Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot

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C. UNDERWRITING AND FINANCIAL SERVICES Service i Comments Overall program accounting (year -end reconciliatioi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Claim... projections. .................................................................................................... ............................ - Annual Projection of cost impact for benefit design Annual Projection of conventional premium equivalent rates. . . . . ..... . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annual Reserve estimates. . ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................................ . . . . . . . . . . . . . . ............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annual government filings of 1099 reports to the IRS regarding payments made to physicians and other health care Provide required data necessary to enable Customer to file Form 5500. D. ESERVICES° CUSTOMER REPORTING SERVICES Service An online customer reporting system including up to five customer IDs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reporting Access Levels: • Standard — Basic report package of "subscription" financial and utilization information produced on a pre - scheduled basis. • Select — In addition to the Standard features, interactive access to eCR tools allowing the user to customize report parameters to facilitate detailed views of the data. Includes a broad array of membership and utilization reports. • Expanded — In addition to the Select features, allows the user greater ad -hoc and customizable capabilities to obtain detailed performance information. Non - standard or ad hoc reports .......................................................................... ............................... Interface with third party stop loss vendor. United provides claim statistical reports, designed to meet the requirements of most insurers, to support Customer's filing of Individual Stop Loss (ISL) claims. The report includes the total dollars paid for any claimant exceeding 50 percent of the Individual Stop Loss (ISL) threshold for policy year to date claims paid through the end of the previous month. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . United reserves the right, from time to time, to change the con Comments Customer's access level is based upon its election. Expanded Level reports are available to customers with Select Level reporting on an ad hoc basis for an additional charge per report. Fees are determined on a report- specific basis ....... ... .. ..... Customer and its third party stop loss carrier must execute United's standard nondisclosure and indemnification agreement prior to United's providing any of the information. Customer understands that it is its responsibility to detect claims that may be covered by a third party stop loss carrier policy purchased by Customer. format and /or type of its E. CLAIMS ADMINISTRATION SERVICES Service Comments Claims for Plan benefits must be submitted in a form that is satisfactory to United in order for it to determine whether a benefit is payable under the Plan's provisions. Customer delegates to United the discretion and authority to use United's claim procedures and standards for Plan benefit claim determination. Implementation of Customer's benefit plans. Claim history load from one prior carrier using United's standard process. .......... ............................ ............................................................................ ....................................... - ............................... ........................................... ....................................... ................. ................. ..................... .................. ............................ ............................................................... .................... .... ............... ................ Standard claims processing including: • Re- pricing and payment of claims. • Auto and manual adjudication using proprietary software. • Claim edit/review and cost containment program • Pending and subsequent claim review. ....................................................................-...................................................................................................................................... ............................... Standard claim forms when applicable). 19