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Home My WebLink AboutR-2024-048 Designating an Agent and Accepting Certain Employee Insurance Benefits Beginning July 1, 2024 RESOLUTION NO. R-2024-048 A RESOLUTION DESIGNATING AN AGENT AND ACCEPTING CERTAIN EMPLOYEE INSURANCE BENEFITS BEGINNING JULY 1, 2024. BE IT RESOLVED BY THE BOARD OF ALDERMENT OF THE CITY OF RIVERSIDE, MISSOURI AS FOLLOWS: THAT the City of Riverside designates Bukaty Companies as its broker/agency of record for employee insurance benefits beginning July 1, 2024; and FURTHER THAT the City will provide its full-time employees with medical insurance coverage options through Blue Cross and Blue Shield of Kansas City, effective July 1, 2024. There will be 5 plan options with the City providing an equal contribution to each tier across all options in accordance with the attached plan summaries; and FURTHER THAT the City will provide its full-time employees with dental and vision insurance coverage options through Pacific Life, effective July 1, 2024, all in accordance with the attached plan summaries; and FURTHER THAT the City agrees to provide Group Term Life, Voluntary Term Life, Voluntary Short-Term Disability, Long-Term Disability, Hospital Indemnity, Critical Illness, and Accident polices from Reliance Standard all in accordance with the attached plan summaries; and FURTHER THAT the City agrees to provide a Voluntary Identify Theft Protection policy from Identity Force all in accordance with the attached plan summaries; and FURTHER THAT the City will partner with Surency to provide administrative management of the Section 125 Flexible Spending Account, the Health Savings Account, and COBRA Administration, effective July 1, 2024. Surency will manage the Health Savings Account with it's banking partner, UMB Bank; and FURTHER THAT the Mayor, the City Administrator, Human Resources Manager, and other appropriate City officials are hereby authorized to take any and all actions as may be deemed necessary or convenient to carry out and comply with the intent of the Resolution and to execute and deliver for and on behalf of the City all certificates, instruments, agreements, and other documents as may be necessary or convenient to perform all matters herein authorized. PASSED AND ADOPTED by the Board of Aldermen of the City of Riverside, Missouri, the 7th day of May 2024. ' � ' .. 1(ti714&, D • • �' Mayor Kathleen L. Rose ATTEST': Robin Kincai , City Clerk City of Riverside Medical-July 1,2024 BCBa"Options BlueCross/BlueShield of KC BlueCross/BlueShield of KC BlueCross/BlueShield of KC P Preferred-Care Blue PPO$1000 PCB BlueSaver PPO HSA$3200 PCB BlueSaver PPO HSA$4000 BENEFITS Preferred Care Blue Network Preferred Care Blue Network Preferred Care Blue Network Nearer* 1 Non-Network Network f 1 Han-Nenrork NetwA ] Non-Nwwork CALENDAR YEAR DEDUCTIBLE wrartpanrPay, ParICpantPays dampen Pays •Individual $1,000 $1.000 $3,200 $3,200 $4,000 $4,000 •Family $3,000 I $3,000 $6,400 $6,400 $8,000 $8,000 PHYSICIAN OFFICE VISITS S OTHER Arectpare Pays Pamcylrs Pegs Pa.Kpan Pays Pnmary Care Physician Office Visit 830 copayMet Deductible;Co-Insurance Deductible Deductible Co-Insurance Deductible,Co-Insurance Deductible;Co-Iraurance Specialist Physician Office Visit 530 aopayh isit Deductible:Co-Insurance Deductible Deductible:Co-Insurance Deducible:Co-insurance Deductible:Co-Insurance Urgent Care Center Visit S30 copaylvtstt Deductible:Co-Insurance Deductible Deductible;Co-Insureno. Deductible:Co-insurance Deductible;Co-Insurance Emergency Room Visit 1100 Copay:Ded+Coins 3100 Copay:Ded+Cdns Deductible Deductible Deductible:Co-insurance Deductible:Co-Insurance Lab Services Deductible:Co-Insurance Deductible:Co-insurance Deductible Deductible:Co-Insurance Deductible:Co-Insurance Deductible:Co-Insurance X-Ray Services Deductible Co-Insurenu Deductible:Co-Insurance Deductible Deductible;Co-Insurance Deductible;Co-Insurance Deductible:Co-Insurance Hph-Tech Radiological Services Deductible:Co-Insurance Deductible:Co-Insurance Deductible Deductible;Co-insurance Deductible:Co-Insurance Deductible;Co-Insurance Surgery(Physicians Office) Deductible Co-Insurance Deductible:Co-ktsure c. Deductible Deductible:Co-Insurance Deductible;Co-Insurance Deductible;Co-Insurance ChkopractorVis.t Spnal Maapulations(Lanns May Apply) Deductible:Co-Insurance Deductible:Co-insurance Deductible Deductible:Co-Insurance Deductible:Co-insurance Deductible;Co-Insuancee Inpatient/Outpatient Hospital Services(GeMral Deductible:Co-Insurance Deductible:Co-Insurance Deductible Deductible;Co-Insurance Dottiest/bit Co-insurance Deductible Co-insurance Other Cowed Services(Genera! Deductible Co-Insurance Deductible:Co-Insurance Deductible Deductible:Co-Insurance Deductible:Co-Insurance Deductible Co-Insurance PLAN CO-INSURANCEio.r.al 80% 50% 100% I 80% 80% 60% CALENDAR YEAR OUT-OF-POCKET MAX. Rem/paid Pays PanK4,anr Pays Participant Pays *Nudes The Deductible,Medical 4 RX Copayal •Individual $4,000 $8,000 $3,200 $6,400 $5.500 $11,000 •Family $8,000 $16,000 $6,400 $12,800 511,000 I 522,000 Additional Info: ACA Tares:Cheat mat pay arum,not included ACA Tares Caen'must pay diem,not nckrded ACA Tares.Clod must pay New,not included RETAIL PRESCRIPTION DRUGS COPAY tans ors.-Pease Sae camervmec. Tier I-ltS ropey Tier I-f 15 aopay+50%ooins Tier I-Deductible Tier I-Ded:Can Tier I-Ded;Coin Tier 1-Ded.Can GNJMd Summary of 6eneab Tier 2-$70 Tier 2-870 cop. copay+50%coins Tier 2-Deductible Tier 2-Ded:Can Tor 2-Ded:Coin Tier 2-Deft Coin Tier 3-f 110.pay Tier 3-f 110 copay+50%colns Tier 3-Deductible Tier 3-Ded:Can Tier 3-Died:Conn Tier 3-Ded.Con Tier 4-S200 copal Tier 4-1200 copaye 50%cons Tier 4-Deductible Tier 4-Ded:Con Tier 4-Ded:Can Tier 4-Ded:Can Additional RX Information See Summary for Other Prescption Nub See Summary for Other Prescr pbon Details See Summary for Odle Prescription Details COST COUNTS COUNT, COUNTS Employee Only 10 S640.57 24 f002.89 24 S542.00 Employee Plus Spouse I $1.614-24 2 f 1.519.28 2 11.307.35 Employee Plus CIlIId(ren) 2 S1.230.30 8 11.103.57 8 $1,047.22 Employee Plus Family 2 f 1,832.03 19 f 1.721.26 19 11.551.84 Est,maled Monthly Cost S14,156.60 S59.577.42 S53,619.82 Annual Cost S169,879.20 $714,929.04 $643,437.84 Increase/Decrease over current -8.9% 20.2% 8.2% Current Monthly Cost $68,906.99 Current Annual Cost $826,883.84 ADDITIONAL INFORMATION Health Insurance - Blue Cross & Blue Shield of Kansas City • 3 plans in the full network-1 traditional PPO &2 high deductible health plans with HSA City of Riverside Medical-July 1,2024 BCBSKC Options BlueCrossiBlueShield of KC BlueCross/BlueShield of KC p BSP Spira Care EPO ASO$1500 BSP HSA Spira Care EPO BENEFITS Spina Care Network Spina Care Network Network 1 Nan•Nenvork Nenork I Non-Network CALENDAR YEAR DEDUCTIBLE m rn Paricel Pays Pacyanr Pays •Individual $1,500 N/A $3,200 N/A •Family $3,000 I N/A $6,400 N/A PHYSICIAN OFFICE VISITS&OTHER PPutianr Pays Parttpanr Pays Primary Care Physician Office Visit SO Copay at SC Facility Not Covered see Copay at SC Facility Not Covered SPeoiakst Physician Office Visit Deductible Not Covered Deductible Not Covered Urgent Care Center Visit Deductible Not Covered Deductible Not Covered Emergency Roan Visit Deductible Deductible Deductible Deductible Lab Services S0 Copay at SC Facility Not Covered Deductible Not Covered X-Ray Services SO Copay at SC Facility Not Covered Deductible Not Covered High-Tech Radiological Strvrces Deductible Not Covered Deductible Not Covered Surgery(Physicians Office) Deductible Not Covered Deductible Not Covered ChxvpraetorVistlSpmal Manipuietions(Limts May Apply) Deductible Not Covered Deductible Not Covered InpatientIOutpabent Hospital Services((venal) Deductible Not Covered Deductible Not Covered Other Covered Services(Gina) Deductible Not Covered Deductible Not Covered PLAN CO-INSURANCEicemeral 100% N/A 100% N/A CALENDAR YEAR OUT-OF-POCKET MAX. Participant Pay, Parbcpinr Pays (mdudes The Deductible,Medical a RX Copays) •Individual $1,500 N/A $3,200 N/A •Family $3,000 N/A $6,400 N/A Additional Info: ALA Tams'Chet must pay deem.not rtcluded ACA Tarn-Cent must pay than,not ndued RETAIL PRESCRIPTION DRUGS COPAY Mar Cider-grease see Cans erica Tier 1•S 15 Copay Tier I-Not Covered Tier 1-Deductible Tier I-Not Covered araaao Summery aperients Tier 2•550 Copay Tier 2•Not Covered Tier 2-Deductible Tier 2-Not Covered Tier 3-Deductible Ter 3•Not Covered Tier 3-Deductible Tier 3-Not Covered Additional RX Information See Summary for Omer Prescription Dyads See Summary for Other Presctgtion Derals COST COUNTS COUNTS Employee Only 35 S5137.82 35 S512.40 Employee Plus Spouse 4 S1481 30 4 S1.291.39 Employee Plus Child)ren) 10 $1,134.49 10 5089.04 • Employee Plus Family 22 $1.081.10 22 $1,105.02 Estimated Monthly Cost $74,829.32 $65,235.70 Annual Cost S897,951.84 S782,828.40 lncreaselDecrease over current Current Monthly Cost $68,906.99 Current Annual Cost S826,883.84 ADDITIONAL INFORMATION Health Insurance - Blue Cross & Blue Shield of Kansas City • 2 plans in the limited Spira Care network- 1 traditional PPO & 1 high deductible health plans with HSA City of Riverside DENTAL PROGRAM-July 1st 2024 Dental Program Rates Pacific Life-Base Pacific Life-Buy-Up Option Option BENEFITS PPO'Premier 10„.... Ilon-Iktwork PPO.Premier Q lion-lletwork r CALENDAR YEAR DEDUCTIBLE Partn•panl Pays Pancipant Pays •Individual $50 $50 •Family $150 $150 Plan Pays Plan Pays Reimbursement _ _ A.DIAGNOSTIC 8 PREVENTIVE SERVICES 100% 80% 100% 100% B.BASIC SERVICES 80% 60% 80% 80% C.MAJOR SERVICES 50% 40% 60% 50% 0.ORTHODONTIC SERVICES 50% 40% 50% 50% CALENDAR YEAR MAXIMUM BENEFIT(A,B&C) $1,500 $2,000 CALENDAR YEAR MAXIMUM BENEFIT(ORTHODONTIA) St,000 $2,000 COST Count Rates Count Rates Employee Only 15 $22.38 12 $30.28 Employee Plus Spouse 6 $44.74 2 $60.58 Employee Plus Children) 9 $58.88 1 $80.34 Employee Plus Family 17 $8622 7 $117.30 Estimated Monthly Cost 52,600.70 $1,311646 Estimated Annual Cost S31 208.40 S1ti,631.52 2.5% 0.0% Increase/Decreese Over Current Dependents covered to age 26 Dependents covered to age 26 Dental- Pacific Life • Buy-Up plan costs the employee a little more in premium, but provides better coverage on major services and out-of-network providers City of Riverside VISION -July 1,2024 Option Lamer •xi is Life Network EyeMed Insight 12/12/12 Plan Type BENEFITS Network f Non Network Parncpant Pays Plan Allowance VISION EXAM Once every 12 Months $10 Up to$35 FRAMES Plan Allowance wan Alewancv $150 Mowance I Teo STANDARD PLASTIC LENSES Participant Pays Plan Allowance Once every 12 Months Single Vision $25 Copay Up to$40 Bifocal $25 Copay Up to$50 Trifocal $25 Copay Up to$80 Lenticular $25 Copay Up to$80 CONTACT LENSES Partasary Pays Plan Allowance Once Every 12 Months-In Lieu Of Fronresrtenses CONTACT LENS FIT&FOLLOW-UP Up to$55 Not Covered Conventional $150 Allowance $104 Allowance Disposable $150 Allowance $104 Allowance Medically Necessary $0 $300 Alowance See Sunman or Beneet.,for more detail COST Counts Monthly Rate Employee Only 19 $6.74 Employee Plus Spouse 6 $12.78 Employee Plus Childlren) 0 $14 98 Employee Plus Family 21 $21.10 Estimated Monthly Cost $647.84 Estimated Annual Cost $7.774.08 Increase/Decrease Over Current 9.69% Dependents to age 26 Vision - Pacific Life City of Riverside Short Term Disability BENEFITS - Employer Paid Reliance Standard EMPLOYEE SHORT-TERM DISABILITY All Eligible Employees working 30 hours week Elimination Period Accident: 15th Day Sickness: 15th Day Benefit 60% To $1.000 Maximum Benefit Per Week Maximum Benefit Period 11 Weeks Salary Increase/Decrease Occurs On Plan Anniversary COST - Employee Paid Volume Employee Rate - Rare Per$10 $58.836. 19 $0.310 Monthly Premium $1.823.92 Annual Premium $21,887.06 ADDITIONAL INFORMATION Short Term Disability- Reliance Standard City of Riverside Long Term Disability BENEFITS - Employer Provided Reliance Standard EMPLOYEE LONG-TERM DISABILITY Elimination Period 90 Days Benefit 60% To $6,000 Maximum Benefit Per Month Own Occupation Limitation 24 Months Maximum Benefit Period ADEA-B-AGE Mental/Nervous, Substance Abuse Limitation 24 Months Special Conditions Limitation None Social Security Integration Full Family Partial Disability& Recurrent Disability Benefit Included Pre-Existing Conditions Limitation 3/12 Survivor Income Benefit Included Salary Increase/Decrease Occurs On Plan Amiversary COST - Employer Provided VOLUME LONG-TERM DISABILITY $371,160 $0.630 Covered Monthly Payroll Estimated Monthly Cost $2,338.30 Estimated Annual Cost $28,059.66 ADDITIONAL INFORMATION Long Term Disability- Reliance Standard Voluntary Group Accident °' � "'' '�� = Insurance ' .� �� 114 ._. r Accident Insurance COVERAGE Voluntary accident insurance provides a range of fixed,lump-sum FEATURES benefits for injuries resulting from a covered accident,or for ► Portability to Employee Age 70 accidental death and dismemberment(if included).These benefits ► FMLA/MSLA Continuation are paid directly to the Insured and may be used for any reason, ► Newlywed and Newborn Provision from deductibles and prescriptions to transportation and ► 24-Hour Travel Assistance Services childcare. ► 24-Hour Coverage ELIGIBILITY All Active Benefit Eligible Employees,except for any person working on a temporary or seasonal basis. Dependents:You must be insured for your Dependents to be covered.Dependents are: ► Your legal spouse or domestic partner.Spouse must be under age 70 at date of application. ► Your dependent children from birth to 26 years. ► A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT See Full Schedule of Benefits on next page CONTRIBUTION REQUIREMENTS Coverage is 100%Employee Paid. MONTHLY PREMIUM Coverage Low Plan High Plan Employee $ 10.33 $ 17.70 Employee and Spouse $ 17.73 5 29.43 Employee&Children $ 18.44 5 31.31 Employee&Family $ 25.63 $ 42.60 Voluntary Accident- Reliance Standard Plan Highlights } T. Voluntary Group Critical Illness ', 4 Insurance *► Bukaty Shelf Plan COVERAGE Voluntary critical illness insurance provides a fixed,lump- sum benefit CONTRIBUTION REQUIREMENTS upon diagnosis of a critical illness,which can include heart attack, Coverage is 100%Employee Paid. stroke,paralysis and more.These benefits are paid directly to the insured and may be used for any reason,from deductibles and RATES prescriptions to transportation and child care. Age Premium Rate 0-29 $0.58 30-39 $0.82 ELIGIBILITY 40-49 $1.54 All Active Benefit Eligible Employees,except for any person 50-59 $2.94 working on a temporary or seasonal basis. 60-69 $4.29 Dependents:You must be insured for your Dependents to be 70+ $7.61 covered.Dependents are: Child $0.12 P. Your legal spouse or your domestic partner.Spouse must be under age 70 at date of application.Coverage terminates at age 75. ► Your dependent children from birth to 26 years. ► A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT Employee:Choose from a benefit of$5,000 to a maximum of$20,000 in$5,000 increments. Spouse:Choose from a benefit of$5,000 to a maximum of$20,000 in $5,000 increments,not to exceed 100%of approved employee amount. Child(ren):50%of approved employee amount up to a maximum of $10,000. GUARANTEED ISSUE Employee:$20,000 Spouse:$20,000 Child(ren):$10,000 Voluntary Critical Illness - Reliance Standard Plan Highlights Voluntary Group Hospital Indemnity Insurance ! z. ' wire4• Premium Plan COVERAGE BENEFITS Voluntary hospital indemnity insurance provides a range of fixed, Hospital Room&Board Benefits lump-sum daily benefits to help cover costs associated with a hospital admission,including room and board costs.These benefits are paid Room&Board Benefit per Day directly to the insured following a hospitalization that meets the (15 Daily Benefits per Coverage Year $100 )' criteria for benefit payment. Hospital Critical Care Unit Benefits ELIGIBILITY Critical Care Unit Benefits per Day Each Active Full-Time Employee working 20 hours or more per $200 (15 Daily Benefits per Coverage Year) week,except for any person working on a temporary or seasonal Hospital Admission Benefit basis. One Daily Benefit per Coverage Year $1,000 Dependents:You must be insured for your Dependents to be covered.Dependents are: ► Your legal spouse or domestic partner.Spouse must be under age 70 at date of application. ► Your dependent children from birth to 26 years. Nursery Admission Benefit ► A person may not have coverage as both an Employee and One Daily Benefit per Coverage Year $500 Dependent. Non-Insurance Services FEATURES On-Call Travel Assistance Included ► No pre-existing conditions exclusions ► No deductibles MONTHLY PREMIUM ► Eligible for continuation of coverage (overage Premium ► Coverage Offered on a Voluntary Basis Employee $ 20.75 ► FMLA/MSLA Continuation Employee&Spouse $ 43.59 ► Portability Employee&Child(ren) $ 30.67 Employee&Family $ 52.52 CONTRIBUTION REQUIREMENTS - Coverage is 100%Employee Paid. Voluntary Hospital Indemnity- Reliance Standard City of Riverside Basic Life/AD&D Current Option BENEFITS-Employer Provided KC Life Reliance Matrix EMPLOYEE BASIC LIFE/AD&D All Eligible Employees:S50.000 All Eligible Employees:$50,000 35%at age 65;50%at age 70 35%at age 65;50%at age 70 Age Reductions Occur On Plan Anniversary Age ReCuccons Occur On Plan Anniversary COST-Employer Provided ESTIMATED VOLUME EMPLOYEE BASIC LIFE $3,665,000 $0.125 $0.120 Per$1.000 caned Benefit EMPLOYEE BASIC AD&D $3,665,000 $0.025 $0.030 Per$1.000 Estimated Monthly Cost S549.75 $549.75 Estimated Annual Cost $6,597.00 $6,597.00 ADDITIONAL INFORMATION increase/Decrease over current 0% Group Term Life - Reliance Standard City of Riverside Voluntary Life AD&D Option BENEFITS-Employee Paid Reliance Matrix All Eligible Employees working 30 hours week EMPLOYEE SUPPLEMENTAL LIFE/AD&D Available In$10.000 Increments Maximum$500.000 Guarantee Issue$100,000 Coverage Reduces:35%at age 65;50%at age 70 SPOUSE BASIC LIFE/AD&D Available In$10,000 Increments Maximum$500,000 Guarantee Issue.S20.000 Coverage Reduces By 50% at age 70 CHILD SUPPLEMENT LIFE/AD&D Available In$2,500 Increments But up to 6 months:$1,000 F morths-26 years:S10,000 COST-Employee Paid Employee Rate-Rate Per$10,000 Spouse Rate-Rate Per$f0,000 25-29 $1.100 $1.100 30-34 $1.480 $1.480 35-39 $1.910 $1.910 40-44 $2.620 $2.620 45-49 $3.710 $3.710 50-54 $5.690 $5.690 55-59 $8.530 $8.530 60-64 $12.200 $12.200 65-69 $20.790 $20.790 70-74 $35.550 $35.550 Employee/Spouse AD&D: $020 included in the above rates Child(renl Rate-Rate Per;10,000$1.60 Child Rate Based On Fmdy Jnt+Not Per Cr ADDITIONAL INFORMATION 2 year rate guarantee This is an Overview of Benefits only, where this summary&the contract differ,the contract will prevail. Voluntary Term Life- Reliance Standard .!IC)UKAT M Y CNHNItS G Employee Benefit Plans Fkpernse MU el pl.niLW • Plan Features UltraSecure IdentityForce Premium IDENTITY THEFT PROTECTION A Sontiq"Brand Financial Account Takeover Monitoring • Mobile Attack Control • Secure My Network(V PN) • Online PC Protection Tools • Employee Password Managen • Bream ro- • • Benefit Plans Bank and Credit Card Achy icy Alerts • identity Vault and Secure Storage • Auto On Monitoring • Easy to Enroll Advanced Fraud Monitoring(Instant Inquiry Alerts) • Change of Address Monitoring • Court Records Monitoring • 1.Enroll along with other voluntary acid Alert Reminders • benefits through your employer. nark Web Monitoring • Compromised Credentials Alerts • 2.Receive confirmation email. $a Offender Notification • II you do not receive the email, please check your Spam colder. Social Media Activity Alerts(Adult and Child) • Data Breach Notification • 3.Click on link in confirmation email Identity Threat Alerts • to complete regist ration and access junk Mail Opt Out • your Identity Protection Dashboard. Smart SSN Trader ISSN Monitoring) • -s Medical ID Fraud Protection • Questions? Motile App(iOS and Android) • Two Factor Authentication • Call Member Services at 1 855 441 0270 Lost Wallet Assistance • Child Monitoring(55N and Dark Web) • IMPORTANT:To access your 401(ki NSA&investment Accoum Act wity Alerts • Identit yr.,rce plan please CREDIT MONITORING ,m/ Credit Report Assistance • Credit Freeze and Lod Assistance(Adult and Child) • lI, \Ic Credit Report Monitoring(DailN 3 Credit Bureaus 1 •JAVELIN \7 °\/R Credit Report and Score(Quarterly) 3 Credit Bureaus �...ill : ��\� /.- `LyJ Credit Score Simulator • :._ n Credit Score Tracker(Monthly) • Protect What Matters Most RESTORATION SERVICES Ramomware Expense Reimbursement $25,000 Social Engineering Expense Reimbursement 125.000 #1 Rated Consumer Cybetbullying Expense Reimbursement 125,000 Senior Fraud Resolution(Insurance Intluded with Family Plant • ID Theft Plans White Glow Restoration • As seen on CNOC and Irvestopedla Pre.existing Identity Theft Restoration • Deceased Family Member Fraud Remediation • `1 identity TheftInsurance S2,000,000 ...F- ••„•I:.�,_ Stolen Funds Replacement • - Any Financial Account Covered • •bapal.d Famuy Member Rau.l•mM lane I Arola.Ior adultr or eiipme Mgnaentx en rNkd in an active Went ityfmo for ly Plln el Inn Ilnw(Jr ow.(NAY ABOUT SONTIO Employ Only:$9.49 Employee•Family:$17.49 Sonbq is an Intelligent Identity Security company arming businesses and consumers with award-winning products built to protect what matters most Sontiq's brands,IdentityForce,Cyberscout.and EZShreld,provide a full range of identity monitoring,restoration,and response products and services chat empower customers to be less vulnerable to the financial and emotional consequences of identity theft and cybercrimes.Learn wwwidentityforca:.mm 1455441.0270 Identity Theft Protection — Identity Force SurencySurency COBRA Administrative Fees - * Surency Flexible Spending Accounts COBRA LEX Administrative Fees — Fee Amount Initial(one-time)Implementation Fee Waived Fee Details Amount Takeover Fees Waived -Drafting Plan Document&SPD. Annual Renewal Fee Waived -Set up all plan parameters. On going Monthly Fees -ConsumerWebsrte Set-up Fee -Employer Website Per Employee Per Month(Pt PM (Initial Implementation) Waived ) 01.00 -Dedicated account management team. Administrative Fee" -Enrollment and communication materials -EDI Feed set-up and/or Online eligibility via portal Qualifying Event Notices Included _ Carrier Notifications Included -Form 5500 data. Annual Renewal Fee -Updates to PD/SPD Waived Real-t- Reporting Included -Includes administration for-Medical FSA,DCFSA, On-line portal/Mobile App Included 8 LPFSA $4.00 PPPM - -Real-time reporting,tracking&claims processing Past Due Notices to QBs Included -Mobile Application -- - ------------------ Rate Guarantee:4 Years Carrier communication and -24/7 member services Included -Educational videos premium remittance FSA Monthly Administration Fee -Electronic and paper account summaries Monthly Minimum-$35 Monthly Minimum Administrative $75.00 (PPPM) -Ongoing electronic eligibility. Fee We only charge one fee(34.00)If -2 VISA Debit Cards per participant Renewal Fees -Rollover/grace period administration member enrolls in the medical FSA as -Consumer direct deposits well as dependent care FSA,and/or Annual Renewal Rate Reset Fee OE and Benefit Fair support LPFSA. (per enrolled QB-to send their $10 per mailed OE packet to enrolled Q5 - PP COBRA Open Enrollment packets) Additional Fees as Needed Additional/Replacement Surency Flex Benefits Cards(per set) Waived Special Mailing Projects At Cost -- - - -- --__-- Rate Guarantee 4 Years 'PPPM=Per Participant Per Month 'Please note that prang is based on Sat Life and Health retaining the 2%administrative lee. HSA/FSA/COBRA Administration -Surency UMB Healthcare Services Health Savings Account Pricing Zero Monthly Service Charge Zero Minimum Balance Requirement' Services included at ZERO COST UMB ATM Withdrawals cwnen ATM access is a//owed! Stop Payment Requests Client Call Center and 24/7 customer service support UMB VISA`HSA Debit Card Mobile Banking Quarterly e-statements Online Banking Online Bill Pay Online Contributions Online Reimbursement Fees for Additional Services' Non-UMB ATM Withdrawal fee Other networks may impose their own fee structure Quarterly Paper Statement fee $ 1.50 UMB HSA Saver;Monthly Service fee $ 3.00 Account Closing/Transfer fee $25.00 'HSA deposit account does not require a minimum balance to maintain the account.Minimum balance requirements are applicable to UMB HSA Saver.See UMB HSA Saver Terms and Conditions for more details. If electronic statements are made available to you,and you wish to avoid the Quarterly Paper Statement fee,you must sign up to receive electronic statements on your HSA administrator's website.If you do not receive electronic statements.you will be charged a Quarterly Paper Statement fee.This fee will be deducted from your Deposit Account ,Additional services are fully described in the UMB Health Savings Deposit Account Terms and Conditions-available upon request. ,To be eligible for the UMB HSA Saver',you must have a certain minimum dollar amount in your HSA Deposit Account. The minimum dollar amount,or Peg Balance,required to participate in UMB HSA Saver can be found in the UMB HSA Saver Terms and Conditions and may be changed from time to time by UMB.UMB Investment Management selects mutual funds in various asset classes for inclusion in the UMB NSA Saver Investment Program.UMB Custody Services provides safekeeping and settlement of the mutual fund investments in the UMB NSA Saver Investment Program.UMB Investment Management and UMB Custody Services are departments of UMB Bank,n.a.UMB Bank,n.a.is a wholly owned subsidiary of UMB Financial Corporation. INVESTMENTS IN SECURITIES THROUGH HSA INVESTMENT ACCOUNT ARE: NOT FDIC INSURED I MAY LOSE VALUE I NO BANK GUARANTEE Capitalized fees are subject to change by UMB at any time,including,but not limited to,the expiration of your high deductible health plan,upon notice to you as required by applicable law. For questions or more information call 1.866.520.4HSA(4472). S.C.r19 one t 2023 LIMO[NON. orpunlbn HSA Bank - UMB