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GROUP BENEFITS SERVICES AGREEMENT NON-PARTICIPATING This Agreement is between the Emp(oyer named in the Schedule and the TML Intergovernmental Employee Benefits Pool, 1821 Rutherford Lane, Suite 300, Austin, Texas 78754 SCHEDULE 1. Employer. City of Paris 2. Effective Date: 5/1/02 3. Monthly Service Charge per employee per month: Claims Administration 5/1/02 Medical $12.50 Medical Management $2.55 SelfFunded Vision .50 5. Optional Services (PEPM = per employee per month; PPPP = per participant per month) ❑ PPN Access Fee using direct contracts $3.50 ❑ HIPAA Compliance Adm.PEPM $0.50 ❑ Continuation of Coverage/Set Up $50.00 PEPM a Medical Conversion PEPM ❑ Disease Management ❑ Flex Plan PPPP/Set up $50.00 enrollee ❑ Retiree Direct Billing (PRPR) ❑ Altemate Plan ❑ Dental (Self-funded) ❑ Vision (Self-funded) ❑ HealthChex -AutoAudit ❑ Custom Claims Reports ❑ Rx Card Claims $0.50 $0.40 $0.00 (per coordination with PCS) $5.00 $1.00 $1.25 $2.10 $0.00 No Charge per Addendum A attached $150.00/programming hour $ 032/claim PA $30.00 initial and every 6 or 12 months after initial pre-authorization -pre-authorization is an optional service ❑ HIPAA Certificates Included in Medical Admin Fee ❑ Benefit Booklets (every 2 years) Included for Number of EE Plus 10% ❑ PPO Directories Included For Number of EE Plus 10% ❑ Run-in/ 90 day Run-out ❑ Outpatient Audits ❑ Hospital Audit ❑ Subrogation Vendor ❑ Out of State Network ❑ Out of Network Claims (Concentra) ❑ Usual and Customary (Concentra) ❑ Dental Consultant $12.50 per claim 15% of savings - Extemai Vendor 20% of savings - External Vendor 20% of savings - In-House Counsel/Extemal 18°/a of savings - Extemal Vendor 25% of savings - Extemal Vendor 25% of savings- Extemal Vendor $23.00 dental, $50.00 medical, $75.00 TMJ referral EXWIBIT A_