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HomeMy Public PortalAbout010_010_Combined Benefits Broker Services Agenda March 19 2015 MAYOR FE CITY MANAGER Jason Buelterman ;x.. Diane Schleicher CITY COUNCIL kiR CLERK OF COUNCIL Wanda Doyle, Mayor Pro Tern 41. Janet LeViner Barry Brown Paul Wolff Orf0,0''" CITY ATTORNEY Bill Garbett CITY OF TYBEEISLAND Edward M. Hughes Rob Callahan Monty Parks City Council Agenda Item Request Council Workshop Meeting Date: Thursday, March 19, 2015 Purpose: The purpose of this agenda is to obtain the City Council's approval to acquire Benefits Broker Services from Midsouth Benefits. Explanation/Description: The City of Tybee Island issued a request for proposal ("RFP") to acquire Benefits Broker Services to assist the City of Tybee Island with the strategic plan, design and negotiation of the most cost effective employee benefit programs as well as the implementation and ongoing service of the program and development of an effective wellness plan. The City is constantly competing to recruit and retain the best employees possible. Our management is looking to ensure we have financially competitive and affordable benefit programs to offer our employees. The City has had the same Benefits Broker since 2003, and in the proposal submitted by that broker, they stated that proposal said the broker plans to keep everything the same and continue to provide the same level of service as provided since 2003. The only thing constant in government is change; therefore,there is a constant need for strategic planning. The City must update and enhance the plan designs and benefits to ensure that the City's entire benefits package remains competitive for hiring purposes. The plan must be sustainable financially and be able to identify the City's focus and objectives, both in terms of a short-term and long-term plans. This means doing things differently and thinking outside the box and exploring other opportunities. The demographics of our employees represent its' own unique insurance needs.These needs have to be balanced against the city's needs, past experience, budget and benefits philosophy. The planning and implementation of employee benefit plans includes the City Manager, Finance Director and Human Resource Manager. As the demographics of our employees' changes and ages, our health benefits cost will increase or fluctuate over time. The only real way to impact the rising healthcare cost is to lessen the need for healthcare. This is accomplished by creating a culture of wellness within the City's organization by providing access to resources and information to help educate employees on how to retain a healthy lifestyle or give employees ideas and suggestions on how to reach a healthy lifestyle. Providing City employees with a comprehensive benefits package is no longer simply about providing them with the basic life, disability, and medical and retirement benefits'. As the Director of Finance and General Administration my objective for the City is to create an holistic approach in development of a comprehensive wellness plan and implementation of that plan for employees, as wellness is not limited to the your weight, diet, and exercise. Wellness entails treating the whole person, body, mind and spirit. If an individual is dealing with work stress and personal stress they are less likely to focus on their personal well being and health. The City will benefit from having employees who are healthier and feel good about themselves, physically, mentally and emotionally because they will become more positive and productive employees. With that said, the recommended Benefit Broker Service company selected can provide the services needed by the City and its' employees. They will assist us in developing a wellness program and prepare a cost analysis for executing the program. P.O.Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749 (866)786-4573—FAX(866)786-5737 * www.cityoftybee.org *Ctrulicd % Ethics RECOMMENDATION: On March 2, 2015,the City of Tybee Island received four proposals to provide Benefits Broker Services to the City. The names of the proposers and their ranking are listed follows: 1. Midsouth Benefits 2. MSI Benefits Group, Inc. 3. The Greer Agency 4. The Hardeman Co. Of the four proposals submitted, Midsouth Benefits Company is recommended to provide Benefits Broker Services to the City of Tybee Island for plan year beginning July 1, 2015 with the City Council's approval. Benefits Broker Services - RFP 2015-662 Criteria for Evaluation and Award RFP 2015-662 CRITERIA PERCENTAGE The Hardeman Co Midsouth Benefits Greer Employee Benefits MSI Benefits Group 1 Ability to provide a level of service sufficient to meet the City of 20% 8% 18% 7% 12% Tybee Island's needs. 2 Extent and success of previous work your firm has provided to 20% 10% 19% 14% 15% organizations similar in nature and size to City of Tybee Island. 3 3.Proposal itself 20% 5% 20% 8% 12% 4 Experience of key personnel to be assigned to the project 20% 8% 16% 10% 8% 5 Adherence to RFP requirements,including:completion of all 20% 8% 19% 10% 12% required forms;provision of all requested information;adequacy of responses,and return of the RFP by the stated deadline. TOTAL 100% 39% 92% 49% 59% Midsouth Benefits is located on 4994 Lower Roswell Road, Marietta, GA 30068. Of the four companies Midsouth Benefits presents the most professional and adequate proposal, answering all questions in specific detail. Midsouth Benefits are a Certified Woman's Business Enterprise. The company shall assign four employees to provide services to the city throughout the year which includes two account managers, senior consultant and the director of compliance and communications; the company focus is on the small employer group market where plan design options and funding mechanism are limited and simply to ensure the company receive the attention that small groups require. For the first time, employees will be able and allowed to sign up for benefits online which will assist the city in streamlining the administration of our benefit plans. During open enrollment the Midsouth Benefits will provide an Employee Handbook Book to each employee and a power point presentation explaining the city's benefits. In addition, they will provide the city with an auditory power point presentation for the city to use to show newly hired employees explaining the insurance benefits available. The company shall provide the service of reconciling our monthly insurance bills to ensure accuracy prior to the bills being paid by the City. They will provide educational and wellness newsletter to employees. They provided a detail timeline of their plan to acquire insurance coverage for the city in order to meet our July 1, new plan effective date. They will help the City develop a compressive wellness program and prepare a cost analysis for having the program. On March 24, 2015, Midsouth Benefits is conducting a HIPPA training webinar and the training will last for one hour and they have invited me to participant. Following HIPPA requirements is a Federal law and is crucial to our employees' rights to privacy. Therefore, I want all of the department heads, managers and supervisors to attend the training. Once we have attended the training, Midsouth Benefits will give each person with the required HIPPA annual training certificate. This is a service that has never been offered to City employees by our current broker,yet receiving training for HIPPA is annual requirement. BUDGET/COST: N/A ATTACHMENTS: Yes 1. Attachment A— Reference Response on Midsouth Benefits 2. Attachment B- Request for Proposal for Benefits Broker Service; 3. Attachment C— Midsouth Benefits Proposal for Benefits Broker Service 4. Attachment D— Draft Agreement between the City of Tybee and MidSouth Benefits Submitted By: Angela Hudson, Director of Finance and General Administration Comments: None 31 ATTACHMENT A REFERENCE CHECK ON MIDSOUTH BENEFITS FOR BENEFITS BROKER SERVICE RFP#2015-662 BENEFITS BROKER MIDSOUTH BENEFITS - City of Norcross - Kimberly Turpin 770-448-7086 Overall Satisfaction Excellent!Very happy with Midsouth Ease of Communication Great. Personal rep is lust a phone call away and offers immediate assistance. Benefits package Extremely satisfied. Wellness Program? Starting one now Training for New Employees HR handles training,but there is a guide provided City of Fairburn - Abril Montano 770-964-2244 x111 Overall Satisfaction Beyond Satisfied!Always has the interest of the company in mind. Ease of Communication Very accessible.Rep has been known to call a Drs office when necessary Benefits package Very happy,and they are always shopping,looking for better deals Wellness Program? Working with HR to develop wellness program Training for New Employees Training done once a year,handouts for HR in the event of new employees Town of Tyrone - Sandy Beach - 770-487-4038 x104 Overall Satisfaction Extremely satisfied Ease of Communication Easy!Very good customer service from individual representative Benefits package Great rates.One year their rates went down when all others went up Wellness Program? No.They have less than 40 employees Training for New Employees Not needed ATTACHMENT B CITY OF TYBEE ISLAND REQUEST FOR PROPOSAL - BENEFITS BROKERS SERVICES ATTACHMENT B 44 , RFP #2015-662 CITY OF TYBEE ISLAND TYBEE ISLAND, GEORGIA IS ISSUING THIS REQUEST FOR PROPOSAL FOR FURNISHING THE PRODUCT DESCRIBED HEREIN: BENEFITS BROKER SERVICES Respondents shall offer services and materials which may be upgraded with optional services and materials which may not be purchased at time of award. Bidder shall specify in the proposal the delivery schedule for the products and services from time of notification of award of bid. PROPOSALS ARE TO BE RETURNED NO LATER THAN: MARCH 4,2015 AT 10:00AM PROPOSALS WILL BE OPENED ON MARCH 4, 2015 AT 11:00 AM AT CITY HALL. ALL RESPONDENTS ARE INVITED TO ATTEND. The City is seeking a total bid package for service/materials equal to or exceeding specifications set forth on the attached pages which must meet or exceed stated specifications. Those not meeting these standards will be rejected. The attached material specifications become and remain a part of this request for proposal All responses, inquiries, or correspondence relating to, or in reference to, this request for proposal, and all reports, charts, displays, schedules, exhibits and other documentation by the respondants shall become the property of the City when received. All proposals submitted in response to this request shall become the property of the City. The City retains the right to use any or all ideas presented in any proposal, whether amended or not. Selection or rejection of the proposal does not affect this right. Mail proposal to: RFP#2015-662 BENEFITS BROKER MELISSA FREEMAN 403 BUTLER AVE PO BOX 2749 TYBEE ISLAND, GA. 31328 Inquiries or other need for clarification in this document should be submitted no later than February 24, 2015. Email questions only: Melissa Freeman Email: mfreeman @cityoftybee.org 1 Page Bids shall be submitted in a sealed envelope, clearly marked on the outside of the envelope, to the office of the above address prior to the time specified. Signature of bidder indicates that bidder understands and will comply with attached terms and conditions and all other specifications made a part of this invitation for bid and any subsequent award or contract. All terms, conditions and representations made in this invitation will become an integral part of the contract. Nothing contained within this RFP is indicative of intent by the City of Tybee Island to reimburse the bidder, in whole or in part, for any costs associated with preparation, submission, or presentation of proposals. WAIVER: The City of Tybee Island reserves the right to reject any or all bids received. The City reserves the right to waive any variances from original bid specifications in cases where the variances are considered to be in the best interest of the City. SCOPE OF SERVICES Purpose: The purpose of this Request for Proposal (RFP) is to seek qualified brokers to assist the City of Tybee Island with the strategic plan, design and negotiation of the most cost effective employee benefit programs as well as the implementation and ongoing service of the program. The City of Tybee Island has approximately 92 full-time and 26 part-time employees. The City is constantly competing to recruit and retain the best employees possible. Our leadership is looking to ensure we have financially competitive and affordable benefit programs to offer our employees. Broker Period: The broker designee which results from the awarding of this RFP shall begin services as Agent/Broker of Record immediately following notification of proposal approval. The term of service shall continue until any subsequent (Request for Proposals) RFP for the same services is issued and awarded, or a 90 day advance notice given by either party to severe services. Respondent Qualifications: The City requires qualified respondents to this RFP to be Licensed Brokers in the State of Georgia that are independent and not employees or affiliates of any insurance company, third party administrative agency or provider network. The brokerage firm must have not less than 5 years' experience in providing brokerage services to employers with at least 100 employees. Experience in the provision of brokerage services to public sector employers is required. Scope of Work: Brokerage services to City of Tybee Island under any agreement ensuing from this Proposal will entail the following, at a minimum: 1. Auditing resulting contracts for accuracy of coverage, term and conditions. 2. Assisting with annual benefits renewals, including negotiation of changes in contracts. 3. Assisting the City in determining specifications for future insurance coverage. 4. Marketing the City of Tybee Island's desired insurance package through identification of appropriate markets, analysis of proposals, provisions of recommendations, and assistance in contract negotiation. 5. Preparing, disseminating, and analyzing carrier proposals packages in accordance with City's specifications. 2 IPage 6. Reviewing the employee benefit package for quality of benefits provided, cost effectiveness, competitiveness and plan administration on an annual basis. 7. Monitor ongoing contracts, including third party administrators, to insure contract compliance. 8. Analyzing claims history and insurance utilization at least quarterly. 9. Providing information on employee benefit issues, trends and proposed or new legislation. 10. Meeting with the City of Tybee Island administrative staff as needed. 11. Assisting in the design of employee benefits communications and participating in Benefit Fairs and annual enrollment process. 12. Providing a key contact person to be available to answer questions and resolve issues that arise during the year regarding employee benefits, contract administration, and service provisions. 13. Evaluating various insurance products submitted for consideration by insurance carriers. 14. Perform other related benefits consulting services as needed or requested. 15. Assist with compliance in: QRS Form 5500's, EE01 reports, Legislative updates, FMLA Regulations, Employee Communications, and Open Enrollment Communication. TO BE INCLUDED IN RESPONSE Broker Proposal Questionnaire: The proposal response must clearly demonstrate the required qualifications, expertise, competence and capability of the vendor. Please provide a concise description of your firm's ability to provide the services required in the Scope of Work section of this document. Costs incurred by firms responding to this RFP are solely their responsibility. Additionally, please include the answers to the following questions (Address each by number): 1. Describe your organizational structure (i.e. publicly held corporation, partnership, etc.). How many employees do you have in your organization and what are their job categories? 2. Confirm that you are a licensed broker in the State of Georgia and provide documentation. Confirm that you serve as a broker, independently, and are not employed by any insurance company, third party administrative agency or provider network. 3. Briefly describe your company's organization, philosophy, and management. Also, please provide a brief company history. 4. Describe your contractual relationships, if any, with organizations or entities necessary to your proposal's implementation (i.e. actuarial services, data information services, etc.). 5. How long has your organization been providing brokerage services? 6. How many public sector clients does your firm currently provide brokerage services to? 7. What is your firm's plan of communication and customer service interaction with clients? 3 8. Please provide a list of four verifiable public sector references, all of whom are able to comment on your organization's relevant experience. Please include group name, contact name, and telephone number. Please furnish for each vendor: 1. Services you provided 2. Benefit programs addressed 3. Time period covered 4.Number of covered employees 5. Contact name and phone number It is the vendor's responsibility to provide valid reference information and the City of Tybee Island reserves the right to use reference checks in its evaluation of proposals. 9. Indicate the method of service provision your organization would utilize in implementing your proposal (i.e. individual broker, individual broker with supporting back up, team of brokers). Include a brief professional history for each key individual who would work closely with City of Tybee Island and how they are qualified to provide services to the City of Tybee Island. 10. Briefly describe the level of service and support provided to the City of Tybee Island by your broker(s) on a day-to-day basis. 11. How many of your customer service employees are licensed insurance agents? 12. How does your firm provide continuing education to ensure that each broker is educated on current market trends and legislative developments? How is this information communicated to your clients? 13. Describe how you build an understanding of the direction and priorities of the City of Tybee Island employee benefit program and how you would utilize this information to recommend changes and project future trends. 14. Detail how your organization assists clients in developing a strategic benefit plan. 15. Describe your organization's anticipated involvement in the annual renewal process. Include information regarding process timeframes, negotiation of rates and vendor selection. NOTE: City of Tybee Island's current plan year for heath and dental insurance is July 1 to June 30. 16. How does your firm assist City of Tybee Island in developing plan specifications? Explain your process for providing plan recommendations to your clients. 17. Explain the process your organization would utilize to assist City of Tybee Island in selecting an insurance vendor. How would your company's experience and expertise benefit the City of Tybee Island in this process? 18. Please provide a list of the vendors you have relationships with in regard to health, disability, long term disability life, supplemental health, dental insurance, and vision plans. 4IPage 19. Describe how your organization strives to streamline benefit administration for your clients. Include any services you provide for automation of the benefit process (i.e. electronic capabilities, outsourcing options). How many of your clients are enrolled online? How many employees does this represent? Does your staff build these enrollment websites? Attach any associated costs for these services on a separate fee schedule. 20. Describe how your organization has assisted other vendors in the evaluation and/or formulation of any Healthcare Reimbursement Accounts or Healthcare Spending Accounts. Attach any associated costs for these services on a separate fee schedule. 21. Detail how you develop a benefit communication strategy with your clients. Include what tools or resources you have available to assist your clients in effectively communicating not only the specific plan details but also the value of the benefits offered? 22. What training resources does your organization provide to assist your clients in educating and training their benefit staff? 23. How will you facilitate or participate in the implementation, communication, and enrollment and training their benefit staff? 24. What makes your organization unique from other organizations that may submit proposals for the City of Tybee Island's consideration? 25. Detail the wellness plan services your company provides. Describe the firm's views on the role wellness plans have on controlling healthcare costs. 26. Provide any additional information regarding your organization or services that you feel would be beneficial in helping the City of Tybee Island to select a benefits broker. 27. Describe your proposed form of compensation. If you are proposing a fee, please include your fee schedule/rates. Customer Service/Claims: 1. Where is your customer service office located? 2. What are the hours of operation for the customer service office? 3. Describe your problem or issue resolution process. 4. Do you have web based customer service? If yes, what is the website address? Is this password protected? 5. How many employees are located in your customer service office? 6. Please discuss a customer service representative's group load, to include: a. Total number of clients b. Total number of lives administered and/or insured 5 IPage c. Maximum number of lives for which a customer service representative is responsible? 7. Would the client have a dedicated team of customer service representatives and agents? 8. What website customer care capabilities does your company offer? Please describe in detail the following, and outline any additional costs where applicable: a. On-line web enrollment capabilities (open enrollment only or ongoing enrollment) b. Group Administrator capabilities to include eligibility, change in status, address change, etc. c. Employee viewing capabilities to include eligibility, claims reporting 9. What enrollment services will you provide, and at what charge? 10. Who will be responsible for assisting the City with enrollment? 11. Who will assist the City with ongoing administration(i.e. billing and enrollment)? 12. Who will assist the City with ongoing claims questions or problems? 13. What is your customer service toll free number? 14. Does your firm provide on-site employee enrollment meetings for new hires? HIPAA / COBRA: 1. Do you provide COBRA administrative services? If yes, please explain the services provided and any cost associated for this service. 2. Do you provide HIPAA administrative services? If yes, please explain the services provided and any cost associated for this service. Broker/Value Added Services: 1. Does your firm have experience in developing Wellness Programs, Disease Management Programs, Health Fairs or Employee Assistance Programs? Please provide names of clients who have utilized these offerings in the last 24 months. 2. Do you provide a consolidate employer HR web portal to access all benefit data to include plan summaries, certificates, network links, plan costs and census data on all employer programs? 3. Does your firm provide the necessary resources to generate annual "Employee Benefit Statements"? 4. Does your firm provide an Employer Handbook? 5. What HR training does your firm provide your group clients? 6. Does your firm provide access to a State and Federal Forms Library? 6IPage 7. Does your firm provide a consolidated "Benefits Guide"? 8. Does your firm provide IRS Section 125 plans? 9. What is your website address? What capabilities does your site offer your clients? 10. What additional services does your firm provide? Criteria for Evaluation: All proposals will be evaluated according to, but not necessarily limited to, the following: • Your firm's indicated ability to provide a level of service sufficient to meet the City of Tybee Island's needs, as stated in your response. • Extent and success of previous work your firm has provided to organizations similar in nature and size to City of Tybee Island, as determined by City of Tybee Island's contact with references provided. • The proposals itself as an example of your firm's work product. • Proposals/experience of key personnel to be assigned to the project • Adherence to RFP requirements, including: completion of all required forms; provision of all requested information; adequacy of responses, and return of the RFP by the stated deadline. Pricing: It is City of Tybee Island's expectation that brokerage fees and commissions will be borne by the selected insurance provider. If additional brokerage fees are expected of the City of Tybee Island or if your firm offers additional fee-supported services which are supplemental to your proposal, please clearly outline such costs and services on a separate fee addendum. Oral Presentations: During the evaluation process, City of Tybee Island may at its discretion, request oral presentations from any or all respondents for the purpose of clarification or amplifying the materials presented. However, respondents are cautioned that the City of Tybee Island is not required to request clarification; therefore, all proposals should be complete and reflect the most favorable terms available from the broker. Final Selection: 7 IP c Following review of all qualified proposals, a suitable vendor will be recommended to the City Council. The selected vendor should be prepared to commence working on the employee benefit package immediately following proposal award. Note: City of Tybee Island reserves the right to accept the response that is determined to be in the best interest of the City of Tybee Island and its employees. The City of Tybee Island reserves the right to reject any and/or all proposals. PROPOSAL FORMAT AND REQUIREMENTS The proposer should submit one (1) original (Clearly marked "Original"), one (1) copy, and one (1) memory stick or CD of their proposal and all relevant documentation (in PDF) of their written proposal that presents their qualifications and understanding of the work to be performed. Include all information requested, organized in tabbed sections, clearly identified in a table of contents as described in the paragraphs below. Any other information thought to be relevant but not applicable to the enumerated categories, may be provided as a separate appendix to the proposal. The following information/documents must be included in the proposal package to be considered responsive to the request for proposal: All proposals must include a W-9, vendor application, affidavit verifying status, and contractor affidavit which can be found at the end of this request. About this Document - Competitive sealed proposals will be evaluated based on criteria formulated around the most important features of the service. The proposal evaluation criteria should be viewed as standards which measure how well a firm's approach meets the desired requirements and needs of the City. The City will thoroughly review all proposals received. The City reserves the right to select and subsequently reward the proposal which best meets its required needs, quality levels, and budget constraints. 8IPage City of Tybee Island TERMS AND CONDITIONS DEFINITIONS. As used herein, the following terms shall have the meanings set forth below, whether or not capitalized. (a) "Purchase Order" or"Order"means this purchase order. (b) "Buyer"means The City of Tybee Island. (c) "Seller" or"Vendor"means the party furnishing the supplies under this order. (d) "Supplies" means what the Seller furnishes the Buyer under this order and includes with limitation, the following; (1) the work; materials; articles; deliverable items, items, data and services, whether tangible or intangible or any combination thereof; and (2) what is leased or licensed, pursuant to the lease(s) or license(s) signed by both the Buyer and the lessor or licensor if attached to and made a part of this order. (e) "Loss" means any or all the following: claims, liabilities, damages, losses, costs, or expenses (including reasonable attorneys' fees and expenses and other legal costs). ACCEPTANCE. This order constitutes an offer which shall become a binding contract upon the terms and conditions herein set forth upon acceptance by Seller either by acknowledgement of this order or commencement of performance. Buyer objects to any difference, conflicting or additional terms proposed by Seller in the acceptance of this order, and no such terms shall be effective unless expressly accepted by Buyer in writing. Each shipment received by Buyer from Seller shall be deemed to be only upon the terms and conditions contained in this order, except by such written instrument modifying the order, signed by Buyer, notwithstanding any terms and conditions that may be contained in any acknowledgment, invoice, or other form issued by Seller and notwithstanding Buyer's act of accepting or paying for any shipment, or similar act by Buyer. PRICES. Seller represents that the prices, terms, warranties, and benefits contained in this order are comparable to or better than those offered to any other customer of Seller for items which are the same or substantially similar. Buyer shall receive the benefit prospectively or retrospectively if Seller offers any item or service included in this order to any other customer at a lower price, more favorable terms, more favorable warranties, or more favorable benefits up to one year after completion of this order. PACKING AND SHIPPING. All items shall be suitable packed and prepared for shipment to insure their safe transportation, to secure the lowest transportation cost, and to comply with the requirements of carriers. Buyer's order number shall appear on all documents and correspondence relating to these items. Packing lists shall accompany the items and shall include the order number, Buyer's part number, Seller model number, description of items shipped and any other information called for in the order. Buyer's count or weight shall be final and conclusive on shipments not accompanied by a packing list. Seller shall be liable for all excess transportation or other charges resulting from Seller's failure to comply with Buyer's packing, shipping, routing and delivery instructions. DELIVERY. Any delivery schedule made a part of this order is an important, material condition; time is of the essence of the order. Unless otherwise agreed to in writing. Seller shall not make material commitments or production arrangements in excess of the amount or in advance of the time necessary to meet Buyer's delivery schedule. It is Seller's responsibility to comply with this schedule, but not to anticipate Buyer's requirements. In addition to any other rights or remedies, Buyer may cancel all or any part of this order for Seller's failure to deliver in strict accordance with the delivery terms set forth herein. Seller shall promptly notify Buyer of any anticipated delay in the delivery date and Buyer may require Seller to ship by alternate 9IPage means in order to expedite delivery. Any additional costs shall be paid by Seller and Seller shall be liable for all resulting damages to Buyer occasioned by the delay. Delivery shall not be deemed to be complete until the items have been received and accepted by Buyer. Advance and excess shipments may at Buyer's option be rejected and returned to Seller at Seller's expense. TRANSPORTATION. Except as otherwise provided on the face of this order, transportation charges on Supplies shall be f.o.b. destination, at Seller's sole cost and expense. Risk of loss from any casualty to supplies ordered hereunder, regardless of cause, shall be Seller's responsibility until goods have been delivered to Buyer's designated delivery post. No insurance or premium transportation costs beyond the price listed in this order will be allowed unless authorized by Buyer in writing. If Seller does not comply with Buyer's delivery schedule, Buyer may, in addition to any other rights that Buyer may have under this order, require delivery by fastest way, and charges resulting from the premium transportation must be fully prepaid and absorbed by Seller. WARRANTY. Seller warrants that all supplies delivered pursuant to this order shall strictly conform to the applicable specifications (including without limitation information or functional performance, material content, size, appearance, response time, etc.), shall be free from all defects and workmanship in materials including latent defects, shall be free from defects in design and suitable for their intended purpose, and shall be free from all claims, encumbrances, and liens. This warranty shall survive inspection, delivery and payments shall run to Buyer, its successors, assigns and the users of the items and shall not be deemed to be exclusive. Seller agrees to indemnify, defend and hold Buyer, Buyer's employees, and those for whom Buyer may act as agent, harmless from all damages, including consequential and incidental damages, incurred or sustained by Buyer by reason of any breach of any warranty with respect to the supplies purchased. Buyer shall be promptly reimbursed for all expenses incurred in the handling, inspection and return of defective items, and Seller shall bear the risk of loss on all such items. If any of the supplies are found at any time prior to acceptance to be defective in material or workmanship, or otherwise not in conformity with the requirements of this order, Buyer (in addition to any other rights which it may have under warranties or otherwise) may at its option (1) correct or have corrected the nonconformity at Seller's expense, or (2) reject and return such supplies or other deliverable items at Seller's expense, such supplies or other deliverable items not to be replaced without suitable written authorization from Buyer. CHANGES. Buyer may at any time request in writing changes to this order in the specifications, packing, shipment, quantities, delivery schedules, and other matters. If any such change causes an increase or decrease in the costs of or the time required for performance, Seller shall immediately notify Buyer. Any request for an equitable adjustment must be made in writing with 30 days from the date of the written request for the change. No additional charge or change in the specifications, packing, shipment, quantities, delivery schedules, and other matters will be allowed unless authorized by Buyer in writing. TAXES. The Buyer, a municipality in the State of Georgia, is exempt from Georgia Sales Tax under the Sales and Use Tax ID # 302 526 178. All sales and use tax due on materials purchased by the city for installation by the seller under this contract are the responsibility of the contractor. ASSIGNMENT. Neither this order nor any interest herein may be assigned, in whole or in part, by Seller without the prior written consent of Buyer. Notwithstanding the above, Seller may assign any monies due or to become due to him hereunder, provided that such assignment shall not be binding upon Buyer until receipt of a copy of the assignment agreement is acknowledged and approved by Buyer in writing. 10 ' Page SUBCONTRACTING. Seller shall not enter into a subcontract for any part of this order, including completed or substantially completed items or major components thereof, with Buyer's written consent. Nothing in this order shall be seen as prohibiting Seller's purchase of standard commercial articles, raw materials, or other supplies specified in this order if these are typically purchased by Seller in the normal course of business. TERMINATION. Buyer may terminate or suspend performance under this order in whole or in part from time to time by sending written notice to Seller. Upon receiving notice of such action by Buyer, Seller shall immediately comply with its terms and take all reasonable steps to avoid incurring any additional costs under this order. Buyer's sole liability to Seller shall be for items completed and delivered to Buyer in accordance with this order and for Seller's reasonable costs to the date of termination, such costs being solely attributable to this order and not being recoverable from other sources. INDEMNIFICATION. Seller agrees to indemnify, defend and hold Buyer, Buyer's employees, and those for whom Buyer may act as agent harmless from (1) any and all claims and liabilities for injuries or death of persons or damages to or destruction of property; (2) any other Loss caused by or resulting from the acts or omissions of Seller, its agents, subcontractors, suppliers or employees in the performance of this order; (3) any Loss caused by or resulting from the supplies purchased under this order, (4) any intended use of products or materials provided by Seller; (5) any defective products or materials provided by Seller, including without limitation the use or disposal of hazardous and/or toxic materials, such materials to include at minimum all materials recognized by the Environmental Protection Agency as hazardous; or(6) any breach by Seller of any express or implied warranties. If Seller's work hereunder involves operations by Seller's agents, subcontractors, suppliers or employees on Buyer's premises or any place where Buyer conducts operations, Seller shall take all necessary precautions to prevent the occurrence of any injury or damage to persons or property during the progress of such work. Further, Seller shall indemnify, defend and hold Buyer, Buyer's employees, and those for whom Buyer may act as agent harmless for any injuries occurring to Seller's agents, subcontractors, suppliers or employees and Seller shall maintain public liability, property damage and employee's liability and compensation insurance sufficient to protect Buyer from any claims under any applicable law, statute, or regulation. MODIFICATION; WAIVER. No waiver or modification of this order shall be effective unless in writing and signed by both of the parties hereto. Failure of either party to enforce its rights under this order shall not constitute a waiver of such rights or any other rights. ENTIRE AGREEMENT. This order is intended by the parties as a final expression of their agreement and also as a complete and exclusive statement of the terms thereof, any prior or contemporaneous oral or written agreements as to the same subject matter notwithstanding. INVALIDITY. In the event that any provision of this order is declared invalid, illegal, or otherwise unenforceable by any tribunal or law, the remainder of the provisions shall not be affected thereby, and each term and provision not declared invalid, illegal or unenforceable shall be valid and shall be enforced to the fullest extent permitted by law. DRUG FREE WORKPLACE. By accepting this order, the Seller certifies that he shall provide a drug free workplace for his employees in accordance with the laws of the State of Georgia. 11 Page SPECIFICATIONS, PROPOSALS, BID DOCUMENTS. The documents which form the basis for this order shall include the plans and specifications and bid documents as attached hereto, together with any other documents so listed and enumerated, if any, and it is expressly understood that any special conditions listed and attached hereto are specifically made a part of this contract. APPLICABLE LAW. The provisions and performance of this purchase order shall be governed by the laws of the State of Georgia and applicable federal law. Seller agrees to bring any and all actions relating to this purchase order only in the state and federal courts located within Chatham County in the State of Georgia. APPROPRIATION. Notwithstanding any other provision hereof, this agreement shall terminate at the end of each calendar year without liability or obligation on the part of the city in any calendar year where the City has not appropriated funds for the obligations hereunder for the next calendar year. 12IPage Forrn -9 Request for Taxpayer Give form to the (Rev.October 2004) Identification Number and Certification requester. Do not rh3pertrrent of the Treaeury send to the IRS. Internal Reeenue Service ni Name(as reported on your income tax return) a m a Business name,if different from alcove v c a Individual/ Exempt from backup Check appropriate box: ❑ Sole proprietor ❑ Corporation ❑ Partnership ❑ Other! ❑withholding 2 Address(number,street,and apt.or suite no.) Requester's name and address(optional) . c aU 6 City,state,and ZIP code m. G7 List account number(S)here(optional) u7 Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding.For individuals,this is your social security number(SSN).However,for a resident 1 1 1 1 1 alien,sole proprietor,or disregarded entity.see the Part I instructions on page 3. For other entities.it is your employer identification number(EIN).If you do not have a number,see Flow to get a Titi on page 3. or Note.if the account is in more than one name,see the chart on page 4 for guidelines on whose number Employer identification number to enter. Mil Part II Certification Under penalties of perjury,I certify that: 1 The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding.or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.person(including a U.S.resident alien). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return, For real estate transactions,item 2 does not apply. For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt.contributions to an individual retirement arrangement(IRA),and generally, payments other than interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.(See the instructions on page 4.) Sign Signature of Here u.s.person■ Date City of Tybee Island, PO Box 2749, Tybee Island, GA 31328 912-786-4573 I (fax) 912-786-9465 What products/services do you provide to the City of Tybee Island: To whom shall we direct the Purchase Order? Sales Contact: Email: Phone# Fax# Location: To whom shall we direct Payment? A/R Contact: Email: Phone# Fax# Remittance Address: Our terms are Net 30. 13 ' Page t_n Affidavit Verifying Status for City Public Benefit Application By executing this affidavit under oath, as an applicant for a City of Tybee Island, Georgia, Business License or Occupation Tax Certificate, Alcohol License, Taxi Permit, Contract, or other public benefit as referenced in O.C.G.A. Section 50-36-1,I am stating the following with respect to my application of a City of Tybee Island: • Business License or Occupational Tax Certificate, • Alcohol License, (circle all that apply) • Taxi Permit, • Contract • Other public benefit for (printed name of natural person applying on behalf of individual, business, corporation,partnership, or other private entity). 1) I am a United States citizen. OR 2) I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non- immigrant under the Federal Immigration and Nationality Act, 18 years of age or older and lawfully present in the United States. * In making the above representation under oath,I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16-10- 20 of the Official Code of Georgia. Signature of Applicant Date Printed Name *Alien Registration Number for Non-citizens SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20 Notary Public My Commission Expires: Note: O.C.G.A. §50-36-1(e)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their alien registration number. Because legal permanent residents are included in the federal definition of"alien", legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below: 14IPage 1 5 ATTACHMENT C MIDSOUTH BENEFITS PROPOSAL FOR BENEFITS BROKERS SERVICES nryFN Yx[i� NO Xp.05 RFP#2015-662 Benefits Broker Services "°" 5* NAT wily WHERE WN,AE �\ Y+" k 3 ..'„,' rr r' E. & RESCUE CITY OF TYBEE ISLAND ///` • 4,, .,a . 1i, , ,, Afilk. I ME '.1, AI.,-: — -•si - A v O RESPONSE TO RFP FOR ; ' ' = BENEFITS BROKER SERVICES 41 4 March 4, 2015 Midsouth ' *tea BENEFITS \\:__, ..(441it., t .44, \\:, Ct. ! -.' \ ,Ifi. . , 6 it We Are - ? `, `_► I�ea�th Cage tr. LK Midsouth Benefits ike_.�orm? , - v/ "11P. 4 / AA . -A ,g -i ',, \ March 4, 2015 Midsouth BENEFITS Ms. Melissa Freeman City of Tybee Island 403 Butler Ave. P.O. Box 2749 Tybee Island, GA 31328 RE: Proposal for RFP #2015-662 Benefits Broker Services Enclosed is our response to the request for proposals for Benefits Broker Services for the City of Tybee Island, including one original and one copy along with one memory stick and all required attachments. As CEO of Midsouth Benefits, I attest to the accuracy of the responses we have provided. We welcome the opportunity to be considered as the Benefits Broker for the City of Tybee Island. This year 2015, is going to be a pivotal year in the employee benefits arena and Midsouth Benefits is prepared to assist City of Tybee Island with the strategic planning, development, compliance and implementation process. We appreciate the opportunity to show how we can help City of Tybee Island, its employees, and their families with their insurance needs. Sincerely, Karen Larkin, CLTC CEO OUR GOAL IS SIMPLE. TO DEMONSTRATE TO THE CITY OF TYBEE ISLAND - BEYOND ANY DOUBT- THAT MIDSOUTH BENEFITS IS THE RIGHT CHOICE TO BE YOUR PROVIDER OF BENEFITS BROKER SERVICES. ILO L 3 TABLE OF CONTENTS SCOPE OF WORK Page 6 BROKER PROPOSAL QUESTIONNAIRE: General Questions Page 10 BROKER PROPOSAL QUESTIONNAIRE :Customer Service/Claims Page 25 BROKER PROPOSAL QUESTIONNAIRE: HIPAA/COBRA Page 30 BROKER PROPOSAL QUESTIONNAIRE: Broker/Value Added Services Page 32 Attachment A—Agent&Agency Licenses Page 36 Attachment B— Pricing/Fee Addendum Page 38 Attachment C— Vendors/Carriers Page 39 Signed W-9 Page 40 Affidavit Verifying Status Page 41 Contractor Affidavit Page 42 Appendix Page 43 • Attachment D-Sample Employee Benefits Guide • Attachment E-Sample Newsletters • Attachment F— Secure Employee Assistance Link • Attachment G-Broker services/value-added services RFP #2015-662 Benefits Broker Services SCOPE OF WORK • miasout BENEFITS 5 SCOPE OF WORK This section of our proposal is in response to the request to clearly demonstrate the required qualifications, expertise, competence and capability of our firm and our employees and to provide a concise description of our firm's ability to provide the services required in the Scope of Work section of the RFP. 1) Auditing resulting contracts for accuracy of coverage,terms and conditions. All of your plan documents, including but not limited to the Certificates of Coverage, Summaries of Benefits and Policies are reviewed for accuracy and compliance. Our Director of Compliance and Communications will be in charge of making sure the contract language is accurate in regards to the carrier's proposed benefits and rates,as well as all agreed upon administrative provisions. She will also make sure that all plan documents adhere to all Federal and State requirements applicable to a governmental entity. 2)Assisting with annual benefits renewals,including negotiation of changes in contracts. Months before your annual renewal we will meet with you to discuss any problems or concerns that have arisen throughout the plan year, we will present a year-to-date claims analysis, review your goals and set a strategy for the renewal year. We do this to ensure that when we do receive your various renewals, we can begin the marketing and negotiation process immediately and with a clear direction on what changes need to be brought about and where pricing needs to fall. We will always negotiate with the carriers/vendors regarding your renewal on your behalf. We never simply accept a flat renewal without negotiating for something better. Our risk management experience and knowledge of the various renewal formulas used by the insurance carriers allows us to develop a clear and concise understanding of your best options. It also affords us the ability to communicate"at the same level" with the underwriters handling your benefit renewals. During the renewal process we do not focus on rates alone, but will also make recommendations on plan design changes and benefit enhancements to ensure that your entire benefits package remains competitive for hiring purposes and sustainable financially. 3)Assisting the City of Tybee Island in determining specifications for future insurance coverage. We will work with you to identify exposures and design the appropriate risk management solutions for your employee benefits program. There are many factors to consider when building an employee benefits program, and only a broker with years of experience can imagine the numerous variables that might present themselves. We start by working with you to collect all pertinent information regarding your existing benefits program.This includes gathering information on all major initiatives undertaken within a specific time period.We ask a lot of questions in order to obtain a clear understanding of your focus and objectives, both in terms of a short-term and long-term time frame. We then analyze your current plans in relation to your benefit program objectives, including your overall benefits package, each individual plan design, and all funding arrangements to determine design and funding appropriateness and cost effectiveness. Finally, we benchmark your current plans against other similar employers' plans. We use all the information gathered during the above outlined processes to develop a strategic plan for moving forward. 6 SCOPE OF WORK(continued) 4) Marketing the City of Tybee Island's desired insurance package through identification of appropriate markets, analysis of proposals, provisions of recommendations, and assistance in contract negotiation. Reality is,the marketing of your benefits plan is step number three or four in a six step program. So if you're not getting the before and after steps, you're not getting much at all from your insurance broker. After completing our review of your existing benefits program and developing a strategic plan, we will focus on marketing your individual benefit plan(s) as appropriate. We will request proposals from the insurance companies or third party administrators based on a specific outline of services, benefits and administrative provisions;all of which are designed to meet your objectives. Before presenting you with our recommendation, we will have worked and negotiated diligently with each carrier or vendor to ensure that we are presenting you with the best possible offers. 5)Preparing,disseminating,and analyzing carrier proposal packages in accordance with City of Tybee Island's specifications. Based on information gathered during the benefits review and strategic planning phase of our services,we prepare all RFPs to be distributed, and determine the appropriate carriers/vendors to receive the RFP based on our industry knowledge. All proposals will be collected by our office to be reviewed and analyzed based on the carrier's or vendor's proposed benefits, costs, reporting capabilities, administrative provisions and value-added services. Before presenting you with our recommendation, we will have worked and negotiated diligently with each carrier or vendor to ensure that we are presenting you with the best possible offers. 6) Reviewing the employee benefit package for quality of benefits provided,cost effectiveness,competitiveness and plan administration on an annual basis. Providing your employees with a comprehensive benefits package is no longer simply about providing employees with the basic life, disability, medical and retirement benefits;we understand this.The demographics of your workforce represent its own unique insurance needs.These needs have to be balanced against the city's needs, past experience, budget and benefits philosophy. We work diligently and carefully on an annual basis to review and analyze all your current programs, claims experience and associated costs.We ask questions, really listen to your responses, and use the information that we collect to develop a customized strategic plan for you that defines your objectives and outlines the short- and long-term actions needed to accomplish your goals.This ensures an organized and comprehensive approach to implementing and maintaining the benefits program you desire. 7) Monitor ongoing contracts,including third part administrators,to insure contract compliance. Our Director of Compliance and Communications is dedicated to monitoring the accuracy and performance of all the contracts and vendors working in a partnership with us and our clients.With input from the client,we can develop and monitor appropriate performance guarantees that are tied to claims payment accuracy and timeliness, claims data gathering and reporting requirements, case management and utilization management programs, as well as service and responsiveness at both the Human Resources level and the employee level. SCOPE OF WORK(continued) 8)Analyze claims history and insurance utilization at least quarterly. We review all available claims data for our clients on a quarterly basis at a minimum,and can provide claims data to the client on an established frequency, or as requested. We recommend meeting to review claims history and trends no less than three times a year, and work with our clients to set expectations for such reporting and meetings. We will provide a thorough analysis,comparing current data to prior periods and various benchmarks. 9) Providing information on employee benefit issues,trends and proposed or new legislation. We have a Compliance Director who is responsible for keeping both our staff and our clients informed on regulatory issues that affect their employee benefits. We subscribe to several legal and compliance services which are constantly feeding us with information that is reviewed to determine the impact to our clients,their benefit plans and/or their employees. Our Senior Consultants track industry issues and trends in order to ensure that we are keeping our clients informed and their benefits program up to date. In addition to receiving information on benefit updates and industry trends from the 20+ insurance carriers that we work with, we also subscribe to numerous magazines and periodicals that focus on employee benefits. 10) Meet with the City of Tybee Island administrative staff as needed. Our office is located in Marietta,Georgia and we are readily available to meet with the administrative staff for the City of Tybee Island when and where as needed. 11)Assisting in the design of employee benefits communications and participating in Benefit Fairs and annual enrollment process. While some brokers are only focused on working with the employer, we believe that the ability to work with your employees is equally as important. We will meet with your employees on a group basis or one-on-one. We provide clear and professional benefit summaries, enrollment material, wellness communications, educational newsletters and other resources to help keep your employees engaged in the decisions they make that will impact the benefits you provide. See attachment E for samples of our educational and wellness newsletters. We routinely prepare and present PowerPoint Presentations at employee annual enrollment meetings to assist in educating the employees about their benefits and any changes in the new Plan Year. Along with the carrier/vendor reps,we will coordinate participation in all Benefit Fairs to ensure full representation at each event. 12) Providing a key contact person to be available to answer questions and resolve issues that arise during the year regarding employee benefits,contract administration, and service provisions. Each of our clients is assigned a dedicated Account Manager to handle day-to-day issues. They are responsible for ensuring that our clients receive the highest level of service. In addition, one of our consultants would be responsible for providing you with senior level consulting services. Our Director of Compliance and Communications will work with your carrier to gather and prepare all claims data for analysis, review and presentation. Should there be a need for an audit, the Director of Compliance and Communications will be responsible for working with you and the carrier to complete this task. t3 SCOPE OF WORK(continued) 13) Evaluating various insurance products submitted for consideration by insurance carriers. It is our job to perform a due diligence review of the contracts/policies being offered to ensure the employer limits unnecessary and inefficient policies from being passed through to their employees. By allowing Midsouth Benefits to perform due diligence and make recommendations on their company wide benefits offerings,the employer can rest assured that they are giving their employees the opportunity to purchase financially sound,cost effective and valuable coverage. 14) Perform other related benefits consulting services as needed or requested. We have over 60 years of combined experience in servicing firms of all sizes—from just a few employees to several thousand. Benefit plans are complex,often requiring a risk management approach that our varied technical and financial backgrounds utilize. Experience has taught us how to interface with the different disciplines often involved in the planning and implementation of employee benefit plans.This typically includes, but is not always limited to,the human resources, accounting and financial departments. As you broker, we would look forward to any opportunity to be of service. Although the majority of work that we do will focus on Employee Benefits, we also provide services in the areas of Executive Benefits, Estate Planning and Individual Medical. 15)Assist with compliance in:QRS Form 5500's, EE01 reports,Legislative updates,FMLS Regulations, Employee Communications,and Open Enrollment Communication. We understand that there is an ever expanding workload placed on your human resources staff. With the applicable years of experience within our firm, our employees are able and make themselves readily available to assist our clients in all the above areas. Samples of our Legislative Updates, as well as Employee and Open Enrollment communication material has been provided under Attachments D and E. End of SCOPE OF WORK 9 RFP #2015-662 Benefits Broker Services BROKER PROPOSAL QUESTIONNAIRE : General Questions M idsouth BENEFITS BROKER PROPOSAL QUESTIONNAIRE:General Questions This section of our proposal is in response to the request for our answers to the following questions. 1) Describe your organizational structure(i.e. publicly held corporation, partnership,etc.). How many employees do you have in your organization and what are their job categories? Midsouth Benefits is a privately held corporation. Karen Larkin, CLTC is the CEO and majority shareholder. We are a certified "woman owned business" and member of the Women's Business Enterprise National Council, and as such qualify as a diversity supplier. We currently have seven employees on staff; three benefits consultants, two account managers, one administrative assistant and a director of compliance & communications. At this time we are currently interviewing qualified applicants for another Senior Account Manager position. 2)Confirm that you are a licensed broker in the State of Georgia and provide supporting documentation. Confirm that you serve as a broker, independently,and are not employed by any insurance company,third party administrative agency or provider network. Midsouth Benefits is an independent agency, licensed in the State of Georgia and is neither owned nor financially affiliated with any other entity. None of our employees, including the principals and owners, are employed by any insurance company, third party administrative agency or provider network. Please see RFP Attachment A for appropriate licenses. 3) Briefly describe your company's organization, philosophy,and management. Also, please provide a brief company history. We are a local full-service brokerage and consulting firm. Although the majority of work that we do will focus on Employee Benefits, we also provide services in the areas of Executive Benefits, Estate Planning and Individual Medical. Originally known as Midsouth Planning,the firm was incorporated in 1990. In 2003, Karen Larkin joined Midsouth Benefits as a Senior Consultant and Broker,and in 2012,she became the firm's majority shareholder and CEO. In 2013, our name was changed to Midsouth Benefits to better reflect both our expertise in the employee benefits arena as well as our focus in assisting clients in the design, communications, and regulatory compliance of those benefits. We have over 75 years of combined experience in managing the employee benefits for firms ranging in size from 2 employees to 3000 employees. Midsouth Benefits is a privately held corporation,with Karen Larkin,CLTC, as the CEO and majority shareholder. We are a Certified Women's Business Enterprise,and qualify as a diversity supplier. As an independent firm, we are not constrained by arbitrary sales goals and quotas set by a parent company or corporate board members,which could cloud our objectivity. Consequently,we can confidently ensure that our clients' needs always come first. Our owners and operators are our two senior consultants, with each having 25 plus years of experience. Our core belief is that our clients deserve and should expect their account work to be managed by our most seasoned people who have the background and experience to effectively assist in the design and management of the client's employee benefits program. All our clients with over 100 employees are handled by a four person team consisting of a senior consultant, a compliance and communications specialist, and two account managers. Should your assigned account manager be unavailable,a second account manager will step in to provide assistance. We understand that customer service is the cornerstone of our business, and that having the ability to work well with your employees and their families is equally as important as having the ability to work well with those in human resources and top management. 1"B BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 4) Describe your contractual relationships, if any, with organizations or entities necessary to your proposal's implementation (i.e. actuarial services, data information services,etc.). Our firm will provide all of the services outlined and discussed within our responses to this Broker Proposal Questionnaire,at no direct cost to the client outside of our normal commissions. All commissions are to be paid to us by the selected carrier/vendor. Any exceptions to this will be outlined in Attachment B: Pricing/Fee Addendum,which is a part of this proposal. We do utilize relationships with a few Third Party Vendors to compliment the services that we provide. In most cases, services provided to us by these vendors for the benefit of our clients,are at no cost to the client. Zywave— Mywave HR Online Resource Portal and HR Connection Online Enrollment Port Smith,Gambrell, Russell—ERISA Attorneys 5)How long has your organization been providing brokerage services? The firm was incorporated in 1990, and has been providing brokerage services ever since that time. 6) How many public sector clients does your firm currently provide brokerage services to? We currently provide services to six public sector clients. 7)What is your firm's scheme of communications and customer service interaction with clients? When handling customer service issues related to employee benefits,we believe communication requires a strong attention to compassion when interacting with employees and their families. The employees of Midsouth Benefits care about our clients and their employees, and we often act as their advocate. We enjoy getting to know your employees as well as your HR staff, and we pride ourselves in taking the necessary steps to resolve their issues. We also work to develop a good working relationship with the carrier's customer service representatives, so they are always willing to go the extra mile for us and our clients. When we are contacted for assistance, we will never redirect you,your employees nor a family member, back to the carrier/vendor for assistance.We encourage you to reach out to our references on this question, as service is the cornerstone of our business. Insurance is complicated and we alleviate the stress that can be associated with dealing with insurance companies, networks, providers,etc. 8) Please provide a list of four verifiable public sector references, all of whom are able to comment on your organization's relevant experience. Please include group name,contact name,and telephone number. Please furnish for each vendor: 1-Services you provided 2-Benefit programs addressed 3-Time period covered 4-Number of covered employees 5-Contact name and phone number BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 8) Continued - It is the vendor's responsibility to provide valid reference information and the City of Tybee Island reserves the right to use reference checks in its evaluation of proposals. City of Norcross • Employee benefits brokerage services provided • Retiree Medical, Medical, Dental, Basic Life/ADD Insurance, Vol Dependent Term Life Insurance, Long-Term Disability Insurance, Vol Employee term Life Insurance,Vision,Voluntary Critical Illness,Voluntary Whole Life and Voluntary Accident, HRA Program. • Awarded the business in 2011, and still a client. • Approximately 110 employees • Contract: Mr. Rudolph Smith,City Manager,678-421-2027 X2904 or Kimberly Turpin, HR Manager 770-448-7086 City of Fairburn • Employee benefits brokerage services provided • Medical, Dental, Vision, Basic Life/ADD Insurance, Basic and Vol Dependent Term Life Insurance, Long Term Disability, Short Term Disability,Vol Employee Term Life Insurance,Group Long-Term Care Insurance,Voluntary Critical Illness,Voluntary Accident,Voluntary Whole Life, Wellness program planning, HRA Program. • Awarded the business in 2008, and still a client • Approximately 140 employees • Contact: Mr. David Johnson, Director of Finance, 770-964-2244 X314, Tom Barber, City Manager, 770-964-2244 X 110 or Ms. Abril Montano, HR Coordinator, 770-964-2244 X 111 Town of Tyrone • Employee benefits brokerage services provided • Medical, Dental, Vision, Basic Life/ADD Insurance, Vol Employee Term Life Insurance, Vol Dependent Term Life Insurance, Long-Term Disability and Short-Term Disability • Awarded the business in 2008, and still a client • Approximately 35 employees • Contact: Ms.Sandy Beach, Finance Manager, 770-487-4038 X104 Cherokee County Water&Sewerage Authority • Employee benefits brokerage services provided • Basic Life/ADD Insurance,Vol Employee Term Life Insurance,Vol Dependent Term Life, Long-Term Disability and Short-Term Disability • Awarded the business in January 2014, and still a client • Approximately 174 employees • Contact: Mr. Ryan Sarks, Human Resources/Risk Management/Fleet&Safety Manager,770-479-1813 X271 BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 9) Indicate the method of service provision your organization would utilize in implementing your proposal (i.e. individual broker, individual broker with supporting back up,team of brokers). Include a brief professional history for each key individual who would work closely with City of Tybee Island and how they are qualified to provide services to the City of Tybee Island. The Midsouth Benefits service model would employ a team of professionals to assist your Senior Consultant(Broker)with providing services to the City of Tybee Island . The combined technical expertise of this team ensures the comprehensive delivery of the right programs and services for the City. Karen Larkin,CLTC—Senior Consultant As CEO of Midsouth Benefits, Karen Larkin brings to the table over 25 years of experience in employee benefits. In 2003, Karen joined Midsouth Benefits as a Senior Consultant and Broker, and in 2012, she became the firm's majority shareholder and CEO. Her background includes working as a senior sales executive and manager with several major insurance carriers and as a broker/consultant with another employee benefit brokerage firm. She has first-hand experience working with clients of all sizes, ranging from small, privately held organizations to large nationally known corporations. Karen's specialty and experience in managing employee benefits gives her clients an added advantage through her wide network of contacts and industry resources. By listening to her clients' goals and objectives, Karen strives to meet their needs and expectations with a high-level of service, paying close attention to details and the long-term objectives. Karen is responsible for providing consultative services, identifying new products and services for client's consideration and handling all new business and renewal plan design and pricing negotiations,as well as overseeing ongoing account management which includes,communications, marketing, compliance,financial evaluations. Meg Marland—Senior Account Manager As a Senior Account Manager, Meg comes has over 20 years of experience in accounting and finance with 14 of those years working for an employee benefits firm focusing on 401K plans. She earned her degree from Georgia Tech in Management focusing in accounting and finance. Meg's background in finance gives her the ability to thoroughly research and prepare costs and marketing analysis reports for our clients benefit programs. Our clients have the confidence in Meg's follow through with all aspects of customer service issues at both the employer and employee level. She has leadership qualities and believes in the team approach to do what it takes to make our customers happy. Her attention to detail,friendly demeanor, and strong work ethic is why our clients have come to rely on her. Lee Ann Sharpton—Account Manager As an Account Manager, Lee Ann has a special emphasis on customer service. She works along with the Senior Account Manager providing additional administrative backup and support, including but not limited to billing reconciliations, claims resolution, and enrollment processing. In addition, Lee Ann manages our individual health insurance business. Lee Ann is dedicated to making the lives of our clients and their employees easier. With her friendly and outgoing personality, she proves on a daily basis that she cares and will go the extra mile to help the employer and employees resolve all issues to their satisfaction. Elizabeth Bass-Director of Compliance and Communications Elizabeth has over 20 years of experience working in the employee benefits arena. She has been a senior account manager for a national employee benefits brokerage firm and VP of Account Management with a local brokerage firm. She has personally handled employers ranging in size from 50 to 5000 employee lives. In addition to overseeing the renewal, marketing and plan administration for her clients, she has done extensive work with these employers in developing comprehensive communication strategies and educational material. She brings a detailed oriented approach to her work that compliments her knowledge in the compliance, plan design and communications area. 1 c BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 10) Briefly describe the level of service and support provided to the City of Tybee Island by your broker(s)on a day-to-day basis. Your Senior Consultant(Broker), Karen Larkin,will manage your account and work directly with you during the benefits review and strategic planning phase, both on an initial and on going annual basis. She will be fully involved in the marketing and negotiation process every year. All periodic claims reviews and presentations will also be handled by your Senior Consultant. All our consultants take a very"hands on"approach with our clients; and we believe this type of service is just one of the areas that separates us from other brokerage firms. Ultimately, your consultant will take full responsibility for ensuring that you, your staff and employees are happy with the services we are providing on a day-to-day basis. Meg Marland will be the Senior Account Manager for the City of Tybee Island and the primary day-to-day contact person. Meg will work closely with Karen Larkin to coordinate any marketing efforts, participate in employee enrollment meetings, manage plan implementations and work to assist you, your administrative staff and employees with any administrative issues, benefit questions and claim problems. Meg would also be responsible for managing any additional administrative services that may be required, such as enrollment and billing reconciliations. Our clients' employees appreciate the thoroughness in our service. Meg's attention to detail has gained her respect with our clients' HR and administrative staff in helping them have a higher level of understanding of the benefit plans and administrative functions including billing, COBRA, FSA's, HRA., etc. In the event that Meg is unavailable to provide immediate assistance to you, her backup is another Account Manager, Lee Ann Sharpton, who will step in to ensure that all questions and issues are resolved in a timely manner. Elizabeth Bass, our Director of Compliance and Communications and Karen Larkin will work with you to develop a communications strategy and the material to be used to educate your employees about their various benefits. Elizabeth's goal is to also make sure that City of Tybee Island is communicating all the legally required information to the plan participants at the appropriate times and in an efficient and effective manner. Elizabeth is also tasked with the job of ensuring that all material prepared for you and your employees by the insurance company is accurate. We believe that an informed employee is an appreciative employee;therefore benefits communication should not be just an "annual enrollment period" project. Elizabeth will work with you on a routine basis to identify those opportunities to further educate and remind your employees of the value of the benefits they are receiving from the City of Tybee Island. 11) How many of your customer service employees are licensed insurance agents? Our customer service employees are not licensed insurance agents. They are however required to participate in educational seminars/webinars and other learning opportunities on a regular basis. 12) How does your firm provide continuing education to ensure that each broker is educated on current market trends and legislative developments? How is this information communicated to your clients? All our consultants (Brokers) are actively involved in The Society of Financial Service Professionals, The National Association of Health Underwriters and The National Association of Insurance& Financial Advisors. BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 12)Continued We require our employees to participate in educational meetings,seminars and webinars, ranging in topics from carrier specific products, HIPAA updates and annual training, ACA presentations to continuing education courses. We subscribe to many informational sources that our staff is expected to review on a regular basis, including Employee Benefit News services, Benefits Advisors, Liemberg Information Services, National Underwriter Insurance and Employee Benefits, Commerce Clearing House Employee Benefits Management,Zywave HR Connection and Broker Briefcase. We subscribe and receive legislative briefs on a regular basis from various organizations including our ERISA attorneys. Our Compliance and Communications Director is responsible for ensuring that everyone on our staff is informed and knowledgeable about the various regulations affecting our business, including HIPAA, COBRA, and ACA. Because we are a small firm it is easy to internally communicate and discuss recent trends, new products, innovative funding ideas and regulatory issues so that we all stay well informed. Information that is relevant is disseminated to our clients in many forms, including via electronic newsletter, email blasts and face-to-face meetings. We communicate regularly with our clients and provide many resources for them to use in addition to those offered by their insurance carriers. We can provide our clients with access to an online HR Resources website, including a national HR Community Chat room. We provide periodic legislative updates to our clients on topics that we think may be of interest to them or will impact them. We also engage the services of attorneys and human resource specialists as needed to provide clients with expertise addressing specific complex legal and compliance issues. We encourage regular dialogue with our clients so that we can remain up-to-date with their daily challenges. 13) Describe how you build an understanding of the direction and priorities of the City of Tybee Island employee benefit program and how you would utilize this information to recommend changes and project future trends. As a part of our strategic planning and review efforts (as discussed in more detail in our response to question#14),we work diligently and carefully to review and analyze all your current programs and associated costs, which will include meeting with City's HR staff, benefits team and current vendors/carriers to gather the appropriate information. We then benchmark your plan designs, pricing, contribution strategy and wellness initiatives with other municipalities, employers in the south and firms of similar size. We use all this information, along with what you have told us are your objectives for the next 12, 24 and 60 months time period, to develop a plan that will help the City of Tybee Island to achieve their goals both in the short-term and long-term. BROKER PROPOSAL QUESTIONNAIRE: General Questions (continued) 14) Detail how your organization assists clients in developing a strategic benefits plan. We use the following structure and process to assist our clients with the development of a strategic benefits plan. Together we will work with you to: • Gather information on all your major initiatives undertaken within the prior 36 months. • Gather information regarding your focus and objectives for the next 12 months, 24 months and 60 months down the road and develop these into a formal working plan and timeline. • Obtain a clear understanding of your financial goals, needs and budget,as well as your administrative capabilities as they all relate to your employee benefits program. • Analyze your current plans in relation to your benefit program objectives (including your overall benefits package, each individual plan design, and all funding arrangements). • Benchmark your current plans against other similar employers' plans. • Analyze the existing plans for design and funding appropriateness and cost effectiveness. • Share our knowledge on alternative plan designs and other product options, benefit structures and enrollment strategies, and how to structure an effective wellness incentive program. • Make recommendations on modifying,changing or adding to existing benefits. 15) Describe your organization's anticipated involvement in the annual renewal process. Include information regarding process timeframes, negotiation of rates and vendor selection. NOTE: City of Tybee Island's current plan year for health and dental insurance is July 1 to June 30. Based on a July 1 renewal date, and assuming that the City of Tybee Island selects us as their Broker by no later than March 25th, this will give us approximately 96 days to complete the following steps prior to your renewal date. We would like to however make a suggestion or recommendation prior to the City's Broker selection, that during the first week of March the City (if not done already) request their July 1 renewal offers from their current carriers/vendors for receipt by no later than April 1St. This would be beneficial to both the City and their selected broker. March 26th- April 6th • Meet with client to discuss prior carriers, plan designs,wellness initiatives,goals/objectives, contribution strategy. • Collect and review current plan documents and communication material,funding,contribution data and claims reports. • Benchmark current benefits against other similar employers. • Make recommendations for any plan modifications, new coverage,funding arrangements, etc., and establish renewal objectives. • Collect data for marketing plans. • Notify current carriers/vendors of any revised renewal request. April 6th -April 22nd • Prepare and distribute RFPs to vendors/carriers. • Receive and review all renewal proposals from current carriers/vendors. • Begin renewal negotiations with current carriers/vendors. BROKER PROPOSAL QUESTIONNAIRE: General Questions (continued) 15) Continued April 23rd—May 3rd • Start reviewing all alternative proposals from other vendors/carriers. • Select finalist alternative proposals from other vendors/carriers. • Finalize negotiate rates and plan designs with current vendors and selected carrier/vendors finalist. May 4th-May 17th • Present renewal options and recommendations to City of Tybee Island. • Develop a strategic plan for moving forward and present to the client. • Meet with client to develop a communication strategy for the Open Enrollment Period. • Benefit/carrier selection completed. May 18th—29th • Prepare communication material for Open Enrollment Period. • Execute communication strategy. June 15t—14th • Open Enrollment Period begins and ends. • Execute selected communication venues during open enrollment period (i.e., Benefit Fair, Lunch-n-Learns, Employee Educational meetings/webinars, etc.). June 15th-30th • Hold meetings/conference calls with the various carriers and the client to review administrative provisions and processes for new plans. • Review,scrub and submit enrollment data to the various carriers/vendors. July 2015 • Policies effective July 1st • Prepare and present administrative handbook and new hire packets. • Review and distribution of new plan documents to City of Tybee Island, including Certificates of Coverage and Policies upon receipt from carriers/vendors. Vendor Selection and Negotiation of Rates: Once we have the renewal proposal(s) from the current vendor(s) and all the proposals from the alternative vendors (if we have gone to the market on that particular benefit),we will determine the top three or four alternative vendors for a more in depth comparison and benefits/rate negotiations. We determine these top vendors by doing an extensive comparison of their proposals, including their proposed plan designs, rates, rate guarantee periods, value added services, ability to meet our RFP specs, underwriting formula, and the sustainability of their proposed rates to expected claims experience. From all the data we've collected, we will select the top three or four vendors to proceed to the next level of negotiations. Depending on the situation,the current vendor may be one of the selected vendors or in addition to the three or four selected alternative vendors. Based on our review and knowledge of your claims experience, current inflationary and market trends and competitive pricing information, we will use this information to negotiate with these finalists for the best benefits, rates and administrative services for the City of Tybee Island. While we do not always recommend the lowest priced vendor, we will always share every vendors pricing with you and why we would or would not recommend them. 18 BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 15) Continued In the event that we do not market a particular benefit, we take the same approach when the renewal proposal is received. We will review your claims experience and determine the appropriateness of the renewal action. Based on our review and knowledge of your claims experience,current inflationary and market trends and competitive pricing information we have seen while marketing other similar plans, we will use this information to negotiate the best renewal possible. We will perform this task every year regardless of whether the current vendor's renewal proposal offers a 0%increase. 16) How does your firm assist City of Tybee Island in developing plan specifications?Explain your process for providing plan recommendations to your clients. We would start by completing our strategic planning and review (as outlined above under #14), and follow that up with a detailed benefit cost and claims analysis. This process would include: • Analyzing your past 24-36 months of claims incurred and utilization data to identify large ongoing claims and over utilization that may have future cost implication. • Analyze your current and alternative funding arrangements as appropriate for cost effectiveness and calculate current and future funding requirements. • Analyze and identify trends affecting your plan. • Assist in the development of a sustainable contribution strategy. • Recommend benefit plan changes that reflect industry best practices and current trends. 17) Explain the process your organization would utilize to assist City of Tybee Island in selecting an insurance vendor. How would your company's experience and expertise benefit the City of Tybee Island in this process? Once we have the renewal proposal(s) from the current vendor(s) and all alternative proposals from our marketing efforts, we will determine the top three or four vendors for a more in depth comparison and benefits/rate negotiations. We determine these top three or four vendors by doing an extensive comparison of all the proposals received, including review of all proposed plan designs, rates, rate guarantee periods, value added services, ability to meet our RFP specs (including plan design and administrative requirements), underwriting formula, and the sustainability of their proposed rates to expected claims experience. Based on this review, we then select the top three or four vendors to proceed to the next level of negotiations. Depending on the situation, the current vendor may be one of the three or four selected vendors to move to the next level, or in addition to the them. Based on our review and knowledge of your claims experience, current inflationary and market trends and competitive pricing information, we will negotiate with these finalists for the best benefits, rates and administrative services for City of Tybee Island. While we do not always recommend the lowest priced vendor, we will always share every vendors pricing with you and why we would or would not recommend them. In the event that we do not market a particular benefit, we take the same approach when the renewal proposal is received. We will review your claims experience and determine the appropriateness of the renewal action. Based on our review and knowledge of your claims experience,current inflationary and market trends and competitive pricing information we have seen while marketing other similar plans,we will negotiate the best renewal possible. We will perform this task every year regardless of whether the current vendor's renewal proposal offers a 0%increase. BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 17) Continued There are a lot of variables that impact the costs associated with each type of benefit plan, and from our years of experience we understand how these variables can be manipulated in the proposal process.We are able to identify these variables in each proposal and will work with the carriers/vendors to ensure that the proposed pricing and plan design is based on the desired benefits and administration. We follow the insurance companies to discern their trends and underwriting changes, and how those changes might affect your plan. Our risk management experience pertaining to the various underwriting formulas used by the insurance companies allows us to develop a clear and concise understanding of your best options. 18) Please provide a list of the vendors you have relationships with in regard to health,long term disability, life,supplemental health,dental insurance,and vision plans. Please see attachment C— Vendors/Carriers 19) Describe how your organization strives to streamline benefits administration for your clients. Include any services you provide for automation of the benefit process (i.e. electronic capabilities, outsourcing options). How many of your clients are enrolled online? How many employees does this represent? Does your staff build these enrollment websites?Attach any associated costs for these services on a separate fee schedule. Along with the selected carriers/vendors,we can provide City of Tybee Island with online benefits administration. The Director of Communications in coordination with your Senior Account Manager, will be actively involved in the set-up and implementation process, as well as providing ongoing assistance with billing reconciliations. We will also provide periodic enrollment/premium audits to determine accuracy of the enrollment records. Two clients representing approximately 350 lives have chosen to use our online benefit enrollment portal. We offer our online enrollment program through HR Connection to all of our clients at no additional charge. Our staff is responsible for building the enrollment website and will assist in educating employees how to enroll online. The online enrollment website also is available to new hires and will include all plan summaries, required plan documents and enrollment information for each employee. Each employee will be assigned a user name and password and will have access to this program throughout the year. 20) Describe how your organization has assisted other clients in the evaluation and/or formulation of any Healthcare Reimbursement Accounts or Healthcare Spending Accounts. Attach any associated costs for these services on a separate fee schedule. If the client is interested in establishing or continuing an existing Health Reimbursement Arrangement for their employees,with the client's input and from our review of the medical plan design, we will make a recommendation on how to best structure the HRA for optimum impact and administrative ease. We then use our internal risk management studies to determine optimum funding levels and expected claims liability for the client. Usually the health insurance companies provide the administration of the HRA at little or no additional charge as part of the overall plan design on a fully insured plan basis. We would work with the insurance company to negotiate the cost for this administrative service. 20 BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 20) Continued Healthcare Savings Accounts,whether they are to be subsidized by the employer or totally contributory,and the associated High Deductible Health Plans, are considered for recommendation only after our review of your employee demographics, past claims experience, as well as the contribution cap and participation level of any Healthcare FSA, if such a plan is being offered. If any employer contributions are to be included,we will assist with the financial analysis to determine an appropriate employer funding level. HSA's are usually attached to the insurance company's overall medical plan package even though they are typically administered by a separate bank or trust company. If there are additional fees for the administration of the HSA which we recommend,then we will negotiate for the best pricing with the carrier and/or vendor, but these costs will be passed on to either the employer or the employees. Plan participants however are free to use any qualified HSA administrator of their choice although they (the participant)will be responsible for all HSA administrative costs. If the client is interested in offering their employees a Flexible Healthcare Spending Account(FSA), our level of services will be determined based on whether the FSA will be administered internally or by an outside vendor. If the claims administration is to be handled internally by the client,then we can assist with the preparation of the necessary plan documents and forms, compliance issues(performance of testing excluded) and communication. If the use of an outside vendor for claims administration is desired, then we will handle the marketing, proposal analysis and pricing negotiations for an outside FSA Administrator. All negotiated third party FSA administrator fees are passed directly to the client for payment. When we are the client's Broker for their medical benefits and at least one other line of coverage, to assist with the FSA Plans as outlined above, we charge no consulting fees nor do we add any commissions for our services onto the third party FSA Administrator's fees. See attachment B-Pricing/Fee Addendum 21) Detail how you develop a benefit communication strategy with your clients. Include what tools or resources you have available to assist your clients in effectively communicating not only the specific plan details but also the value of the benefits offered? We start by first gathering information from you about the culture of your workplace and how information and ideas are typically communicated within the organization. We look at the demographics of your employee population and the City's own internal communication capabilities. Finally, we look at what benefits are being offered, what changes or requirements are taking place at renewal, and what message you would like to communicate to your employee population.All these factors will be considered in determining the best method for communicating information about your employee benefits program. In some cases we may do an employee survey to get their feedback on what communication format works best for them. Once the communication format is determined, we will work with you to develop both the communication material and a timeline for distribution of that material. This will include information that is disseminated during the annual enrollment period as well as to new hires, and periodically throughout the plan year to keep the employees engaged in their benefit choices. If it is determined that holding employee group meetings is an effective means of communicating your benefits, we will assist or take the lead in making the presentation, including putting together a fully customized PowerPoint Presentation. During these meetings we will deliver the value of the benefits on behalf of the City. We find that meeting face to face with the employees to answer their questions/or concerns,goes a long way towards building goodwill between the employees and the HR staff. We can also host webinars for your employees where we review instructions on how to enroll, benefits being offered and answer any questions. % BROKER PROPOSAL QUESTIONNAIRE: General Questions (continued) 21)Continued In addition, we are able to provide the following methods for communicating not only information about your benefits and costs, but how to get the most out of your benefits through: an Employee Benefits Guide (which will include a summary of all benefit options, value added services, payroll deductions and carrier/vendor contact information), Lunch-n-Learns on various topics, monthly wellness newsletters, and if of interest, we can provide the HR Staff with training on how to effectively communicate the benefits to their employees. See attachment D for a sample of our Employee Benefits Guide and attachment E for a sample of our monthly wellness newsletters. 22)What training resources does your organization provide to assist your clients in educating and training their benefit staff? At the direction of the City of Tybee Island, our Director of Compliance and Communications, along with your Senior Consultant, will develop a benefits training program for the HR staff based on their specific needs and culture. We periodically provide free webinars on various industry related topics. We also provide our clients with free access to an online HR resources website that offers information on many topics, including wellness, health care reform, HIPAA, employee communications, legal news and compliance issues. 23) How will you facilitate or participate in the implementation,communication,and enrollment and training their benefit staff? Your Senior Account Manager will manage the training with the benefits staff through onsite visits and conference calls. We work with insurance carriers and prepare all enrollment material, including Benefit Summary/Employee Benefits Guide to ensure compliance with government regulations (where applicable). We routinely set up administrative training sessions between your HR staff and the carrier/vendor reps to review all administrative processes and procedures whenever a new carrier/vendor is selected. See attachment D for a sample of our Employee Benefits Guide. 24)What makes your organization unique from other organizations that may submit proposals for the City of Tybee Island's consideration? We are active participants in the GLGPA(Georgia Local Government Personnel Association), an educational association sponsored by the Carl Vinson Institute of Government. We are focused on growing our municipality business throughout the State of Georgia and will continue to be a part of this educational organization. Each industry has unique characteristics and municipalities are no exception. We have gained insightful knowledge of the needs and concerns of our municipality clients which should prove valuable to City of Tybee Island. Our target group size is 100-500 employee lives. We feel that employers in this size range are in a class of their own, with their own unique needs and concerns. To big for the "small employer" group market, where plan design options and funding mechanisms are pretty limited and simply; but, too small for the larger national or regional size brokers to get the attention and service you need and deserve. In addition, Midsouth Benefits qualifies as a diversity vendor/supplier,and we are a Certified Woman's Business Enterprise by the WBENC. BROKER PROPOSAL QUESTIONNAIRE: General Questions (continued) 25) Detail the wellness plan services your company provides. Describe the firm's views on the role wellness plans have on controlling healthcare costs. With an understanding of your unique workplace culture and benefits structure,we can provide best practices in developing a wellness program for the City of Tybee Island. We will not only help with the development and design of a wellness program, but where applicable we will also provide a cost analysis, and assistance with the coordination of any Health Fairs, including providing additional manpower when needed. Your wellness strategy may take many forms, it may be totally voluntary, incentive driven or penalty driven. We will help you to determine which form might work best for your organization. When negotiating with your medical carrier, we will clearly define the City's wellness initiative ideas and desired outcome, as well as your needs or expectations for assistance in funding the wellness initiatives.We know how imperative it is that we be able to effectively communicate all these areas to the medical carrier. To develop and implement a wellness program that is effective in changing lives and impacting costs, it takes a shared common goal between the client and the carrier. Our Senior Consultants have experience in reaching out directly to the carrier's underwriter to advance the wellness strategy of our clients and to sell that strategy and its associated cost as a partnership between the two. Our goal in this regard is two fold; by showing the carrier that the employer is serious about having an impact on the health and wellness of their employees,we use this to mitigate any potential rate increases at renewal,and gain access to the vast wellness resources and assistance programs available through the carrier. We believe that the only real way to impact rising healthcare cost is to lessen the need for healthcare. How do you do this? By creating a culture of wellness within the workplace. After all, the workplace is where most employees spend the majority of their awake hours. As an employer, you can do this by sponsoring activities and encourage participation. By providing access to resources and information to help educate your employees on how to retain a healthy lifestyle or give them ideas and suggestions on how to reach a healthy lifestyle. There are many ways to create a wellness program but it does require strong support from the top management and involvement from all departments within the City. 26) Provide any additional information regarding your organization or services that you feel would be beneficial in helping the City of Tybee Island to select a benefits broker. One area of insurance that we find we are more involved in than most Brokers is in the area of"voluntary benefits",typically referred to as Worksite Products(i.e.,whole life insurance, critical care insurance, cancer insurance, accident Insurance, hospital indemnity insurance, etc.). Today there are more carriers than ever selling these worksite products;AFLAC and Colonial no longer corner the market. We have found that a lot of employers let the voluntary benefit companies come in and "sell"their employees products that a) may or may not be the right fit for them, b) undercut participation in the group benefits and/or c) bring little to no value to their overall benefits program. We understand how these policies are written and where the hidden differences are between one carrier's policy and another's. Having Midsouth Benefits do a review and analysis of what is being offered and the policies themselves is one way of protecting the integrity and value of your voluntary benefits program and your employee benefits program as a whole. We have been successful in determining and implementing the right voluntary products with the right carrier for our clients. BROKER PROPOSAL QUESTIONNAIRE: General Questions(continued) 27) Describe your proposed form of compensation. If you are proposing a fee,please include your fee schedule/rates. We will receive our compensation for the work we provide to the City of Tybee Island in the form of commissions paid by the selected carrier/vendor. However,we can also work on a consulting fee basis if so desired by the client. Commission levels are determined individually by the type of coverage being offered and by the size of the account. Generally commission percentages are inversely proportionate to the amount of premiums. We are transparent on the compensation we receive and commissions are negotiable. See attachment B-Pricing/Fee Addendum End of BROKER PROPOSAL QUESTIONNAIRE: General Questions RFP #2015-662 Benefits Broker Services BROKER PROPOSAL QUESTIONNAIRE : Customer Service/Claims M idsouth BENEFITS BROKER PROPOSAL QUESTIONNAIRE :Customer Service/Claims 1)Where is your customer service office located? Our customer service office is located at 4994 Lower Roswell Road, Marietta,Georgia 30068 2)What are the hours of operation for the customer service office? Monday—Friday,8:30 a.m.to 5:00 p.m. 3) Describe your problem or issue resolution process. All problems or issues should be brought to the attention of Meg Marland, your assigned senior account manager. Such matters can be communicated to Meg either via a phone call, direct email or through our website. If Meg is not immediately available,you will receive an acknowledge of your communication within the same business day if received before 2:00 p.m. and if after 2:00 p.m., by no later than noon the following business day. However, in most cases, if Meg is not available to provide immediate assistance, your call or email will be forwarded to another account manager for assistance. It is Meg's responsibility to ensure that all issues/problems are resolved in a positive and timely manner. If the issue at hand cannot be addressed and resolved immediately,you will be kept informed as to what is being done to resolve the matter and the anticipated time frame for resolution. You will be advised by email (or phone if email is not an option) once the issue has been resolved or matter closed. The account managers are required to keep a log of all customer service issues and communications. In the unlikely event that you were to be dissatisfied with the manner in which your problem or issue is being handled by our staff, we would ask that you contact your Senior Consultant. Our Senior Consultants are very hands on and maintain a strong connection and relationship will all their clients. They believe that ensuring your satisfaction with the services that we provide is ultimately their responsibility, and they will welcome your feedback and comments. 4)Do you have web based customer service? If yes,what is the website address? Is this password-protected Yes,your HR personnel as well as employees can request assistance via our website by clicking on the EMPLOYEE ASSISTANCE link in the top right corner of our home page. This will take them directly to a site where they will complete a form and provide information regarding how we may assist. This information is collected and sent to both an account manager and our communications director via a secure link which follows HIPAA regulatory guidelines. See attachment F. Our website address is www.midsouthbenefits.net 5) How many employees are located in your customer service office? We have only one office, in which all seven employees are located.At this time we are currently interviewing qualified applicants for another Senior Account Manager position. 26 BROKER PROPOSAL QUESTIONNAIRE: Customer Service/Claims (continued) 6) Please discuss a customer service representative's group load,to include: a) Total number of clients b) Total number of lives administered and/or insured c) Maximum number of lives for which a customer service representative is responsible? We do not determine the account managers' group load or workload based on a pre-determined number of clients nor on a set number of total lives to be handled.We find that these methods of work distribution are not always effective and in the best interest of all our clients for the following reasons: 1) Our clients vary in size from 2-3,000 employees; 2) Regardless of the number of employees that the client has,the workload can vary drastically based on the type of service we are hired to provide, as well as the number of benefit plans that we handle/administer for that client;and 3)The experience level and number of the those employees working within the client's HR department will usually determine the amount of assistance they will require from us. However, Our account managers typically service between 30 to 40 accounts each and are supported by our entire team including our Director of Compliance and Communications,our Consultants and the administrative staff. 7)Would the client have a dedicated team of customer service representatives and agents? Yes,the Midsouth Benefits service model would employ a team of professionals to assist your Senior Consultant (Broker) with providing services to the City of Tybee Island . The combined technical expertise of this team ensures the comprehensive delivery of the right programs and services for the City. Karen Larkin,CLTC—Senior Consultant As CEO of Midsouth Benefits, Karen Larkin brings to the table over 25 years of experience in employee benefits. In 2003, Karen joined Midsouth Benefits as a Senior Consultant and Broker, and in 2012, she became the firm's majority shareholder and CEO. Her background includes working as a senior sales executive and manager with several major insurance carriers and as a broker/consultant with another employee benefit brokerage firm. She has first-hand experience working with clients of all sizes, ranging from small, privately held organizations to large nationally known corporations. Karen's specialty and experience in managing employee benefits gives her clients an added advantage through her wide network of contacts and industry resources. By listening to her clients' goals and objectives, Karen strives to meet their needs and expectations with a high-level of service, paying close attention to details and the long-term objectives. Karen is responsible for providing consultative services, identifying new products and services for client's consideration and handling all new business and renewal plan design and pricing negotiations,as well as overseeing ongoing account management which includes,communications, marketing,compliance,financial evaluations. BROKER PROPOSAL QUESTIONNAIRE: Customer Service/Claims (continued) 7)Continued Meg Marland—Senior Account Manager As a Senior Account Manager, Meg comes has over 20 years of experience in accounting and finance with 14 of those years working for an employee benefits firm focusing on 401K plans. She earned her degree from Georgia Tech in Management focusing in accounting and finance. Meg's background in finance gives her the ability to thoroughly research and prepare costs and marketing analysis reports for our clients benefit programs. Our clients have the confidence in Meg's follow through with all aspects of customer service issues at both the employer and employee level. She has leadership qualities and believes in the team approach to do what it takes to make our customers happy. Her attention to detail,friendly demeanor,and strong work ethic is why our clients have come to rely on her. Lee Ann Sharpton—Account Manager(back up) As an Account Manager, Lee Ann has a special emphasis on customer service. She works along with the Senior Account Manager providing additional administrative backup and support, including but not limited to billing reconciliations, claims resolution, and enrollment processing. In addition, Lee Ann manages our individual health insurance business. Lee Ann is dedicated to making the lives of our clients and their employees easier. With her friendly and outgoing personality, she proves on a daily basis that she cares and will go the extra mile to help the employer and employees resolve all issues to their satisfaction. Elizabeth Bass-Director of Compliance and Communications Elizabeth has over 20 years of experience working in the employee benefits arena. She has been a senior account manager for a national employee benefits brokerage firm and VP of Account Management with a local brokerage firm. She has personally handled employers ranging in size from 50 to 5000 employee lives. In addition to overseeing the renewal, marketing and plan administration for her clients, she has done extensive work with these employers in developing comprehensive communication strategies and educational material. She brings a detailed oriented approach to her work that compliments her knowledge in the compliance, plan design and communications area. 8)What website customer care capabilities does your company offer?Please describe in detail the following, and outline any additional costs where applicable: a)On-line web enrollment capabilities(open enrollment only or ongoing enrollment) b)Group Administrator capabilities to include eligibility, change in status,address change,etc. c)Employee viewing capabilities to include eligibility, claims reporting We offer online enrollment for both the annual open enrollment period and ongoing enrollments throughout the Plan Year. This website can also be accessed and used for eligibility, changes in status, address changes, etc.. Plan documents, forms and other information that the client wishes to communication to their employees can also be posted on the website. Employees will need to use the carrier's/vendor's website to access information pertaining to their personal claims data. 9)What enrollment services will you provide,and at what charge? We will work closely with your HR staff to develop the most appropriate enrollment strategy based on your workplace culture, type of workforce and work schedules. We manage the open enrollment process and have the ability to provide online enrollment or paper enrollment. We can assist or take the lead on presenting the benefit options during the annual enrollment period via employee group meetings or webinars. BROKER PROPOSAL QUESTIONNAIRE :Customer Service/Claims (continued) 9)Continued We will provide a Benefit Summary/Employee Benefits Guide for distribution during the annual enrollment period and for new hires(limited to 150 printed and bound copies per Plan Year). And we can provide you with a live recording of our PowerPoint Presentation on the benefits that can be used for those employees who are unable to attend the enrollment meetings and new hire orientations.There are no additional charges for these services. 10)Who will be responsible for assisting the City with enrollment? Both Karen Larkin,Senior Consultant and Meg Marland,Senior Account Manager,will assist City of Tybee Island with enrollments. 11)Who will assist the City with ongoing administration(i.e. billing and enrollment)? Meg Marland,Senior Account Manager and her backup, Account Manager Lee Ann Sharpton,will assist the City with ongoing administration. 12)Who will assist the City with ongoing claims questions or problems? Meg Marland,Senior Account Manager and her backup,Account Manager Lee Ann Sharpton 13)What is your customer service toll free number? We do not currently have a toll free number but should we be awarded this business we will make a toll-free phone available at no cost to the client. 14) Does your firm provide on-site employee enrollment meetings for new hires? Yes,we can set up and provide on-site employee enrollment meetings for new hires to be handled by your account manager and on a time frame mutually agreed upon. End of BROKER PROPOSAL QUESTIONNAIRE: Customer Service/Claims RFP #2015-662 Benefits Broker Services BROKER PROPOSAL QUESTIONNAIRE : HIPAA / COBRA M idsouth BENEFITS BROKER PROPOSAL QUESTIONNAIRE: HIPAA/COBRA 1) Do you provide COBRA administrative services?If yes, please explain the services provided and any cost associated for this service. We are able to provide regulatory and administrative guidance on the employer's responsibilities under COBRA, as well as the customized material, but we do not provide actual COBRA administrative services. However, as part of our marketing process we will determine the medical carrier's ability to provide COBRA services. In most cases we have been able to negotiate the inclusion of the COBRA administration with the medical carrier at no additional cost to the client. This will typically include the COBRA administration for other lines as well, such as dental and vision, even if those lines of coverage are provided by another carrier/vendor. If this is not an option with your particular medical carrier, we will then recommend an outside third party vendor for COBRA administration. The charge to the City is typically between $.90 to $1.20 per employee, per month for COBRA Administration See attachment B-Pricing/Fee Addendum 2) Do you provide HIPAA administrative services?If yes, please explain the services provided and any cost associated for this service. In the event that you choose to receive protected health information,we are able to provide regulatory and administrative guidance on the employer's responsibilities under HIPAA, as well as material for compliance (such as the Business Associate Agreement, Privacy Manual Instructions, sample HIPAA notices, etc.) , but we do not provide actual HIPAA administrative services. Due to changes brought about the Affordable Care Act,the distribution of Certificates of Creditable Coverage to terminated plan participants is no longer required. See attachment B-Pricing/Fee Addendum End of BROKER PROPOSAL QUESTIONNAIRE: HIPAA/COBRA 3:I. RFP #2015-662 Benefits Broker Services BROKER PROPOSAL QUESTIONNAIRE : Broker / Value Added Services M idsouth BENEFITS BROKER PROPOSAL QUESTIONNAIRE: Broker/Value Added Services 1) Does your firm have experience in developing Wellness Programs, Disease Management Programs, Health Fairs or Employee Assistance Programs? Please provide names of clients who have utilized these offerings in the last 24 months. Yes, we have assisted or made presentations/recommendations to a number of our clients on the development of a Wellness Program and/or Health Fairs for their employees.This includes BIAS Corp, City of Fairburn, iSigma, City of Norcross and LTI Atlanta. BIAS Corp, with approximately 100 employees, was recently awarded 7th place as one of Atlanta's Healthiest Employers by the Atlanta Business Chronicle. 2) Do you provide a consolidate employer HR web portal to access all benefit data to include plan summaries,certificates, network links, plan costs and census data on all employer programs? If enrollments are handled through our HR Connection portal, then anyone within the organization, including employees, can access the plan summaries, certificates, network links,and plan costs through this web portal. Census data reports can be pulled by your assigned account manager and shared with the HR staff upon request. 3) Does your firm provide the necessary resources to generate annual "Employee Benefit Statements"? Yes, we have the capability to produce Employee Benefit Statements as part of the service available when employers utilize our online enrollment service through HR Connection. 4) Does your firm provide an Employer Handbook? Yes, we can provide an administrative guide, as we have done this for some of our clients upon request. This guide provides all the instructions and steps necessary to process new hire enrollments, termination of employment, change in elections, billing administration, submission timelines, etc., for the various benefit plans. It will also include all the forms from the various insurance carriers. More importantly, it will provide you with the compliance requirements and guidelines for proper administration. 5) What HR training does your firm provide your group clients? Our firm's focus is employee benefits. We have partner relationships with HR consultants that we refer our clients to for In-depth HR training. Our online HR portal does provide resources to sample HR policies, FMLA forms, state and federal regulations and a chat room with other HR professionals. If the HR training that you are looking for would be employee benefits specific,then we can provide the HR training. The type and level of training will vary depending on the client and the experience of those individuals on the HR staff. After assessing the needs of the client,we will develop an appropriate timeline and curriculum for the training. Training can be on an annual basis, as needed basis (e.g. turnover in HR staff) or just when there are changes to the employee benefits program and/or the administrative process and procedures. Training can cover everything from understanding the benefits, compliance issues, how to communicate the benefits to new hires, continuation of benefits for employees no longer active(e.g., disabled, FMLA,terminated, etc.)to the individual carrier administrative procedures. BROKER PROPOSAL QUESTIONNAIRE: Broker/Value Added Services(continued) 6) Does your firm provide access to a State and Federal Forms Library? Yes, access is available through our HR Connection portal. In this case, use of our HR Connection Web portal for enrollments is not required. 7) Does your firm provide a consolidated"Benefits Guide"? Yes, we will provide an Employee Benefits Guide at the beginning of every Plan Year. For the City of Tybee Island we will commit to providing up to 150 printed copies per Plan Year. See attachment B for any additional cost, and attachment D for a sample of our Employee Benefits Guide. 8) Does your firm provide IRS Section 125 Plans? Yes, we can assist with the set up of a Premium Only Plan under IRS Section 125, as well as a Flexible Spending Arrangement (to include both or either a healthcare FSA and dependent care FSA). Our level of services will be determined based on whether the FSA will be administered internally or by an outside vendor. If the claims administration is to be handled internally by the client, then we can assist with the preparation of the necessary plan documents and forms, compliance issues (performance of testing excluded) and communication. If the use of an outside vendor for claims administration is desired, then we will handle the marketing, proposal analysis and pricing negotiations for an outside FSA Administrator. All negotiated third party FSA administrator fees are passed directly to the client for payment. When we are the client's Broker for their medical benefits and at least one other line of coverage, to assist with the FSA Plans as outlined above, we charge no consulting fees nor do we add any commissions for our services onto the third party FSA Administrator's fees. 9)What is your website address?What capabilities does your site offer your clients? Our website address is www.midsouthbenefits.net. On our website our clients can access our Legislative Updates, our Wellness Newsletters, videos from prior webinars which we sponsored,and send us emails via secure link with specific questions or issues. 10)What additional services does your firm provide? See Attachment G for a list of our value-added services. End of BROKER PROPOSAL QUESTIONNAIRE: Broker/Value Added Services 34 RFP #2015-662 Benefits Broker Services BROKER PROPOSAL QUESTIONNAIRE : Attachments M idsouth BENEFITS Attachment A—Agent License for Karen Larkin rHES IS YOUR GEORGIA INSURANCE LICENSE KAREN LARKIN REHM Litcri 7\1.111111er: 4001.42N ; 5i tos8.1 Expirmian dale I. LEteasett Roidlon AVIA 10-31-20L6 • Qthatined for AVIK- SIONfo-, twig,-Lflk Apra-Variable Prodmizts Flalph T Htidgens Commtisiktiwr Lif Irhir 36 Attachment A—Agency License for Midsouth Benefits (:omp]inncc Express*"' https:llwwwsirxea.cern/Coo pl anceExpressiSery iceRequestil icPmL,,. • Principal Agency - Resident Principal Agency-Accident and Sickness, Principal Agency- Life, Principal Agency-Variable Products MIDSOUTH BENEFITS CORP 4994 LOUVER ROSWELL RD. STE 5 MARIETTA, GA 30068 is authorized to transact business as described above License No:96995 Issue Date:91-07-1999 Expiration Dale: 12-31-2016 Generates by S.cun 104339630 IC HEREBY AUTHORIZED TO TRANSACT BUSINESS Georgia Department IN ACCORDANCE TO THE LICENSE DESCRIPTION SHOWN BELOW: of Insurance THIS is TO CERTIFY THAT Principal Agency-Resident Principal Agency-Accident and MIDSOUTH BENEFITS CORP Sickness Principal Agency-Life. 45941 MEP ROSWELL RD.,STE 5 NARETTA,GA 3COMB Principal Agency-Variable Products LICENSE NUMBER.59995 Issue Dale.DI-DT 1989 Er time Lela:12-31-2018 G,...R.,q SMR11m4335s3m Lori 12~1121114 15:1)0 AM 37 Attachment B— Pricing/ Fee Addendum We do not charge a separate fee over and above the commissions that will be built into the carrier's/vendor's rates. These will be reasonable and customary commissions based on industry standards. The actual percentage of commissions built into the rates will vary based on the type of coverage (e.g., medical, dental, disability,etc.). All such compensation will be paid to us directly by the insurance carrier or vendor. EXCEPTIONS: 1) City of Tybee Island will be responsible for the printing and binding cost of the Employee Benefits Handbook if more than 150 copies are requested per Plan Year. 2) City of Tybee Island will be responsible for the cost to implement and use any online enrollment services outside of those available through our HR Connection web portal.We will assist with the marketing and costs negotiations for another online enrollment vendor, if so desired. 3) City of Tybee Island will be responsible for all costs related to the use of a third party FSA claims administrator, including set up costs and monthly fees. We will assist with the marketing and costs negotiations, if so desired. 4) City of Tybee Island will be responsible for all costs related to the implementation and use of a third party COBRA and/or HIPAA administrator if we are unable to negotiate these services to be provided by their medical carrier at no additional costs. We will assist with the marketing and costs negotiations, if so desired. Attachment C— Vendors/Carriers The list below represents those vendors/carriers whom we will typically obtain proposals from for the benefit of our clients. The list will vary based on the type of coverage (e.g., medical, dental, life, disability, etc.) for which we are requesting proposals. Those with an * are vendors/carriers with whom we currently have business. Advantica EyeCare Hartford Life* Admin America* HCC Life Insurance Aetna* HM Insurance Group Allstate Humana* AlwaysCare* John Hancock Life Ameritas Life Insurance* Kaiser Permanente* American General Life Companies* Liberty Mutual Arch Insurance Group Lincoln Financial Group* Assurant/ Employee Benefits* Mass Mutual Assurant/ Health/John Alden* MedCom* AUL/One America MetLife* Avesis* Mutual of Omaha* Bankers Fidelity National Vision Administration (NVA) Blue Cross Blue Shield* Nationwide* Celtic Insurance Company Pacific Life* Ceridian* Principal Life Insurance Company* Chubb Prudential Insurance CIGNA Insurance* Reliance Standard* Colonial Supplemental Insurance Sun Life Financial* CNA Insurance Standard Insurance Company* Coventry* Superior Vision Davis Vision Symetra Life Insurance Delta Dental* TransAmerica Insurance Discovery Benefits Underwriters at Lloyd's, London EyeMed* United Concordia (UCCI)* Fort Dearborn National Life United Healthcare* Genworth Financial UNUM Provident* Golden Rule Insurance Co. VIP PET Insurance Greater Georgia Life Insurance* Vision Service Plan (VSP)* Guardian* Forth -9 Request for Taxpayer Give form to the (Rev.October 2004) Identification Number and Certification requester.Do not Department of the 7/eatery send to the IRS. internal rt,,,e errvke N Name(as reported on your Income tax return) a Business name,If different from above c o h ®a Individual/ Exempt from backup Check appropriate box: ❑ Sole proprietor IYJ Corporation �I Partnership LJ Other ❑withholding O Address(number,street,and Or suite no.) Requeater•s name and address(optional) 4 4Lo u- 5 w City,state,and ZIP code A$ CV)Px--X+c.•4&- r ' Tr C .kf., s i List account number(s)here(optional) ■ j Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid social security number backup withholding.For individuals,this is your social security number(SSN).however,for a resident I 1 4 1 4 1 I alien,sole proprietor,or disregarded entity,see the Pail I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose number E+ Y�Identification number to enter: &I SO I SIC11$166I 1 I c) Part II Certification Under penalties of perjury,I certify that 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.person(mcluding a U.S.resident alien). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you we currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply. For mortgage interest paid,acquisition or abandonment of secured property,cancelation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.(See th instructions on page 4.) Sign signature ry Date 11. .3 ` ` / .Her@ f i2 l (... .)2,1 tC / City of Tybee Island, PO Box 2749, Tybee Island, GA 31328 912-786-4573 I (fax) 912-786-9465 What products/services do you provide to the City of Tybee Island: To whom shall we direct the Purchase Order? Sales Contact: PAC`v_Ai L,.,PsvVs•% J Email: k -Viti,rc SVN,�f-co-kV,ts ►-c-Rv\s •k3 Phone# 1)170- -N3-)pRS Fax# '7v)() - 51-10,-vr?Cif 91 Location: R "A, Low - a. -. a-t L.1L ,0"F')-6.., '*5, MN a .,a, i ' To whom shall we direct Payment? A/R Contact: Email: Phone# Fax# f l Remittance Address: Our terms are Net 30. 13IPage 4D V,t+4 M Affidavit Verifying Status ' for City Public Benefit Application III \ . By executing this affidavit under oath, as an applicant for a City of Tybee Island, Georgia, Business License or Occupation Tax Certificate, Alcohol License,Taxi Permit, Contract,or other public benefit as referenced in O.C.G.A. Section 50-36-1,I am stating the following with respect to my application of a City of Tybee Island: i 0 • Business License or Occupational Tax Certificate, 0 • Alcohol License, (circle all that apply) • Taxi Permit, • Contract • Other public benefit Cons 7-RAcTOR --- M(DSoU T H 13E J R I T S 0 for kA R G N L A {2l'1 NI (printed name of natural person applying on behalf of individual, business, corporation,partnership, or other private entity). ml) gC 1 am a United States citizen. OR "' 2) I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non- immigrant under the Federal Immigration and Nationality Act, 18 years of age or older and lawfully present in the United States. * In making the above representation under oath,I understand that any person who knowingly and willfully makes a false, fictitious,or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16-10- 20 of the Official Code of Georgia. i)).„/„) N 0 Q- C- Q-., (.�_t. -e; Signature of Applicant 111 - -/ 5 Date II K4RE i E.-ANl<t N Printed Name II * Alien Registration Number for Non-citizens SUBSCRI ED AND SWORN BEFORE ME ON THIS CHARLOTTE S THOMPSON THE 'n, DAY OF ` c. . 2,) ,20 I c-, NOTARY PUBLIC COBB COUNTY, GEORGIA Notary Public ( ,m. , MY COMMISSION EXPIRES 11 My Commission Expires: ,,, CCU L 3 JULY 18, 2015 Note: O.C.G.A. §50-36-1(e)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., IJ as amended, provide their alien registration number. Because legal permanent residents are included in the federal definition of"alien", legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identing number below: II NI14IPage 41 CONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned contractor/ subcontractor/ sub-subcontractor who is engaged in the physical performance of services under a City of College Park contract verifies its compliance with The Georgia Illegal Immigration Reform and Enforcement Act of 2011 that they are enrolled in and use E-Verify or, in the case of a contractor/ subcontractor/ sub-subcontractor who has no employees and does not intend to hire employees during the term of the contract, will provide a copy of a state-issued driver's license or ID Card issued by a U.S. state that will verify lawful immigration status. 01 SS__3_0_23 E-Verify User Identification Number E-Verify bate of Authorization Rcroi -4i-ao, -(cste? Thiwk_giAs'Wov_inr- S Name of Contract/Project 111 -Thc Name o Contracto Subcontractor/ Sub-subcontractor (Circle one) 1-ARK 1,1 Name of Authorized Officer (7ecl Signature of Authorized Officer SUBSCRIBED TO AND SWORN BEFORE ME ON THIS THE 01_0-)(Q_, DAY OF , 20 L55 . Notary Public C QL�,� c7-8. My commission expires on: q ;,;� I9 &C) CFL°►RLOOTTE g TMOMPSON ARY PUBLIC COBS COON r GEORGIA MY COMMISSION EXPIRES JULY 18, 2015 RFQC-HR-050714-BBS BENEFITS BROKER SERVICES Page 7 12 RFP #2015-662 Benefits Broker Services Appendix idsouth BENEFITS 43 Attachment D -Sample Employee Benefits Guide Our Employee Benefits Guides are all customized for each individual client. Most of our clients prefer to receive these handbooks in a .pdf format so that they can post them on their internal website and distribute them via email. We will provide the City of Tybee Island with a maximum of 150 printed and bound copies per Plan Year at no additional cost. For more than the 150 copies,the cost of printing and binding will be passed on to the client. Included in this section is a sample Employee Benefits Guide. YOUR COMPANY LOGO HERE EMPLOYEE BENEFITS GUIDE FOR THE DECEMBER 2014 - NOVEMBER 2015 PLAN YEAR CLASS-ALL REGULAR FULL-TIME EMPLOYEES WORKING, ON AVERAGE 30 HOURS OR MORE PER WEEK,130 HOURS PER MONTH The following is a summary of the benefit package available to all employees in the above defined Class,working for [client name]. We are providing this information to assist you and your family in making an educated decision regarding your healthcare coverage and other benefits.For more specific details regarding the benefits,including any coverage limits and exclusions,you should consult the Certificate of Coverage issued for each benefit plan. Please review all of your options in this packet and contact your Office Manager if you have any questions. SEE INSIDE FOR YOUR BENEFITS & PREMIUMS EFFECTIVE 12/01/2014 Disclaimer Please read this document and the Insurer's Certificates of Coverage to learn about your Plan benefits.Please keep your Plan documents in a safe place for future reference.Please note that this document does not provide any substantive rights to benefits that are not included in the Insurer's Certificate of Coverage. If you have any questions regarding the Plan,including whether you are eligible to participate in the Plan, please contact your Human Resources Department.If you have questions regarding benefits payable under the Plan,please contact the Insurer. [client name]is not responsible for the processing of claims and payment of benefits under the Plan. The information in this Employee Benefits Guide is intended to only provide you with a brief overview of each plans administrative provisions, highlights and benefits. Please consult each Insurer's Certificate of Coverage for the complete details on exclusions,benefits,covered charges, limitations,waiting periods and pre-authorization requirements that may apply. The information in this document is not binding. If there are any discrepancies between the information in this Employee Benefits Guide and the Insurer's Certificate of Coverage,the Insurer's Certificate of Coverage will prevail and govern how the benefits are provided and administered. Premium contributions are paid in part by[client name]out of its general assets and in part by employees through pre-tax contributions. Any refund,rebate,dividend,experience adjustment,or other similar payment under a group insurance contract entered into between the company and the Insurer will be allocated,if permitted by law,to reimburse the company for premiums that it has paid. [client name] may modify, amend or terminate the entire Plan or any benefits under the Plan at any time at its sole discretion. The right to modify, amend or terminate also applies to the insurance contract between [client name] and the Insurer. Any modification, amendment, or termination will be communicated to participants under the Plan. Neither this document nor any benefit plan document constitutes a contract of employment between you and [client name] or any other arrangement indicating that you will be employed for any specific period of time. 2 TABLE OF CONTENTS DISCLAIMS PAGE PAGE 2 THINGS YOU SHOULD KNOW ABOUT OUR PLAN PAGE 4 PLAN CHANGES FOR OUR 2014-2015 PLAN YEAR PAGE 4 HIPAA PRIVACY PRACTICES PAGE 4 ELIGIBILITY&ENROLLMENT FOR BENEFITS PAGE 4 COVERAGE EFFECTIVE DATE PAGE 6 COVERAGE TERMINATION DATE PAGE 6 CONTINUATION OF COVERAGE PAGE 6 SPECIAL ENROLLMENT RIGHTS PAGE 7 PRE-TAX PREMIUMS(SECTION 125 PREMIUM ONLY CAFETERIA PLAN) PAGE 8 MEDICAL PLAN SUMMARY OF BENEFITS PAGE 9 OTHER MEDICAL PLAN PROVISIONS PAGE 12 MEDICARE PART D DISCLOSURE NOTICE PAGE 14 VISION PLAN SUMMARY OF BENEIFITS PAGE 15 DENTAL PLAN SUMMARY OF BENEFITS PAGE 16 BASIC LIFE AND ACCIDENTAL DEATH&DISMEMBERMENT SUMMARY OF BENEFITS PAGE 18 LONG TERM DISABILITY SUMMARY OF BENEFITS PAGE 19 VALUE-ADDED SERVICES-WILL&LEGAL SERVIVCES PAGE 20 VALUE-ADDED SERVICES-EMPLOYEE ASSISTANCE PROGRAM PAGE 20 VALUE-ADDED SERVICES-TRAVEL ASSISTANCE PROGRAM PAGE 21 PREMIUM INFORMATION PAGE 22 FOR ASSISTANCE-CONTACT INFORMATION PAGE 23 CHILDREN'S HEALTH INSURANCE PROGRAM(CHIP)NOTICE PAGE 24 SUMMARY PLAN DESCRIPTION PAGE 26 If you and/or any one of your dependents are eligible for Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see page 14 for more details. THINGS YOU SHOULD KNOW ABOUT YOUR HEALTH&WELFARE BENEFITS THROUGH client name] Our Plan provides benefits, to you, your spouse/domestic partner and dependents,for which you(and they)are eligible for and enrolled. Included in this document are benefit highlights for the various benefits available under our Plan. For a detailed description of the benefits provided, please review the insurer's Certificate of Coverage for each benefit in which you are enrolled.It is your responsibility to understand _ your benefits under the Plan and to ask questions if you need r more information. [client name] reserves the right to WHEIN HH terminate, amend or eliminate any and all benefits under our ow WHO Plan. Benefits are no longer payable if your coverage is terminated for any reason. The Plan reserves the right to recover W H' " overpayments of benefits or benefits paid in error through } WHERE the rights of subrogation and reimbursement as described WHAT more fully in the insurer's Certificate of Coverage. Please review the Certificates of Coverage carefully for information on other situations that may affect your right to receive benefits under the Plan, such as applicable deadlines for submitting claims.The insurer is responsible for reviewing and deciding all benefit claims in accordance with its reasonable claims procedures, as required by ERISA and other applicable law. The Certificate of Coverage provides more information about the insurer's claims procedures, including information on how to file a claim. Plan Changes for our 2014-2015 Plan Year 1. Premium increases will apply to both our medical and dental premiums (See page 23 for premiums and your bi-weekly contribution amount) 2. Our medical plan will no longer include a pre-existing condition exclusion period, regardless of whether health care services or treatment for a pre-existing condition were incurred in-network or out-of-network. 3. Benefits paid for preventive care under our dental plan will no longer be applied towards the$1,000 annual maximum benefit. The annual maximum benefit will only apply to the Basic and Major services combined. HIPAA Privacy Practices HIPAA requires that organizations follow certain privacy practices regarding your protected personal health information (PHI). PHI is defined as your individually identifiable health information that is created or received by the company's various welfare benefit insurers. You have specific rights with respect to the use and disclosure of your PHI. The insurers are required by law to maintain the privacy of medical information about you and your covered dependents and to provide you with notice about their legal duties and privacy practices with respect to this information.When applicable,you will find the Insurer's Notice of their Privacy Practices for Protected Health Information within the Certificate of Coverage. Eligibility and Enrollment for Benefits To be eligible for benefits you must be an active,regular full-time employee who regularly works a minimum of 30 hours per week for[client name]. You are eligible to enroll for benefits on your date of hire(this is referred to as your initial eligibility date). For benefits that require your contribution towards the premium,you must enroll within 30 days following your date of hire (this is referred to as your initial enrollment period),otherwise you will be considered a Late Enrollee and must wait until the next annual open enrollment period if you later decide to enroll. 4 Eligibility and Enrollment for Benefits-continued Dependents must also be enrolled within 30 days following your date or hire,or if later,within 30 days after they initially become eligible as your dependent,otherwise they will be considered a Late Enrollee and must wait until the next annual open enrollment period if you later decide to enroll them. You may elect to waive the dental insurance for your eligible child until 30 days after the child's third birthday. If request for dental coverage if more than 30 days after your child's third birthday,you must wait until the next annual enrollment period to elect this coverage. NOTE:If you experience a qualified family status change,you may be able to enroll or change your benefit election under the medical, dental and vision plans before the next annual open enrollment period under the Special Enrollment Rights. Special Enrollment Rights may also apply if you or your dependents declined enrollment in the medical and/or dental plans due to having other similar coverage and that other coverage is lost. See the Special Enrollment Rights section on page 7 and consult your medical and dental Certificate of Coverage for more information. If you are enrolled for the coverage,the following family members may also be eligible for coverage: For the Medical Plan:a) the employee's legal spouse or a domestic partner*, and b) the employee's or spouse's children, including natural children, stepchildren, newborn, legally adopted children, children for whom the employee or spouse is a legal guardian, and children who the employer has determined are covered under a Qualified Medical Child Support Order. Such children are eligible from birth to their 26th birthday. Children who are mentally or physically handicapped and totally dependent on you for support, regardless of age, with the exception of incapacitated children age 26 or older. To be eligible for coverage as an incapacitated dependent, the dependent must have been covered under this plan prior to reaching age 26. For the Dental Plan:a)the employee's legal spouse or a domestic partner*,b)the employee's natural or legally adopted child, if the child is not in the Armed Forces of any country; and is less than 26 years of age. The term "child" also includes a stepchild who receives principal support from the employee, a foster child(under legal guardianship of the employee or the employee's spouse) who lives and receives principal support from the employee(and is approved in writing by the insurer),and c)a child who is incapable of self-support because of a Developmental Disability or Physical Handicap and is dependent on the employee for primary support. For the Vision Plan:a)the employee's legal spouse or a domestic partner*,b)the employee's children, including stepchild, foster children, legally adopted children, children legally placed in the employee's home for adoption and children under the employee's legal guardianship. Such children are eligible from birth to their 26th birthday, regardless of their student, financial dependency,marital or residency status,and c) each unmarried child at least 26 years of age:who is primarily dependent upon the employee or the employee's spouse for support and maintenance because the child is incapable of self- sustaining employment by reason of mental incapacity or physical handicap; who was so incapacitated and is an insured person under the policy on his/her 26th birthday; who has been continuously so incapacitated since his/her 26th birthday. *For the definition of a Domestic Partner, or Domestic Partnership as defined under each benefit plan, see the Certificate of Coverage issued by the insurer for that particular benefit plan. NOTE: No employee may be enrolled under any Benefit Plan as both an employee and as a dependent. If both parents are employees of [client name],a dependent child may be covered for benefits under only one parent. 5 An individual who is a child of a covered employee shall be enrolled for coverage under the group medical and/or dental plan in accordance with the direction of a Qualified Medical Child Support Order (QMCSO). You or your dependent may contact the Office Manager for more information on the Plan's procedures for determining whether a child support order is a qualified medical support child order(QMSCO). This information is available free of charge. Your Coverage Effective Date If you meet the definition of an eligible employee as defined on page 4;are enroll within 30 days of your initial eligibility date, and pay the required premium(when your contribution towards the premium is required)your coverage will be effective on your date of hire if you are actively at work on that date. If you are electing coverage, for which you are eligible for, during an annual open enrollment period,your coverage or any change in coverage will be effective on the later of: a) The first day of the next Plan Year,or b) The first of the month following the date the carrier approves your Evidence of Insurability (EOI), if EOI is required. The above assumes you pay the required premium,when your contribution towards the premium is required. If you are not Actively At Work on the day that your insurance, or any increase in insurance,would otherwise be effective, then your insurance or increase in insurance will be subject to a Deferred Effective date.This applies even if you elect coverage during an annual open enrollment period. For the definition of"Actively At Work" and the Deferred Effective date,consult the insurer's Certificate of Coverage. Note,a deferred effective date provision does not apply to the medical coverage. A different coverage effective date may apply if you are enrolled due to Special Enrollment Rights. See the Special Enrollment Rights section on page 7 and consult the insurer's medical and dental Certificate of Coverage for more information Your Dependent's Coverage Effective Date If your dependent meets the definition of an eligible family member as defined on page 5; is enrolled within 30 days of your initial eligibility date, and you pay the required premium (when your contribution towards their premium is required),their coverage will be effective on your date of hire. If you are electing coverage, for which your dependent(s) are eligible for, during an annual open enrollment period, their coverage or any change in coverage will be effective on the later of: a) The first day of the next Plan Year,or b) The first day of the month following the date the carrier approves their Evidence of Insurability (EOI), if EOI is required. The above assumes you pay the required premium,when your contribution towards the premium is required. A different coverage effective date may apply if your dependent is enrolled due to Special Enrollment Rights. See the Special Enrollment Rights section on page 7 and consult the insurer's medical and dental Certificate of Coverage for more information. Coverage Termination Date Your Life/ADD and Disability coverage terminates when your employment with [client name]terminates. If enrolled for the medical, dental and/or vision coverage, your coverage terminates at the end of the month in which your employment with [client name]ends. Coverage may also terminate in other circumstances, such as failure to pay required premiums, failing to meet eligibility requirements,submitting fraudulent claims and other reasons described in the insurer's Certificate of Coverage. Coverage for your spouse and dependents terminates when your coverage ends and for other reasons described in the Certificate of Coverage,such as divorce or reaching the Plan's limiting age for dependents. Continuation of Coverage ❑ If your coverage or the coverage of your dependent(s) terminates because of certain reasons, you may be eligible for continuation of coverage based on certain policy or administrative provisions, including: those under State Continuation Rights or COBRA (whichever is applicable),a Conversion Privilege,Waiver of Premium or during a leave of absence from employment due to disability, active duty military service (USERRA) or other approved leave of absence. To find out which, if any, continuation rights apply to you and/or your dependents, consult the insurer's Certificate of Coverage or contact your Office Manager. 6 ❑ Special Enrollment Rights If you declined enrollment in the medical and/or dental plan for yourself and/or your dependents (including your spouse) solely because of having other health or dental insurance or group health or dental coverage, you may be able to enroll yourself and/or your dependents in the medical or dental plan available through [client name] during a Special Enrollment Period if you and/or your dependents have: a)exhausted COBRA benefits, b)lost eligibility for that other coverage,or c)in regards to the medical plan,stop receiving employer contributing towards the cost of that other coverage. However,you must request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing towards the other medical coverage). Coverage will be effective on the date of the request for enrollment, provided all premium contribution requirements have been met. In addition, if you have a new dependent as a result of one of these events: marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents in the medical, dental and vision plans during a Special Enrollment Period. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If properly enrolled, coverage will be effective on the date of the event, provided all premium contribution requirements have been met. To elect benefits or make a benefit election change as allowed under the Special Enrollment Rights, contact your Office Manager for assistance. ❑ Medicaid and CHIP Special Enrollment/Special Enrollee Rights Eligible Employees and Dependents may also enroll in the [client name] medical plan prior to the next Annual Open Enrollment Period under two additional circumstances: 1) the Employee's or Dependent's Medicaid or Children's Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility; or 2) the Employee or Dependent becomes eligible for a premium subsidy (state premium assistance program) under Medicare or CHIP. The Employee or Dependent must request the Special Enrollment within 60 days of the loss of Medicaid or CHIP coverage, or within 60 days of when they become eligible for the premium subsidy. If you apply within 60 days of the date Medicaid or CHIP coverage is terminated or within 60 days of the date the Member is determined to be eligible for employment assistance under a state Medicaid or CHIP plan,coverage will start no later than the first day of the month following receipt of your enrollment request. For more information on Medicaid and the Children's health Insurance Program (CHIP) and the availability of premium subsidies in your state,see page 25 of this Guide. Victim of Family Violence The laws of the State of Georgia prohibit insurers from unfairly discriminating against any person based upon his or her status as a victim of family violence. 7 Pre-Tax Premiums(Section 125 Premium Only Cafeteria Plan) Your portion of your medical, dental and vision premiums will be paid with pre-tax dollars (except for premiums to cover a domestic partner)unless you submit in writing on the appropriate form,to your Office Manager at[client name] that you want these premiums deducted on an after-tax basis. With the pre-tax feature,your premiums are subtracted from your gross pay before taxes are determined. By doing this, your taxable pay is reduced so you pay less in taxes. However, you should be aware that premiums deducted on a pre-tax basis will also reduce your Social Security and Medicare wages for future benefit purposes. Because this pre-tax feature impacts what you pay in taxes,the IRS has specific regulations that affect when you can make changes to your election for these Plans. Once enrolled in the Plan,your election for coverage under the medical,dental and vision plans cannot be changed during the Plan Year unless you experience a qualified Change in Election Event.If you experience a qualified Change in Election Event, you may change certain elections so long as the election change is on account of and consistent with the Change in Election Event. A change in a benefit election is considered"consistent with a change in status"only if the change in status results in the employee,spouse,or dependent child gaining or losing eligibility for coverage under our Plan or the same type of coverage sponsored by the employee's spouse or dependent's employer, and the change in your benefit election corresponds with such a gain or loss of coverage. Listed below are some events that may enable you to change elections mid-year. You should contact your Office Manager to determine whether or not your change in election event qualifies. • Change in your legal marital status • Significant reduction in coverage • Change in your number of dependents • Significant change in coverage cost • Your spouse or dependent satisfies or ceases to satisfy • Court judgments,decrees or orders regarding dependent Eligibility Requirements insurance coverage for spouses or dependents • Change in the place of residence or work of the • Change in coverage of spouse or dependent under employee,spouse or dependent their Employer's Plan • Addition or elimination of Benefit Plan • You become eligible for Medicare or Medicaid • Change in your employment status or the employment status of your spouse or dependent(e.g.,termination or commencement of employment,from full-time to part-time or vice versa,LOA,etc.) If a Change in Election Event(including a Change in Status)occurs,you must inform the your Office Manager and complete a new Section 125 Election Form within 30 days of the occurrence. N If you do not wish to have your premiums deducted on a pre-tax basis, you must submit a written 0 request on the appropriate form to your Office Manager prior to the start of the Plan Year.To obtain the appropriate form,contact your Office Manager. ▪ Due to IRS regulations,premiums for coverage of a domestic partner must be deducted on an after-tax E basis. 8 BLUE CROSS BLUE SHIELD OF GA MEDICAL PLAN CONTRIBUTORY PLAN Medical Group# All benefits are subject to the calendar year deductible, except those with in-network copays, unless otherwi noted. All calendar year maximum visit/day limits are combined between in-network and out-of-network unless otherwise noted. In addition to copays, members are responsible for the deductibles and any applicable coinsurance. Members are also responsible for all costs over the plan maximums. Some services may require pre-certification before services are provided. When using out-of-network providers, members are responsible for any difference between the Maximum Allowed Amount and the amount the provider actually charges, as well as any copays, deductibles and/or applicable coinsurance. This Plan uses the Blue Open Access POS Network. Deductibles,Coinsurance and Maximums In-Network Benefit Level Out-of-Network Benefit Level Calendar Year Deductible* •Individual $2,500 $5,000 •Family $7,500 $15,000 Coinsurance Member pays 20% Member pays 40% Plan pays 80% Plan pays 60% Calendar Year Out-of-Pocket Maximum* (includes calendar year deductible) •Individual $7,500 $15,000 •Family $22,500 $45,000 Lifetime Maximum Unlimited Unlimited *Deductibles and out-of-pocket maximums are added separately for in-network and out-of-network services and cannot be combined.One family member may reach his or her Individual deductible and be eligible for coverage on health care expenses before other family members. Each family member's deductible amount also goes toward the Family deductible and out-of- pocket maximum. Not everyone has to meet his or her deductible and out-of-pocket maximum for the family to meet theirs. When the Family deductible is met, all family members can access coverage for health care expenses. The following do not apply to the out-of-pocket maximums: copayment amounts, non-covered items and any member cost shares for pharmacy Covered Services In-Network Benefit Level Out-of-Network Benefit Level Preventive Care Services for Children and Adults (preventive care services that meet the requirements of federal and state law,including certain screenings, immunizations and physician visits) Member pays 30%after Member pays 0% deductible •Well-child care,immunizations (not subject to deductible) (deductible waived through •Periodic health examinations age 5) •Annual gynecology examinations •Prostate screenings Physician Office Visits for Illness and Injury(including labs,x-rays,and diagnostic procedures) •Primary Care Physician(PCP)* $25 copayment OB/GYN $25 copayment Member pays 40%after •OB / deductible •Specialist Physician $50 copayment *Also applies to services rendered at Retail Health Clinics Covered Services In-Network Benefit Level Out-of-Network Benefit Level Maternity Physician Services •1st Prenatal visit $25 copayment Member pays 40%after deductible •Global obstetrical care(prenatal,delivery and Member pays 20%after deductible Member pays 40%after postpartum services) deductible Telemedicine Services $25 PCP copayment or Member pays 40%after $50 Specialist copayment deductible Allergy Services •Office visits,testing and the administration of allergy $25 PCP copayment or Member pays 40%after injections $50 Specialist copayment deductible Member pays 40%after •Allergy injection serum Member pays 20%after deductible deductible Office Surgery(surgery and administration of general Member pays 20%after deductible Member pays 40%after anesthesia) deductible Office Therapy Services •Physical Therapy and Occupational Therapy: 20-visit benefit period maximum combined $25 copayment Member pays 40%after •Speech Therapy:20-visit benefit period maximum deductible •Chiropractic Care/Manipulation Therapy: 20-visit benefit period maximum Other Therapy Services(chemotherapy, radiation therapy,cardiac rehabilitation[36-visit Member pays 20%after deductible Member pays 40%after benefit period maximum]and deductible respiratory/pulmonary therapy) Advanced Diagnostic Imaging(MRI,MRA,CT Member pays 20%after deductible Member pays 40%after Scans and PET Scans) deductible Urgent Care Services $60 copayment Member pays 40%after deductible Emergency Room Services •Life-threatening illness or serious accidental injury only $150 copayment;then member pays $150 copayment;then member •The ER copayment will be waived if admitted to the 20% pays 20% hospital Outpatient Facility Services •Surgery facility/hospital charges Member pays 40%after •Diagnostic x-ray and lab services Member pays 20%after deductible deductible •Physician services(anesthesiologist,radiologist, pathologist) Inpatient Facility Services •Daily room,board and general nursing care at semi-private room rate,ICU/CCU charges;other medically necessary hospital charges such as Member pays 40%after diagnostic x-ray and lab services; newborn nursery Member pays 20%after deductible deductible care •Physician services(anesthesiologist,radiologist, pathologist) Skilled Nursing Facility Member pays 20%after deductible Member pays 40%after •150-day benefit period maximum deductible 10 Covered Services In-Network Benefit Level Out-of-Network Benefit Level Mental Health/Substance Abuse Services(*services must be authorized by calling 1-800-292-2879) •Inpatient mental health and substance abuse services* Member pays 20%after Member pays 40%after (facility and physician fee) deductible deductible Member pays 20%after Member pays 40%after •Partial Hospitalization Program(PHP)and Intensive Me p Y Outpatient Program(IOP)*(facility and physician fee) deductible deductible Member pays 40%after •Office/Outpatient mental health and substance abuse $25 copayment services (physician fee) deductible Home Health Care Services 400-visit benefit period maximum $25 copayment Member pays 40%after deductible Hospice Care Services • Inpatient and outpatient services covered under the Member pays 0% Member pays 30%after hospice treatment program (not subject to deductible) deductible Durable Medical Equipment(DME) Member pays 20%after Member pays 40%after deductible deductible Ambulance Services(covered when medically necessary) Member pays 20%after Member pays 20%after deductible deductible Prescription Drugs(Option A) Note:If a member receives a brand name drug that falls on Tier 2 or Tier 3 that has a generic equivalent available,the member pays the Tier 1 copay,plus the difference in cost between the brand drug and generic drug. This applies even when physician indicates DAW(dispense as written)or obtains an authorization. •Retail Drugs-Tier 1(30 day supply) $15 copayment •Retail Drugs-Tier 2(30 day supply) $35 copayment •Retail Drugs-Tier 3(30 day supply) $60 copayment •Retail Drugs-Tier 4(Specialty Drugs)(30-day supply) Member pays 20%,up to a$200 maximum per prescription drug; $3,000 RX out-of-pocket maximum per member,per benefit period. •Home Delivery Maintenance Drugs-Tier 1 (90 day $15 copayment supply) •Home Delivery Maintenance Drugs-Tier 2(90 day $70 copayment supply) •Home Delivery Maintenance Drugs-Tier 3(90 day $180 copayment supply) •Home Delivery Maintenance Drugs-Tier 4(Specialty Member pays 20%,up to a$200 maximum per prescription drug; Drugs)(90 day supply) $3,000 RX out-of-pocket maximum per member,per benefit period. Retail and Home Delivery maintenance drug coverage is provided at one of four tier levels in accordance with the Formulary Drug List. Members must file a claim form for reimbursement when using an out-of-network pharmacy. Specialty drugs can only be obtained from a Specialty Pharmacy. See the following page for Tier definitions. The above is just a highlight of the benefits provided under our Medical Plan. For a complete list of all contract/policy exclusions, limitations,benefits and benefit restrictions or waiting periods,please refer to the insurer's Certificate of Coverage for this Plan. 11 Prescription Drug Tier Definitions Tier 1 - These drugs have the lowest copayment. This tier will contain low cost or preferred medications. This tier may include generic, single source brand drugs,or multi-source brand drugs. Tier 2 - These drugs will have a higher copayment than tier 1 drugs. This tier will contain preferred medications that generally are moderate in cost. This tier may include generic,single source,or multi-source brand drugs. Tier 3 - These drugs will have a higher copayment than tier 2 drugs. This tier will contain non-preferred or high cost medications. This tier may include generic,single source brand drugs,or multi-source brands drugs. Tier 4 - Tier 4 Prescription Drugs will have a higher Coinsurance or Copayment than those in Tier 3. This tier will contain Specialty Drugs. Summary of Limitations and Exclusions Your Certificate Booklet will provide you with complete benefit coverage information.Some key limitations and exclusions, however,are listed below: •Routine physical examinations necessitated by employment,foreign travel or participation in school athletic programs •Non-emergency use of the emergency room •Removal/extraction of impacted teeth •Private duty nursing •Care or treatment that is not medically necessary •Cosmetic surgery,except to restore function altered by disease or trauma •Dental care and oral surgery; except for accidental injury to natural teeth, treatment of TMJ and radiation for head and neck cancer •Occupational related illness or injury •Treatment,drugs or supplies considered experimental or investigational •Smoking cessation products See Certificate Booklet for Complete Details It is important to keep in mind that this material is a brief outline of benefits and covered services and is not a contract. Please refer to your Certificate of Coverage (the contract) for a complete explanation of covered services, limitations and exclusions. IMPN. This Plan uses the BCBS Blue Open Access POS Network. • OTHER MEDICAL PLAN PROVISIONS INCLUDE: Patient Protection Act ❑ Choice of Primary Care Physician This Plan does not require that you select a specific Primary Care Provider to coordinate your care. However,you will pay a lower in-network copy if you use a Designated Network Provider over simply a Network Provider. ❑ Access to Obstetrical and Gynecological(OB/GYN)Care You do not need a referral from a Primary Care Provider nor prior authorization from UHC to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology.However,you will pay a lower in-network copay if you use a Designated Network Provider over simply a Network Provider. ❑ Emergency Care There is no prior authorization requirement for emergency services in a true emergency,even if the emergency services are provided by an out-of-network provider.Medically necessary services will be covered whether the care is rendered by an In- Network Provider or an Out-of-Network Provider. Emergency Care rendered by an Out-of-Network Provider will be covered as an In-Network service,however the Member may be responsible for the difference between the Out-of-Network Provider's charge and the Maximum Allowed Amount, in addition to any applicable Coinsurance, Copayment or Deductible. For more information on how Emergency Care and Emergency Services are covered under our medical plan, consult the insurer's Certificate of Coverage. 12 OTHER MEDICAL PLAN PROVISIONS INCLUDE:(continued) Preventive Services Preventive Care Services, as outlined in the insurer's certificate of coverage, shall meet requirements as determined by federal and state law. Many preventive care services are covered by this plan with no Deductible, Copayments or Coinsurance from the Member when provided by a Network Provider. Covered Services fall under four broad categories as shown below: A. Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations from the United States Preventive Services Task Force; B. Immunizations for children,adolescents,and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; C. Evidence-informed preventive care and screenings provided for infants,children and adolescents as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. This includes well baby and well child care;and D. Additional preventive care and screening for women provided for in the guidelines supported by the Health Resources and Services Administration For a list of all covered preventive care services, review the Preventive Care Services Brochure available on HR Connection, or request a copy from your Human Resources Department. You may also call Customer Care using the number on your medical ID card for additional information about these services or view the federal government's web sites: http://www.healthcare.gov/center/regulations/prevention.html,and http://www.cdc.gov/vaccines/recs/acip/. Women's Health and Cancer Rights Act For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient.The Women's Health and Cancer Right s Act requires that all health insurance plans that cover mastectomy also cover the following medical care: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses and treatment of physical complications of the mastectomy,including lymphedema. These benefit will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan and described on pages 10-15 of this Guide. Mental Health Parity and Addiction Equity Act A group health plan that provides mental health and substance abuse benefits cannot impose special caps or limits on these benefits. Treatment limits and cost sharing,including deductibles,co-pays,coinsurance,and out-of-pocket expenses cannot be more restrictive than the most common or frequent rules that apply to all other medical and surgical benefits provided under the plan. Newborns'and Mothers'Health Protection Act Under federal law,our medical plan may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn to less than forty-eight hours following vaginal delivery,or less than ninety-six(96)hours following a cesarean section. However,federal law generally does not prohibit the mother's or newborn's attending Provider, after consulting with the mother, from discharging the mother or her newborn earlier than forty-eight (48) hours, or ninety-six (96) hours, as applicable. In any case,as provided by federal law,our medical plan may not require that a Provider obtain authorization from the insurer before prescribing a length of stay which is not in excess of forty- eight (48) hours for a vaginal delivery or ninety-six(96)hours following a cesarean section. 13 Medicare Part D for Prescription Drugs - DISCLOSURE NOTICE TO ALL MEDICARE ELIGIBLE INDIVIDUALS, INCLUDING SPOUSES AND DISABLED DEPENDENT CHILDREN PLEASE READ THIS SECTION CAREFULLY IF YOU ARE ENROLLED OR ARE CONSIDERTING ENROLLING IN OUR GROUP MEDICAL PLAN. If you are an employee,spouse or dependent child who is Medicare eligible,the following information may apply to you. This is information about your current prescription drug coverage options through [client name]and options under Medicare's prescription drug coverage. If you are considering joining a Medicare drug plan, you should compare the prescription drug coverage available under the [client name] Health Plan, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. There are two important things you need to know about the drug coverage available under the [client name] Health Plan and Medicare's prescription drug coverage: First, Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. Second, Blue Cross Blue Shield has been determined that the prescription drug coverage offered under the [client ngame]Health Plan is,on average for all plan participants,expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because the [client name]prescription drug coverage through BCBS is Creditable Coverage,you can keep this coverage and not pay a higher premium(a penalty) if you later decide to join a Medicare drug plan. You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two(2)month Special Enrollment Period(SEP)to join a Medicare drug plan. If you or your covered dependent decide to join a Medicare drug plan, the coverage through [client name]will be affected.If you or your dependent enroll in a Medicare prescription drug plan,you/they will still be eligible to receive all of your current medical and prescription drug benefits; however, you should be aware that the [client name] medical plan will pay all benefits after Medicare,including your prescription drug benefits. Your current coverage through [client name] pays for other health expenses in addition to prescription drugs. You cannot drop your prescription drug coverage through [client name] without losing ALL your medical benefits. If you decide to drop your current prescription drug (and medical) coverage through[client name] and enroll in Medicare prescription drug coverage,you may enroll back into the [client name]health plan during an annual open enrollment period, or earlier if you qualify for Special Enrollment Rights. Please see page 11 of this document for a description of the current prescription drug benefits. When Will You Pay A Higher Premium(Penalty)To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage through [client name]and don't join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage,your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage.For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage.In addition,you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage... Contact the Office Manager at[client name]. You'll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through your employer changes. You also may request a copy of this notice at any time. 14 lie EYEMED r P VISION PLAN VOLUNTARY-100%CONTRIBUTORY PLAN GROUP# Iti % L li E D ' 7 C C 7' I IN-NETWORK OUT-OF- MEMBER COSTS NETWORK REIMBURSEMENT Exam With Dilation as Necessary $10 copay Up to$30 MORE FOR The Contact Lens Fit and Follow Up(contact lens Fit and Follow Up visits are available once LESS...... a comprehensive eye exam has been completed) Standard Contact Lens Fit&Follow Up Up to$55 N/A Premium Contact Lens Fit&Follow Up 10%off retail N/A Retinal Imaging Up to$39 N/A Frames $0 copay;$130 allowance;then Up to$65 20%off retail price over$130 Standard Plastic Lenses 4 .3„,,,; 0 Single Vision $25 copay Up to$25 Bifocal $25 copay Up to$40 OFF Trifocal $25 copay Up to$60 Lenticular $25 copay Up to$60 CQrnpiele pair Standard Progressive Lens $90 Up to$40 of prescription Premium Progressive Lens* eyeglasses Tier 1 $116 Up to$40 Tier 2 $122 Up to$40 2 Tier 3 $128 Up to$40 0 Tier 4 $90,then 80%of charge less Up to$40 OFF $120 allowance Non-prescri ptian Lens Options*(paid by the member and added to the base price of the lens) UV Treatment $15 N/A Sunglasses Tint(Solid and Gradient) $15 N/A Standard Scratch Resistant Coating $15 N/A Standard Polycarbonate(Adults) $40 N/A 2 0 OFF Standard Polycarbonate(Kids under 19) $40 N/A Standard Anti-Reflective Coating $45 N/A Remaining balance Photochromic/Transitions $75 N/A beyond plan coverage Polarized 20%off retail price N/A Other Available Add-on Lens Options _ 20%off retail price N/A T-n! :s:aunt are for in- Contact Lenses In lieu of any other Lens benefit during same benefit period -ekrark prodders only $0 copay,$130 allowance;then Up to$104 Conventional Lens 15%off retail price over$130 Disposable Lens $0 copay,$130 allowance;plus Up to$104 balance over$130 Medically Necessary Contact Lenses $0 copay,paid in full Up to$210 Laser Vision Correction 15%off the retail prices or 5% N/A (Lasik or PRK from U.S.Laser Network) off the promotional price Frequency Examination Once every 12 months Lenses or Contact Lenses Once every 12 months Frames Once every 12 months EyeMed Network You are on the Insight Network I N/A *These costs are subject to change without notice. If you are thinking about enrolling and want more information about the vision plan,visit www.enrollwitheyemed.com This is just a highlight of benefits under our Vision Plan. For a complete list of all contract/policy exclusions,limitations,benefits and benefit restrictions or waiting periods,please refer to the Certificate of Coverage for this Plan. 15 PRINCIPAL FINANCIAL GROUP mi D JP ENTAL PLAN CONTRIBUTORY PLAN y GROUP# DENTAL BENEFITS* IN-NETWORK OUT-OF-NETWORK Calendar Year Maximum Benefit (Applies to Basic and Major Services) Per Person $1,000 Calendar Year Deductible(Applies to Basic and Major Services)Per Person $50 Family Maximum $150 THE PLAN PAYS: Preventive Services Routine Oral Exams Prophylaxis(routine cleaning) Bitewing X-rays Fluoride Treatment 100% 100% Full Mouth X-rays Space Maintainers Sealants Basic Services Restorative Fillings Routine Periodontal Maintenance Extractions Emergency Exams Oral Surgery General Anesthesia/IV Sedation 80% 80% Periodontics Endodontic Harmful Habit Appliances Stainless Steel Crowns Major Services Inlays and Onlays Crowns Installation&Repairs Dentures -Full and Partial Bridgework Installation&Repairs 50% 50% Denture Repairs Orthodontic Services Not Covered Not Covered Allowable Charges Based on PPO Based on Prevailing Fees Negotiated Fees at the 90 Percentile Preventive Passport Provision- This provision exempts preventive charges from applying towards the calendar year maximum benefit.Therefore,the calendar year maximum benefit will not be impacted by use of preventive services. Special Conditions Benefit - When an Enrollee is pregnant, diabetic or suffers from heart disease, Principal will pay for additional routine or periodontal services within a calendar year. Network Savings- You have the option to receive services from any Providers. Your maximum benefit will go further and you will pay less out-of- pocket if you use a PPO In-Network Dentist. ➢ PPO In-Network Dentist-this is a provider who agrees to accept a negotiated discounted fee for services provided. They cannot balance bill. ➢ Out-of-Network Dentist-this is a provider who is not a PPO In-Network Dentist. An Out-of-Network Dentist can balance bill you for charges that exceed what Principal deems to be usual and customary charges. Late Enrollee Penalty- If a member enrolls in this dental plan at any time other than: 1) within 31 days of their initial eligibility date, or 2) during an annual open enrollment period,they will be subject to a benefit waiting period of 12 months for all Basic Services and 24 months for all Major Services. Epic Xylitol Dental System- Under the Principal dental plan,you have access to discounts on Epic Xylitol Dental products- including toothpaste,oral rinse, mints and gums. Xylitol is a natural sweetener that is very effective in preventing tooth decay. *Frequency and age limitations may apply. 16 The following is a list of common procedures,how often they are covered and any age limits. This is not a complete list of those services subject to frequency and/or age limits. Preventive Services: • Routine exams-two per calendar year • Routine cleaning(prophylaxis) -two per calendar year (expectant mothers, diabetics and those with heart disease receive one additional routine or periodontal cleaning within a calendar year) • Fluoride-two treatments each calendar year(covered only for dependent children under age 16) • Space maintainers-covered only for dependent children under age 16;repairs not covered • Sealants-on first and second permanent molars for dependent children under age 16;one each tooth each 36 months • X-rays-Bitewing(one set every calendar year),occlusal,periapical) • X-rays-Full mouth survey(one every 36 months),extraoral Basic Services: • Periodontal prophylaxis - if three months have elapsed after active surgical periodontal treatment; two per calendar year (expectant mothers, diabetics and those with heart disease receive one additional routine or periodontal cleaning within a calendar year) • Emergency exams-subject to routine exam frequency limit • Harmful Habit Appliances-covered only for dependent children under age 16 • Non-surgical Periodontics, scaling and root planning - once each quadrant each 24 months(expectant mothers, diabetics and those with heart disease, this procedure is provided with no deductible and at 100%coinsurance level) • Surgical Periodontal-once each quadrant,each 36 months • Occlusal Guards-one guard per 36 months Major Services: • Crowns-each 60 months per tooth,if tooth cannot be restored by filling • Inlays,Onlays,Cast Post and Core,Core Buildup-each 60 months per tooth • Bridges-replacement of Bridges over 60 months old • Dentures-replacement of complete or partial dentures over 60 months olds Benefits for the initial placement of bridges, partials and dentures are not covered if those teeth were missing prior to becoming insured under the Principal dental policy. When this policy replaces coverage under a prior plan, continuous coverage under the prior plan may be applied to the missing tooth provision requirement. This is just a highlight of the benefits provided under our Dental Plan. For a complete list of all contract/policy exclusions, limitations,benefits and benefit restrictions or waiting periods,please refer to the Certificate of Coverage for this Plan. This Dental Plan uses the Principal Dental Preferred Provider Organization(PPO)Network 17 PRINCIPAL FINANCIAL GROUP BASIC LIFE AND AD&D PLAN NON-CONTRIBUTORY Group# One times your basic annual earnings*, rounded up to the next higher EMPLOYEE LIFE INSURANCE multiple of$1,000. BENEFIT: • Maximum benefit of$100,000 • Minimum benefit of$10,000 Benefit reduces to 65%at age 65;and then to 50%of the original amount at age 70 EMPLOYEE ACCIDENTAL One times your basic annual earnings*, rounded up to the next higher DEATH OR DISMEMBERMENT multiple of$1,000. BENEFIT(ADD): • Maximum benefit of$100,000 • Minimum benefit of$10,000 Benefit reduces to 65%at age 65;and then to 50%of the original amount at age 70 If you suffer any of the following loses as a direct result of a covered accident and otherwise qualify, you will receive a benefit equal to the following percentage of the above ADD Benefit:: • 50%if you lose a hand,a foot,or the sight of one eye • 100% if more than one of the above listed losses results from the same accident • 25%for loss of thumb and index finger on the same hand • 100%if you lose your life • 100%for loss of Speech and Hearing(in both ears) • 50%for loss of Speech or Hearing(in both ears) • 25%for loss of Hearing(in one ear) Loss must occur within 365 days of the date of injury Additional Benefits Provided • Waiver of Premium-applies to both the Life and ADD premium. Include: • Accelerated Death Benefit - must be deemed terminally ill with a life expectancy of 12 months or less. Accelerated Death Benefit will be limited to a minimum of $5,000 and a maximum of 75% of your life insurance benefit.Payable only once. • Conversion Privilege • Coverage for Disappearance or Exposure • Seat Belt and Air Bag Benefit-$10,000 additional benefit • Paralysis Benefit • Repatriation Benefit - reimbursement of eligible expenses up to a maximum of$2,000 • Child Higher Education Benefit - $3,000 per qualified child, paid annually for a maximum of 4 years when employee suffers a covered loss of life under this policy *For a definition of your Basic Annual Earnings,contact your Office Manager This is just a highlight of the benefits provided under our Basic Life and ADD Plan. For a complete list of all contract/policy exclusions,limitations,benefits and benefit restrictions or waiting periods,please refer to the Certificate of Coverage for this Plan. 18 18 PRINCIPAL FINANCIAL GROUP "" LONG TERM DISABILITY PLAN NON-CONTRIBUTORY PLAN Group# EMPLOYEE LTD BENEFIT: if Primary Monthly Benefit 60%of your pre-disability earnings.For a definition oour pr d e- `' •ility earnings, contact your Office Manager. A n - • Maximum Monthly Benefit of$5,000 ;r ; • Minimum Monthly Benefit of$100 s., Elimination Period 90 days •�r —� Own Occupation Period Twenty-Four Months(24);after 24 months you must be totally or partially disabled from performing the duties of any gainful occupation for which you are or may reasonably become qualified based on education,training,or experience. Maximum Benefit Duration Later of a)the Maximum Benefit Duration Period shown below,or b)your Social Security Period Normal Retirement Age(SSNRA) Age on Date of Disability Maximum Benefit Duration Period Duration may be limited if Before age 65 Greater of 36 Months or to your SSNRA disability is due to Specific 65-67 24 Months Conditions* 68-69 18 Months 70-71 15 Months 72&older 12 Months Rehabilitation Benefits • Rehabilitation Services • Pre-Disability Intervention Services • Rehabilitation Incentive Benefit, 5%benefit increase for a maximum of 12 months • Return to Work Child Care Benefit,reimbursement of eligible child care expenses up to a maximum of $350 per child, per month,maximum of 12 months • Reasonable Accommodation Benefit, reimbursement of eligible expenses up to a maximum$5,000 for workplace modifications *Specific Condition Disabilities due to mental health or substance abuse related conditions will limited to a Limitations combined lifetime maximum benefit duration period of 24 months. Pre-existing Condition No benefits will be paid for a disability that results from a Pre-existing Condition Exclusion Period unless,on the date you become disabled,you have been actively at work for one full day after completing 24 consecutive months during which you were insured under the LTD Plan. A Pre-existing Condition is any sickness or injury, including all related conditions and complications, or pregnancy, for which you received medical treatment, consultation, care or services for, or were prescribed or took prescription medications for, in the six month period before you became covered by this Plan. Waiver of Premium Provision No premiums are required when benefits are payable Benefit Offset Provision Benefits may be reduced by other sources of income and disability earnings,including but not limited to Social Security Disability Primary and Family Benefits. Additional Benefits Provided • Work Incentive Benefit for 12 months Include: • Benefits for Total or Partial Disability • Spouse Rehabilitation Benefit-reimbursement of eligible expenses up to a maximum of$500 • Survivor Income Benefit Equal to 3X the Primary Monthly Benefit • ADL Benefit-additional benefit equal to 20% of your pre-disability earnings up to a maximum monthly benefit of$5,000 • Extended Earnings Protection Benefit This is just a highlight of the benefits provided under our Long Term Disability Plan. For a complete list of all contract/ policy exclusions,limitations,benefits and benefit restrictions or waiting periods,please refer to the Certificate of Coverage for this Plan. 19 PRINCIPAL FINANCIAL GROUP VALUE-ADDED SERVICES The following services are made available,at no additional cost,to all employees to whom we provide Basic Life/ADD and LTD benefits. These services are not part of the insurance policies issued to[client name]and can be changed or cancelled at any time. WILL&LEGAL DOCUMENT CENTER Available to our employees and their spouses,we provide access to free online resources from the Will&Legal Document Center provided by ARAG Services, LLC. The use of these resources and services provided by ARAG should not be considered a substitute for consultation with an attorney. With easy-to-use interactive online software,employees can prepare,print and store these essential legal documents: - Will - Specifies what happens to property when you die, who executes the estate and names a guardian for minor children. - Living Will-Informs healthcare providers and family about desires for medical treatment if you cannot make them. - Healthcare Power of Attorney-Grants someone permission to make medical decisions in case you cannot make them. - Financial Power of Attorney-Grants someone permission to make financial decisions in case you cannot make them. In addition,employees can also access: - Estate planning education and tools-View a variety of articles and links to legal information. - Identity Theft Protection - Includes an Identity Theft Prevention Kit to help protect you from becoming a victim of identity theft and an Identity Theft Victim Action Kit to help speed recovery if you do become a victim of identity theft. EMPLOYEE ASSISTANCE PROGRAM (EAP) At no cost to our employees and their families, we make available an Employee Assistance Program through Magellan Health Services. And if you need assistance beyond the scope of the EAP, the counselor will help find an affordable solution. (employees are responsible for any fees resulting from referrals outside of the EAP, including those associated with medical benefits.) Through an EAP provided by Magellan Health Services, employees and their families can get help that's easy to access, convenient and confidential. Counselors are available 24 hours a day, seven days a week from anywhere in the United States. You can call or visit them online at:www.MagellanHealth.com/member The EAP offers assistance with day-to-day issues and is available for: • Managing stress • Caring for children or aging parents • Handling relationship issues • Dealing with conflict or violence • Balancing work and life i v , • Working through grief and loss issues • Quitting tobacco,alcohol or drug use • Controlling depression and anxiety Services for employees and their families include: • Telephone consultation, available 24/7, with licensed mental health professionals • Referrals to local child and elder care services and resources • Online information,webinars,podcasts and services at www.MagellanHealth.com/member • Referrals to local community resources when employees need additional assistance • Speak to a counselor or participate in our private self-screening services 20 TRAVEL ASSISTANCE PROGRAM Employees, their spouses and dependent children (whether traveling together or separately) have access to travel assistance services provided by AXA Assistance. The services includes travel, medical, legal and financial assistance plus emergency medical evacuation benefits — when traveling domestically or internationally 100 or more miles away from home for up to 120 consecutive days. And it's all available 24 hours a day, 365 days a year. With over 600,000 providers worldwide in more than 230 countries,AXA Assistance is available to help quickly and professionally in a travel emergency. Information and assistance includes Pre-trip and cultural information services • Urgent message relay • Visa and passport requirements • Emergency cash and bail assistance • Travel advisories and customs information • Legal referrals • Immunization/inoculation requirements • Political evacuation • Cultural information Medical assistance services • Consular/embassy locations and referrals • Medical/dental referrals • Currency exchange rates • Hospital admission guarantee and discharge planning • Local voltage information • Medical pre-certification and referral management Personal assistance services • Lost prescription and eyeglass/contact assistance • Lost luggage • Replacement of medical devices • Emergency telephone interpretation • Shipment of medication • Lost/stolen documents(i.e.,passports,driver's • Medical monitoring license,credit cards) AXA Assistance arranges for these services for free.The participant is responsible for any fees incurred. 21 PREMIUM INFORMATION • Basic Life and AD&D Plan [client name]pays 100%of the cost for your enrollment in this plan. You will be subject to imputed income on any benefit amount that exceeds$50,000. • Long Term Disability Plan [client name]pays 100%of the cost for your enrollment in this plan. • Medical Plan If enrolled,[client name]contributes 50%of the monthly cost based on the Employee Only rate.You pay 100%of the additional cost for you and your dependents(if enrolled).Your cost per pay period(26),based on coverage type is: Total Monthly Premium Your Bi-weekly Cost Employee Only $444.79 $102.64 Employee&Spouse $934.06 $328.46 Employee&Child(ren) $867.34 $297.66 Employee,Spouse &Child(ren) $1,356.61 $523.48 • Dental Plan If enrolled,[client name]contributes 50%of the monthly cost based on the Employee Only rate.You pay 100%of the additional cost for you and your dependents(if enrolled).Your cost per pay period(26),based on coverage type is: Total Monthly Premium Your Bi-weekly Cost Employee Only $40.23 $9.28 Employee &Spouse $76.71 $26.12 Employee &Child(ren) $99.33 $36.56 Employee,Spouse &Child(ren) $142.89 $56.66 • Vision Plan -r If enrolled,you pay 100%of the cost to participate in this Plan. Your cost per pay period(26),based on coverage type is: Total Monthly Premium Your Bi-weekly Cost Employee Only $7.98 $3.68 Employee&Spouse $15.16 $7.00 Employee&Child(ren) $15.96 $7.37 Employee,Spouse&Child(ren) $23.46 $10.83 If you do not wish to have your premiums deducted on a pre-tax basis, you must submit a written request on the appropriate form to your Office Manager prior to the start of the Plan rIN�P Year.To obtain the appropriate form,contact your Office Manager. 1Z- A'2 Q Due to IRS regulations,premiums for coverage of a domestic partner must be deducted on an after-tax basis. 22 FOR ASSISTANCE-CONTACT INFORMATION Contact us • [client name]Office Manager --- Jane Doe Jane Doe @clientname.com 404.555.6677 • Medical plan-Blue Cross Blue Shield Group For questions regarding your eligibility,medical benefits or claims,call BCBSGA at 1-800-441-2273 To locate a provider in your network,call 1-855-397-9267 or visit www.bcbsga.com and select the Blue Open Access POS Network • RX plan-Express Scripts(in coordination with BCBSGA) For questions regarding your RX benefits,call Express Scripts at 1-855-397-9268,or visit your Customer Support at www.bcbsga.com • Vision Plan-EyeMed Group# For questions regarding your vision benefits,call EyeMed at 1-866-723-0513 To locate a provider in your network,call 1-866-804-0982 or visit www.eyemed.com and choose the Insight Network If you need to print an ID card,check a claim status or view your benefit details,register online at www.eyemed.com To locate a network Lasik provider,call 1-877-5LASER6 or visit www.eyemedlasik.com • Dental Plan-Principal Financial Group* Group# For questions regarding your dental claims and benefits,call Principal at 1-800-247-4695 To locate a provider in your network,call 1-800-832-4450 or visit www.principal.com and choose the Dental PPO Network • Life Insurance Plan and Long Term Disability Plan-Principal Financial Group* Group# For questions regarding your Life Insurance or Disability benefits,call Principal at 1-800-245-1522 • Travel Assistance Program-AXA Assistance USA, Inc. Online:www.principal.com/travelassistance Toll-free within the U.S.:1-888-647-2611 Outside the U.S.,call collect:630-766-7696 • Employee Assistance Program(EAP)-Magellan Health Services Online:www.MagellanHealth.com/member Toll-free counselor:1-800-450-1327(T1'Y for hearing impaired:1-800-456-4006) International access only:1-800-662-4504 • Will&Legal Document Center-ARAG Services Online:www.ARAGwills.com/Principal Questions:1-800-546-3718 • All Above Benefit Plans-Midsouth Benefits Should you need assistance and are unable to get a satisfactory response by going directly to the insurers listed above, please contact your Senior Account Manager, Meg Marland, with Midsouth Benefits at 770-579-7099 or via email at mmarland @midsouthbenefits.net *Use your smartphone or mobile device to access all of your group dental, life and disability benefits information from Principal Financial Group. If you are interested in obtaining information on the Principal Mobile®Application, contact Meg Marland with Midsouth Benefits at 770-579-7099 or at mmarland @midsouthbenefits.net 23 Premium Assistance Under Medicaid and the Children's Health Insurance Program(CHIP) If you or your children are eligible for Medicaid or CHIP and you're eligible for health coverage from your employer,your state may have a premium assistance program that can help pay for coverage,using funds from their Medicaid or CHIP programs. If you or your children aren't eligible for Medicaid or CHIP,you won't be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information,visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below,contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP,and you think you or any of your dependents might be eligible for either of these programs,contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify,ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP,as well as eligible under your employer plan,your employer must allow you to enroll in your employer plan if you aren't already enrolled. This is called a"special enrollment"opportunity,and you must request coverage within 60 days of being determined eligible for premium assistance.If you have questions about enrolling in your employer plan,contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA(3272). If you live in one of the following states,you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31,2015. Contact your State for more information on eligibility. ALABAMA—Medicaid GEORGIA—Medicaid Website:www.myalhipp.com Website:http://dch.georgia.gov/ Phone:1-855-692-5447 Phone:1-80o-869-n5o -Click on Programs,then Medicaid,then Health Insurance Premium Payment(HIPP) ALASKA—Medicaid INDIANA—Medicaid Website:http://health.hss.state.ak.us/dpa/programs/medicaid/ Website:http://www.in.gov/fssa Phone(Outside of Anchorage):1-888-318-8890 Phone:1-800-889-9949 Phone(Anchorage):907-269-6529 COLORADO—Medicaid IOWA—Medicaid Medicaid Website:http://www.colorado.gov/hcpf Website:www.dhs.state.ia.us/hipp/ Medicaid Customer Contact Center:1-80o-221-3943 Phone:1-888-346-9562 FLORIDA—Medicaid KANSAS—Medicaid Website:https://www.flmedicaidtplrecovery.com/ Website:http://www.kdheks.gov/hcf/ Phone:1-877-357-3268 Phone:1-800-792-4884 KENTUCKY—Medicaid NEW HAMPSHIRE—Medicaid Website:http://chfs.ky.gov/dms/default.htm Website:http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone:1-800-635-2570 Phone:603-271-5218 LOUISIANA—Medicaid NEW JERSEY—Medicaid and CHIP Website:http://www.lahipp.dhh.louisiana.gov Medicaid Website: Phone:1-888-695-2447 http://www.state.nj.us/humanservices/ dmahs/clients/Medicaid/ Medicaid Phone:609-631-2392 CHIP Website:http://www.njfamilycare.org/index.html CHIP Phone:1-80o-7m-0710 MAINE—Medicaid NEW YORK—Medicaid Website:http://www.maine.gov/dhhs/ofi/public- Website:http://www.nyhealth.gov/health care/medicaid/ assistance/index.html Phone:1-80o-977-674o Phone:1-800-541-2831 TTY:1-80o-977-6741 24 MASSACHUSETTS—Medicaid and CHIP NORTH CAROLINA—Medicaid Website:http://www.mass.gov/MassHealth Website: http://www.ncdhhs.gov/dma Phone:1-80o-462-112o Phone: 919-855-4100 MINNESOTA—Medicaid NORTH DAKOTA—Medicaid Website:http://www.dhs.state.mn.us/id_oo6294 Website:http://www.nd.gov/dhs/services/medicalsery/medicaid/ Click on Health Care,then Medical Assistance Phone:1-80o-657-3739 Phone:1-80o-755-2604 MISSOURI—Medicaid OKLAHOMA—Medicaid and CHIP Website:http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Website:http://www.insureoklahoma.org Phone:573-751-2005 Phone:1-888-365-3742 MONTANA—Medicaid OREGON—Medicaid Website:http://medicaid.mt.gov/member Website:http://www.oregonhealthykids.gov Phone:1-80o-694-3084 http://www.hijossaludablesoregon.gov Phone:1-80o-699-9075 NEBRASKA—Medicaid PENNSYLVANIA—Medicaid Website:www.ACCESSNebraska.ne.gov Website:http://www.dpw.state.pa.us/hipp Phone:1-855-632,-7633 Phone:1-80o-692-7462 NEVADA—Medicaid RHODE ISLAND—Medicaid Medicaid Website: http://dwss.nv.gov/ Website:www.ohhs.ri.gov Medicaid Phone: 1-80o-992-090o Phone:401-462-5300 SOUTH CAROLINA—Medicaid VIRGINIA—Medicaid and CHIP Website:http://www.scdhhs.gov Medicaid Website: http://www.coverva.org/programs premium assistance.cfm hone:1-888-549-0820 Medicaid Phone:1-80o-432-5924 CHIP Website: http://www.coverva.org/programs premium assistance.cfm CHIP Phone:1-855-242-8282 SOUTH DAKOTA-Medicaid WASHINGTON—Medicaid Website:http://dss.sd.gov Website:http://www.hca.wa.gov/medicaid/premiumpymt/pages/ Phone:1-888-828-0059 index.aspx Phone: 1-80o-562-3022 ext.15473 TEXAS—Medicaid WEST VIRGINIA—Medicaid Website:https://www.gethipptexas.com/ Website: www.dhhr.wv.gov/bms/ Phone:1-800-440-0493 Phone:1-877-598-5820,HMS Third Party Liability UTAH—Medicaid and CHIP WISCONSIN—Medicaid and CHIP Website: Website: Medicaid:http://health.utah.gov/medicaid https://www.dhs.wisconsin.gov/badgercareplus/p-1oo95.htm CHIP:http://health.utah.gov/chip Phone:1-866-435-8427 Phone:1-80o-362-3002 VERMONT—Medicaid WYOMING—Medicaid Website:http://www.greenmountaincare.org/ Website:http://health.wyo.gov/healthcarefin/equalitycare Phone:1-80o-250-8427 Phone:307-777-7531 To see if any other states have added a premium assistance program since January 31,2015,or for more information on special enrollment rights,contact either: U.S.Department of Labor U.S.Department of Health and Human Services Centers Employee Benefits Security Administration for Medicare&Medicaid Services www.cms.hhs.gov www.dol.gov/ebsa 1-877-267-2323,Menu Option 4,Ext.61565 1-866-444-EBSA(3272) 25 SUMMARY PLAN DESCRIPTION INFORMATION [the Company] maintains this group benefits plan (the Plan) to provide benefits to you and your eligible dependents. Your benefits are provided under an insurance contract between the Company and Principal Financial, Blue Cross Blue Shield of Georgia and Fidelity Security Life(the insurers). This document and the Certificates of Coverage from the insurers make up your summary plan description (SPD). Please read this document and the insurer's Certificates of Coverage to learn about your Plan benefits. It is your responsibility to understand your benefits under the Plan and to ask questions if you need more information. Please keep your Plan documents in a safe place for future reference. Please note that this document does not provide any substantive rights to benefits that are not included in the insurer's Certificate of Coverage. If you have any questions regarding the Plan, including whether you are eligible to participate in the Plan,please contact your Office Manager.If you have questions regarding claims and benefits payable under the Plan,please contact the insurer. Name of Plan: [client name]Employee Group Benefits Plan Name,Address of Plan Sponsor: [client name] 1235 Marietta Blvd Atlanta,GA 30318 404-567-7439 Plan Sponsor Tax ID Number: 26-4101123 Type of Plan: Group Insurance Plans • Life and Accidental Death&Dismemberment(ADD) • Long Term Disability(LTD) • Medical • Dental • Vision Type of Administration: Contract Administration. With respect to paying claims for benefits or determining eligibility for coverage under our fully insured contracts,each insurance carrier (insurer), as administrator for claims determinations and as ERISA claims review fiduciary, shall have full and exclusive discretionary authority to interpret plan provisions,make decisions regarding eligibility for coverage and benefits;and resolve factual questions relating to coverage and benefits. Name of Plan Administrator: [client name] Plan Number: 501 Name,Address of Registered Agent for [client name] Service of 1235 Marietta Blvd Legal Process: Atlanta,GA 30318 404-567-7439 If Legal Process Involves Claims for Benefits Principal Financial Group-Life/ADD,LTD and Under the Group Policy,Additional Dental 2000 River Edge Parkway,Suite 1000 Notification of Legal Atlanta,Georgia 30328 Process Must Be Sent To: Blue Cross Blue Shield of Georgia- Medical 3350 Peachtree Road,NE Atlanta,Georgia 30326 EyeMed-Vision 4000 Luxottica Place Mason,Ohio 45040 Sources of Premium Contributions: Employer Paid Group Life and Accidental Death& (For information on how premium Dismemberment Group Long Term Disability contribution amounts are determined,see the Employee Paid PREMIUM INFORMATION page Group Vision of this booklet) Employer&Employee Paid Group Medical Group Dental 26 Funding: All benefits under the Plan are fully insured.Plan benefits are payable pursuant to a contract with the insurer.Claims for benefits are sent to the insurer and the insurer is responsible for paying benefits. The Company is not responsible for paying benefits under the Plan. Premium contributions are paid in part by the Company out of its general assets and in part by employees through pre-tax contributions,or if elected,through after-tax contributions. Any refund, rebate,dividend, experience adjustment, or other similar payment under the group Insurance contract entered into between the Company and the insurer will be allocated, if consistent with the fiduciary obligations imposed by ERISA and permitted by law, to first reimburse the Company for premiums that it has paid. Plan Year: December 1-November 30 Plan Effective Date: December 1,2013 Amendment or Termination of One Or More The Company may modify, amend or terminate the Plan at any time at its Benefit Plans: sole discretion. The right to modify, amend or terminate also applies to the insurance contract between the Company and the Insurer. Any modification, amendment, or termination will be communicated in writing to participants under the Plan prior to the effective date of any such change. Conflicting Terms: If the terms of this document conflict with the terms of the policy or certificate of coverage issued by the insurer,the insurance policy or certificate of coverage will control.This document may not confer additional rights that are not contained in the insurer's document. No Contract of Employment: The Plan does not constitute a contract of employment between you and the Company or any other arrangement indicating that you will be employed for any specific period of time. Compliance with State and Federal Laws To the extent required by law, the Plan will provide coverage and benefits in accordance with the requirements of all applicable laws, as amended. Please consult the Certificate of Coverage for each specific benefit plan for more information. Information pertaining to the following can be found in the Certificate of Coverage as issued by the insurer for each specific benefit plan,and provided to you upon enrollment. You may request an additional electronic or paper copy of this document or any Certificate of Coverage from your Office Manager. • Calculation methods for service and benefits • Benefit payment procedures and timing • Benefit/coverage Exclusions and Limitations • Claims submission process and claims appeal process • Circumstances that may result in the loss or denial of benefits • A statement of your ERISA Rights 27 The information in this Employee Benefits Guide is intended to only provide you with a brief overview of each plan's administrative provisions,highlights and benefits. Please consult each insurer's Certificate of Coverage for the complete details on benefits,covered charges,limitations,and exclusions that may apply. The information in this document is not binding. If there are any discrepancies between the information in this Employee Benefits Guide and the insurer's Certificate of Coverage,the insurer's Certificate of Coverage will prevail and govern how the benefits are provided and administered. Prepared By: Midsouth BENEFITS Attachment E - Sample Newsletters Included in this section are sample wellness, educational and legislative newsletters. v -_a ate- te - t i' \t ^ � ,-.1 1:• ': t ! . n M ` r W f Pr ms a ti s ,�N � �e ___ __ IA 4 r -N- .1 - - , ,,:-_,benefits specialists at Midsouth Benefits. The new year is the perfect A New Year, A New You time to take a step back and assess your health and Planning for a Future of Financial Stability finances.Whether you need Obtaining the peace of mind financial stability brings starts with reviewing your current financial resources. This is important because your financial resources affect not only your to take a closer look at your ability to reach your goals, but your ability to protect those goals from potential financial financial well-being or your crises. These are the resources you will draw on to meet various life events. Start by physical fitness,what better calculating your net worth—this isn't as difficult as it might sound. Your net worth is simply the total value of what you own: your assets, minus what you owe: your liabilities. It's a time to do so than today? snapshot of your financial health. These tips help First, add up the approximate value of all of your assets. This includes personal possessions, p p y Ou vehicles, homes, checking and savings accounts, and the cash value (not the death benefits) discover a new (and of any life insurance policies you may have. Include the current value of investments, such as improved!) you stocks, real estate, certificates of deposit, retirement accounts, IRAs and the current value of any pensions you have. Now add up your liabilities: the remaining mortgage on your home, credit card debt, student and personal loans taxes due on the profits of your investments if you cashed them in and any other outstanding bills. Subtract your liabilities from your assets. Do you have more assets than liabilities? Or the other way around? If so, don't beat yourself up. According to Forbes Magazine, a person with no debt and $10 in his or her pocket has more wealth than 25 percent of Americans. Your aim is to create a positive net worth, and you want it to grow each year. Your net worth is part of what you will draw on to pay for financial goals and your retirement. A strong net worth also will help you through financial crises. Review your net worth annually as a good way to monitor your financial health. Websites like Mint.com help you keep track of your income,expenses and net worth on a daily basis. Identify other financial resources.You may have other financial resources that aren't included in your net worth but that can help you through tough times. These include the death benefits of your life insurance policies, Social Security survivor's benefits, health care coverage, disability insurance, liability insurance, and auto and home insurance.Although you may have to pay for some of these resources, they offer financial protection in case of illness, accidents or other catastrophes. Healthy Portion Sizes For a general idea of the amount of food you should be consuming, use the following recommendations: • A serving of meat is about two or three ounces—about the size of a deck of cards,or the palm of your hand. •M i d sa ut h • One serving of grains is equal to one slice of bread, one ounce of cereal, or 1/2 BENEFITS cup of pasta or rice. Provided by Midsouth Benefits http://www.midsouthbenefits.net Pptio n • A serving of fruit or vegetables is equal to one piece of fresh fruit or vegetable, 1/2 cup chopped, or%cup of fruit or vegetable juice. In general, it's not as necessary to be vigilant about vegetable and fruit intake, as any amount is healthy—just make sure you're getting enough while being aware of the sugar content in fruit. • The key to any meal is to have 75 percent of your plate covered with vegetables and 25 percent covered with meat or pasta. Making Time for Fitness Everyone has time for fitness—even if your life already seems too hectic with your job,family and other commitments,there's still room to tend to your health and fitness. Here are some tips: • Park your car far away,and walk farther to your destination. • Participate in a charity run,walk or bike event. • Take the stairs instead of the elevator or escalator. • Squeeze a stress ball while at work to relieve tension, burn calories, increase flexibility and improve blood flow. • Exercise during your lunch hour, even if it's just a walk around the block or up and down a flight of stairs. Getting even 20 to 30 minutes of exercise per day will improve your health. It will also make you feel better overall and can be fun. Get out there and get active! The Importance of Knowing Your Numbers Knowing your blood pressure, cholesterol, blood sugar and body mass index (BMI) are vital in determining whether you are at risk for developing major illnesses, such as heart disease and diabetes. If you know your numbers are out of healthy range, you can take measures to get yourself back into good health. Cholesterol:An unexpected heart attack may be caused by years of living with high cholesterol and extra fat stored in the body. Total cholesterol should be 200 or less. You should also ask your doctor what your HDL cholesterol(good)and LDL cholesterol(bad)levels are. Blood Pressure: Blood pressure is the amount of force that it takes for your heart to pump blood through your body. High blood pressure, known as hypertension, increases your risk of heart attack, stroke and kidney disease. It can also cause damage to your brain, eyes and arteries. Blood pressure should be around 120 over 80. Blood Sugar: Glucose is sugar that is stored in the blood as your main source of energy. If your glucose levels are too high or too low, you can develop diabetes. The normal range for blood sugar is 80 to 120. Body Mass Index: BMI measures your weight in relation to your height. This measurement indicates whether your weight falls within a normal,healthy range.Your BMI should be less than 25.A BMI over 25 indicates you are overweight,and a BMI over 30 indicates obesity. Source:U.S. Department of Labor(Financial Stability)www.dol.qov/ebsa/pdf/savingsfitness.pdf \1 1 • This newsletter is for informational purposes only,and is not intended as professional advice.Design©2010 ' Zywave,Inc.All rights reserved. �� Live r o Well i, November 2014 It 4 IP Presented by your benefits specialists at Midsouth Benefits .\\\ \ \ \ \\\\\ \\ \ \ \ \\%\\\\\\\\, \ any casseroles, but how about complementing A Healthier Thanksgiving these sides or ignoring them altogether in favor \ of steamed or roasted vegetables and cornbread? If you must have a holiday favorite, make sure it Thanksgiving meals usually include an Americans make it a habit to wait to eat until is just that, and not something you consume abundance of unhealthy food options, the holiday meal is set out, eating a small regularly during the year. And be sure to police making it easy to stray from proper nutrition meal in the morning can give you more your portions, since there are definite until the start of the new year.But if you opt control over your appetite, allowing you to be consequences to having too much of a good for a healthy Thanksgiving meal instead, it more selective in your food and beverage thing. doesn't mean it can't also be enjoyable. choices later on. Keep in mind that you can With a few changes, you can make your always have leftovers the next day. Once you've made smarter choices regarding "Turkey Day" an extension of your year- your turkey and your side dishes, you may be round commitment to good health. When moving on to Thanksgiving's wondering if there is anything else you can do. centerpiece—the turkey—be sure to go There is! Begin with the elephant in the room: food. skinless. Just 1 ounce of turkey skin contains You can probably stand to forgo a luxury or 80 calories and 2 grams of fat. Also, be sure Take a walk early in the day and then again after \\\\ two come turkey time. But don't worry; you to use fat-free chicken broth to baste the dinner. It is a wonderful way for families to get can still enjoy a delicious meal with the turkey and to make the gravy. some physical activity and to enjoy the holiday added bonus of feeling much better together. For those who have the day off after afterward. Plus, Thanksgiving is just the Next, turn your attention to the side dishes. Thanksgiving, plan an additional workout. You start of the holiday season, so there will be a Substituting skim milk or half-and-half for will feel like your old self in no time, ready to whole milk and cream in recipes is an obvious manage your diet and exercise regimen right lot of large meals to come. g Y g choice,as is omitting bacon and cheese from away,instead of waiting until Jan. 1. Start by having breakfast.While many Ebola is not a Ebola Outbreak Reaches U.S. respiratory disease like the flu, SO it i5 The recent deadly outbreak of Ebola in West Africa—the worst in history—has seized the world's attention,along with news that the virus has shown up in the United States. not transmitted Ebola is an acute viral illness characterized by the sudden onset of fever, debilitating weakness, \ through the air. muscle pain,headache and sore throat. People often confuse the illness' early symptoms with cold or \ flu symptoms. Ebola is not a respiratory disease like the flu, so it is not transmitted through the air or through ����\� ����� ��������\�\„\\,,,,,, contaminated food or , sweat,, blood can only vomit, so people other can humans get contact with touching bodily fluids, including saliva, sweat, blood and vomit, so people can only get Ebola from touching the bodily fluids of a person or animal that is sick with or has died from Ebola, or from exposure to 4 contaminated objects,such as needles. ' Though the Ebola outbreak has shown up in America, health officials have stressed repeatedly that \\\\ t C 1 Y 1 i d s o u t h \�\` the general public is at very low risk for contracting the virus,and they are instructing health workers L BENEFITS h on the proper precautions to take if they are called upon to treat an infected patient. \ ‘‘ \\\\XI:\\\\\\\.\\\\\\\\\\\\\\\\\\\\\.\\\\\\\\\\\\\\\\\\\\\\\\\\.\\,\\\:\\\:\\\\\1 N\\\\\\\\, \ \\\\\\\\\ N \f„ \\\. \\\\\\\\\\\\\\\ \\\\\\ \\\\\1 \\ Can You Really Boost \ . _ . \\ Your Immunity? \ ,, „ .. __. it As cold and flu season rolls around,there are a bevy of products you can turn to - that purport to help boost your immunity.But how well do they actually work? \ Since the function of the immune system is to react to challenges and develop {, new defenses,it can be improved.Every time you catch a cold or get vaccinated, . your immune system builds a new army of killer T-cells, ready to fight off a future recurrence of the same pathogen. � \N \ \\\ But there is no nutritional supplement, superfood, or mind, body or spirit \\\ .,,. °{ \\\ \li technique that will do this for you. Harvard Medical School has stated, "The `�\� concept of boosting immunity actually makes little sense scientifically. In fact, \ boosting the number of cells in your body—immune cells or others—is not \\ necessarily a good thing," and can lead to autoimmune disease in the case of your immune system. So while you can't supercharge your immune system, you can take precautions Sweet Potato \� to prevent getting sick. These include practicing good hygiene (like regular hand-washing), getting vaccinated (including flu shots), practicing food safety, Casserole being knowledgeable and vigilant when traveling to foreign countries, drinking clean water and practicing safe sex. �\ Skip the marshmallows this year. This five-ingredient sweet potato casserole is low in fat and rich in flavor, and makes for a perfect side to complement your Thanksgiving Lower Winter Fuel Costs meal. • 2 tbsp.low-fat milk Pr ,m 1,C,' r 11/2 tsp.brown sugar ,h / I it • 1 tsp.ground cinnamon i . • 1/4 cup quick cooking oats,dry • 1 can low-sodium sweet potatoes,drained and chopped Preheat oven to 350° F. In a small bowl, combine milk, brown sugar, cinnamon and oatmeal. Mix well and set *\ aside. In a medium-sized baking pan, add the sweet Budgeting money for the holidays is always important,but many people often forget � �\ about the increased energy costs associated with winter until they get hit with the potatoes so they cover the bottom of the pan. Add the \ bill. Use the following recommendations from the Department of Energy to keep oatmeal mixture on top of the sweet potatoes. Bake for 20 your costs in check this year. minutes. Serve hot,or refrigerate and serve cold. • Cover drafty windows with heavy-duty,clear plastic sheets,or tape clear plastic Yield: 6 servings. Each serving provides 94 calories, 0.5g film to the inside of your window frames. of fat, Og saturated fat, 0mg of cholesterol, 30mg of sodium,5g of sugar and 3g of fiber. • Seal the air leaks around utility cut-throughs for pipes, in gaps around recessed lights in insulated ceilings and in unfinished spaces behind cupboards and o Source:USDA �\ closets. o A N • Maintain a regular service schedule for your heating systems. Replace filters e once a month or as needed. F • Set your thermostat as low as is comfortable. Turning it back 10 degrees at night or before leaving your home can save around 10 percent of your heating bills. 7 • Finally, use LED holiday light strings to save on the price of seasonal decorations. \ Live WWork Well • ,\,\\\\-\\\\\\\\\\\\\ \\\ :\.\\K\v\\\k\ \ %\\1\A\ \a % % \\\\\\\\\\\%\t`\\ \\L\\\;\ \\ - i� . } i P ( k - ( ,.. -- - .,. —. -ae r r n d i v i d u a I • Claim a coverage exemption from the individual mandate for some or all of 2014 and attach Form 8965; or Insurance■ • Pay an individual mandate penalty(called a shared responsibility payment)for any month in 2014 that you, your spouse(if filing jointly)or any individual you claim as Reportinga dependent did not have coverage and did not qualify for a coverage exemption. If you and your dependents all had minimum essential coverage for each month of Coverage and The federal tax return forms and instructions have Paying been updated to include a line for reporting health care coverage under the individual mandate. Penalties the tax year,you will indicate this on your 2014 tax return by simply checking a box A key provision of the Affordable Care Act on Form 1040, 1040A or 1040EZ; no further action is required. (ACA)is the individual mandate,which requires most individuals to purchase health If you obtained a coverage exemption from the Marketplace or you qualify for an insurance coverage for themselves and their exemption that you can claim on your return, you will file Form 8965, and attach it to family members or pay a penalty. your tax return. Starting in 2015, individuals will have to For any month you or your dependents did not have coverage or a coverage report on their federal tax return whether exemption,you will have to make a shared responsibility payment.The amount of the they had health insurance coverage for 2014 payment due will be reported on Form 1040, Line 61, in the"Other Taxes"section, or were exempt from the individual mandate. and on the corresponding lines on Form 1040A and 1040EZ. Any penalties that an individual owes for not having health insurance coverage will Who is exempt from the individual mandate? generally be assessed and collected in the You may be exempt from the individual mandate penalty if you: same manner as taxes. • Cannot afford coverage How will coverage be reported under the individual mandate? • Have income below the federal income tax filing threshold Starting in 2015,when you file a federal tax return for 2014,you will have to: • Are not a citizen, are not considered a national or are not lawfully present in the United States • Report that you, your spouse(if filing jointly)and any individual you claim as a • Experience a gap in coverage for less than a continuous three-month period dependent had health care coverage throughout 2014; or • Qualify as a religious conscientious objector - This Know Your Insurance article is provided by Midsouth Benefits and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional.Visit us at http://www.midsouthplanning.com.Design©2015 Zywave,Inc. All rights reserved. Midsouth BENEFITS Individual Insurance: Reporting Coverage and Paying Penalties • Are a member of a health care sharing Calculating your payment requires you to know your household income and your tax ministry return filing threshold. • Are a member of certain American Indian Household income is the adjusted gross income from your tax return plus any tribes excludible foreign earned income and tax-exempt interest you receive during the taxable year. Household income also includes the adjusted gross incomes of all of • Are given a hardship exemption by the your dependents who are required to file tax returns. Department of Health and Human Services Tax return filing threshold is the minimum amount of gross income an individual of your age and filing status(for example, single, married filing jointly, head of • Are incarcerated household)must make to be required to file a tax return. How much will the individual mandate 2014 Federal Tax Filing Requirement Thresholds penalty cost me? Must File a Return if The penalty for not obtaining acceptable iling Status Gross Income Exceeds health care coverage is being phased in over a three-year period.The amount of the Under 65 $10,150 penalty is either your"flat dollar amount"or Single your"percentage of income amount"— 65 or older $11,700 whichever is greater. Under 65 $13,050 Head of Household For 2014,the annual penalty is either: 65 or older $14,600 • One percent of your household income Under 65 (both spouses) $20,300 that is above the tax return filing Married Filing Jointly 65 or older(one spouse) $21,500 threshold for your filing status; or 65 or older(both spouses) $22,700 • Your family's flat dollar amount,which is Married Filing Separately Any age $3,950 $95 per adult and $47.50 per child, limited to a family maximum of$285. Qualifying Widow(er) Under 65 $16,350 with Dependent Children 65 or older $17,550 Your payment amount is capped at the cost of the national average premium for a bronze level health plan, available through the Marketplace in 2014. For 2014, the annual The IRS will generally assess and collect individual mandate penalties in the same national average premium for a bronze level manner as taxes,with certain limitations.As a result, any penalty under the individual health plan available through the mandate will likely be subtracted from the tax refund that the individual is owed, if Marketplace is$2,448 per individual ($204 any. per month), but$12,240 for a family with five or more members($1,020 per month). Source:Internal Revenue Service_..: e 41, 1 , ,, , \, 1 _ ) .: 140 ,. , _ _ _ ___. _._ : . 4.. i, r �� \,. • •_ YOUR 1i � yyk INSURANCE. ., „„F ,, , s � �� , , L vi,h111 it _ , '' .____ BenEll"s DID YOU KNOW? +� - The Affordable Care Act's (ACA) prohibition on pre-existing condition exclusions(PCEs)for plan years beginning on or after Jan. 1, 2014, makes HIPAA certificates of Creditable Coverage unnecessary. Beginning Dec. 31, 2014, group health plans and issuers are not required to provide HIPAA Benefits tips brought to you by Certificates for 2015 and following years. Midsouth Benefits Under the Health Insurance Portability and Accountability Act of 1996(HIPAA), plans and issuers had to provide HIPAA Certificates to individuals when they lost coverage under the plan or upon request for 24 months after coverage was terminated. The HIPAA Certificate allowed individuals to establish prior creditable coverage in order to reduce or eliminate PCEs. January 2015 HHS Issues Proposed yeaol efethe reinsurance program, is$27 per ACA Affordability Benefit and Payment The Nov. 21 Notice also addresses the Percentages Parameters for 2016 2016.The Marketplace open period f N Nov. 15od for Increase for 2016 2016.The 2015 period of o . 15, 2014,to Feb. 15, 2015, remains the same, but the On Nov. 21, 2014, the Department of Health proposed rule changes the open enrollment On Nov. 21, 2014,the IRS released and Human Services(HHS) issued the 2016 period for 2016 and following years to run affordability contribution percentages for Notice of Benefit and Payment Parameters from Oct. 1 to Dec. 15 of the year prior to the 2016.Affordability contribution Proposed Rule, which contains several benefit year. percentages measure a plan's proposed changes for 2016.Among these affordability and apply to three provisions changes are adjustments to the reinsurance Annual cost-sharing limitations are also 9 1 under the ACA:the employer-shared program's annual contribution rate,the addressed in the proposed rule.The ACA responsibility penalty,the individual Health Insurance Marketplace open generally requires non-grandfathered plans p p mandate and the premium tax credit. enrollment period for 2016 and following to have an out-of-pocket maximum for years, and annual limitations on cost- essential health benefits, which is updated These updated affordability percentages sharing. annually based on the percent increase in are effective for taxable years and plan average premiums per person for health years beginning after Dec.31, 2015: The transitional reinsurance program, insurance coverage.The 2015 out-of-pocket created by the Affordable Care Act(ACA)to maximum for self-only coverage is$6,600 • The new affordability percentage for help stabilize coverage premiums in the and the proposed 2016 maximum is$6,850. the individual mandate is 8.13 individual market for the first three years of For family coverage, the 2015 maximum is percent for 2016. the Exchange, imposes fees on health $13,200 and the proposed maximum for insurance issuers and self-insured group 2016 is$13,700. • The affordability percentage for the employer mandate and the premium health plans.The fees are lowered each The Notice also addresses proposed tax credit eligibility rules is 9.66 year that they are assessed. The 2015 percent for 2016. annual fee is$44 per enrollee, and the changes to the minimum value of employer- p proposed contribution rate for 2016,the final sponsored plans, the affordability exemption • Employers that use an affordability for the individual mandate, medical loss ratio safe harbor under the pay or play rebate requirements and provisions for the rules will continue using a Small Business Health Options Program contribution percentage of 9.5 (SHOP). percent. The changes addressed in the Notice are For 2015 plan years,the individual .,,;ii' proposed rules, so the HHS may still change mandate affordability percentage is 8.05 them before finalizing benefit and payment percent, and it is generally 9.56 percent parameters for 2016. for the employer mandate and premium I\,L i d C 3 O u t h tax credit eligibility. BENEFITS ©2014 Zywave,Inc.All rights reserved Health Care Reform LEGISLATIVE BRIEF May 13,2014 Provided by Midsouth Benefits 90-day Waiting Period Limit—Permitted Orientation Periods For plan years beginning on or after Jan. 1, 2014, the Affordable Care Act (ACA) prohibits group health plans and group health insurance issuers from applying any waiting period that exceeds 90 days. However, other eligibility conditions that are not based solely on the lapse of time are generally allowed, unless the condition is designed to avoid compliance with the 90-day waiting period limit. On Feb. 20, 2014, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (the Departments) released final regulations on the 90-day waiting period limit. These regulations generally finalize provisions in proposed rules that were issued in March 2013, with minimal changes. At the same time, the Departments released a separate proposed rule regarding a new provision permitting reasonable and bona fide orientation periods under the 90-day waiting period limit. The final regulations apply for plan years beginning on or after Jan. 1, 2015. However, the 2013 proposed rules provided that the 90-day waiting period limit would apply for plan years beginning on or after Jan. 1, 2014. For plan years beginning in 2014, the Departments will consider compliance with either the 2013 proposed rules or the final regulations to constitute compliance with the 90-day waiting period limit requirement. OVERVIEW OF THE 90-DAY WAITING PERIOD LIMIT A waiting period is the period of time that must pass before coverage for an employee or dependent who is otherwise eligible to enroll in the plan becomes effective. An employee or dependent is otherwise eligible for coverage when he or she has met the plan's substantive eligibility conditions. Under the ACA, group health plans and health insurance issuers offering group health insurance coverage may not apply a waiting period that exceeds 90 days. Thus, after an individual is determined to be otherwise eligible for coverage under the terms of the plan, any waiting period may not extend beyond 90 days. All calendar days are counted beginning on the enrollment date, including weekends and holidays. However, if an individual enrolls as a late enrollee or special enrollee, any period before the individual's late or special enrollment is not a waiting period. For purposes of the 90-day waiting period, "enrollment date" means: • The first day of coverage; or • If there is a waiting period, the first day of the waiting period. If an individual receiving benefits under a group health plan changes benefit packages, or if the plan changes group health insurance issuers, the individual's enrollment date does not change. The waiting period limit does not require an employer to offer coverage to any particular employee or class of employees, including part-time employees. The waiting period limit only prevents an otherwise eligible employee (or dependent) from having to wait more than 90 days before coverage under a group health plan becomes effective. PERMISSIBLE ELIGIBILITY CONDITIONS Under the ACA, eligibility conditions that are based solely on the lapse of time are permissible for no more than 90 days. However, other eligibility conditions that are not based solely on the lapse of time are generally allowed, unless the condition is designed to avoid compliance with the 90-day waiting period limit. Examples of permissible eligibility conditions include: • Being in an eligible job classification; or • Achieving job-related licensure requirements specified in the plan's terms. This Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.Sources:Departments of Labor,Health and Human Services and the Treasury,Zywave. Health Care Reform Legislative Update 90-day Waiting Period Limit—Permitted Orientation Periods The final rules add a third example of a permissible eligibility condition, allowing the satisfaction of a reasonable and bona fide employment-based orientation period. This means that a requirement to successfully complete a reasonable and bona fide employment-based orientation period may be imposed as a condition for eligibility for coverage under a plan. REASONABLE AND BONA FIDE ORIENTATION PERIODS During a reasonable and bona fide orientation period, the Departments envision that: • An employer and employee could evaluate whether the employment situation was satisfactory for each party; and • Standard orientation and training processes would begin. Maximum Length Separate proposed regulations published at the same time as the final regulations propose one month as the maximum length of any orientation period. This one-month maximum is generally a period that begins on any day of a calendar month, and would be determined by adding one calendar month and subtracting one calendar day, measured from an employee's start date in a position that is otherwise eligible for coverage. • For example, if an employee's start date in an otherwise eligible position is May 3, the last permitted day of the orientation period is June 2. Similarly, if an employee's start date in an otherwise eligible position is Oct. 1, the last permitted day of the orientation period is Oct. 31. If there is not a corresponding date in the next calendar month upon adding a calendar month, the last permitted day of the orientation period is the last day of the next calendar month. • For example, if the employee's start date is Jan. 30, the last permitted day of the orientation period is Feb. 28 (or Feb. 29 in a leap year). Similarly, if the employee's start date is Aug. 31, the last permitted day of the orientation period is Sept. 30. If a group health plan conditions eligibility on completing a reasonable and bona fide orientation period, the eligibility condition would comply with the 90-day waiting period limit if the orientation period did not exceed one month. The maximum 90-day waiting period would begin on the first day after the orientation period. Example The following example helps explain the rules for permitted orientation periods under the 90-day waiting period limit. • Facts—Employee H begins working full time for Employer Z on Oct. 16. Z sponsors a group health plan, under which full-time employees are eligible for coverage after they have successfully completed a one-month orientation period. H completes the orientation period on Nov. 15. • Conclusion—The orientation period is not considered a subterfuge for the passage of time and is not considered to be designed to avoid compliance with the 90-day waiting period limitation. Accordingly, plan coverage for H must begin no later than Feb. 14, which is the 91st day after H completes the orientation period. (If the orientation period was more than one month, it would be considered to be considered a subterfuge for the passage of time and designed to avoid compliance with the 90-day waiting period limitation. Accordingly, it would violate the ACA's 90-day waiting period limit rules.) Effective Date Under the ACA, the 90-day waiting period limit applies for plan years beginning on or after Jan. 1, 2014. However, the proposed rules on the reasonable and bona fide orientation period have not been finalized. The Departments will consider compliance with the separate 2014 proposed regulations to constitute a reasonable and bona fide employment-based orientation period at least through the end of 2014. To the extent final regulations or other guidance is more restrictive on plans and issuers, the final regulations or other guidance will not be effective prior to Jan. 1, 2015, and plans and issuers will be given a reasonable time period to comply. This Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.Sources:Departments of Labor,Health and Human Services and the Treasury,Zywave. Attachment F— Secure Employee Assistance Link ASSISTANCE AVAILABLE VIA EMAIL, PHONE OR THE MIDSOUTH BENEFITS WEBSITE FOR HUMAN RESOURCES & EMPLOYEES EMPLOYEE ASSISTANCE IJ®BV search... Midsouth BENEFITS HOME ABOUT US WHAT WE DO BENEFITS SERVICES ME Employee Benefits 1 Gros Insurance \ • ...* ,r1 , ; :-_ ,'_ . :'7--:-:— ...7 4' "4' ..'----------_--7___-2.7 ,, w y e , "Mlidsouth Benefhelped us to better understand ii i . _ . . . . rr''} our benefits and how to best utilize them:' 1 I d {r�` search_- IM BENEFITS HOME ABOUT US WHAT WE DO BENEFITS SERVICES Quick Links Employee Assistance .Employee Benefits/Group 4 rA Insurance This page is ssL Secured and your submitted information will he sent in a secure manner. '4. •Individual Health Insurance " i Please fill out Form below L- •Executive Benefits ■r■ I". em •Estate Planning •Group Voluntary Benefits a- i Employees Foot Name.: •contact us - Employee's Last Marne: "Helping employers make Employers company the right choice for Name: their employees:' U Employee's Location (slate): EMPLOYEE INDIVIDUAL LEGISLATIVE Employees Dare of Bath BENEFITS HEALTH UPDATES Best method Inc reaching '"' INSURANCE employee: I I.‘.:::\.' S Phone(number) 11!...i:Witk., Email(address) + t .d mo _ + - r-d more + +x,at D Real Issues. Real Solutions. 46 Attachment G- Broker services/value-added services OVERVIEW If you have been in the business of handling your employer's employee benefits program for any amount of time, you pretty much know what services a typical insurance agent/broker will provide; the marketing, proposal reviews and a plan/carrier recommendation, assistance with the implementation (at least with the first year), day-to-day support with administrative issues, renewal negotiation. But do you know what services you should expect? In this proposal we will outline all the services that you should and will receive from Midsouth Benefits. There are many factors to consider when designing and implementing a group health plan, and only a broker with years of experience can imagine the numerous variables that might present themselves. We will work closely with you to identify potential exposures and design an appropriate risk management solution for your group health insurance program. We do this by working with you to collect all pertinent information regarding your existing health insurance program. We ask a lot of questions in order to obtain a clear understanding of your focus and objectives, both in terms of a short-term and long- term time frame. We will communicate regularly with you and provide many resources for you and/or your staff to use in addition to the standard insurance carrier's services. We also engage the services of attorneys and Human Resource Specialists as needed, to provide clients with expertise addressing specific complex legal and compliance issues. We encourage regular dialogue with our clients so that we can remain up-to-date with their daily challenges. When we handle the health plan benefits for a client, Midsouth Benefits'services will include, but may not be limited to: ✓ Benefits review and consulting ✓ HR Connection Web Portal for online enrollment ✓ Strategic planning and implementation ✓ Mywave HR Resources Portal ✓ Benefits marketing including proposal analysis and negotiations ✓ Legislative Updates ✓ Communication strategy and material development ✓ Wellness Newsletters(monthly distribution and customized topics upon ✓ Benefit plan implementation, including enrollment assistance request) ✓ Education and resources services ✓ Plan document reviews ✓ Participation in Benefit Fairs, Lunch-N-Learns, Employee Group ✓ Plan document preparation including Benefit Summaries and Employee Meetings, Open Enrollment Meetings Benefit Guide ✓ Day-to-day consultation and administrative services and support ✓ Assist with claim problems, billing questions, policy interpretations,and ✓ Employer and employee customer service other carrier issues ✓ Reporting(claims, benchmarking,cost analysis, etc.) ✓ Provide billing/premium reconciliation services if required ✓ Wellness program development, marketing and communication ✓ Maintain complete and up-to-date policy digest of plan designs, ✓ Renewal review and negotiations contracts,contract amendments, etc. ✓ Compliance/Health Care Reform assistance ✓ Provide training to HR Staff as needed on various HR topics and extend invitations to complimentary seminars and webinars 47 Midsouth BENEFITS REAL ISSUES. REAL SOLUTIONS ATTACHMENT D MIDSOUTH BENEFITS DRAFT AGREEMENT FOR BENEFITS BROKERS SERVICES Midsouth March 11, 2015 BENEFITS Ms. Angela Hudson Finance Director City of Tybee Island 403 Butler Avenue Tybee Island, Georgia 31328 Subject: Statement of Work for Benefit Broker Services-Midsouth Benefits Dear Ms. Hudson, The objective of this Statement of Work ("SOW") is to confirm the scope of our work and the compensation for this engagement. This SOW is subject to the terms and conditions contained in the Benefits Broker Services Request for Proposal RFP#2015-662 1) Description of Midsouth Benefits responsibilities: By retaining Midsouth Benefits, you hereby authorize Midsouth Benefits to perform the following services on your behalf: • Benefits review and consulting • Strategic planning and implementation • Benefits marketing including proposal analysis and negotiations • Communication strategy and material development • Benefit plan implementation, including enrollment assistance • Education and resources services • Participation in Benefit Fairs, Lunch-N-Learns, Employee Group Meetings, Open Enrollment Meetings • Day-to-day consultation and administrative services and support • Employer and employee customer service • Reporting (claims, benchmarking, cost analysis, etc.) • Wellness program development, marketing and communication • Renewal review and negotiations • Compliance/Health Care Reform assistance • HR Connection Web Portal for online enrollment • Mywave HR Resources Portal • Legislative Updates • Wellness Newsletters (monthly distribution and customized topics upon request) • Plan document reviews • Plan document preparation including Benefit Summaries and Employee Benefit Guide • Assist with claim problems, billing questions, policy interpretations, and other carrier issues • Provide billing/premium reconciliation services if required • Maintain complete and up-to-date policy digest of plan designs, contracts, contract amendments, etc. • Provide training to HR Staff as needed on various HR topics and extend invitations to complimentary seminars and webinars 2) Description of client responsibilities: Provide Midsouth Benefits with information necessary to perform above described services. 3) Compensation: We will receive our compensation for the work we provide to the City of Tybee Island in the form of commissions paid by the selected carrier/vendor. Commission levels are determined individually by the type of coverage being offered. We are transparent on the compensation we receive. We appreciate your business and look forward to working with you on this engagement. Please acknowledge your agreement to the terms contained herein by signing below. Midsouth Benefits By : Name: Title: Date: Accepted and Agreed City of Tybee Island By: Name: Title: Date: 4994 Lower Roswell Road, Suite 5 Marietta,GA 30068 770-579-7099 www.midsouthbenefits.net