Checklist • • Implementation of account Rememumn nibble for enrollment mee®es Minima= dme between snlectim and monument including all standard enrollment materials Additional Cat for Sava s by SPA/ bump= Company 'Steadied earog®t remolds mclwdoa: • Benefit summaries • Benefit =rash In ritlafj�t shores) • Eat Eons and brethren • SOW)N provider ding es Y '�. Emdlmma kk kdtd f aadduag pelage Mailing Cam hrJVhdfNot included Bulk =tiling of emonmem kis ina gcamtb to satisfy 115% ddible employees Haar tooling of enrollment kits - ledhAdml identification Sladad m Cant moducdao and' Emmett CD Cads m=ild to have address Ongoing =vice and account management wade the &once of m accent =ago Drafts of Smnmay Pion Deschmims (SPD's) provided with 2 proofs per document electronic fa nx Pr'vnag of Summary Plan DaaiptionstSPD'si madded. Qsamity of 110% of membership. Cost of printing SPDS including mailing to Mt known address Become eligtliiity confmuoe based upon a single sconce received at bast monthly but not more dm once per at in tom= gam ®yf1PA stadad forma HIPAA Naiecarirm for newly hired employees HPAA Notifssation for newly Ind =erne= cost for service Issuance of Cattlemen of Creditable Coverage (HPAA Certificates to employees and dependents upon terto ®doe of employment whether covered tide the plan of bane fias re not and/or men remind Amon goverment filings of 1099 scone to the IRS tegoduta paymem made re providers Provide required data if necessary to =able asmedto fee F=en 5500 Instance Com par&TPA =win fiduciary respmctbifky for claim Wsmenb a mass of specific Banking Cmaal banking - are bank =cant aubbsl d at bank al choice Ind time required toemnplete beehive anmgem=a Positive Pay(sa m fee.Pmyamming fmPEPM Rot '7BI 19 • Standard banking reports on a monthly basis to ackda Derail Daily Staauics. Summary and Net Chnge Dsmbudm, aM Issued-Na-Paid Outstanding cheek moons Insured provide depart and mmtaha a balaxe a bads account equal lo amount of mature paid cbfm opened to be paid daring aI or 2 day wad deomd on method ofamsfer Inured pieaahoriam tearOen of fury to coca drafts cleared during ! working day paled for FdWae and 2 weekiov days for Autpmmed Clearing Reuse Insured finds a at balance bank case vac a week after clam decks breve bent produced and approad by 'used. • • • • • • 1 • • Employer eServices • • Acura for all members W msieencw'rpmm Wbsire providing a private, settee. easy to use Macaw fa member senior including: • l Cairn E • fN information S ar • ercbeb for nava* provides • Pixel =swag to Frequently Asked Questions • Order =War ne t ® Cads e Faepbw aevidedaa -I a exam] based statistical and rtmmeal teams' Cost for denims Underwriting Services Overall anual Plan yea end temcilvtion Cla®atgemm And ra * aj Dn of impact for lear Animal pvjecti Armof dean equivalent news Annual mum estimates Actuarially determeed and amfed COBRA eaves Claim Services Plan itnplemenceice of Insures employee benefm arms. set up of plan design. eligibility dap and a tstee &semple claims prim to effective date Estimated Lead time mbe online effective October 1, 2009 Claim o' sing service Claim Animate saviea including payout control. eligrbiii maugnnem. prospective Saud and abuse denaiaa and control. bundled and wb ®dkd billing disputes - Standard claim fang and ID cards provided under Insureds name Standard COB for all claims Submi tMe d • finenal oxmal Cost foeSebrcadna • Pm&snon ad dimbntion of sanded EOBs mampbvee• if applicable Utilization Maagentei to valuate claims prior an payment ==sure that members m receiving appropriate are and m guard egaivst inapproprialr payments Cost for Utilization Management Audits am required so be in the Agreement including audits during coma paled and up to six molts folloamg termination. Insured or its epresauauvn may pefom an annual audit al its an expense subject nwd5ntion to the provider! TPA of de sanded requirements regarding pommarm eraaymiality 'math rime we DI.T awl WWI RB.0 guetrlina f:romof nervmck surgical medical. lab and Fray claims using what conceal meat end coda What are DON charges? Toll-free aeons on aeustomer service unit during normal business hours 8 AM m S:30 PM CST valudino bi.li•av4 moesenadva !, Ron Off a Rim to unites Vaifable H =au1 Discounts vaifabe Physician Deana !, Network Access DON Negodadon Clangs Formula for 'cexrmining Dimas If Fees at risk what amamt • • • Prescription Benefit Management Services Pharmacy Sat including nenvoi access. cvamsc r and wmpcmw °Mirada, review and • me management. claim processing and adrydcaioo and customer service Pocemge ofsmbarebates shaed/rnethadobev Costa tam tome TS= Famvluy . Soo:akv Mat Oelmc ral amhiliry Qt teem database Md pmerie akeRmcsetmoraadiadms.ete AWP thwart Depmmg feeRa • RebvJR Pr:fa rel Network (sue and name) Mail Savior', Ate game add®oil TPA imposed admen fees?'i. Optional Customer Reporting Services 24 - 7 Optical] Customer Reporting System in addiem to last 'sandaled reporting package Ad hoc customer generated nom, or standard repam at a men - Branded frequency Awacation of sot/M:1630 saviors Esde mai Clain whew for claims Cobra Services COBRA Direct Situ Administration Bismg and Collection): Din tacicss Din Klan. alkedan, and dsmLOdoo services Being donna= COBRA Setae martaewin magma comwnies Saaatlad va°Bment tics Claim wofi atim °wort Bank Ace= C OB evices Sd tand COBRA Report fkmiBVmn. Np4 Service OP Set-up w fore inclod Se time/ Cmmered cove lea, (am tee/ PreSdea:ia Pelage New Hire NaEfaaraop ach)mg: go- ,m.(nne Mme) Notification letters • • • • A Stop Loss Rating Assumptions Individual Stop Loss v v The AeovelyioWatptmisien maybe waived. subject to disclosure of tosses fatlaimcpaid by me prior conic. This Discos n Statement maybe completed up to 90 / 6& 10115 prior m curd of plan year Required no btu than 15 days offer the effective dam. Does the Sumacs CoTPA resavet a right to set sepame hdivideal Stop 3oss Risk levels or exclude specific individuals from coverage based upon the Disclosure Statement (A sample of the Dbdasw Form is provided at the end of this document) What is canna am? Incurred and Brad dams? Pre-Existing cadiion 'Western will cot apply to employees covered wder the eunent plat Prescription Drug Claim are mtiWdhxclaal from the Individual. Stop Loss benefits Are gfdoo maximums teiesmed a do roes assume a wry over of the lifetime lima or liabiim of sd.000moD.• Apdre#ate Stop Loss Not required but if included Individual claims above the selected bavapi Stop Loss levet will not cow toward setbfamm of the Avmroam Apwhmmt Point Rates shown m attachment assume W medial beoeft under the potcyhwrca:t are included m cdahtmg the Individual and Aggregate Sam Loss benefit, except for the followig: Benefits fa setieu. cored pier to the effective date of dt policy. Lerma in excess *rowel and msamav for out of mwork claims '. Losses associated with services nl *Wlie the we considered WabxmL Losses associated with benefit not covered bytheamderiying employee bmeft plass b are mWteles paid by d atRlgx en Plan. ptuaivdon D claims will be olorkd A, p aeaLoss e Sep Loss benefits The offer of Aggregate Stop loss is sediment mat the purchase of • Individual Son toss from setae caste. Aggregate Stop loss Fema ac adr®stetd m a ofd e first basis. minimum The minimum attachment palm wpl be sr/bandeau sr/bandeau of the st month's=tam= times to Attachment Factor times 12. Is the M.anhly Accommodation feature *cabbie? The pellet's limit of (ability is I .000.000during each coley seas - • ill • • • • Non- Standard Services Additional Claim Services • Annual rt sumo° of m cards to all employes if changes a bane% do ore occur Nat- aavmtd T3mss. •aria copies oflOBs sent to the empbse Claim mdits .regested amide o l d s a adad swats EAP - Single smear f assistance in ro ging health, pasmut rutty and work -related ism. ,i Member have tog-flee 24-hour access to registered =arse and master's level counselors as well as a eadanwAe naive* of fl mein comae= and amormys. Additional Account Management Services - chamssn mmmtexiedmmaterials Catania= leader d'¢ceaia trmkvm seddanooa seven apaofc to (name Additional draft£ pr the SPD Cmmmved mating of SPD's E4gai&y informed= seeaved in papa forma, aco atadard Canna tdlor realer than tore svanisswm tar aomh. Provide claim information ad reports for th"vd party Sap Loss Insurer Mulpk bank accounts adror multiple dins coda :tuna a0to[mfl of each individual tender tdrviiu[ammao policies l Nooshodad coal that Maude asw®'I bends awotaus, foreign language translations. =camera Proofs- adaccess to heal ap'vioes f negtdaed agreements Performance Guarantees _ Claim cycle time Wanted from due a dum claim is received to to due precaad it paid ar denied w/o 'adjacent info had m e net savor) Financial Amncy(defaad as pvemuge of dollars red oamv'y. =lc fen= by dividing mod eh= dollars d less the absolute valise( ovcpavoo s/ lemnmrms by as dawn da0ms oat) Payment A y (define a % of claims pd entreaty. Galsd by dividing and number of casectlY d by total wader ofckims d1 Abmdommt Rae (Percent ofallas the hag m prior 10 reaching a Cairo swim mwmeomcve) Telephone Response (Percent of tags amwed within 'a' secede) Pricing Assumptions The savior ad/aampage effective Octet= 1. 2109- Smrafn 30.20 t0 Multiple vat emratea included? Quoted rates an bad on losses sal claims wit dare of services nn or after the effective date (ie no nee al There will m change a the =set roopttrdo kveb. which an assumed m be at least 51% emoava contributions For ematrees ad 25% for demotes. as. Comae is armament upon a minimum pateri mm of 50% of eligible emNarms. This gmdat assume n ataodtd Romance Co'IPA acmmtov sneeze: Suffixes ere reelable to mrmdaw separate chins meats for efferent =befit elms. Claim awaits to aarammdme separate claims dais for Iot/aaws =dolans. Vendor reserves the right to mine this quotation amd¢ dm following circumstances Yes/No. I. Thenmber d covered employee and depedaa 'ceases or deer-sees by mac tar l0% from what µ.shown a the fmmiat rate ednbii 2. Tlmbemfa or service requirements requested a Wor quote change prim m or after to drachm dace 3. An media not made within 90 dam of the issuance of this m tU1. 4. Changes it federal stare or other applicable legislation or regulation require cbanga m this quotation. Is the Insured remind m sign to Admirusnuvssa dare viee Agreement =or to the effective d o of de= prcesmg services. Coukt te effective date be&lard if to Apeman µ not signed All Fe payment Intros are required to be specified in macs. Including Ttradm Ceram. The due daze of fees la the fast of to month. Are Foo santerweeany wimdmn tram Insureds uacoom IS dam an anat mvmet ±n t for late payouts. Yes et No Skid Cam= is for 12 maths. if parley is cancelled before to end of the fns 12 molts is a • full 12 months of premium reneged to te paid based on the last mode full enrollment. Yes/ No • • • • •