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CIGNA IMPLEMENTATION GUIDE - LIST OF DOCUMENTS REQUIRING SIGNATURE CIGNA Implementation Guide List of Documents Requiring Signature There are a number of documents that are critical to the case implementation process. Customer Acknowledge Form(CAF) Discretionary Claim Authorization Form HWPA Declaration Form Hold Harmless Agreement for SPD Drafts State Accept/Reject Forms Summary Information Form_(SIF) Without the proper documents and signatures,the case implementation process cannot be completed. Timely receipt of these documents is essential to a successful implementation. CUSTOMER ACKNOWLEDGMENT FORM CIGNA To be completed by Field Salesand Customer IfeubbCa,, PART 1: Producer of Record Information Section;(Complete all) Effective 1/1/2OQ9 . |xen*uxoc*nnw|odQe GE0R|NG GROUP 100% Producer(individual/Firm to Whom Compensation will be paid) (%share if other than 100%) Producer(Individual/Firm to Whom Compensation will be paid) I share if other than 100%) tphr designated the producer pf record for CITY OFCLEARVVATER 3331468 Customer Name Account Number PART 11: Funding Arrangement Information Section:(Check&Complete one) Traditional Insured Cases: 4cmounmo,oupwumuar HMO Site(if applicable) CITY OF CLEARVyATER / Acct# 3331468 Cash Management Program<ci Customer understands funding arrangement of the policies applied for will reduce the amount of premium paid directly to Connecticut General Life Insurance Company. Customer hereby authorizes Connecticut General Life Insurance Company to act as transfer agent in paying compensation to our designated producer of record based upon the premium paid to Connecticut General and the amounts funded by Customer through their benefit payment occovnt(m under the funding arrangement elected. Administrative Services Only(»SO}: Customer recognizes this account is funded on an Administrative Services Only basis. We request Connecticut General Life Insurance Company compensate our designated producer m record aafollows: annual flat compensation per covered employee Other(Please specify) The compensation will be included ia Connecticut General's retention expenses. PART III: Signature Requirements Section:(To be complet2d�y"C5STM"E"RI Autborized Customer Signature Date eo Authorized Customer Name(Print) Customer Street Address Customer City,State and Zip Code To comply with New York's four percent(4m)nmuv^compensation paid murc^eru"^HMO contracts,c/sw^x°"/mo=°win not pay more than four perc°'(4m)commissions""HMO,roe formerly cn^).poa Open Access and HMO Open Access products for membership covered b'o/wwx Healthcare m New York,Inc. 1u4-ooms DISCRETIONARY CLAIM AUTHORIZATION PLEASE RETURN THIS SIGNED FORM TO YOUR SALES REPRESENTATIVE Plan Administrator: CIGNA HealthCare Policy Number: 3331468 Policyholder: City of Clearwater The Plan Administrator named above hereby delegates to the Claim Administrator the discretionary authority to interpret and apply plan terms and to make a factual determination in connection with its review of claims under the plan. Such discretionary authority is intended to include, but is not limited to, the determination of the eligibility of persons desiring to enroll in or claim benefits under the plan and the computation of any and all benefit payments. The Plan Administrator also delegates to the Claim Administrator the discretionary authority to perform a full and fair review, as required by ERISA, of each claim denial which has been appealed by the claimant or his duly authorized representative. NAME POSITION/TITLE DATE 1113CI J, If you sign this form, this language should be made part of your Summary Plan Description. If the Summary Plan Description appears in your certificate, a rider for your certificate will be issued adding the above statement to those pages in the certificate. DISCLO1 04-18-98 CIGNA HEALTHCARE c HIPAA CERTIFICATION CIGNA. DECLARATO,N AGREEMENT The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that a proof of prior coverage certificate (HIPAA Certificate)be issued to individuals who, for any reason, have lost their active or COBRA medical plan coverage. For fully insured customers, CIGNA HealthCare will automatically generate individual HIPAA Certificates for members and their dependents sinless the employer has declined this service by indicating below (unless required by state law). For self-insured customers, CIGNA HealthCare will not provide this service unless the customer elects this optional service by indicating below. Please complete the following information and return this Declaration Agreement to: CIGNA HealthCare 900 Cottage Grove Ind, GIMIG Bloomfield, CT 06152 Or fax: 860.22 .3 7 1. Account Dame: City of Clearwater 2. Contact Name: Allen Del Prete Title: Human Resources Manager Phone: 727.562.4576 3. Contact Address: 100 S. Myrtle Avenue City: Clearwater State: Fl, Zip: 33756 Account Number(s):: 3331468 Please select one of the following: We do not elect to use CIGNA HealthCare Certification Services. We will have full responsibility to comply with the issuance of HIPAA Certificates as required by federal law. X We elect to have CIGNA HealthCare perform HIPAA Certification Services. We acknowledge that CIGNA HealthCare's ability to provide HIPAA Certificates may be dependent on the quality of information provided by us. We understand that CIGNA HealthCare is responsible only for coverage periods administered by CIGNA HealthCare. If you have elected CIGNA HealthCare to perform the services,please complete the following: 4. START DATE: For new accounts, the start date will be the account effective date. For existing accounts, please indicate one of the following: ❑ At renewal / ] OR As of 01 / 01 j 2009 5. Type of Medical Coverage (Check all that apply): Commercial HMO/POS x Indemnity/PPO/OAP Point-of-Service/PlexCare/Network Preferred Provider Access 6. Type of Funding Arrangement (check one box): X Insured ASO/Self-Funded Both 7. If you have elected the HIPAA certification services, CIGNA HealthCare will generate quarterly reports of HIPAA Certificates that were generated for your account. Please indicate if you would like to receive this report: ,r X Yes No ,Signature Date Note: If you have elected to have CIGNA HealthCare perform the HIPAA certification service, YOU will receive a report upon termination of your account. In accordance with HIPAA, no individual HIPAA Certificates will be issued. This report may be used to provide prior coverage in fonration to a new administrator or carrier. Version 04/01/08 AGREEMENT REGARDING ELECTRONIC DOCUMENTS At the request of City of Clearwater ("Employer"), CIGNA Healthcare has agreed to provide Employer the following documents ("Documents") in an electronic form for use by participants in a benefit plan sponsored by Employer: Medical SPI)s in consideration for which Employer hereby agrees as follows: 1. Employer shall not alter the Documents and shall be responsible for promptly making any updates to the Documents when such updates are provided by CIGNA Healthcare. 2. Employer shall prominently display the following notice so that it is visible to anyone accessing the Documents electronically: THESE MATERIALS ARE MADE AVAILABLE ELECTRONICALLY FOR YOUR CONVENIENCE BY YOUR EMPLOYER. CIGNA HEALTHCARE DOES NOT CONTROL AND IS NOT RESPONSIBLE FOR THE CONTENT OF THESE MATERIALS AND DOES NOT WARRANT THEIR ACCURACY. 3. Employer shall assume responsibility for compliance with applicable federal and state laws, including Department of Labor's Rules for Disclosure Through Electronic Media [29 CFR 2520.104b-I and 29 CFR 2520.107-1]. 4. Employer shall defend, indemnify and hold CIGNA Healthcare, its officers, employees and directors, harmless from and against any and all losses, damages, expenses, casts (including attorneys' fees), claims, causes of action, or obligations of any kind arising directly or indirectly from the provision by CIGNA HealthCare of the Documents to Employer or the use of the Documents by any person or entity. CIGNA HealthCare By: Date: City of Clearwater ("Employer") By: , Date: "l c / o CONNECTICUT GENERAL LIFE INSURANCE COMPANY ALABAMA STATE REQUIRED ACCEPTANCE/REJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected,will not be provided at a later date unless specifically requested. Mental Health benefits must be offered to all Alabama residents regardless of contract situs. ACCEPT REJECT CITATION BENEFIT ge 27-20A.1 Alcoholism: Coverage of inpatient, residential, and outpatient treatment of through 4 alcoholism. May be limited to 30 days of inpatient care or its equivalent per calendar year. 27-54-7 Mental Health: Coverage at the same terms and conditions as for physical xillness. Must include inpatient, outpatient, and day treatment benefits. Can limit to in-network benefits. 2004 SB ON/AFTER 81112004: Colorectal Cancer Screening*: Must offer coverage 403 for colorectal cancer screenings. *This benefit is standardly covered under CGLIC plans and therefore does not have an impact on premium for those plans. —City of Clearwater CG#3331468 Name of Policyholder By Title A/unco &eSoL4e-C,0J MegetiZpv- Name Date Lo (f CONNECTICUT GENERAL LIFE INSURANCE COMPANY COLORADO STATE REQUIRED ACCEPTANCE/REJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected, will not be provided at a later date unless specifically requested. ACCEPT REJECT CITATION BENEFIT 10-16-104 Alcoholism*: Coverage for the inpatient and outpatient treatment of (9) alcoholism for 45 days per calendar year for inpatient care and $500 per twelve-month period for outpatient care. 10-16- Home Health Care and Hospice Care: Coverage for up to 60 visits 104(8) per calendar year for Home Health Care services; coverage for hospice care services, limited to $100 per day except for short term inpatient care in a Hospice Facility or crisis care at home for a period of 30 days and bereavement support services of up to $1,150 for the family of the deceased for up to 12 months following death. 10-8-116; Reduction in Work Hours: Extension of coverage for employees 10-17-137 whose work hours are reduced due to economic conditions. .*If this benefit is rejected,any level of alcoholism benefits, including no coverage, may be provided. -City of Clearwater CG#3331468 Name of Policyholder AP±r- Title &M60 'e'- Name Date CONNECTICUT GENERAL LIFE INSURANCE COMPANY FLORIDA STATE REQUIRED ACCEPTANCEIREJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected,will not be provided at a later date unless specifically requested. ACCEPT REJECT CITATION BENEFIT 627.669 Alcoholism and Drug Dependency: Coverage for inpatient and outpatient treatment of alcoholism or drug dependency, up to 44 /X outpatient visits, with a lifetime limit of no less than $2,000. Detoxification is covered only on an inpatient basis. 627.668(2) Mental Illness: Coverage for mental and nervous disorders at the (b) same basis as any other illness, subject to an inpatient maximum of 30 days per benefit year. Mental illness coverage is not required, but if provided, cannot be less than this benefit. (Rejection would only mean that this particular set of benefits has been refused. A better benefit may be provided, or no mental health benefits may be provided.) 627.42395 Nutritional Formulas*: Coverage for prescription and non- prescription enteral formulas prescribed by a physician for inherited 1< diseases or malabsorption, up to $2,500 annually through the age of 24. *This benefit is standardly covered under CGLIC plans and therefore does not have an impact on premium for those plans. -City of Clearwater CG#3331468 Name of Policyholder By Title ov - ae Nm Date CONNECTICUT GENERAL LIFE INSURANCE COMPANY GEORGIA STATE REQUIRED ACCEPTANCE/REJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected,will not be provided at a later date unless specifically requested. All Georgia laws are extraterritorial for METS, and this form must be signed by any MET group covering Georgia residents. ACCEPT REJECT CITATION BENEFIT 33-30-4.4 Bone Marrow Transplant: Coverage for bone marrow transplants for the treatment of breast cancer and Hodgkin's disease. Must be covered at the same level as provided for other types of physical illness. 1< 33-30-4.1 Human Heart Transplant*: Coverage for human heart transplants at same level as other types of physical illness. 31-15A-3 Bone Mass Measurement*: Coverage for bone density testing for prevention, diagnosis, and treatment of osteoporosis. 33-24-29.1 Mental Illness: Coverage for treatment of mental disorders the same as coverage for physical illnesses. 33-20A-9.1; Consumer Choice Option: Coverage from out-of-network Georgia 120-2-83 providers by nominating a provider. Additional premium charged to employee for CCO option; choice to enroll at employee level. This benefit is standardly covered under CGLIC plans and therefore does not have an impact on premium for those plans. City of Clearwater CG#3331468 Name of Policyholder By & I le& Title 4L�go 0 V/ ,� Kevvt Ae, Date 12-- CONNECTICUT GENERAL LIFE INSURANCE COMPANY ILLINOIS STATE REQUIRED ACCEPTANCE/REJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected, will not be provided at a later date unless specifically requested. ACCEPT REJECT CITATION BENEFIT 51370c Mental, Emotional and Nervous Disorders; Coverage for the reasonable and necessary treatment and services for mental, emotional or nervous disorders or conditions up to the limits in the policy for other disorders and conditions. Coinsurance may be limited to 50%, 215 ILLS TMJ: Coverage for the reasonable and necessary medical treatment of 51356q temporomandibular joint disorder(TMJ)and craniomandibular disorder subject to the same limitations and cost sharing as for other disorders. The lifetime maximum may be no less than$2,500. City of Clearwater CG#3331468 Name of Policyholder By Title 14(kA40 Name Date CONNECTICUT GENERAL LIFE INSURANCE COMPANY KENTUCKY STATE REQUIRED ACCEPTANCE/REJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected,will not be provided at a later date unless specifically requested. ACCEPT REJECT CITATION BENEFIT 304.17-312 Home Health Care: Coverage for home health care providing no less 304.18-037 than 60 home health care visits in a calendar year. 304.5-160 Elective Abortions: Coverage for elective abortions that are not life _y threatening. Note: Policies that provide maternity benefits include coverage for non-elective abortions. 304.17A- Bone Density Testing: Coverage for bone density testing for women 134 age 35 and over to obtain baseline data for purpose of early detection of osteoporosis.* 304.17A- Endometriosis and Endometritis: When a plan provides coverage 134 for hysterectomies, coverage for the treatment of endometriosis and endometritis must be offered and made available,** *This benefit is standardly covered under certain CGLIC plans that include preventive care benefits for adults and therefore does not have an impact on premium for those plans. **This benefit is standardly covered under CGLIC plans and therefore does not have an impact on premium for those plans. Rejection of this benefit is a non-standard choice which requires Screening Board approval, For Plans offering Dependent Coverage: Note: Kentucky's dependent age requirements may have tax implications. Coverage for Dependent Age is automatically included as follows: Coverage to the nineteenth (19) birthday and coverage to unmarried children from nineteen (19)to the twenty-fifth (25th) birthday who are full-time students enrolled in and attending an accredited educational institution and who are primarily dependent on the policyholder for maintenance and suppo t. ACCEPT REJECT CITATION BENEFIT 304.17A Dependent Age: Coverage up until their twenty-fifth 25th birthday, regardless of student status. City of Clearwater CG#3331468 Name of Policyholder Title X)All�iO q By Name Date CONNECTICUT GENERAL LIFE INSURANCE COMPANY NORTH CAROLINA STATE REQUIRED ACCEPTANCE/REJECTION FORM Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected,will not be provided at a later date unless specifically requested. ACCEPT REJECT CITATION BENEFIT 58-51-50; Substance Abuse Benefits: Coverage for the necessary care and 58-67-70 treatment of substance abuse that is not less favorable than benefits for physical illness generally. City of Clearwater CG#3331468 Name of Policyholder By �- Title J + ✓,�c�er Name Date / o CONNECTICUT GENERAL LIFE INSURANCE COMPANY NEW YORK STATE REQUIRED ACCEPTANCE/REJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected,will not be provided at a later date unless specifically requested. This form must be signed for any multiple employer trust or association group covering residents of New York regardless of situs. ACCEPT REJECT CITATION BENEFIT 3221(l)(10), *Hospice Care: Coverage for the reasonable and customary 4303(o) charges for Hospice Care Services for a terminally ill covered individual and 5 bereavement counseling sessions for that individual's family. 3221(l)(6); Inpatient Alcohol and Substance Abuse and Inpatient Detox 4303(k) Services: Coverage for 30 inpatient days and 7 inpatient detox days for alcohol and/or substance abuse. (Note: 60 outpatient visits for alcohol and/or substance are mandated by law and cannot be rejected.) 3221(l)(2); *Nursing Home Care: Coverage provided in a nursing home or 4303(d); skilled nursing facility for a participant who has been in a hospital for 4406(4) at least three days immediately preceding admittance to the nursing home or the skilled nursing facility and for whom further hospitalization would otherwise be necessary. 3221(1)(3); *Outpatient Services/Ambulatory Care: Coverage for ambulatory tl 4303(e) and care in an outpatient facility, including diagnostic x-rays, laboratory (f) and pathological examinations, physical and occupational therapy, radiation therapy, and nonexperimental cancer chemotherapy and cancer hormone therapy. 3221(l)(9); *Registered Professional Nurse Services: Coverage for services 4303(m) rendered by a duly licensed registered professional nurse. *This benefit is standardly covered under CGLIC plans and therefore does not have an impact on premium for those plans. City of Clearwater CG#3331468 Name of Policyholder By OP if Title aJ)hVaA4 Afo VrC—ef 1J4qvqe- Name Date to CONNECTICUT GENERAL LIFE INSURANCE COMPANY SOUTH CAROLINA STATE REQUIRED ACCEPTANCE/REJEC7[lONFORK80 Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose tm accept nr reject the benefits and understands that such coverage, if rejected,will not be provided eta later date unless specifically requested. This law is extraterritorial and must be offered toaccounts covering South Carolina residents regardless of situs. ACCEPT REJECT CITA TION BENEFIT 38-71-737 Mental Illness, Alcoholism and Drug Abuse*: Coverage for mental illness, alcoholism and drug abuse benefits subject to an annual maximum of$2,000 and a lifetime maximum of$10,000. 38-71-1730 POS Offering to Employer: A point-of-service option must be offered to employers of 50+ employees who are seeking closed panel coverage. Acceptance of this law indicates the employer chooses to /X offer a CIGNA POS plan. Rejection of this offer indicates that the employer has been offered a CIGNA POS plan but chooses not to provide that plan to employees. Wental Illness benefits cannot be limited to an annual or lifetime dollar maximum unless the plan is exempt from mental health parity legislation. Alcoholism and drug abuse may bolimited. City of Clearwater CG#333140 Name ofPolicyholder By Title Name CV7 Date CONNECTICUT GENERAL LIFE INSURANCE COMPANY TENNESSEE STATE REQUIRED ACC2PTANCE/REJECT0NFORK8S Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage,if rejected,will not be provided at a later date unless specifically requested. Note: The offer of coverage required by 5,6-7-2601 (Mental Illness,Alcoholism and Drug Dependence) is extraterritorial;therefore,this form must be completed even if the situs state of the plan is other than Tennessee. ACCEPT REJECT CITATION BENEFIT 56-7-2504 Bone Marrow Transplant*: Coverage for the treatment of cancer by close- intensive chernothe rapy/auto logo us bone marrow transplants or stem cell transplants to the same extent as any other illness under the plan 56-7-2363 Cancer Screenings -Colorectal: Coverage for colorectal cancer examinations and laboratory tests for colorectal cancer screening of asymptomatic individuals according to the guidelines of the American Cancer Society or the U.S. Preventive Services Task Force. Benefits will be covered at the same cost-sharing rate as other benefits under the plan.** 56-7-2606 Chlamydia Screening: Coverage for one annual Chlamyclia screening test in conjunction with an annual pap smear for covered females who are not more than 29 years old if the screening test is determined to be medically 56-7-2601 Mental Illness, Alcoholism and Drug Dependence: Coverage of mental health benefits with the same lifetime and annual aggregate limits and cost- sharing provisions as other illnesses. Substance abuse benefits do not need to be covered at that level unless provided through Community Mental Health Centers. Note: Pursuant to 56-7-2601(a)this required offer does not apply to group plans with 25 or more employees which must provide minimum coverage mandated by 56-7-2360. 56-7-2602 Alcohol and Drug Dependency: Coverage for inpatient and outpatient care and treatment of alcohol or other drug dependency subject to the same durational limits,coinsurance,deductibles, and copayments,that are no less favorable than for physical illness generally. Benefits so provided shall be determined as if necessary care and treatment in an alcohol or other drug dependency treatment center were care and treatment in a hospital, 56-32-228 Point of Service Option: No lock-in plan can be sold unless a point-of-service plan is either offered through CG or through another carrier with the employer's written representation that a point of service plan is available to employees. Accepting this requirement means that CG will provide an open network option as well as a lock-in Network plan, Rejecting this option means that the employer will provide a point of service option through another carrier. Indicate name of other carrier This benefit is stand2rdly covered under a Connecticut General Life Insurance Company medical plan and therefore does not have an impact on premium. **This benefit is stand@rdly covered under certain CGLIC plans that include preventive care benefits for adults and therefore does not have an impact on premium for those plans. ***This benefit is standardly covered under certain CGLIC plans that include preventive care benefits and therefore does not have am impact on premium for those plans. __.City of Clearwater CG#333140 Name mfPolicyholder By_ctai/Je Title Name � ,/ Date CONNECTICUT GENERAL LIFE INSURANCE COMPANY WASHINGTON STATE REQUIRED ACCEPTANCEIREJECTION FORMS Connecticut General Life Insurance Company is required to offer to the group policyholder the following benefits. The policyholder may choose to accept or reject the benefits and understands that such coverage, if rejected,will not be provided at a later date unless specifically requested. ACCEPT REJECT CITATION BENEFIT 48.21.250 Continuation: Continued group medical coverage for terminated employees and their insured dependents upon loss of group coverage for a period of time and at a rate agreed upon by the group and CGLIC. Federal COBRA would still apply- 48.21.220 Home Health: Home Health with a minimum of 130 visits per calendar year. A visit of any duration by an employee of a home health agency, for the purpose of providing services under the plan of treatment constitutes one visit. May require that home health agencies have written treatment plans approved by a licensed physician and may require such treatment plans to be reviewed at designated intervals. The coverage may contain provisions for utilization review. CG's base medical plans include coverage for Home Health. If the home health benefit noted above is rejected, CIGNA's base home health coverage would be included in the contract. 48.21.220 Hospice: No less than an initial coverage period of 6 months, authorized if medically necessary. CG's standard plan design includes hospice coverage, which may be provided for 6 months or morefiess depending on the treating physician's request and indications of medical necessity. If the hospice benefit noted above is rejected, CIGNA's base hospice coverage would be included in the contract. 48.21.240; Mental Illness: Coverage for mental health, subject to reasonable 48.46.290 deductibles or copayments, for treatment rendered by a licensed physician, a licensed psychologist, a state hospital, or a licensed community mental health agency. (Standard CG benefit plan designs /X comply with this law. Rejection of this coverage would mean no mental health benefits.) 48.21.320; TMJ: Coverage for temporomandibular joint disorders at the same 1 48.46.530; level as other musculoskeletal disorders, to a maximum of$1,000 per 284-96-020 calendar year and $5,000 per lifetime. 48.21.244 Maternity Congenital Testing: Coverage for prenatal screening to diagnosis of congenital disorders of the fetus during pregnancy when those services are determined to be medically necessary. — Note, CIGNA currently covers medically necessary fetal screenings. City of Clearwater CG#3331468 Name of Policyholder By tu Title Na�me- # Date f l 0-e th are CIGNA HealthCare Group Benefits Proposal City of Clearwater 100 South Myrtle Avenue Clearwater, FL 33756 SIC Code : 9111 Group Contact : 3331468 Total Eligible Employees: participating Subscribers : , 11'87q '3 Employer Contributions : Employee Contribution : 1 N /001. 0/— sawn, OAPW Dependent Contribution: Flo of- &- src 0 A#OtlJ A 6 1P, 68c/ sic,.0 A ad —r �oero r � a{ waing Period : IS`of the month following date of hire Eligibility Definition : Active Employees working at least 37 112 hrs, a week Note: The Quoted rates are subject to final Underwriting approval and, as noted below, are subject to change in the event of changes in benefits selected or changes in the risk factors upon which the Quoted Rates are based. In addition, state law may require regulatory approval of rates. If required regulatory approval has not been obtained on the proposed effective date, the healtbplan shall use rates that are consistent with its then currently approved rating methodology and the quoted rates shall be effective immediately on the date for which they are approved for use. The Quoted Rates are guaranteed while the Group Service Agreement remains in effect until the next anniversary date, unless enrollment changes by 15% in which case the CIGNA Companies may change the Quoted bate. S2-FXG1I71-SIF-1 Revisionl 1 of 23 10/29/08 City of Clearwater CTGNA HealthCeixe Proposed Benefits Product: Open Access Plus loll- Network (Buy-lip) Situs Mate: FL Effective Date: 01/01/2009 Benefits Summary Category Description In Network Medical Benefits Modular Medical Management Program Benefit PHS+ Option Office Visit Copay NA Primary Care Copay $25 Specialty Care Copay—Tier 1 $35 Specialty Care Copay—Tier 2 $55 Coinsurance 100% Hospital IP-Per Admit Copay $500 Hospital IP Copay Per Day NA Collective Deductible/OOP Admin Option NO Combined Medical/Pharmacy Deductible/OOP Admin NO Option Annual Individual Plan Deductible $0 Annual Family Plan Deductible $0 Deduct Accumulator Standard: One Way Accumulation OOP-Individual Maximum Amount 52,000 OOP-Family Maximum Amount 54,000 OOP Max-Accumulator Standard:One Way Accumulation OOP Max Ded NA OOP Max Copays Includes Copays Lifetime Maximurn Amount Unlimited Lifetime Maximum-Annual Reinstatement Amount NA Outpatient Facility Copay '$100 Emergency Room Copay $150 Urgent Care Copay $75 Other Health Care Facility IP Maximum Days 60 Lab/Radiology Standard Coverage Plan.Ded/Coins MRI,CT PET Scans Copay 50 Lab/Radiology Mid-Point Coins Option Coinsurance NA Home Health Care Maximum Days 60 Durable Medical Equipment Included Durable Medical Equipment Maximum Amount Unlimited External Prosthetic Appliances Included External Prosthetic Appliances Deductible 5200 External Prosthetic Appliances Maximum Amount 51,000 Short Term Rehab and Chiro Combined Maximum 60 Days Short Term Rehab Maximum Days NA S2-FXG1171-SIF-1 Revisionl 2 of 23 10/29/08 City of Clearwater CAIGNA HealthCare Proposed Benefits Product: Open Access Plus In- Network (Buy-Up) Situs State: FL Effective Late: 01/01/2009 Benefits Summary (Cont.) Category Description In Network Medical Benefits(Cont.) Chiropractic Care Maximum Amount NA Chiropractic Care Maximum Days NA Infertility Treatment Standard Coverage Not Covered Infertility!Opt I -Diagnoses/Corrective procedure Excluded Infertility Opt 2-Opt I plus invitro,GIFT,ZIFT Excluded Infertility Opt 2-Lifetime Maximum Amount NA Bariatric Services Excluded Bariatric Surgery-Lifetime Maximum Amount NA Preventive Care-Children thru Age 2 Included Preventive Care Opt 2-Annual Physicals Age 3+ Included Preventive Care Opt 2-Immunizations Included Preventive Care Opt 2-Calendar Year Benefit Unlimited Maximum Amount Organ Transplant Included Health Advisor Benefit Option Health Advisor Corc/Non-CCF Routine Foot Care Buy-up Excluded Routine Foot Care-Cal Yr Buy-up Benefit Maximum NA Amount Non-Surgical TMJ Included PCL Included Medicare COB:Retirees>=65 Admin Option NA Medicare COB Type None Percent of Medicare Eligible NA. Well Aware Program(Diabetes) Included Well Aware Program(Cardiac) Included We]I Aware Program(Asthma) Included Well Aware Program(Low Back Pain) Included Well Aware Program(COPD) Included Well Aware Program(Weight Complications) Included Well Aware Program(Targeted Conditions) Included Well Aware Program(Depression Management) Included Wellness Program(Healthy Steps to Weight Loss) Included 24HIL Included Healthy Rewards Included LifeSource Organ Transplant Network Transplant Included Program Language Line Included S2-FXG1I71-SIF-1 Revisiortl 3 of 23 10/29108 City of Clearwater CYGNA are Proposed Benefits Product: Open Access Plus In- Network (Buy-Up) 5itus State: FL Effective Date: 01/01/2009 Benefits ,Summary(Cont.) Category Description In Network Medical Benefits(Cont.) Transition of Care Included Case Management Included Provider Channeling Included Away From home Care Included Drugstore.Com Included S2-FXG1171-SIF-1 Revision) 4 of 23 10/29/08 City of Clearwater CTGNA ear Proposed Benefits Product: Open .Access Plus In- Network (Buy-Up) Situs State: FL Effective Date: 01/01/2009 Benefits Summgy(Cont.) Category Description In Network Out of Network Pharmacy Benefits CIGNA PharmacyPlus 3-Tier Copay Plan Buy Up Option Coinsurance NA Retail-Generic Copay $15 Retail-Brand Copay $30 Retail-Non Preferred Copay $50 Mail Order-Generic Copay $30 Mail Order-Brand Copay $60 Mail Order Copay_Non-prefcrred $100 Retail-Individual Buy Up Option Deductible NA. Retail-Family Buy Up Option Deductible NA Retail-Individual Deductible Nip. Retail-Family Deductible NA COP-Individual Maximum NA NA OOP-Family Maximum NA NA Standard Preventive Drugs Excluded from Deductible NO Ded&OOP Max Apply to MOD Do Not Apply to MOD MOD Program No Mandatory Maintenance Drug List NA Oral Contraceptives/Devices Covered Lifestyle Drugs Not Covered Oral Fertility Drugs Not Covered Self-Administered Injectables Covered Optional Injectables Buy-Up Not Covered Insulin Covered Insulin Needles&Syringes Covered Glucose Test Strips Covered Lancets Covered Prenatal Vitamins Covered Step Therapy Program Included Clinical Management Program Enhanced Enh.-Benefit Exclusion Selected Enh.-Intensive Appropriateness of Use Selected Enh.-Utilization and Unit Cost Management Selected Generic Push Included Formulary Incentive Prescriber Panel Open S2-FXG1I71-SIF-1 Revision], 5 of 23 10/29/08 City of Clearwater CIGNA are Proposed Benefits Product: Open Access Plus In- Network (Buy-Up) Situs State: FL effective Tate: 01/01/2009 Benefits Summary(Cont.) Category Description In Network MH/SA Benefits OAPIN MHSA Combined CIGNA Behavioral Health Benefit Option In&Outpatient Mgmt. CAP MH/SA Hospital IP Coinsurance 100% MH/SA Hospital IP-Per Admit Copay '5500 MH/SA Hospital IT-Per Day Copay NA MH/SA Hospital IP Combined Maximum Days 25 MH/SA Outpatient Copay S35 MH/SA Outpatient Coinsurance NA MH/SA Intensive Outpatient Copay S50 MH/SA Intensive Outpatient Coinsurance 50°l MH/SA OP&MH Group Therapy Combined 20 Maximum Visits MH Grp Therapy Copay S35 MH Grp Therapy Coinsurance NA MH/SA OP Tiered Copay Option Excluded MH/SA OP Tier 1 Copay NA MH/SA OP Tier I Visits(I to_)Maximum NA MH/SA OP Tier 2 Copay NA MH/SA OP Tier 2 Visits(Tier I Max to ) Maximum NA MH/SA OP Tier 3 Copay NA MH/SA OP Tier 3 Visits(Tier 2 Max to ) Maximum NA Standard IP Review/Case Mgmt UR Program Included OP Review/Case Mgmt Buy Up I UR Program Excluded OP Review/Case Mgmt Buy Up 2 UR Program Excluded Transition of Care(90 day period) Included Vision Benefits None S 2-F XG 1171-S1F-1 Revision 1 6 of 23 10/29/08 City of Clearwater CIGNA Health Care Proposed Medical and RX rates Group Description All Employees Electing The OAPIN (Buy-Up)Medical Plan. Tier Subscribers Premium Date Monthly Premium Employee 228 $508.99 $116,049.72 Emp+ 1 81 $875.47 $ 70,913.07 Emp+Family 67 $1,440.45 $ 96,510.15 Total 376 $283,472.94 52-FXG1I71-5IF-I Revisionl 7 of 23 10/29/08 City of Clearwater CIGNA Health Care Proposed Benefits Product: Open Access Plus Situs State: FL Effective Bate: 01/01/2009 Benefits Slimmary Category Description In Network Out of Network Medical Benefits Modular Medical Management Program Benefit PHS+ Option Office Visit Copay NA Primary Care Copay S25 Specialty Care Copay®Tier 1 S35 Specialty Care Copay -Tier 2 $55 Coinsurance 100% 70% Hospital IP-Per Admit Copay 5500 Hospital IP Deductible-Per Admit NA Hospital IP Copay Per Day NA Hospital IP Deductible-Per Day NA Maximum Reimbursable Charge Benefit Option Option 2- 110%Inc[ NSP&Bill Negotiatio Collective Deductible/OOP Admin Option NO NO Combined Medical/Pharmacy Deductible/OOP Admin NO NO Option Annual Individual Plan Deductible 50 S500 Annual Family Plan Deductible SO 51,000 Deduct Accumulator Standard:One Way Standard: One Way Accumulation. Accumulation OOP-Individual Maximum Amount 52,000 S3,000 OOP-Family Maximum Amount 54,000 56,000 OOP Max-Accumulator Standard: One Way Standard: One Way Accumulation Accumulation OOP Max Ded NA Includes Ded OOP Max.Copays Includes Copays Includes Copays Lifetime Maximum Amount Unlimited Lifetime Maximum-Annual Reinstatement Amount NA Outpatient Facility Copay 5100 Outpatient Facility Deductible 5100 Emergency Room Copay S150 Emergency Room Deductible 5150 Urgent Care Copay S75 Urgent Care Deductible S75 Other Health Care Facility IP Maximum Days 60 Lab/Radiology Standard Coverage Plan Ded/Coins Plan Ded/Coins MRI,CT PET Scans Copay SO 50 Lab/Radiology Mid-Point Coins Option Coinsurance NA NA Home Health Care Maximum Days 60 Durable Medical Equipment Included Cvrd-Dcd/Coins Durable Medical Equipment Maximum Amount Unlimited External Prosthetic Appliances Included Cvrd-Ded/Coins S2-FXG1171-SIF-1 Revision] S of 23 10/24/08 City of Clearwater CIGNA Health Care Proposed Benefits Product: Open Access Plus Situs State: FL Effective Date: 01/01/2009 Benefits Summ4a(Cont.) Category Description In Network Out of Fretwork Medical Benefits(Cont.) External Prosthetic Appliances Deductible $200 External Prosthetic Appliances Maximum Amount $1,000 Short Term Rehab and Chiro Combined Maximum 60 Lays Short Term Rehab Maximum Days NA Chiropractic Care Maximum Amount NA Chiropractic Care Maximum Days NA Infertility Treatment Standard Coverage Not Covered Not Covered Infertility Opt 1 -Diagnoses/Corrective procedure Excluded Not Covered Infertility Opt 2-Opt 1 plus Invitro,GIFT,ZIFT Excluded Not Covered Infertility Opt 2-Lifetime Maximum Amount NA Bariatric Services Excluded Bariatric Surgery-Lifetime Maximum Amount NA Preventive Care-Children thru Age 2 Included Not Covered Preventive Care Opt 2-Annual Physicals Age 3+ Included Not Covered Preventive Care Opt 2-Immunizations Included Preventive Care Opt 2-Calendar Year Benefit Unlimited Maximum Amount Organ Transplant Included Not Covered Health Advisor Benefit Option health Advisor Core/Non-CCF Routine hoot Care Buy-up Excluded Not Covered Routine Foot Care Separate Buy-up Coinsurance NA. Routine hoot Care-Cal Yr Buy-up Benefit Maximum NA NA Amount Non-Surgical TMJ Included Excluded PCL Included Included PAC/CSR-Standard IP Admit/Case Management UR Included Program PAC/CSR IP Non Compliance Penalty Amount 5750 PAC/CSR IP Non Compliance Penalty Percent 50% Medicare COB:Retirees>�65 Admin Option NA Medicare COB Type None Percent of Medicare Eligible NA Well Aware Program(Diabetes) Included Well Aware Program(Cardiac) Included Well Aware Program(Asthma) Included S2-FXG1I71-SIF-I Revisionl 4 of 23 10/24/08 City of Clearwater LIE etr Proposed Benefits Product: Open. Access Plus Situs State: FL Effective Date: 01/01/2009 Benefits Su>:nnr gaa Cont j Category Description In Network Out of Network Medical Benefits(Cont.) Well Aware Program(Low Back Pain) Included Well Aware Program(COPD) Included Well Aware Program(Weight Complications) Included Well Aware Program(Targeted Conditions) Included We]]Aware Program(Depression]management) Included Wellness Program(Healthy Steps to Weight Lass) Included 24HIL Included Healthy Rewards Included LifeSource Organ Transplant Network Transplant Included Program Language Line Included "Transition of Care Included Case Management Included Provider Channeling Included Away From Horne Care Included Drugstore.Com Included S2-FXG1171-SIF-1 Revisionl 10 of 23 10/29/08 City of Clearwater CAGNA HealthCaxe Proposed Benefits Product: Open Access Plus Situs State: FL Effective Date: 01/01/2009 Benefits Summary(Cont.) Category Description In Network Out of Network Pharmacy Benefits CIGNA,PharmacyPlus 3-Tier Copay Plan Buy Up Option Coinsurance NA Retail-Generic Copay $15 Retail-Brand Copay $35 Retail-Non Preferred Copay $50 Mail Order-!Generic Copay S30 Mail Order-Brand Copay $70 Mail Order Copay-Non-preferred s l 00 Retail-Individual Buy Up Option Deductible NA Retail-Family Buy Up Option Deductible NA Retail-Individual Deductible NA Retail-Family Deductible NA OOP-Individual Maximum NA NA OOP-Family Maximum NA NA Standard Preventive Drugs Excluded from Deductible NO Ded&OOP Max Apply to MOD Do Not Apply to MOD ;MOD Program No Mandatory Maintenance Drug List NA Oral Contraceptives/Devices Covered Lifestyle Drugs Not Covered Oral Fertility Drugs Not Covered Self-Administered Injectables Covered Optional Injectables Buy-Up Not Covered Insulin Covered Insulin Needles&Syringes Covered Glucose Test Strips Covered Lancets Covered Prenatal Vitamins Covered Step Therapy Program Included Clinical Management Program Enhanced Enh.-Benefit Exclusion Selected Enh.-Intensive Appropriateness of Use Selected Enh.-Utilization and Unit Cost Management Selected Generic Push Included Formulary Incentive Prescriber Panel Open S2-FXGlI71-SIF-1 Revision]. 11 of 23 10/29/08 City of Clearwater LIE CIGNA Health Care Proposed Benefits Product: Open Access Plus Situs State: FL Effective Date: 01/01/2009 Benefits Summary(Cont.) Category Description In Network Out of Network MR/SA Benefits OA Plus MHSA Combined CIGNA Behavioral Health Benefit Option In&Outpatient Mgmt. CAP MH/SA Hospital IP Coinsurance 100% 70% MH/SA Hospital IP-Per Admit Copay 5500 $500 MH/SA Hospital IP-Per Day Copay NIA NA MH/SA Hospital IP Combined Maximum Days 25 MH/SA Outpatient Copay S35 MH/SA Outpatient Coinsurance NA 70%n MH/SA Intensive Outpatient Copay S50 S50 MH/SA Intensive Outpatient Coinsurance 50%Q 50% MH/SA OP&MH Group Therapy Combined 20 Maximum Visits MH Grp Therapy Copay $35 MH Grp Therapy Coinsurance NA 70% MH/SA OP Tiered Copay Option Excluded MH/SA OP Tier 1 Copay NA MH/SA OP Tier 1 Visits(I to_)Maximum NA MH/SA OP Tier 2 Copay NA MH/SA OP Tier 2 Visits(Tier I Max to } Maximum NA MH/SA OP Tier 3 Copay NA MH/SA OP Tier 3 Visits(Tier 2 Max to_j Maximum NA Standard IP Review/Case Mgmt UR Program Included OP Review/Case Mgrnt Buy Up I UR Program Excluded OP Review/Case Mgmt Buy Up 2 UR Program Excluded Transition of Care(90 day period) Included Vision.Benefits None S2-FXG1171-SIF-1 Revisiortl 12 of 23 10/29/08 City of Clearwater CIGNA HealthC-cue Proposed Medical and RX rates Group Description : All Employees Electing The Open Access Plus Medical Plan 'Pier Subscribers Medical Monthly Premium Rate Premium Employee 57 $544.43 $31,032.51 Ernp+ 1 20 $936.44 $18,728.80 Emp+Fan-Lily 17 $1,540.75 $26,192.75 Total 94 $75,954.06 S2-FXG11.71-S1F-1 R visionl 13 of 23 10/29/08 City of Clearwater CIGNA Health Care Proposed Benefits Product: Open Access Plus In- Network (Basic) Stus State: FE Effective Date: 01/01/2009 Benefits Sutrtrtlary Category Description to Network Medical Benefits Modular Medical Management Program Benefit PHS+ Option Office Visit Copay NA Primary Care Copay S20 Specialty Care Copay—Tier I S40 Specialty Care Copay -Tier 2 S60 Coinsurance 80% Hospital IP-Per Admit Copay NA Hospital IP Copay Per Day NA Collective Deductible/OOP Adrnin Option NO Combined Medical/Pharmacy Deductible/OOP Admin NO Option Annual Individual Plan Deductible $750 Annual Family Plan Deductible $1,500 Deduct Accumulator Standard.One Way Accumulation OOP-Individual Maximum Amount $3,000 OOP-Family Maximum Amount 56,000 OOP Max-Accumulator Standard: One Way Accumulation OOP Max Ded Includes Ded OOP Max Copays Includes Copays Lifetime Maximum Amount Unlimited Lifetime Maximum-Annual Reinstatement Amount NA Outpatient Facility Copay NA Emergency Room Copay 5200 Urgent Care Copay S I M Other Health Care Facility IP Maximum Days 60 Lab/Radiology Standard Coverage 100%,No Ded. MRI,CT PET Scans Copay S0 Lab/Radiology Mid-Point Coins Option Coinsurance NA Home Health Care Maximum Days 60 Durable Medical Equipment included Durable Medical Equipment Maximum Amount Unlimited External Prosthetic Appliances Included External Prosthetic Appliances Deductible S200 External Prosthetic Appliances Maximum Amount 51,000 Short Term Rehab and Chiro Combined Maximum 60 Days Short Term Rehab Maximum Days NA S2-FXG1I71-SIl~-1 Revision]. 14 of 23 10/29/08 City of Clearwater Proposed .Benefits Product: Open Access Plus In- Network (Basis) Situs Mate: FL Effective Date: 01/01/2009 Benefits Summary(Cont.) Category Description In Network Medical Benefits(Cont.) Chiropractic Care Maximum Amount NA Chiropractic Care Maximum Days NA Infertility Treatment Standard Coverage Not Covered Infertility Opt I -DiagnoseslCorrectivc procedure Excluded Infertility Opt 2-Opt.I plus Invitro,GIFT,ZIFT Excluded Infertility Opt 2-Lifetime Maximum Amount NA Bariatric Services Excluded Bariatric Surgery-Lifetime Maximum Amount NA Preventive fare-Children thru Age 2 Included Preventive Care Opt 2-Annual Physicals Age 3+ Included Preventive Care Opt 2-Immunizations Included Preventive Care Opt 2-Calendar Year Benefit Unlimited Maximum Amount Organ Transplant Included Health Advisor Benefit Option Health Advisor Cor"on-CCF Routine Foot Care Buy-up Excluded Routine Foot Care-Cal Yr Buy-up Benefit Maximum NA Arnount Non-Surgical TMJ Included PCL Included Medicare COB: Retirees­65 Admin Option NA Medicare COB Type None Percent of Medicare Eligible NA Wel I Aware Program(Diabetes) Included Well Aware Program(Cardiac) Included Well Aware Program(Asthma) Included Well Aware Program(Low Back Pain) Included Well Aware Program(COPD) Included Well Aware Program(Weight Complications) Included Well Aware Program(Targeted Conditions) Includedd Well Aware Program(Depression Management) Included Wellness Program(Healthy Steps to Weight Loss) Included 24HIL Included Healthy Rewards Included LifeSource Organ Transplant Network Transplant Included Program Language Line Included S2-FXG1171-SIF-I Revisiorrl 15 of 23 10/29/08 City of Clearwater CIGNA are Proposed Benefits Product: Open Access Plus In- Network (Basic) Situs State: FL Effective Date: 01/01/2009 Benefits Summary(Cont.) Category Description. In Network Medical Benefits(Cont.) Transition of Care Included Case Management Included Provider Channeling Included Away From Home Care Included Drugstore.Com Included S2-FXG1I71-SIF-1 Revision], 16 of 23 10/29/08 City of Clearwater CIEGNA are Proposed Benefits Product: Open Access Plus In- Network (Basic) Situs State: FL Effective Date: 01/01/2009 Benefits Summary(font, Category Description In Network Out of Network Pharmacy Benefits CIGNA PharmacyPlus 3-Tier Copay Plan Buy Up Option Coinsurance NA Retail-Generic Copay 520 Retail-Brand Copay 540 Retail-Non Preferred Copay S60 Mail Order-Generic Copay 540 Mail Order-Brand Copay S50 Mail Order Copay-Non-preferred 5120 Retail-Individual Buy Up Option Deductible NA Retail-Family Buy Up Option Deductible NA Retail - Individual Deductible NA Retail -Family Deductible NA OOP-Individual Maximum NA ILIA OOP-Family Maximum NA NA Standard Preventive Drugs Excluded from Deductible NO Ded&OOP Max Apply to MOD Do Not Apply to MOD MOD Program No Mandatory Maintenance Drug List NA. Oral Contraceptives/Devices Covered Lifestyle Drugs Not Covered Oral Fertility Drugs Not Covered Self-Administered Injectables Covered Optional Injectables Buy-Up Not Covered Insulin Covered Insulin Needles&Syringes Covered Glucose Test Strips Covered Lancets Covered Prenatal Vitamins Covered Step Therapy Program Included Clinical Management Program Enhanced Enh.-Benefit Exclusion Selected Enh.-Intensive Appropriateness of Use Selected Enh.-Utilization and Unit Cost Management Selected Generic Push Included Formulary Incentive Prescriber Panel Open S2-FXG1I71-SIF-1 Revisionl 17 of 23 10129/08 City of Clearwater Proposed Benefits Product: Open Access Plus In- Network (Basic) Situs State: FL Effective Date: 01/01/2049 Benefits Summary Cont.) Category= Description In Network MH/SA Benefits OAPIN MESA Combined CIGNA Behavioral Health.Benefit Option In&Outpatient Mgmt. CAP MH/SA Hospital IP Coinsurance 80% MH/SA Hospital IP-Per Admit Copay 51,000 MH/SA Hospital IP-Per Day Copay NA MH/SA Hospital IP Combined Maximum Days 25 MH/SA Outpatient Copay S60 MH/SA Outpatient Coinsurance NA MH/SA Intensive Outpatient Copay S50 MH/SA Intensive Outpatient Coinsurance 50% MH/SA OP&MH Group Therapy Combined 20 Maximum Visits MH Grp Therapy Copay $60 MH Grp Therapy Coinsurance NA MH/SA OP Tiered Copay Option Excluded MH/SA OP Tier I Copay NA MH/SA OP Tier l Visits(I to )Maximum NA MH/SA OP Tier 2 Copay NA MH/SA OP Tier 2 Visits(Tier l Max to_) Maximum NA MH/SA OP Tier 3 Copay NA MH/SA OP Tier 3 Visits(Tier 2 Max to } Maximum NA Standard IP Review/Case Mgmt UR Program Included OP Review/Case Mgmt Buy Up I UR Program Excluded OP Review/Case Mgmt Buy Up 2 UR Program Excluded Transition of Care(90 day period) Included Vision Benefits None S2-FXGI171-SIF-I Revisiont 18 of 23 10/29/08 City of Clearwater CIGNA t ,-. Proposed Medical and M rates Group Description : All Employees Electing The OAPIN(Basic)Medical Plan Tier Subscribers Medical Monthly Premium Rate Premium. Employee 854 $425.05 $362,992.70 Emp+ 1 303 $731.07 $221,514.21 Emp+Family 252 $1,202.85 $303,118.20 Total 1,409 A $887,625.11 S2-FXG1I71-SIF-1 Revsionl 19 of 23 10/29/08 City of Clearwater CIGNA HealthC-cue Medical History Itxformatian For City of Clearwater 1. Have there been any claims over$10,000 in the last 12 months? 2. Has any employee missed more than 10 consecutive days in the last 12 months date to illness or injury? 3. Are there any employees with ongoing disabilities? 4. Have any individuals been diagnosed,received treatment, or are currently receiving treatment for any of the following conditions in the past three years:Alcohol/Drug abuse, Cancer, Diabetes,Heart Conditions, Immune System Disorders,Kidney Ailments, Liver Diseases,Lung Conditions,Obesity,Organ Transplants? S2-FXG11 71-SIF-1 Revisioril 20 of 23 10/29/08 City of Clearwater CIGNA HealthCcare Underwriting Contingencies For City of Clearwater CIGNA may revise or withdraw this Proposal if: • there is a change to the effective date of the quote. • the policy period length is different than 12 months. • the policy will not be sitused in Florida. • the current waiting period is different than 0 of the month following date of hire. • the census or experience provided by the consultant or account is deemed inaccurate. • there is a change in law,regulation, tax rates,or the application of any of these that affects CIGNA's costs.. * enrollment increases or decreases by 10% or more,by product, from the enrollment assumptions used in establishing the rates and/or fees set forth herein. * the final enrollment deviates from the quoted enrollment such that it results in a needed change in the premium rates. Rates are based on final enrollment factors,including total number of enrollees,their age, sex, demographics, location and the distribution of enrollees by product or membership tier. * participation is below 70%. This will be based on the total eligible employees, identified as Erruployees working at least 37 1/2 hours per week. * any of the informmation upon which these rates or benefits were based(including Medical History Information)changes or is inaccurate. * CIGNA is not the exclusive provider of Medical/Prescription Drugs or like products for all of the City of Clearwater's employees in all worksites. • the employer contributes less than 50%toward the total cost of the plan. • the employer changes it's contribution to the plan rates(either the percentage or amount). • either one or more of the quoted sites withdraws prior to the effective date or terminates during the contract term, or at any time following enrollment. Unless othenvise indicated, this Proposal: • supercedes and renders null and void any prior CIGNA offer or proposal with respect to the Plan. • or policy may be canceled as of any Premium Due Date if the number of hrsured Employees fails to meet the minimum required per group participation rules;or for failure to comply with any other material plan provision relating to employer contributions or group participation rules. • reflects the claims and administrative savings realized by packaging the following specialty coverage with medical: Pharmacy,Behavioral Advantage,Health Advocacy. • requires a separate benefit option due to state regulations,if you have purchased OAP/PPO with CIGNA Behavioral Advantage and you have members residing in NC or CA. • does not apply to part-time or seasonal employees for any plan. • does not apply to Medicare eligible retirees for any plan. • includes Network Savings Program(NSP) and other bill negotiation. • includes a maximum reiimbursable charge for out-of-network coverage equal to 110% of a fee schedule developed by CIGNA based upon a methodology similar to that used by Medicare to determine the allowable fee for similar services in the geographic market. • assumes that all employees are located in the network area,and that all employees are only eligible for the product offerings specified. • requires you notify us within 30 days if any information set forth in this form changes at any time while coverage is provided to you by CIGNA Healthcare Companies. • does not provide administration of"run-out"claims incurred prior to the effective date. S2-FXG1I71-5IF-1 Revisionl 21 of 23 10/29/08 City of Clcarwater CIGNA are • may require regulatory approval of rates. If,as of their proposed effective date,regulatory approval is not obtained,the healthplan shall use rates consistant with it's then currently approved rates and the foregoing rates shall be effective automatically. If a product is new and has never had approved rates, the effective date of coverage will be postponed until regulatory approval is received. • allows caveats and conditions set forth in this document to survive execution of any final contract and/or issuance by CIGNA Healthcare of any policy and/or Group Service Agreement. S2-FXG1I71-SIF-I Revisionl 22 of 23 10/299/08 City of Clearwater 0-9 CIGNA HealthCaxe Underwriting Contingencies For City of Clearwater (cant) The CIGNA Healthcare Companies reserve the right to change the Quoted Rates and/or Quoted Benefits or to decline to offer coverage if any of the foregoing information is inaccurate or changes prior to the proposed Effective Date indicated above,or if the quoted rates and/or fees are not agreed to within 60 days of receipt of this suntinary information form. If any of the information identified above changes either prior to the proposed Effective Date or while coverage is in effect,you agree to notify us promptly of such change. The "Underwriting Contingencies"set forth above shall survive execution of any insurance policy, application, etc., issued by Connecticut General Life Insurance Company or any other CIGNA Healthcare company, and, shall further survive the effective date of any such policies. The benefits displayed in this summary are,for the most part,modular benefit packages used to develop the rates.Please review the Benefit Summary and its attachments for information about the benefits available in your sites. "CIGNA Healthcare"refers to various operating subsidiaries of CIGNA.Corporation.Products and services are provided by these subsidiaries and not by CIGNA Corporation. These subsidiaries include Connecticut General Life Insurance Company,Tel-Drug, Inc. and its affiliates,CIGNA Behavioral Health, Inc.,Intracorp, and HMG or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health,Inc. Icep Client Signature / Date {j d: icv- 47 Client Name Title S2-FXG1171-SIF-I Revisionl 23 of 23 10/29/08 City of Clearwater