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1. Inputs <br />OnlinEnroll Service Estimate <br />January 1, 2017 through December 31, 2019 (Years 1, 2, & 3) <br />OnlinEnroll Service Elections (Y/N) <br />On -going (including: Open Enrollment & Ongoing <br />Yes Maintenance) <br />Il. OnlinEnroll Charges <br />A. Initial Set -up Charge - I x charge <br />B. Ongoing (OE & Maintenance) <br />Employees x PEPM <br />1 _ 600 1 $2.34 <br />C. Connection Build Fees - I x charge <br />Standard <br />Connections x Cost <br />1. UHC - Medical <br />D. Total Service Charges <br />Ongoing Service - 1st month I -Time Fee <br />Ongoing Service - Monthly Service Fee <br /># of Employee records to be <br />loaded on site <br />615 <br />OG <br />Charges <br />C <br />Monthly <br />Fee <br />$1,404 <br />C <br />$1,404 <br />'Total Annual Fee $16,848 <br />Comments <br />'- The first year's fees will include October 1, 2016 through December 31, 2017, to accommodate the use of the OnlinEnroll <br />system during open enrollment, for a Total Annual Fee of $21.060. <br />- United and the Customer may negotiate the fees if the number of Employees covered by the Plan or any Plan option changes <br />by fifteen percent (15 %) or more <br />- All employee records loaded on the site are to be included in monthly fees. <br />- Ongoing customer service & access to site starts once the site build begins and continues through open enrollment and <br />upcoming policy year. Monthly fee is billed to customers for every month they have service, beginning on site build date. <br />27 <br />January 1, 2024 through December 31, 2024 (Year 8) <br />Additional 2% cap fee increase from Years 6& 7 <br />Processing of run -out claims in the event of termination of the <br />In the event the Agreement is terminated prior to December <br />Agreement prior to December 31, 2017 <br />31, 2017, the fee for run -out claims processing is equal to <br />the last two months' Standard Medical Service Fees in <br />effect at the time of termination. <br />In the event the Agreement is terminated January 1, 2018 or <br />later, the fees associated with providing six (6) months of <br />run -out claims processing are included in United's monthly <br />administrative fees as described above. <br />1. Inputs <br />OnlinEnroll Service Estimate <br />January 1, 2017 through December 31, 2019 (Years 1, 2, & 3) <br />OnlinEnroll Service Elections (Y/N) <br />On -going (including: Open Enrollment & Ongoing <br />Yes Maintenance) <br />Il. OnlinEnroll Charges <br />A. Initial Set -up Charge - I x charge <br />B. Ongoing (OE & Maintenance) <br />Employees x PEPM <br />1 _ 600 1 $2.34 <br />C. Connection Build Fees - I x charge <br />Standard <br />Connections x Cost <br />1. UHC - Medical <br />D. Total Service Charges <br />Ongoing Service - 1st month I -Time Fee <br />Ongoing Service - Monthly Service Fee <br /># of Employee records to be <br />loaded on site <br />615 <br />OG <br />Charges <br />C <br />Monthly <br />Fee <br />$1,404 <br />C <br />$1,404 <br />'Total Annual Fee $16,848 <br />Comments <br />'- The first year's fees will include October 1, 2016 through December 31, 2017, to accommodate the use of the OnlinEnroll <br />system during open enrollment, for a Total Annual Fee of $21.060. <br />- United and the Customer may negotiate the fees if the number of Employees covered by the Plan or any Plan option changes <br />by fifteen percent (15 %) or more <br />- All employee records loaded on the site are to be included in monthly fees. <br />- Ongoing customer service & access to site starts once the site build begins and continues through open enrollment and <br />upcoming policy year. Monthly fee is billed to customers for every month they have service, beginning on site build date. <br />27 <br />