETURN SERVICE REQUESTEl3 - - _ ?REM!) NAME I AUTHORS CONICAL PATRP4OOOV ACCOUNT NUMBER STATEMENT OATS LADORATORIWMS.TO DENT pAymENT 10/16/2010 J CnRr Aanvp ,nMOUNT PLEASE SEE OTHER SIDE FOR EXPLANATION OF CHART CS AMOUNT OF I @ TELEPHONE. (312) 673 -1030 - OUT OP AUETIN 1..800 411 3762 T?AY NT DUE TSI+ON RECEIPT PAYMENT W For questions call Monday - Friday, lam -7pm 1597410 . 1 1 11111111111111111111111111111111111111111111 limihIIrIraIlII1u 1I1111aIlraiinitilrll111II IIrr111na1r " CLINICAL PATHOLOGY LABORATORIES INC PO SOX 141669 AUSTIN TX 78714 -1669 CPL001304Pe000130 0 000ianN8294QC 14000306985M. lard - MT 10/20/2010 09:59 _ PAGE 02/02 CLINICAL PATHOLOGY LABORATORIES P.o. sox 141669 AUSTIN, TX 78714.1669 By providing a cileok as aynlent. you aulltorize us to use information from,vour cllcek. l make a one- II�rie electronic funny transfer 1rorn yo pr account which can be deducted as soon as.! lc nom day after bein processc-a at out, alms .lt process your check electronically, you wil alai receive a copy Back 1Tom your linenclal t1 /9111 IElon. STATEMENT RETAIN THIS COPY FOR YOUR TAX ReCOROS ATIENT NAME ACCOUNT NUMBER REQUES1 ING PHYSICIAN • IIATF SERVICE PROCEDURE SERVICE DESCRIPTION - Cr/CDITO V CI IACIOES • • • • • • • • • • • • • • • • IRECT EaLLINO INQUIRIES TO: OLIN1CAL FATIIOLOGY bwormromes, JNC. PAY ONLINE © WWW.CPLLADO.COM TOTAL AMOUNT P.O. BOX 141669 PAYMENT DUE ON RECEIPT $698.50 AX 16. Na 74 AUSTIN TX 787741669 P I ' � I E D CH AND �IR a s 1 4 P I I IC W ITH YOUR PAYMENT 1N ENCLOSER ENOLOPE.. - . — It TEL (512) $73 - 1630 OUT OF AUSTIN: FOOD -411 -2782 6 +D °4 (, Pleer.e she& bar: if addrt tbelow C Irlrnrrant or InsuancaiMomiuLion S changea, end indicam MAKE CHECKS PAYABLE TO: rbPnna(Pl nn munrcs Ark IF PAYING SY VISA, MASTERCARD, AMERICAN EXPRESS OR DISCOVER, COMPLETE BELOW CLINICAL PATHOLOGY I � �, I asrFROAno 5 is LIAMER Ira I DscovER LABORATORIES CARD NUMNER MUST INCLUDE R DIGIT P.O. BOX 141669 ce uI11v FROM AUSTIN, TX 76714 -1669 SACS Of CARD CICNATURE EXPIRATION tart AMOUNT 121711 iRN SERVICE REQUESTED ACCOUNT NUMBER STATEMENT DATE PATIENT :I.' PRINTCD NAME I AIUTNDRIZE CLINICAL PATMDLCDY GARGRATomes. we.= REMIT PAYMENT 10/16/2010 - OPTIC ADOVE AM PLEASE SEE OTHER SIDE FOR EXPL ANATION OF CHARGES 10 /16/2010 / 5698.50 I AMOUNT OF 1 d• TELEPHONE: (512) 873 -1630. 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C LL o 0 0 0 0 0 0 � coE — - Y° co EcdlmZZmd CT 8 a ?o�zz57zz 4 8 c o O 0 c c O £ - U V 000.0 0000 J °n O '0 r O �OO 000 R m ro C d � r 0 a 4 ,. a a CO NM a" 0 0 • O 0700330 O .. C m N y C N N N O 9 m C m O O O 0 0 0 m F O C1 c c m c c C G Q am— mmm O r o 2 f0 o N o W (tl S ❑ O y0 0b >555 Q y a 0000000 $ H A th t o c .4 rn a E a a oo r wmv - W 0 99 • t0 I, C OON CO E mm ° mm 0 C m 9009999 • . ,. R j C 14701 St. Mary's Lane, Suite 150 ' Houston, TX 77079 • October 13, 2010 • . Kerr County Courthouse C/O County Clerk ' Ms. Jannett Pieper • 700 Main Kerrville, Texas 78028 • . RE: Entrust/TCPN Response to KERR County Group Health Bid Request Dear Ms. Pieper: At the request of Eva Hyde, Entrust has provided Kerr County with a response to the proposal for Kerr I ' County Employee Benefits through TCPN. TCPN is an Interlocal Cooperative Purchasing Network that 1 represents multiple governmental entities and ,non-profit organizations in over 30 states. Through TCPN Kerr County has access to preferred vendors and pricing for a variety of products and services. TCPN seledts vendors after diligent evaluation through a competitive bid process. A provision of the TCPN /Entrust proposal is the requirement for entities to be members of the cooperative. Our understanding is that K@rr County is currently a member; however, in the event Kerr County is not currently a member the county will be required to submit an application for membership upon acceptance of this proposal. In response to expressed concerns and media representation that Kerr County is facing budget constraint$ for the coming fiscal year, Entrust has proposed alternate benefit plan design options in an attempt to keep benefits affordable for both the county and its employees. The benefit designs illustrated offer . improvements in coverage for those individuals with low medical claims utilization and through a unique deductible concept shifts a small amount of additional out -of- pocket expenses to those individuals with higher than average utilization. Since Entrust has offered a $1,000 deductible option, as well as a $1,SOQ deductible option, individuals with a one -time claims occurrence should not realize much additional out -of- pocket expense. The deductible does apply to a family unit in any given month; therefore, frequent usage of high dollar claims expenses over multiple months could result in increased deductible exposure. However, the $1,000 Family Month Deductible option offers a maximum of $4,000 in deductible exposure in any given plan year for the entire family and the $1,500 family Monthly Deductible option offers a ' maximum in deductible exposure for the entire family in any given plan year of $4,500. Since the $1,500 Family Monthly Deductible plan offers 100% coinsurance in- network after the deductible has been met', in any month, the total out -of- pocket exposure compared to the current plan is significantly better for an individual with one or two deductible occurrences. Ic \ Corporate Office P.O. Box 440309 Houston, TX 77244 -0309 (281) 368 -7876 Fax (281) 388,7828 • As requested, Entrust has provided proposals with and without dependent coverage. In an attempt to alleviate some of the possible dissatisfaction from employees regarding dropping dependent coverage altogether, Entrust has proposed an additional proposal offering that allows dependents to receive hospitalization services through a local direct EPO contract relationship with Peterson Regional Medical Center exclusively. By offering coverage through the local hospital, Kerr County can assure that employees and•their eligi)tle dependents have access to general services without the total elimination of dependent] coverage altogether. Upon approval to negotiate a direct EPO contract with Peterson Regional Medical Center on behalf of Kerr County, the illustrated financial proposal can remain the same with a deductible credit of $500 being applied when plan participants use Peterson Regional Medical Center for services. The deductible will continue to be as proposed in the enclosed benefit summaries when utilizing any other facilities and the maximum deductible exposure remains the same regardless of the deductible credit at Peterson Regional Medical Center. As requested, Entrust has proposed administration fees based on a three year administrative fee agreement. Since the Kerr County plan year begins January 1, 2011, the three year administrative agreement would remain in effect from January 1, 2011 through December 31, 2013. In the event the agreement is established for the full three year period, Entrust will agree to a level administration fee. Ir' the event the agreement is annually renewable for three years, the fee increase will be capped at 10% per • plan year. • Since TCPN does not authorize independent consultants to present or commit to terms of proposals submitted through the cooperative, Entrust is happy to answer additional questions and review proposal terms directly with Kerr County. We look forward to addressing any concerns.or assisting with any necessary modifications in an effort to allow Kerr County to design a plan that meets the current budgetary constraints. Please contact me directly at (800) 436 -8787 extension 505 or on my cellular phone at (713) 870 -4417. • • B-s Re:. , A 9111 Clin Wilson Business Development Consultant TCPN Liason • Kerr County Self- Funded Welfare Plan Stop -Loss Proposal Comparison All Employees and Dependents with Major Medical Coverage Entrust $1,000 FMD Entrust $1,500 FMD Entrust $1,000 FMD Entrust $1,500 FMD 80% Plan 100% Plan 80% Plan 100% Plan 2011 2011 2011 2011 Insurance Carrier - Third Party Administrator Entrust, Inc. Entrust, Inc. Entrust, Inc. Entrust, Inc. Reinsurance Carrier American National American National American National American National Setup Fee *: $ 1,500.00 $ 1,500.00 $ 1,500.00 $ 1,500.00 Annual Plan Cost: $ 3,000.00 $ 3,000.00 $ 3,000.00 $ I 3,000.00 Run -In /Run -Out: Administration Fee 3 Months of Admin 3 Months of Admin 3 Months of Admin 3 Months of Admin Estimated run out claim liabililty Specific Lifetime Maximum Unlimited Unlimited Unlimited Jnlimited Aggregate Plan Year Annual Maximum $ 1,000,000 $ 1,000,000 $ 1,000,000 $ 1,000,000 a Note: These rotes are not included !n totals below. i1 r Number of Employees: 272 272 272 272 Number of Spouse Only 35 35 35 35 Number of Child(ren) only 41 41 41 41 Number of Family Units 27 27 27 27 Number of Dependent Units: 103 103 103 103 Specific Deductible: $ 60,000 $ 60,000 $ 75,000 $ 75,000 Specific Contract: 15/12 15/12 15/12 15/12 Specific Contract Includes Med & Rx Med & Rx Med & Rx Med & Rx Aggregate Contract: 12/12 12/12 12/12 12/12 Maximum Aggregate Run In N/A N/A N/A N/A Aggregate Contract Includes Med & Rx Med & Rx Med & Rx Med & Rx MONTHLY FIXED COSTS Specific Premium Composite: I $ 142.02 $ 142.02 $ 120.92 $ 120.92 Aggregate Premium 1 1 Composite: $ 3.22 $ 3.22 $ 3.22 $ , 3.22 Monthly Cap I $2.00 Optional $2.00 Optional $2.00 Optional $.00 Optional Administration( all fees per unit per month) 1 1 Claims Cost Per Employee : $ 18.50 $ 18.50 $ 18.50 $ !', 18.50 Claims Cost PerDependent : $ - $ - $ - $ - Utilization Review per EE $ 3.00 $ 3.00 $ 3.00 $ 3.00 PPO Network Per EE: $ 4.50 $ 4.50 $ 4.50 $ 4.50 Rx Program Fees(Describe) $ - $ - $ - $ ' - COBRA per EE $ 3.95 $ 3.95 $ 3.95 $ ',', 3.95 HIPAA Per EE Included Above Included Above Included Above Included Above Fiduciary Liability Fee N/A N/A N/A i N/A Transplant Benefit 1 1 is Employee /Mth N/A N/A N/A N/A Dependent Unit /Mth: N/A I N/A I N/A I N/A Cafeteria Plan FSAAccount Per Participant N/A N/A N/A N/A Child Care Per Participant N/A N/A N/A N/A Debit card expense N/A N/A N/A N/A Start up expense N/A N/A N/A I N/A Other Cafeteria Plan Fees: N/A N/A N/A I N/A , HRA Start up expense N/A N/A N/A N/A Per Account Fee N/A N/A N/A N/A Debit card expense N/A N/A N/A N/A Other HRA Plan fees: N/A N/A N/A N/A Wellness Plan Cost Per EE /Mth Entrust is Proposing World Doc $3.95 $3.95 $3.95 $3.95 Wellness Plan Cost per ?? $0.00 $0.00 $0.00 1 $0.00 Disease Management * Included Included Included I Included Banking System Notes Positive Pay /EE/Mth N/A N/A N/A I N/A Positive Pay Set up Fee (One time set up fee) N/A N/A N/A N/A , l - BrokerFee: ∎d Fee $ - $ - $ - $ _ • Composite: $ 626.60 $ 620.65 $ 652.98 $ 651.35 ttachment Points Monthly: $ 170,435 $ 168,817 $ 177,611 $ 177,167 Annual: $ 2,045,222 $ 2,025,802 $ 2,131,327 $ 2,126,006 TOTAL ANNUAL COSTS _ Specfic Stop Loss Premium 463,553 463,553 394,683 394,683 Aggregate Premium 10,510 10,510 10,510 10,510 Administration 60,384 60,384 60,384 60,384 Administration as % of Maximum Annual Cost 2.31% 2.32% 2.29% 2.30% UR, PPO, Rx, Broker, and all other 37,373 ' 37,373 37,373 , � 37,373 j; Total Fixed 571,820 571,820 502,950 I 502,950 Expected: 2,207,998 2,192,461 2,208,011 2,203,755 Maximum: 2,617,043 2,597,622 2,634,276 2,628,956 Total Fixed Increase in Cost as percent of current Expected Maximum Notes: 'This Spreadsheet is for Illustrative Purposes only. Please refer to the financial pages and proposal terms and conditions for a complete understanding of the proposed financial options. • • I . Kerr County Self- Funded Welfare Plan Stop -Loss Proposal Comparison Employee Only Coverage Entrust 51,000 FMD Entrust $1,500 FMD Entrust 51,000 FMD Entr{ist $1,500 FMD 80% Plan 100% Plan 80% Plan '100% Plan 2011 2011 2011 2011 Insurance Carrier - Third Party Administrator Entrust, Inc. Entrust, Inc. Entrust, Inc. Entrust, Inc. Reinsurance Carrier American National American National American National American National Setup Fee *: $ 1,500.00 $ 1,500.00 $ 1,500.00 $ 1,500.00 Annual Plan Cost: $ 3,000.00 $ 3,000.00 $ 3,000.00 $ 3,000.00 Run -In /Run -Out: Administration Fee 3 Months of Admin 3 Months of Admin 3 Months of Admin 3 Months of Admin Estimated run out claim liability Specific Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Aggregate Plan Year Annual Maximum $ 1,000,000 $ 1,000,000 $ 1,000,000 $ 1 1,000,000 * Note: These rates are not included in totals below. •• Number of Employees: 272 272 272 I 272 Number of Spouse Only 35 35 35 35 Number of Children) only 41 41 41 41 Number of Family Units 27 27 27 27 Number of Dependent Units: 103 103 103 103 Specific Deductible: $ 60,000 $ 60,000 $ 75,000 $ 75,000 Specific Contract: 15/12 15/12 15/12 - 15/12 Specific Contract Includes Med & Rx Med & Rx Med & Rx Med & Rx Aggregate Contract: 12/12 12/12 12/12 12/12 Maximum Aggregate Run In N/A N/A N/A N/A Aggregate Contract Includes Med & Rx Med & Rx Med & Rx i Med & Rx MONTHLY FIXED COSTS Specific Premium Composite: I $ 104.41 $ 104.41 $ 90.61 $ 90.61 Aggregate Premium 1 1 1 1 Composite: 2.05 $ 2.05 $ 2.39 $ i 2.39 Monthly Cap I $ $2.00 Optional $2.00 Optional 52.00 Optional $2.00 Optional Administration( all fees per unit per month) 1 1 1 1 Claims Cost Per Employee : $ 18.50 $ 18.50 $ 18.50 $ 18.50 Claims Cost Per Dependent : $ - $ - $ $ Utilization Review per EE $ 3.00 $ 3.00 $ 3.00 $ 3.00 PPO Network Per EE: $ 4.50 $ 4.50 $ 4.50 $ 4.50 - Rx Program Fees(Describe) $ - $ - $ $ COBRA per EE $ 3.95 $ 3S5 $ 3.95 $ 3.95 I-IIPAA Per EE Included Above Included Above Included Above Included Above Fiduciary Liability Fee N/A N/A N/A N/A Transplant Benefit Employee /Mth I N/A I N/A I N/A N/A Dependent Unit /Mth: N/A N/A N/A l N/A • Cafeteria Plan FSA Account Per Participant N/A N/A N/A I N/A Child Care Per Participant N/A N/A N/A N/A Debit card expense N/A N/A N/A I N/A Start up expense N/A N/A N/A r N/A Other Cafeteria Plan Fees: N/A N/A N/A J. N/A HRA Start up expense N/A N/A N/A N/A PerAccountFee N/A N/A N/A N/A Debit card expense N/A N/A N/A ' N/A Other HRA Plan fees: N/A N/A N/A • N/A Wellness Plan Cost Per EE /Mth Entrust is Proposing World Doc $3.95 $3.95 $3.95 $3.95 Wellness Plan Cost per ?? $0.00 $0.00 $0.00 $0.00 Disease Management * Included Included Included Included Banking System Notes Positive Pay /EE /Mth N/A N/A N/A N/A Positive Pay Set up Fee (One time set up fee) N/A N/A N/A N/A Broker Fee: Fee $ - $ - $ - $ - _ Composite: $ 397.71 $ 394.48 $ 417.01 $ 412.80 • ttachment Points Monthly: $ 108,177 $ 107,299 $ 113,427 $ 112,282 Annual: $ 1,298,125 $ 1,287,583 $ 1,361,121 $ 1,347,379 TOTAL ANNUAL COSTS Specfic Stop Loss Premium 340,794 340,794 295,751 295,751 Aggregate Premium 6,691 • 6,691 7,801 7,801 Administration 60,384 60,384 60,384 60,384 Administration as % of Maximum Annual Cost 3.46% 3.48% 3.43% 3.45% UR, PPO, Rx, Broker, and all other 37,373 37,373 37,373 ', 37,373 Total Fixed 445,242 445,242 401,309 401,309 Expected: 1,483,743 1,475,308 1,490,205 1,479,212 Maximum: 1,743,368 1,732,825 1,762,429 1,748,688 Total Fixed Increase in Cost as percent of current Expected Maximum Notes: *This Spreadsheet is for Illustrative Purposes only. Please refer to the financial pages and proposal terms and conditions for a complete understanding of the proposed financial options. Kerr County Self- Funded Welfare Plan Stop -Loss Proposal Comparison Employee on PPO Plan / Dependents on PRMC Plan Only Entrust $1,000 FMD Entrust $1,500 FMD Entrust $1,000 FMD Entrust $1,500 FMD 80% Plan 100% Plan 80% Plan i.00% Plan 2011 2011 2011 ■ 2011 Insurance Carrier - Third Party Administrator Entrust, Inc. Entrust, Inc. Entrust, Inc. Ehtrust, Inc. Reinsurance Carrier American National American National American National American National Setup Fee *: $ 1,500.00 $ 1,500.00 $ 1,500.00 $ 1 1,500.00 Annual Plan Cost: $ 3,000.00 $ 3,000.00 $ 3,000.00 $ 3,000.00 Run -In /Run - Out: Administration Fee 3 Months of Admin 3 Months of Admin 3 Months of Admin 3 Mpfiths of Admin Estimated run out claim liabililty f Specific Lifetime Maximum Unlimited Unlimited Unlimited ilhlimited Aggregate Plan Year Annual Maximum $ 1,000,000 $ 1,000,000 $ 1,000,000 $ II 1,000,000 " Note: These rotes are not included'in totals below. I 4Tl OSS D I15 {S v .. Number of Employees: 272 272 272 272 Number of Spouse Only 35 35 35 35 Number of Child(ren) only 41 41 41 41 Number of Family Units 27 27 27 27 Number of Dependent Units: 103 103 103 103 Specific Deductible: $ 60,000 $ 60,000 $ 75,000 $ 75,000 Specific Contract: 15/12 15/12 15/12 15/12 Specific Contract Includes Med & Rx Med & Rx Med & Rx Med & Rx Aggregate Contract: 12/12 12/12 12/12 12/12 Maximum Aggregate Run In N/A N/A N/A N/A Aggregate Contract Includes Med & Rx Med & Rx Med & Rx Med & Rx MONTHLY FIXED COSTS 1 1 -__1 i Specific Premium Composite: $ 134.92 $ 134.92 $ 114.87 $ 114.87 Aggregate Premium Composite: $ 3.22 $ 3.22 $ 3.22 $ ! 3.22 Monthly Cap $2.00 Optional $2.00 Optional $2.00 Optional $3.00 Optional Administration( all fees per unit per month) Claims Cost Per Employee : $ 18.50 $ 18.50 $ 18.50 $ 18.50 Claims Cost Per Dependent : $ - $ - $ - $ - Utilization Review per EE $ 3.00 $ 3.00 $ 3.00 $ 3.00 PPO Network Per EE: $ 4.50 , $ 4.50 $ 4.50 $ L 4.50 Rx Program Fees(Describe) $ - $ $ $ COBRA per EE $ 3.95 $ 3.95 $ 3.95 $ ': 3.95 HIPAA Per EE Included Above Included Above Included Above Included Above Fiduciary Liability Fee N/A N/A N/A N/A Transplant Benefit Employee /Mth N/A N/A N/A N/A Dependent Unit /Mth: N/A N/A N/A N/A ,, I Cafeteria Plan FSA Account Per Participant N/A N/A N/A N/A Child Care Per Participant N/A N/A N/A N/A Debit card expense N/A N/A N/A N/A Start up expense N/A N/A N/A I N/A Other Cafeteria Plan Fees: N/A N/A N/A d N/A HRA Start up expense N/A N/A N/A N/A Per Account Fee N/A N/A N/A N/A Debit card expense N/A N/A N/A N/A Other HRA Plan fees: N/A N/A N/A i N/A Wellness Plan Cost Per EEJM Entrust is Proposing World Doe 53.95 $3.95 $3.95 J $3.95 Wellness Plan Cost per ?? I $0.00 $0.00 $0.00 $0.00 Disease Management * � Included included Included Included Banking System Notes Positive Pay /EE %Mth N/A N/A N/A N/A Positive Pay Set up Fee (One time set up fee) N/A N/A N/A 1 N/A Broker Fee: Fee $ - $ $ - $ !. , -a.�. Composite: ,. . $ 563.94 $ 574.92 $ 587.68 $ .h 603.35 !Attachment Points Monthly: $ 153,392 $ 156,378 ' $ 159,849 $ i 164,111 Annual: $ 1,840,700 $ 1,876,539 $ 1,918,188 $ 1,969,334 TOTAL ANNUAL COSTS • Specfic Stop Loss Premium 440,379 440,379 374,936 374,936 Aggregate Premium 10,510 10,510 10,510 10,510 Administration 60,384 60,384 60,384 60,384 Administration as % of Maximum Annual Cost 2.53% 2.49% 2.51% 2,46% UR, PPO, Rx, Broker, and all other 37,373 37,373 37,373 37,373 Total Fixed 548,646 548,646 483,203 i 483,203 Expected: 2,021,206 2,049,877 2,017,753 2,058,670 Maximum: 2,389,346 2,425,185 2,401,390 2,452,537 Total Fixed Increase in Cost as percent of current Expected Maximum Notes: *This Spreadsheet is for Illustrative Purposes only. Please refer to the financial pages and proposal terms and conditions for a complete understanding of the proposed financial options. I , f 111(1 NISI 11Ip1le/1111. /1A . ` u 1 if U . I 1 11 1 ENTRUST 14701 St. Mary's Lane #150 Houston, TX 77079 (281) 368-7878 HEALTH BENEFIT PLAN PROPOSAL PREPARED FOR: KERR COUNTY PRESENTED EN: CLINT WILSON THE COOPERATIVE PURCHASING NETWORK (TCPN) REPRESENTING ENTRUST, INC. 2011 , HEA LTH BENEFIT PLAN PROPOSAL KERR COUNTY ENTRUST INFORMATION PROFESSIONAL SERVICES DESCRIPTION - 1 L • CONFIDENTIAL PROFESSIONAL SERVICES DESCRIPTION General Administration Services Summary Plan Design and Consulting The extensive skills, knowledge and expertise of Entrusts staff and management allows Entrust to set itself apart by being on the cutting edge through creative and innovative plan design. Clients benefit from the creativity and innovation offered by Entrust enabling them to have more control and flexibility with Otheir benefit plan. Since the President of Entrust has over 40 years of experience in insurance, risk assessment and self- funding, the staff of Entrust has become well - versed in advising groups in many arenas. The data warehouse serves as the ultimate tool to bring empirical decisions to the table for consideration when evaluating the needs of a group. The functional approach to plan evaluation and management is applied for each client - and is summarized as follows: Classify the employee and dependent needs Classify by categories the persons the employer may want to protect Analyze current benefits Determine any gaps in coverage Consider recommendations for changes in current plan Estimate costs attached to the recommendations Evaluate alternative methods of financing benefits Consider cost- saving or cost- containment techniques Decide on appropriate benefits and financing methods Implement the desired benefit arrangements Communicate benefit changes and reevaluate the plan Employee Communication Tools & Web Claim Portal In addition to enrollment materials for the employees that describe the plan(s) available . to them, Entrust has also developed animated email or web tools that audibly convey a message to the recipient as well as re -affirm that message in an electronic print presentation format. This proven tool is effective with an employee population that is technologically sophisticated and wants to access enrollment or health information at their convenience. These tools are custom- designed to meet the needs of the client and Entrust would be happy to demonstrate a sample of these tools upon request. Entrust also considers the medical identification card to be a key communication tool and creates them in -house on a customized, client -by- client basis. • • i ENTRUST CONFIDENTIAL. Entrust also provides secured, on -line access for employees, employers and providers so they can view claim information, such as claim status, claim payment, plan documents and explanation of benefits. This data is pulled from the claim administration system on a regular basis to a separate secured server. Compliance Services Entrust considers knowledge to be one of our greatest assets. The compliance department is responsible for preparing and reviewing Administration Service Agreements, Trust Agreements, HIPAA Business Associate Agreements & training, stop loss contracts, policy applications, related vendor contracts, Plan Document/Summary Plan Descriptions, Plan Amendments, COBRA communications and any compliance related items. It is this kind of commitment to excellence that sets Entrust apart. Automated Payroll Deductions & Automated Premium Collection Services Entrust has developed an interface with Human Resource software, such as PeopleSoft, to assist those clients that would like to electronically submit the eligibility files and receive a deduction file back that would apply the business rules required for wherein some employees are opting for certain amounts to be deducted and other employees are not having the same option. This tool is an excellent option for employees where clients may or may not be contributing to their health benefits. Entrust also has the option of using an automated premium collection system for employee contributions directly from bank accounts or selected credit institutions. Data Warehouse Analysis and Plan Forecasting Entrust believes so strongly in empirical decision - making that an integral part of our team is our staff PhD. in Business Management & Logistics, specializing in Decision I Sciences, who is available to assist in extensive forecasting and plan analysis. 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 evaluated. If extensive plan design changes are contemplated then a new plan can be built within the claim system to forecast the potential impact to the group and thereafter such data can be brought over to the warehouse for comparison analysis. Based on the needs of the client and extent of the research desired, there may an additional fee for these services. Consolidated Billing and Payroll Deductions Entrust can offer Consolidated Billing and /or Payroll Deduction services. An electronic interface has been built with payroll systems, including People Soft, so the client cart receive an electronic file of deductions on various products to be taken out of the employee paychecks. The client can also consolidate their billing of life, STD, LTD, health and /or ancillary products onto one bill for administrative ease. The consolidated bill can be customized so it is broken out by sub - group, location or other distinction. 2 ENTRUST • CONFIDENTIAL Trust Accounting Entrust adheres to the most conservative interpretation of ERISA and creates separate' Trusts for each employer plan sponsor to deposit funds and pay plan related costs. The funds from every client are not co- mingled with any other employer funds so true plan assets can be tracked and defined. Entrust provides trust accounting services using; either Peachtree or Quick Books accounting systems, and most clients request we perform monthly reconciliation of their accounts. Checks which are generated from the' claim administration system are electronically transferred to the accounting system so manual error factors are minimized. HIPAA Training Entrust offers annual HIPAA Privacy training at no extra cost for one location. As part 01 1 , training, the Plan Sponsor receives a binder that contains important information,i including sample HIPAA forms, necessary to become and /or remain HIPAA compliant) Additional training is available for multiple locations or other times of the year at an additional fee upon request. Disease Management population is available at an additional fee and can be used to manage risk dynamics. occurring within the group on a customized basis, COBRA, HIPAA and MEDICARE PART D Services Entrust offers the Plan Sponsor the option of full COBRA, HIPAA and Medicare Part D administration. A brief summary of services includes HIPAA Certificates of Continued Coverage which are mailed after termination, a general COBRA notice that includes the agreed COBRA rates, provisions of the Election Notice, tracking of payments and notification of late payments; Medicare Part D creditability assessment, notification of creditable or non - creditable plan status and assistance in residual drug subsidy, if applicable. The Plan Sponsor is responsible for notifying Entrust of any and all qualifying participants. Capitated Rx Program and PBM Coordination Entrust can provide client's access to a fully- capitated prescription drug card program: and the more traditional fee- for - service program for their consideration. We provide our . client's access to a select group of Pharmacy Benefit Managers (PBMs) who are responsible for the ongoing administration of the capitated prescription component, as well as the traditional fee - for - service model. Costs for these services will be based on, the level of coverage selected by the client, prescription drugs they desire to be covered, and plan participant level of cost - sharing selected. Participating pharmacies! will vary based on the PBM selected to administer the program and location of any plani participants. Entrust maintains the eligibility for each employer group which is then; electronically submitted to the PBM on the frequency they requires. Entrust will assist' the client in plan design, benefit coverage levels, and billing administration but the PBM' manages and administers the prescription claims. 3 ENTRUST CONFIDENTIAL'. Plan Modeling Capabilities Benefit plan modeling assists the plan administrator in projecting risk exposure by adding empirical credibility to the projection process. The process of plan modeling requires the administrator, at the direction of the client, to reprocess actual past claims, through a new benefit plan design in order to estimate how the new plan would have performed using last years claims. Various plan design scenarios can be "modeled" in order to more accurately estimate what would happen in future years. The process is to answer with a higher degree of credibility a variety of questions; such as, "How would this plan perform under a different deductible concept "? Note: Some of the value -added services listed herein may, or may not, be at additional costs depending upon the current or future needs of the client. • 4 ENTRUST . • • • _ yea 4 .e .$ n$ �' m i sa 445 • reiNANciAu ' TERMS & CONDITIONS 4 Proposal Terms and Conditions 1 1. 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 based 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 coverages) 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 24- 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 an 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 bytheTPA. 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 57.50 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 guaranteed 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% of the first month's census, times the factors, times 12. The exact minimum aggregate will be provided in the carrier's proposal, application and master contract. 12. 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 fumished 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 12- 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 Specific Deductible(s) may apply after receipt/review 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 protected to have expenses In excess of $7,500. All claimants currently pregnant indicating the expected due dates. 19. Receipt and review of update aggregate and large claims through the 30"' month of the current contract period. 20. 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E $ 1� . x § WI WI s W WW1 u i s cc= 1 3 2 3 d d !^ c W 4 a m _ _ 1 e ate€ �� �aa a = a 9 N 0 N IT ry 8 44 Y N r H A r N CC t n u E a l a u_ l W 11- 2 v — N itd N 3 17 4i H N c a AA 1 B a l gl] CCC E e y E g '� S , c c 8 9 E I g $ g $ j 1 ` ����°i a g a 4 a a E H I1ii I !ih ll J N a S 11 v g 1 HEALTH BENEFIT PLAN PROPOSAL 1 • -.. • KERR COUNTY BENEFITS . Es . i NEW DEDUCTIBLE CONCEPT • 1 1 , " A New Deductible Concept - Now 30 Years Old" I Why 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 budaetable claims — claims tit a patient must recognize as port of their daily cost of living. I • Patient involvement in the economics of purchasing healthcare services in a way that is budaet41q — I 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, unbudaetable, healthcare expenjes — not expenses that could and should be worked into the family's budget. For most American families, it is impossible to budget on an annual basis. Monthly evaluation of exp nses is routine; e.g. car payments, rent or mortgage payments, credit card payments, etc. A monthly timef�ame i I people relate to "monthly cash flow". Then, why do insurance plans contain deductible provisions that re•uire I 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 hospital /surgical benefit, the $100 Calendar Year Deductible per person rapidly became the norm. Times mere different! A $100 Deductible per person represented an investment of more than one week's gross income fo 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 adjustment ; i.e. higher rent, bigger car payments, growing credit card debt, etc. Many American businesses prospered during ose 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 Dedu tible unchanged way beyond its logical, useful lifetime_ I 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 $4000. A patient could face having to write a large check to have medical tests, surgery, or hospitalization and; most Ilkely, the required funds would be unavailable. Also, since a high deductible is perceived as punitive, it tended td fuel excessive utilization. Once that "high" deductible had been satisfied, the patient had the balance of the calcindar year to over - utilize services without impediment. People instinctively seek a return on investment — gettinc the most from a plan. What they don't realize is this action increases claims, creating a need for greater premlui is to cover the risk — a vicious circle! 1 • r i I "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. ;1 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. Pursu ng a different, logical alternative was too enterprising. Why not create and promote a deductible provision that en bled a covered family unit to budget for their share of their covered medical expenses incurred in a Calendar Mont ? It would accomplish the following: I • The covered family (one or more covered persons) could pre- determine, budget for and; therefore, assume n rengell • IP mPnnia,, it .., • . . ..... .. ' . .. . (an iiine hudnatary timafrnm (mcn M that represented a maximum deductible liability for all 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 ,tor 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 /consu hers 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 it 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 simian 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. i • Routine maternity claims are usually subject to only one Family Monthly Deductible (FMD) exposure 1 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 $1,000 or more isn't a big deal — to the average family it can be a significant barrier to appreciation and acceptance. Over the past 30 years, with rnore than 2,000 case -years of experience, the Family Monthly Deductible (FMD) has been a valuable tool, enabling Itlans to optimize the balance between cost of coverage and value to the plan participant. The Family Monthly Deductible (FMD) should be an integral part of any FNTRV$r HEALTH BENEFIT PLAN, ■ ALTERNATE $1,000 FMD 80/60 PLAN OF BENEFITS 4 Kerr County $1,000 FMD 80/60 In- Network Non- Netvukork Routine Medical Expenses - Convenience Care Visit 510 Copay to a max of 5100 per visit 60% after Dec uctible - Office Visit $25 Copay to a max of $350 per visit 60% after Dec uctible - Specialist Office Visit $25 Copay to a max of $350 per visit 60% after Deductible - Diagnostic X -Ray and Lab $25 Copay to a max of $350 per visit 60% after Deductible ' Urgent Care Facility Visit 550 Copay to a max of 5500 per visit 60% after Deductible Hospital Services e- nea.. -�I.. - Out Patient Services 80% after Deductible 60% after Deductible - Emergency Room Visit $250 Copay to a max of 51,000 per visit 60% after Deductible Deductible (Family Monthly Deductible) Per Covered Family Per Calendar Month 51,000 FMD (Limited to 54,000 in Deductible Exposure) Coinsurance Out -of- Pocket Limit (Does Not Include Deductibles or Copays) - Per Covered Family Per Plan Year 52,000 54,000 Other Medical Services - All other Medical Services 80% after Deductible 60% after Deductible - Wellness Benefit Covered at 100% 60% after Deductible - Childhood Immunizations Covered at 100% 60% after Deductible Medical Helpline (Ask - A - Nurse) Registered Nurses are available 24 Hours a day, 365 day a year, to answer your healthcare questions and offer advise of various treatment options and cost .... AVAILABLE AT NO ADDITIONAL COST TO YOUI Prescription Drugs - Generic Drugs $10 Copay for a 30 - Day Supply Formulary Brand Names > of $30 or 30% Copay for a 30 - Day Supply - Non - Formulary Brand Names > of 530 or 30% Copay for a 30 - Day Supply Lifetime Maximum Benefit Plan Year Maximum Benefit Per Plan Participant 51,000,000 - Lifetime Maximum Benefit Per Plan Participant Unlimited ENT3.UST ALTERNATE $1,500 FMD 100/60 PLAN OF BENEFITS ' d I � Air Kerr County $1,500 FMD 100/60 In- Network Non- Net v Routine Medical Expenses Convenience Care Visit 60% after De .uctible " Office Visit The First $750 Individual / $1,500 Family of 60% after D- • uctible Specialist Office Visit Routine Medical Expenses (Illness Only) is 60% after De uctible Diagnostic X -Ray and Lab covered at 100 %, then Deductible Applies 60% after De uctible Urgent Care Facility Visit 60% after De • uctible Hospital Services r fndurH .. OurPatlentServices 100% after Deductible 60% after Deductible - Emergency Room Visit 100% after Deductible 60% after Deductible Deductible (Family Monthly Deductible) Per Covered Family Per Calendar Month 51,500 FMD (Limited to 54,500 in Deductible Exposure) Coinsurance Out -of- Pocket Limit (Does Not Include Deductibles or Copays) - Per Covered Family Per Plan Year $0 $4,000 Other Medical Services All other Medical Services 100% after Deductible 60% after De uctible - Wellness Benefit Covered at 100% 60% after De uctible Childhood Immunizations Covered at 100% 60% after De uctible Medical Helpline (Ask - A - Nurse) Registered Nurses are available 24 Hours a day, 365 day a year, to answer your healthcare questions and offer advise of various treatment options and cost .... 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