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<br />GROUP BENEFITS SERVICES AGREEMENT <br />NON-PARTICIPATING <br /> <br />This Agreement is between the Employer named in the Schedule and the TML Intergovernmental <br />Employee Benefits Pool, 1821 Rutherford Lane, Suite 300, Austin, Texas 78754 <br /> <br />SCHEDULE <br /> <br />1. Employer: City of Paris <br />2. Place of Delivery: Paris, Texas <br />3. Effective Date: May I, 2001 <br />4. Monthly Service Charge per employee per month: <br /> <br />. <br /> <br />Claims Administration <br />Medical <br />Dental <br />Vision <br />Medical Management <br /> <br />5. Optional Services (per employee per month) <br /> <br />iii" PPN Access Fee using direct contracts <br />u(' COC Administration PEPM <br />D Section 125 PPPM <br />D HIP AA Compliance Adm.PEPM <br />D Medical Conversion PEPM <br />D Retiree/COC Direct Billing PRPM <br /> <br />HealthChex - Auto Audit <br />Custom Claims Reports <br />Rx Card Claims <br />HIP AA Certificates <br />Benefit Booklets (every 2 years) <br />PPO Directories <br />Run-Out <br />Outpatient Audits <br />Hospital Audit <br />Subrogation <br /> <br />Out of State Network <br />Out of Network Claims (Concentra) <br />Concentra Professional Negotiations <br />Disease Management <br /> <br />5/1/01-4/30/02 <br />$11.50 <br />$1.50 <br />$0.50 <br />$2.25 <br /> <br />$3.00 <br />$0.50 <br />$5.00 <br />$0.50 <br />$0.40 <br />$1.00 <br /> <br />No Charge <br />$ISO.OO/programming hour <br />$ 0.55/claim until 10/1/01 <br />Included in Medical Admin Fee <br />Included for Number ofEE Plus 10% <br />Included For Number ofEE Plus 10% <br />$12.50 per processed claim <br />15% ofsaviugs - External Vendor <br />20% of savings - External Vendor <br />20% of savings - In-House CounsellExternal <br />Vendor <br />18% of savings - External Vendor <br />20% of savings - External Vendor <br />25% of savings <br />.30 cents PEPM <br /> <br />~XHIBIT A <br />