ESBD_File_346205_Attachment F - 2024 Total Plan Costs.pdf

County of Hays Proposed Cost Exhibit

UnitedHealthcare Proposed Cost Exhibit

Customer Name: County of Hays Effective Date: 1/1/2024

Subscribers: 995 Members: 1,981

Average Contract Size: 1.99 Average Age/Gender Adjustment: 0.99

MAXIMUM Plan Cost Attachment

Claim Liability: Subscribers Claims PSPM Monthly Annual Point Monthly Annual Choice + 466 $1,163.88 $542,369 $6,508,432 $1,396.66 $650,843 $7,810,118 Choice 460 $1,163.88 $535,386 $6,424,632 $1,396.66 $642,463 $7,709,559

Choice + HSA 69 $1,163.88 $80,308 $963,695 $1,396.66 $96,369 $1,156,434

Total Claim Liability 995 $1,163.88 $1,158,063 $13,896,759 $1,396.66 $1,389,676 $16,676,111

Administration Fee: Subscribers Admin PSPM Monthly Annual Admin PSPM Monthly Annual Choice + 466 $10.42 $4,854 $58,246 $10.42 $4,854 $58,246 Choice 460 $10.42 $4,791 $57,496 $10.42 $4,791 $57,496

Choice + HSA 69 $10.42 $719 $8,624 $10.42 $719 $8,624

Total Administration Fee 995 $10.42 $10,364 $124,367 $10.42 $10,364 $124,367

Stop Loss Protection Premium Premium Subscribers Rate Monthly Annual Rate Monthly Annual

Individual 995 $112.04 $111,477 $1,337,722 $112.04 $111,477 $1,337,722 Aggregate 995 $8.38 $8,338 $100,057 $8.38 $8,338 $100,057

Total Stop Loss Administration Premium $119,815 $1,437,779 $119,815 $1,437,779

TOTAL PLAN COST 995 $1,288,242 $15,458,904 $1,519,855 $18,238,256

Imprest Balance Frequency Frequency Required Medical Deposit: $778,000 Weekly ACH 14 Current Req. Deposit $797,000 Weekly ACH 14 FSA Imprest: N/A HRA Imprest: N/A

* If additional lines are sold (ancillary, HRA, FSA, etc.), additional imprest amounts could be needed

EXPECTED Plan Cost

Notes

Expected Claims 90%

Administrative Fees 1%

Stop Loss Premium 9%

Total Plan Cost

Expected Claims

Administrative Fees

Stop Loss Premium

1/8/202412:17 PM Confidential/Proprietary/Competitively Sensitive Information

The quote is based on the following assumptions. Changes to these assumptions may result in an adjustment to the rates or revocation of the quote. Please refer to the Financial Commentary for further assumptions.

• Rates are guaranteed for the contract period of 1/1/24 through 12/31/24.

• UnitedHealthcare is the only carrier offered.

• No carrier with a competing network or affiliated with an entity with a competing network may write Stop Loss coverage (individual or aggregate) on top of a UnitedHealthcare network.

• Quote assumes 995 subscribers 1981 members and an average contract size of 1.99. UnitedHealthcare reserves the right to adjust the rates if the enrollment at issue varies by +/- 10% from the submitted census.

• Employer contributes a minimum of 75% toward the employee only costs and 50% toward the dependent costs.

• UnitedHealthcare reserves the right to adjust rates in the event of (i) any changes in federal, state or other applicable law or rules; (ii) changes in Plan design required by the applicable regulatory authority (e.g. mandated benefits) or by the Plan Sponsor; (iii) any taxes, surcharges, assessments or similar charges being imposed by a governmental entity on the Plan or UnitedHealthcare; or, (iv) as otherwise permitted in our policy.

• Please refer to the ASO Medical Plan Exhibit for plan design overviews and the ASO Administration Fee Components exhibit for additional programs included in the administration fee.

• Packaged Savings does not apply.

• Quote includes commissions of $3.50 PSPM in ISL premium

• Administration fee includes 3 benefit plans and a maximum of 25 claim accounts.

• Quote includes Naviguard Program. A fee of $2.50 PEPM will be billed for this program.

• Quote includes Advanced Analytics and Recovery Service.

• A signed Administrative Service Agreement must be submitted prior to the effective date of our claim processing services. The effective date may be delayed if the Agreement is not signed.

• If the arrangement is terminated by the group during the implementation phase, implementation costs incurred by UnitedHealthcare will be the responsibility of the group.

• UnitedHealthcare reserves the right to adjust the rates if an award is not made within 90 days of the issuance of this quotation.

• Our quotation includes the processing of runout claims upon the termination of our contract. We will complete the processing of runout claims for six months following the termination of our contract.

• The Plan or its sponsor is responsible for state or federal surcharges, assessments, or similar taxes or fees imposed by governmental entities or agencies on the Plan, Plan Sponsor, or us, including but not limited to those imposed pursuant to the Patient Protection and Affordable Care Act of 2010 (PPACA), as amended from time to time, This includes responsibility for determining the amount due, funding, and remitting the PPACA PCORI reinsurance fee which is remitted to the government (federal and/or state).

• The fees quoted do not include state or federal surcharges, assessments, or similar taxes/fees imposed by governmental entities or agencies on the Plan, Plan Sponsor, or UnitedHealthcare. We reserve the right to adjust the rates (i) in the event of any changes in federal, state or other applicable legislation or regulation; (ii) in the event of any changes in plan design or procedures required by the applicable regulatory authority or by the sponsor; and (iii) as otherwise permitted in our Administrative Service Agreement.

• If awarded this business, UnitedHealthcare, on your behalf and under your employer identification number, will open and maintain a bank account to provide us the means to access your funds for the sole purpose of payment of Plan benefits, expenses, and taxes/fees. You agree to hold UnitedHealthcare harmless for any and all federal, state, local or other governmental demand, charge or tax (by whatever name) assessed against or imposed upon UnitedHealthcare arising out of the administration of the plan.

• Individual Stop Loss Experience Refund Endorsement is available at an additional cost.

UnitedHealthcare will only process run-out claims if the customer is current with all premium and fee obligations.

• Additional routine fees associated with self-insured groups, including value-based pricing fees and Shared Savings Program fees (including Facility Reasonable & Customary, Outlier Cost Management or Naviguard), will be collected through the bank account on the due date.

• If Stop Loss is carved out to a provider other than UHC Stop Loss, the cost for the Third Party Stop Loss Reporting fee shall be $5.00 PEPM.

• The administrative fees set forth herein do not include fees related to the requirements set forth in the Consolidated Appropriations Act, 2021, including the No Surprises Act. Additional fees for these new regulatory requirements will be provided at a future date once regulatory guidance is received and final compliance requirements are determined.

• If customer cancels their medical and/or pharmacy coverage with UnitedHealthcare prior to the end of the proposed three year contract period, a pro-rated portion of any fee waiver or one-time credits or allowances will be owed to UnitedHealthcare.

Assumptions

• This quote assumes a Fixed Rx Rebate arrangement. It also assumes the United Rx National Network is used; the Mixed Preferred Drug list (PDL); and the plan design is Closed.

• This quote assumes County of Hays will receive 80% of rebates on prescription drug products dispensed under the medical benefit plan.

1/8/202412:17 PM Confidential/Proprietary/Competitively Sensitive Information

Total Plan Costs