Stop Loss Insurance Terms

EXHIBIT I

STOP LOSS INSURANCE TERMS

REINSURANCE PREMIUM COST PROPOSAL / OPTION #1 / Option #2
CURRENT / PROPOSED / RECOMMENDED / PROPOSED
Name of Proposing Vendor / N/A / N/A
ASO Vendor / Florida Blue / Florida Blue
Medical / Rx Plan Design / District’s current plan designs / District’s current plan designs
Individual Stop Loss
Type of Contract / 12/24 / 12/24
Coverages Included / Medical & Prescription / Medical & Prescription
Policy Year Maximum / Unlimited / Unlimited
Lifetime Maximum / Unlimited / Unlimited
Specific Deductible / $150,000 / $200,000
Aggregate Stop Loss
Type of Contract / 12/24 / 12/24
Coverages Included / Medical & Prescription / Medical & Prescription
Lifetime maximum / 1,000,000 / 1,000,000
Aggregate Loss Corridor / 125% / 125%
Rate Guarantee / 12 Months / 12 Months

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EXHIBIT II

STOP LOSS INSURANCE RATE SHEET

Option 1: $150,000 ISL (Monthly Rates/Factors)

Individual Stop Loss Rates / BlueOptions 3559 / BlueChoice 725 / BlueOptions 05180/05181
Employee Only
Employee + Family
Aggregate Stop Loss Rates: / BlueOptions 3559 / BlueChoice 725 / BlueOptions 05180/05181
Composite Rate
Attachment Factor
(Includes 125% corridor) / BlueOptions 3559 / BlueChoice 725 / BlueOptions 05180/05181
Employee Only
Employee + Family

Option 1: $200,000 ISL (Monthly Rates/Factors)

Are proposed rates contingent on updated claims experience? Yes ______No ______

If so, please provide details on time period needed for sufficient claims experience:

AUTHORIZED SIGNATURE

NAME:

TITLE:

FIRM:

ADDRESS:

EXHIBIT III

QUESTIONNAIRE

General Information:

1. Do you agree to cover Active employees, dependents, retirees (under / over 65), and COBRA participants under your stop loss policy?

2. Do the proposed ISL and ASL rates include 10% commissions payable to Gehring Group?

3. Are proposed ISL and ASL rates firm?

Account Services:

4. Provide the name, title, contact information and resume of the individual who would have direct daily account responsibility. If more than one person will be filling this role, please respond with complete information for all.

5. Describe the services provided by your account service team.

6. What is your account team service team’s average response time to client requests or questions?

Data and Reporting:

7. Describe the reports you will provide regarding the utilization associated with what you are proposing. Please indicate in your description if any of the reports would be provided at an additional cost over the fees associated with the programs.

8. Can you accept claims information directly from Florida Blue in order to determine any applicable stop loss recovery amounts?

Benefits & Claims

9. Are you willing to waive the actively at work provision?

10. Is there an early termination fee?

Renewal Planning & Additional Fees

11. Will your company be willing and/or able to provide the annual renewal for the programs you are proposing a minimum of 150 days prior to the renewal date?

12. Are there any additional fees for reporting? Please provide all reporting options/packages and their associated costs.

13. Are there any additional fees associated with providing the broker / client claims decrements for plan changes?

14. What is the length of any rate guarantees proposed for each employee benefits program you are proposing? Please be specific by program.

15. What additional services are available and the cost?

16. Describe any performance guarantee programs your company proposes. If your company has forfeited funds because of service problems in the last three years, please list the three largest forfeitures by dollar amount and include the agency name, agency address, contact person, the telephone number and email address where they may be reached.