RFP_21-057-DP_1_7-20-21.pdf

AMENDMENT NO. 1

DATED: July 20, 2021

Palm Beach County Purchasing Department

50 South Military Trail, Suite 110, West Palm Beach, FL 33415

RFP No. 21-057/DP

Title: Long Term and Short Term Disability Insurance

Request for Proposal Due Date: July 28, 2021

This Amendment is issued to provide additional information and clarification to the RFP document:

A. Proposers are advised of the following changes to the RFP:

1. Billing statements for Board of County Commissioners and Palm Tran are provided as follows:

a) The “Long Term Disability Billing Statement June 2021” is provided in this

Amendment as Attachment 1.

b) The “Short Term Disability Billing Statement June 2021” is provided in this Amendment as Attachment 2.

2. Current Benefit Summaries are provided in this Amendment as follows:

Attachment 3: Summary of Palm Beach County Board of County Commissioners – Voluntary STD

Attachment 4: Summary of Palm Beach County Board of County Commissions – LTD Class 1 (Core/Basic LTD and Buy-up LTD Plans)

Attachment 5: Summary of Palm Beach County Board of County Commissioners

– LTD Class 2 (Voluntary LTD Plan)

3. A copy of the “PALM BEACH COUNTY BOARD Claims Experience 6-26-2021” presentation is provided in this Amendment as Attachment 6.

4. A copy of the “Palm Beach County Board of County C_DIS_Claims_07-12-2021” presentation is provided in this Amendment as Attachment 7.

AMENDMENT NO. 1 to

B. Questions received from The Standard and the Risk Management Department’s responses:

Q.1. Will electronic submittals be accepted?

A.1. The County does not currently accept electronic submittals. Proposals are required to be submitted in a sealed envelope or container as specified in section 1.9 PROPOSAL SUBMISSION of the RFP.

Q.2. Please provide similar LTD experience for 2016 and 2017 as well as the rates for those years.

A.2. LTD experience for 2016 and 2017 is not available. The rates are the same as current rates listed in the RFP document.

Q.3. Please provide an open/closed LTD claim list with reserves for open claims.

A.3. See Section A., item 4 above - Attachment 7. Please note individual reserve information is not available.

Q.4. Please provide a detailed claim listing with diagnosis.

A.4. Diagnosis information is not available.

Q.5. How is the Buy-up LTD billed? Is the .45 rate charged to employees for the entire covered salary, or is it only charged against the difference in covered salary between the core and buy-up plans?

A.5. For the Buy-Up LTD, the employee is charged the $.45 rate for their entire covered salary, but receives a credit back for the premium attributed to the Core/Basic plan. The employer funds the cost of the Core/Basic premium for employees who participate in the Buy-up plan.

Q.6. Please provide a recent billing statement for the STD & LTD.

A.6. Please see Section A, item 1 above. Billing statements for Board of County

Commissioners and Palm Tran are attached. Supervisor of Elections has approximately 50 employees and is billed separately and is not included in the attached statements.

Q.7. Does the group participate in FRS only or also Social Security as well?

A.7. The group participates in FRS and Social Security.

Q.8. Is sick leave an offset for the STD benefit?

A.8. Yes.

Q.9. Is the County using a current Ben Admin or Enrollment platform, if so please provide name and if funding is needed by the vendor.

A.9. The County uses an Oracle application, PeopleSoft, for benefits administration. PeopleSoft includes an Employee Self Service module. Funding for a Ben Admin or Enrollment platform is not included as a requirement as part of this Request for Proposal.

C. Questions received from Equitable Advisors and the Risk Management

Department’s responses:

Q.1. If coverage is in force currently the following documents are needed:

Current Benefit Summaries Current Certificates Current Rates and/or last renewal Invoice if elections are not on the census

A.1. Current Benefit Summaries: See Section A, item 2. Summaries are attached.

Current Certificates: These were provided with the posted RFP as Attachments 3 and 4.

Current Rates and/or last renewal: This is listed in the RFP in Section 4, Scope of Work/Services Subsection 4.4 D and 4.4 E.

Invoice if elections are not on the census: Disability elections are on the Census.

Q.2. We will also need to know how much the group will be contributing towards the premium for each line of business.

A.2. Funding – LTD:

The County funds the entire cost of the Core/Basic plan for employees who are enrolled in the Core/Basic LTD plan.

For the upgraded LTD plan, the County funds the cost of the Core/Basic plan.

The County does not contribute towards voluntary LTD coverage. The employees pay 100% of the premium.

Funding – STD:

The County does not contribute towards the cost of the STD coverage. The employees pay 100% of the premium.

Q.3. For the LTD there are three different options:

If you are enrolled in the HMO there is a core plan and a buy-up. If you are enrolled in the PPO or waived coverage another LTD option.

The census has core LTD, Buy-up LTD and Voluntary LTD. Are those who are enrolled in the medical PPO or waived medical coverage responsible for paying their own premium on LTD?

A.3. If you are enrolled in the HMO there is a core plan and a buy-up: If an employee is enrolled in the Cigna HMO medical plan or the Cigna OAPIN medical plan, they either receive the employer paid (free to the employee) core/basic LTD plan; or they can buy-up/upgrade to a higher LTD benefit level. Employees who are enrolled in HMO or OAPIN medical and buy-up and upgrade their LTD coverage pay the associated LTD buy-up premium, and these employees will receive a premium credit equivalent to the cost of the core/basic LTD.

If you are enrolled in the PPO or waived coverage another LTD option:

Employees who are enrolled in the POS medical plan, or waived medical coverage, can elect the voluntary LTD plan, which is entirely paid for by the employee.

The census has core LTD, Buy-up LTD and Voluntary LTD. Are those who are enrolled in the medical PPO or waived medical coverage responsible for paying their own premium on LTD? Employees who are enrolled in the POS medical plan, or waived medical coverage, are responsible for paying the entire LTD voluntary premium cost.

D. Questions received from MetLife and the Risk Management Department’s responses:

Q.1. Please provide individual claim reserves for the open LTD claims.

A.1. This information is not available.

Q.2. Please provide net benefit amount for open LTD claims.

A.2. See Section A, item 4 above.

Q.3. Please provide a copy of a recent billing statement.

A.3. Please see Section A, item 1, as well as response to

Section B.Q.6 above.

Q.4. Any historical plan changes on either the LTD or STD?

A.4. For Plan Year 2020 and again for Plan Year 2021, the current carrier offered a guaranteed issue opportunity during the annual enrollment period. The carrier allowed employees to elect short term disability or long term disability, or upgrade long term disability to a higher plan, without any medical underwriting requirements, even if the employee was previously declined. Pre-existing condition limitations in accordance with the long term disability coverage Certificate continued to apply.

Q.5. Is the buy-up LTD volume billed in excess of the core? Or is it billed first-dollar?

A.5. The buy-up LTD is billed first-dollar.

Q.6. Is the medical contributory, non-contributory, or partially contributory?

A.6. The medical plan is partially contributory.

Q.7. Of the 302 participants of the Voluntary LTD plan, how many of them opted out of medical coverage?

A.7. 116

Q.8. Percentage of employees under the medical.

A.8. 93%

Q.9. Is the medical contrib, non-contrib or partially contrib?

A.9. See answer to question Q.6 above in this Section D.

Q.10. Percentage of employees under the core LTD plan?

A.10. 61% of those eligible.

Q.11. Percentage of employees under the buy-up LTD plan?

A.11. 25% of those eligible.

Q.12. Is the LTD 100% non contrib or partially contrib if they are enrolled in the medical?

A.12. If the employee is enrolled in the medical HMO or medical OAPIN plans, the core/basic LTD is 100% employer funded and non-contributory to the employee.

If the employee is enrolled in the medical HMO or medical OAPIN plans, the buy-up LTD is partially contributory with a portion, equivalent to the cost of the core/basic LTD, of the premium funded by the employer.

If the employee is enrolled in the medical POS plan or opts out of medical coverage, the voluntary LTD is 100% employee funded and contributory to the employee.

C. Questions received from Ochs, Inc. | A Securian Financial Company and the

Risk Management Department’s responses:

Q.1. We take COVID 19 seriously. Our associates are working remotely and following social distancing as directed by the CDC. At this time we are providing an electronic signature. We are happy to provide a wet signature / notary, if required, at a later date. Please indicate if this will cause us to be disqualified.

A.1. The County’s Purchasing Department does not currently have a policy that would allow us to accept proposals with electronic signatures.

Disability:

Q.2. Please provide update LTD and STD experience information through at least

5/31/21, including paid claims, paid premium, reserves and claim counts.

A.2. See Section A, item 3 above. Information on individual reserves is not available.

Q.3. Please provide LTD experience information broken out by core plan, buy-up plan and voluntary plan.

A.3. Data is not available at this time.

Q.4. Please provide LTD experience information broken out by core plan, buy-up plan and voluntary plan. Please provide date of birth, individual reserves, Gross Monthly Benefit, Net Monthly Benefit, applied offsets and total paid amounts on the LTD claims exhibit.

A.4. The LTD experience data broken out by core plan, buy-up plan and voluntary plan is not available at this time. See Section A, Item 4 for other information requested in this question. Information on individual reserves is not available.

Q.5. Please confirm whether the group participates in Social Security.

A.5. Yes.

Q.6. Please confirm whether the LTD core premium contributions are paid with pre or post tax dollars.

A.6. The LTD core premium contributions are funded by the employer and are paid pre-tax.

Q.7. Please confirm whether the group prepares W-2s for STD claimants, or if the group requires the carrier to do so.

A.7. The group requires the carrier to prepare W-2s for all claims, including STD claimants.

Q.8. Please confirm whether the group currently has telephonic claims service on the

STD.

A.8. The current carrier offers telephonic claims intake services on the STD.

Q.9. Please provide Sick leave in days on the census.

A.9. This information is not currently available as part of the census. For reference, sick leave is earned bi-weekly and the accrual is based on 10% of an employee’s scheduled hours per week, not to exceed 40 hours per week, times 26 pay periods. For example:

Employees scheduled 40 hours per week equal 104 hours of sick leave per year.

The maximum accumulation of sick leave is unlimited.

All changes addressed in this Amendment No. 1 shall be incorporated into RFP No. 21- 057/DP and the final contract. All other terms and conditions of the RFP remain the same and unchanged.

NOTE: Please acknowledge receipt of this Amendment No. 1 by signing below and returning this page with your Proposal Response. Each Amendment to the RFP shall be signed by an authorized agent and submitted with the proposal or the proposal shall be deemed non-responsive.

WX/HO.

fonna Pagel, Purchasing Manager

ACKNOWLEDGMENT:

COMPANY NAME SIGNATURE

DATE

Palm Beach County Long Term Diability Invoice

Contract Payables Finance Department

To:

IS

Brian Palacios Risk Management Department 561-233-541?

From:

6/28/2021Date:

Coverage Period: June 2021

Remit Payment To: Life Insurance Company of North America PO Box 782447 Philadelphia/PA 19178-2447

PLEASE INCLUDE INVOICE WITH CHECK

VC00001315'

. 7Vendor Number:

Contract Number: KMA-680-15C 65C, R2020-0001

Charge Account

!'olicy/Plan 7001-2290-0335 /001-2295-0123 Total Premium| 7001-229C-0123 7001-2290-0330Payment: 41,288.97

FLK-960504-C 00-000 (BCC) 22,291.817,585.66 11,511.50

7,585.66 Voluntary 7,585.66

11,511.5011,511.50Basic 22,291.81 22,291.81

Buy-Up

FLK-960504-°01-001(Palm Tran) 6,448.34 6,448.34 1,030.63 1,030.63

Voluntary 1,308.701,308.70Basic 4,109.014,109.01Buy-Up

$ $ 47,837.31$ $ 11,511.50 $ 22,291.81 6,448.34Grand Total 7,585.66

Premium PaidPolicy/Plan SalaryLivesDetail:

3,673FLK-960504-000-000 (BCC) 41,388.97140,497,791.02

240 7,585.6615,774,613.56Voluntary 2,527 11,511.5065,059,129.44Basic

906 22,291.8159,664,048.02Buy-Up

6,448.34FLK-960504-PC 1-001 (Palm Tran) 557 20,730,816.00 48 1,030.63Voluntary 2,178,386.08

288 1,308.707,356,857.12Basic 4,109.01221 11,195,572.80Buy-Up

$ 161,228,607.02 $4,230 47,837.31Grand Total

G:\GR0UP INSURANCE BILLING\LTD\2021\LTO Invoice 2021-06

ATTACHMENT NO. 1 to

RFP NO. 21-057/DP

Palm Beach County Short Term Diability Invoice

Contract Payables Finance Department

To:

Brian Palacios isk Management Department r61-233-5419

From:

6/28/2021Date:

Coverage Period: June2021

Remit Payment To: '.ire Insurance Company of North America PO Box 782447 P hiladelphia, PA 19178-2447

'"LEASE INCLUDE INVOICE WITH CHECK

Vendor Number: 7C0000131577

Contract Number: ::MA-680-15065C, R2020- 0001

Payment Total

Policy Charge AccountPayment: Group LivesRate r/cc $31.50VDT-960736-000-000 7001-2290-0124 1,079 33,815.25 $31.50/aim Tran VDT-960736-001-001 7001-2295-0124 331 10,347.75

Grand Total $ 44,163.00

G:\GROUP INSURANCE B1LLING\S~D\2021\STD Invoice 2021-06

ATTACHMENT NO. 2 to

Offered by Life Insurance Company of North America, a Cigna company

SUMMARY OF BENEFITS Prepared for: Palm Beach County Board of County Commissioners

Disability insurance pays a portion of your salary if you’re unable to work due to a covered disability. When reviewing this coverage, consider how long you can personally go without receiving a paycheck.

Who Can Elect Coverage?:

You: You must be an active, full-time employee, including employees classified as collective bargaining unit non-high risk Fire and Rescue Employees, but excluding Employees classified as collective bargaining unit Employees of Fire and Rescue. You must regularly work a minimum of 30 hours per week.

You will be eligible for coverage first of the month coinciding with or next following 60 days of active service.

Available Coverage:

Gross Weekly Benefit1 Maximum Gross Weekly Benefit

Benefit Waiting Period Maximum Benefit Period

67% of your weekly covered earnings

$1,200 14 Days for accident 14 Days for sickness

11 Weeks for accident 11 Weeks for sickness

Employee’s Monthly Cost of Coverage:

Monthly Rate Per $10 of Weekly Benefit = $31.500 Actual per pay period premiums may differ slightly due to rounding.

Rates may be subject to change in the future.

How to Calculate Your Monthly Cost:

Step 1: Divide your annual salary by 52 to calculate your weekly earnings.

Step 2: Multiply this amount by the benefit percentage defined above in the Available Coverage section. For example, 60% would be .60. Now, you have your gross weekly benefit.

Step 3: Find the above Monthly rate. Multiply this rate by your gross weekly benefit, or the maximum gross weekly benefit, whichever is less.

Step 4: Divide the total by 10. The result is your Monthly cost.

Important Definitions and Policy Provisions:

Disability - “Disability” or “Disabled” means if solely because of a covered injury or sickness, you are unable to perform the material duties of your regular job and you are unable to earn 80% or more of your covered earnings from working in your regular job. We will require proof of earnings and continued disability.

Covered Earnings - “Covered Earnings” means your wages or salary, not including overtime pay, bonuses, commissions, and other extra compensation.

When Benefits Begin - You must be continuously Disabled for 14 Days for an accident and 14 Days for a sickness before benefits will be paid for a covered Disability.

How Long Benefits Last - Once you qualify for benefits under this plan, the maximum number of weekly Disability benefits is 11 Weeks for an accident and 11 Weeks for a sickness. Disability benefits will end sooner if you no longer qualify for benefits.

When Coverage Takes Effect - Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form if required, or the date you authorize any necessary payroll deductions if applicable. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit proof of good health, your coverage takes effect on the date we agree, in writing, to cover you.

Employee-Paid

SHORT-TERM DISABILITY INSURANCE

ATTACHMENT NO. 3 to

Benefit Reductions, Conditions, Limitations and Exclusions:

Effects of Other Income Benefits - This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by an amount equal to any Social Security retirement and/or disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will be reduced by amounts received through other government programs, sick pay, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your Certificate of Insurance.

Termination of Disability Benefits - Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, you earn more than your allowable Covered Earnings, or the date you refuse to participate in rehabilitation services.

Exclusions - This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following:

· Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane.

· war or any act of war, whether or not declared.

· active participation in a riot;

· commission of a felony;

· the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy.

· any cosmetic surgery or surgical procedure that is not Medically Necessary.

· an Injury or Sickness for which the Employee is entitled to benefits from Workers' Compensation or occupational disease law.

· an Injury or Sickness that is work related.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

1. Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section.

2. Costs are subject to change.

Terms and conditions of coverage for Short Term Disability insurance are set forth in Group Policy No. VDT 960736. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate. If there are any differences between this summary and the group policy, the information in the group policy takes precedence. Product availability and/or features may vary by state. Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut St. Philadelphia, PA 19192.

“Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries.

All products and services are provided by or through such operating subsidiaries, including Life Insurance Company of North America and Cigna Life Insurance Company of New York, and not by Cigna Corporation.

882861 © 2019 Cigna. Some content provided under license.

ATTACHMENT NO. 3 to

If you had an unexpected illness or injury and were unable to work, how long would you be able to pay your bills? Long-term disability pays a portion of your salary if you’re unable to work due to a covered disability.

Who Can Elect Coverage?:

You: All active, Full-time Employees of the Employer who are participating in the Employers HMO medical plan, regularly working a minimum of 30 hours per week, excluding Employees classified as collective bargaining unit non high risk Fire and Rescue Employees.

You will be eligible for coverage first of the month coinciding with or next following 60 days of active service.

Available Coverage:

Gross Monthly Benefit

Maximum

Gross

Monthly

Benefit

Waiting

Period

Maximum

Benefit

Period Employer Paid - Your Employer provides the following

50% of your monthly covered earnings

$1,000 90 Days Please refer to the

‘How Long

Benefits Last”

Employee Paid - You have the option to elect this plan to enhance what your

60% of your monthly covered earnings

$5,000 90 Days Please refer to the ‘How Long

Benefits Last” section below for

Employee’s Monthly Cost of Coverage:

Monthly Rate Per $100 of Monthly Covered Earnings = $0.45 Actual per pay period premiums may differ slightly due to rounding. Rates may be subject to change in the future.

How to Calculate Your Monthly Cost:

Step 1: Divide your annual salary by 12 to calculate your monthly earnings.

Step 2: Find the above Monthly rate.

Step 3: Multiply this rate by your monthly earnings, or $8,333, whichever is less.

Step 4: Divide the total by 100. The result is your Monthly cost.

Employee-Paid

LONG-TERM DISABILITY INSURANCE

Additional Features

Family Survivor Benefit – If you die while receiving benefits, we will pay a survivor benefit to your lawful spouse, eligible children, or estate. The plan will pay a single lump sum equal to 3 months of benefits.

ATTACHMENT NO. 4 to

Important Definitions and Policy Provisions:

Disability - “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation/regular job and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation/regular job. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability.

Covered Earnings - “Covered Earnings” means your wages or salary, not including overtime pay, bonuses, commissions, and other extra compensation. When Benefits Begin - You must be continuously Disabled for 90 Days before benefits will be paid for a covered Disability.

How Long Benefits Last - Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to the later of your

Social Security Normal Retirement Age, or the following schedule, depending on your age at the time you become Disabled.

Age at Disability Age 62 or younger 63 64 65 66 67 68 69+ Duration of Payments (months)

To age 65 or the date the 42nd monthly benefit is payable, if later.

36 30 24 21 18 15 12 When Coverage Takes Effect - Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form if required, or the date you authorize any necessary payroll deductions if applicable. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit proof of good health, your coverage takes effect on the date we agree, in writing, to cover you.

Benefit Reductions, Conditions, Limitations and Exclusions:

Effects of Other Income Benefits - This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre- disability earnings. Therefore, we reduce this plan’s benefits by an amount equal to any Social Security retirement and/or disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will be reduced by amounts received through other government programs, sick pay, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description.

Earnings While Disabled - During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability

Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.

Limited Benefit Period - Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment:

Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses), Alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the

24-month lifetime outpatient limit is exhausted.

Pre-existing Condition Limitation - Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures), or for which a reasonable person would have consulted a physician during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition

ATTACHMENT NO. 4 to unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.

Termination of Disability Benefits - Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, you earn more than your allowable Covered Earnings, or the date you refuse to participate in rehabilitation services.

Exclusions – This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following: Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane. war or any act of war, whether or not declared. active participation in a riot;

commission of a felony; the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy. any cosmetic surgery or surgical procedure that is not Medically Necessary.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

1 Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section. 2 Costs are subject to change.

Terms and conditions of coverage for Long Term Disability insurance are set forth in Group Policy No.

FLK 960504. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate.

If there are any differences between this summary and the group policy, the information in the group policy takes precedence. Product availability and/or features may vary by state.

Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North

America, 1601 Chestnut St. Philadelphia, PA 19192.

“Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Life Insurance Company of North

America and Cigna Life Insurance Company of New York, and not by Cigna Corporation.

882862 © 2019 Cigna. Some content provided under license.

ATTACHMENT NO. 4 to

If you had an unexpected illness or injury and were unable to work, how long would you be able to pay your bills? Long-term disability pays a portion of your salary if you’re unable to work due to a covered disability.

Who Can Elect Coverage?:

You: All active, Full-time Employees of the Employer who are participating in the Employer’s Point of Service, PPO or Opt out medical plan including Employees classified as collective bargaining union non-high risk Fire and Rescue Employees who Opt Out of the Employer’s medical regularly working a minimum of 30 hours per week, excluding Employees participating in the Employer’s HMO Plan.

You will be eligible for coverage first of the month coinciding with or next following 60 days of active service.

Available Coverage:

Gross Monthly Benefit Maximum Gross

Monthly Benefit Benefit Waiting

Period Maximum

Benefit Period

60% of your monthly covered earnings

$5,000 90 Days Please refer to the ‘How

Long Benefits Last” section below for more details.

Employee’s Monthly Cost of Coverage:

Monthly Rate Per $100 of Monthly Covered Earnings = $0.58 Actual per pay period premiums may differ slightly due to rounding. Rates may be subject to change in the future.

How to Calculate Your Monthly Cost:

Step 1: Divide your annual salary by 12 to calculate your monthly earnings.

Step 2: Find the above Monthly rate.

Step 3: Multiply this rate by your monthly earnings, or $8,333, whichever is less.

Step 4: Divide the total by 100. The result is your Monthly cost.

Employee-Paid

LONG-TERM DISABILITY INSURANCE

Additional Features

Family Survivor Benefit – If you die while receiving benefits, we will pay a survivor benefit to your lawful spouse, eligible children, or estate. The plan will pay a single lump sum equal to 3 months of benefits.

ATTACHMENT NO. 5 to

Important Definitions and Policy Provisions:

Disability - “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation/regular job and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation/regular job. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability.

Covered Earnings - “Covered Earnings” means your wages or salary, not including overtime pay, bonuses, commissions, and other extra compensation.

When Benefits Begin - You must be continuously Disabled for 90 Days before benefits will be paid for a covered Disability.

How Long Benefits Last - Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to the later of your

Social Security Normal Retirement Age, or the following schedule, depending on your age at the time you become Disabled.

Age at Disability Age 62 or younger 63 64 65 66 67 68 69+ Duration of Payments (months)

To age 65 or the date the 42nd monthly benefit is payable, if later.

36 30 24 21 18 15 12 When Coverage Takes Effect - Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form if required, or the date you authorize any necessary payroll deductions if applicable. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit proof of good health, your coverage takes effect on the date we agree, in writing, to cover you.

Benefit Reductions, Conditions, Limitations and Exclusions:

Effects of Other Income Benefits - This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre- disability earnings. Therefore, we reduce this plan’s benefits by an amount equal to any Social Security retirement and/or disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will be reduced by amounts received through other government programs, sick pay, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description.

Earnings While Disabled - During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.

Limited Benefit Period - Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment:

Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses), Alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted.

Pre-existing Condition Limitation - Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures), or for which a reasonable person would have consulted a physician during the 3 months just prior to the most recent effective date of

ATTACHMENT NO. 5 to insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.

Termination of Disability Benefits - Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, you earn more than your allowable

Covered Earnings, or the date you refuse to participate in rehabilitation services.

Exclusions – This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following: Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane. war or any act of war, whether or not declared. active participation in a riot;

commission of a felony; the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy. any cosmetic surgery or surgical procedure that is not Medically Necessary.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

1 Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section. 2 Costs are subject to change.

Terms and conditions of coverage for Long Term Disability insurance are set forth in Group Policy No.

FLK 960504. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate.

If there are any differences between this summary and the group policy, the information in the group policy takes precedence. Product availability and/or features may vary by state.

Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North

America, 1601 Chestnut St. Philadelphia, PA 19192.

“Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Life Insurance Company of North

America and Cigna Life Insurance Company of New York, and not by Cigna Corporation.

882862 © 2019 Cigna. Some content provided under license.

ATTACHMENT NO. 5 to

ATTACHMENT 6

TO AMENDMENT NO. 1

TO RFP NO. 21-057/DP

PALM BEACH COUNTY BOARD Claims Experience 6-26-2021

PROVIDED AS A SEPARATE ATTACHMENT ON THE PURCHASING

DEPARTMENT’S VENDOR SELF-SERVICE (VSS) SYSTEM WEBSITE:

https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService/ https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService http://www.pbcgov.com/purchasing/bus_op/IFB_RFP/

ATTACHMENT 7

TO AMENDMENT NO. 1

TO RFP NO. 21-057/DP

PALM BEACH COUNTY BOARD OF COUNTY C_DIS_CLAIMS_

07-12-2021

PROVIDED AS A SEPARATE ATTACHMENT ON THE PURCHASING

DEPARTMENT’S VENDOR SELF-SERVICE (VSS) SYSTEM WEBSITE:

https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService/ https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService