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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This exhibit lists the fees Customer must pay United for its services during the term of the Agreement. These fees apply for the period from January 1, 2017 through December 31, 2024. If authorized by Customer pursuant to this Agreement or by subsequent authorization, certain fees will be paid through a withdrawal from the Bank Account. Standard Medical Service Fees The Standard Medical Service Fees described below, excluding optional and non - standard fees, are adjusted as set forth in the applicable performance standard(s). The Standard Medical Fees listed below are based upon an estimated 615enrolled Employees The Standard Medical Service Fees are the sum of the following: Per Employee Per Month Fee and Rebate Credit Choice + Choice + HSA Administrative Fee - 2017 Per Employee Per Month (PEPM) RX Rebate Credit 2017 Total Per Employee Per Month (PEPM) Administrative Fee - 2018 Renewal RX Rebate Credit - 2018 Renewal Administrative Fee - 2019 Renewal RX Rebate Credit - 2019 Renewal Administrative Fee - 2020 Renewal RX Rebate Credit - 2020 Renewal Administrative Fee - 2021 Renewal RX Rebate Credit - 2021 Renewal Administrative Fee - 2022 Renewal RX Rebate Credit - 2022 Renewal Administrative Fee - 2023 Renewal RX Rebate Credit - 2023 Renewal Administrative Fee - 2024 Renewal RX Rebate Credit - 2024 Renewal Average Contract Size: 2.17. $49.66 $51.61 ($21.24) ($21.24) $28.42 $30.37 $49.66 $51.61 ($21.24) ($21.24) $49.66 $51.61 ($21.24) ($21.24) $50.66 $52.61 ($21.24) ($21.24) $50.66 $52.61 ($21.24) $21.24) $51.67 $53.62 ($21.24) ($21.24) $51.67 $53.62 ($21.24) $21.24) $52.70 $54.65 ($21.24) ($21.24) Mail Order Pharmacy Generic Target Adjudication Rate The target adjudication rate for prescription drugs obtained through the home delivery Network Pharmacy for generic drugs is AWP -74.5% excluding specialty drugs. United uses Medi- Span's national drug data file as the source for average wholesale price (AWP) information. United reserves the right to revise the pricing and adopt a new source or benchmark if there are material industry changes in pricing methodologies. In the event that certain drugs are priced based on the application of maximum allowable cost methodology, the actual adjudication rate may vary from the target based on variation in the actual mix of drugs dispsensed. 25