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Company Name
••••••••••••••••••
Annual Benefits Review
December 30, 1899




Presented By: Agent



BBVA Compass Insurance Agency, Inc.
9525 Katy Freeway, Suite 410
Houston, TX 77024
Phone - 713-461-3043/Fax - 713-461-5533

BBVA Compass Insurance Agency, Inc. is an affiliate of BBVA Compass Bank.
CENSUS

                                                      Company Name
City                           State:                                                            Zip Code:

                               Employee          Spouse                                          ZIP
         Employee Name   M/F     Date Of Birth    Date Of Birth   # OF CHILD(REN)    CITY          CODE      OCCUPATION          SALARY
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16


             COVERAGE TOTALS                                                    SIC CODE /
EMPLOYEE                 0                                                  Nature of Business
EMPLOYEE / SPOUSE        0
EMPLOYEE / CHILD         0                                                                                   Effective Date
FAMILY                   0
TOTALS                   0




  BBVA Compass Insurance
                                                                                                                              05/28/2011
  713-461-3043
Medical Market Survey - 2011-2012 Current/Renewal Options
                                                                                 CURRENT PLAN -                                            CURRENT PLAN -
Medical Benefits                                                       Network                Non-Network                        Network                Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
     Primary Care Physician (PCP)
     Specialist
     Out-Patient Surgical Expenses
     Lab & X-ray (CT, PET, MRI, etc)
     Preventive Care         (PCP/Specialist)
Hospital Care
     Per Confinement Deductible
     Hospital Services
     Urgent Care Services
     Emergency Room
Prescription Drugs


Monthly Rates                                                          Current                    Renewal                        Current                     Renewal
Employee Only                                            0
Employee & Spouse                                        0
                                                                                                                          RATES ARE AGE RATED          RATES ARE AGE RATED
Employee & Child(ren)                                    0
Employee & Family                                        0

Monthly Total                                            0              $0.00                      $0.00
Annual Total                                             0               $0                         $0                              $0                          $0
% Difference                                                                         #DIV/0!                                                    #DIV/0!
Notes:
     •Many additinal options are available. Please request for more details
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.

     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance
     company is required to pay after the deductible has been satisfied, unless otherwise noted.
     •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment.


     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered health servicesand
     to determine what pre-certifications an/or notification requitements or limitations may apply.
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year
     Website: www.humana.com
Medical Market Survey - 2011-2012 Aetna Options
                                                                               RENEWAL PLAN -                                               PLAN NAME                                                  PLAN NAME
Medical Benefits                                                     Network                Non-Network                         Network                    Non-Network                    Network                    Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
     Primary Care Physician (PCP)
     Specialist
     Out-Patient Surgical Expenses
     Lab & X-ray (CT, PET, MRI, etc)
     Preventive Care         (PCP/Specialist)
Hospital Care
     Hospital Services
     Urgent Care Services
     Emergency Room
Prescription Drugs


Monthly Rates                                                        Current                      Renewal                                  Standard Rate                                             Standard Rate
Employee Only                                           0
Employee & Spouse                                       0
Employee & Child(ren)                                   0
Employee & Family                                       0

Monthly Total                                           0              $0.00                       $0.00                                       $0.00                                                      $0.00
Annual Total                                            0               $0                          $0                                          $0                                                         $0
% Difference                                                                        #DIV/0!                                                   #DIV/0!                                                    #DIV/0!

15% Rate Up                                                                                                                                      $0                                                        $0
30% Rate Up                                                                                                                                      $0                                                        $0
67% Rate Up                                                                                                                                      $0                                                        $0
Notes:
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.
     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments
     indicate what the insurance company pays.
     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she
     plans to receive are covered.
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     Website: www.aetna.com
Medical Market Survey - 2011-2012 Aetna Options (Page 2)
                                                                               RENEWAL PLAN -                                              PLAN NAME                                                 PLAN NAME
Medical Benefits                                                     Network                Non-Network                        Network                    Non-Network                   Network                    Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
     Primary Care Physician (PCP)
     Specialist
     Out-Patient Surgical Expenses
     Lab & X-ray (CT, PET, MRI, etc)
     Preventive Care         (PCP/Specialist)
Hospital Care
     Hospital Services
     Urgent Care Services
     Emergency Room
Prescription Drugs


Monthly Rates                                                        Current                     Renewal                                  Standard Rate                                            Standard Rate
Employee Only                                          0
Employee & Spouse                                      0
Employee & Child(ren)                                  0
Employee & Family                                      0

Monthly Total                                          0              $0.00                       $0.00                                       $0.00                                                     $0.00
Annual Total                                           0               $0                          $0                                          $0                                                        $0
% Difference                                                                       #DIV/0!                                                   #DIV/0!                                                   #DIV/0!

15% Rate Up                                                                                                                                     $0                                                       $0
30% Rate Up                                                                                                                                     $0                                                       $0
67% Rate Up                                                                                                                                     $0                                                       $0
Notes:
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.
     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments
     indicate health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she
     •Certain what the insurance company pays.
     plans to receive are covered.
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     Website: www.aetna.com
Medical Market Survey - 2011-2012 Blue Cross & Blue Shield Options
                                                                               RENEWAL PLAN -                                                 PLAN NAME                                                      PLAN NAME
Medical Benefits                                                     Network                   Non-Network                      Network                      Non-Network                        Network                     Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits

     Primary Care Physician (PCP)


     Specialist




     Out-Patient Surgical Expenses


     Lab & X-ray (CT, PET, MRI, etc)


     Preventive Care         (PCP/Specialist)
Hospital Care


     Hospital Services
     Urgent Care Services


     Emergency Room (Facility/Phys. Charges)


Prescription Drugs


Monthly Rates                                                        Current                     Renewal                                     Standard Rate                                                  Standard Rate
Employee Only                                          0
Employee & Spouse                                      0
Employee & Child(ren)                                  0
Employee & Family                                      0

Monthly Total                                          0              $0.00                       $0.00                                          $0.00                                                          $0.00
Annual Total                                           0               $0                          $0                                             $0                                                             $0
% Difference                                                                       #DIV/0!                                                      #DIV/0!                                                        #DIV/0!

15% Rate Up                                                                                                                                        $0                                                             $0
30% Rate Up                                                                                                                                        $0                                                             $0
67% Rate Up                                                                                                                                        $0                                                             $0
Notes:
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     *Mandatory Generic (MG) - If the member or the physician requests brand when generic is available, the member pays the applicable copay plus the difference between the generic price and the brand price.
     •Many additional options are available. Please request for more details.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.
     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate
     what the health services haveis required torequirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to
     •Certain insurance company notification pay after the deductible has been satisfied, unless otherwise noted.
     receive are covered health services and to determine what pre-certifications and/or notification requirements or limitations may apply.
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     Website: www.bcbstx.com
Medical Market Survey - 2011-2012 Blue Cross & Blue Shield Options (Page 2)
                                                                               RENEWAL PLAN -                                                 PLAN NAME                                                      PLAN NAME
Medical Benefits                                                     Network                Non-Network                         Network                      Non-Network                        Network                      Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits

     Primary Care Physician (PCP)


     Specialist




     Out-Patient Surgical Expenses


     Lab & X-ray (CT, PET, MRI, etc)


     Preventive Care         (PCP/Specialist)
Hospital Care


     Hospital Services
     Urgent Care Services


     Emergency Room
Prescription Drugs


Monthly Rates                                                        Current                     Renewal                                     Standard Rate                                                  Standard Rate
Employee Only                                          0
Employee & Spouse                                      0
Employee & Child(ren)                                  0
Employee & Family                                      0

Monthly Total                                          0              $0.00                       $0.00                                          $0.00                                                          $0.00
Annual Total                                           0               $0                          $0                                             $0                                                             $0
% Difference                                                                       #DIV/0!                                                      #DIV/0!                                                        #DIV/0!

15% Rate Up                                                                                                                                        $0                                                             $0
30% Rate Up                                                                                                                                        $0                                                             $0
67% Rate Up                                                                                                                                        $0                                                             $0
Notes:
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     *Mandatory Generic (MG) - If the member or the physician requests brand when generic is available, the member pays the applicable copay plus the difference between the generic price and the brand price.
     •Many additional options are available. Please request for more details.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.
     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate
     what the health services haveis required torequirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to
     •Certain insurance company notification pay after the deductible has been satisfied, unless otherwise noted.
     receive are covered health services and to determine what pre-certifications and/or notification requirements or limitations may apply.
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     Website: www.bcbstx.com
Medical Market Survey - 2011-2012 Humana Age Rated Options
                                                                                RENEWAL PLAN -                                         PLAN NAME                                           PLAN NAME
Medical Benefits                                                      Network                Non-Network                    Network                Non-Network                  Network                Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
      Primary Care Physician (PCP)
      Specialist
      Out-Patient Surgical Expenses
      Lab & X-ray (CT, PET, MRI, etc)
      Preventive Care         (PCP/Specialist)
Hospital Care
      Hospital Services
      Urgent Care Services
      Emergency Room
Prescription Drugs

Monthly Rates                                                         Current                   Renewal                               Standard Rate                                       Standard Rate
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###

Monthly Total                                                          $0.00                      $0.00          ###                      $0.00                      ###                      $0.00
Annual Total                                                            $0                         $0                                      $0                                                  $0
% Difference                                                                        #DIV/0!                                              #DIV/0!                                             #DIV/0!

15% Rate Up                                                                                                                                 $0                                                  $0
30% Rate Up                                                                                                                                 $0                                                  $0
67% Rate Up                                                                                                                                 $0                                                  $0
Notes:
     •Many additinal options are available. Please request for more details
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.

     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the
     percentage copayments indicate what the insurance company is required to pay after the deductible has been satisfied, unless otherwise noted.
     •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment.

     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the
     services he/she plans to receive are covered health servicesand to determine what pre-certifications an/or notification requitements or limitations may apply.
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year
     Website: www.humana.com
Medical Market Survey - 2011-2012 Humana Age Rated Options (Page 2)
                                                                                RENEWAL PLAN -                                         PLAN NAME                                           PLAN NAME
Medical Benefits                                                      Network                Non-Network                    Network                Non-Network                  Network                Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
      Primary Care Physician (PCP)
      Specialist
      Out-Patient Surgical Expenses
      Lab & X-ray (CT, PET, MRI, etc)
      Preventive Care         (PCP/Specialist)
Hospital Care
      Hospital Services
      Urgent Care Services
      Emergency Room
Prescription Drugs

Monthly Rates                                                         Current                   Renewal                               Standard Rate                                       Standard Rate
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###

Monthly Total                                                          $0.00                      $0.00          ###                      $0.00                      ###                      $0.00
Annual Total                                                            $0                         $0                                      $0                                                  $0
% Difference                                                                        #DIV/0!                                              #DIV/0!                                             #DIV/0!

15% Rate Up                                                                                                                                 $0                                                  $0
30% Rate Up                                                                                                                                 $0                                                  $0
67% Rate Up                                                                                                                                 $0                                                  $0
Notes:
     •Many additinal options are available. Please request for more details
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.

     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the
     percentage copayments indicate what the insurance company is required to pay after the deductible has been satisfied, unless otherwise noted.
     •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment.

     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the
     services he/she plans to receive are covered health servicesand to determine what pre-certifications an/or notification requitements or limitations may apply.
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year
     Website: www.humana.com
Medical Market Survey - 2011-2012 United Healthcare Age Rated Options
                                                                                RENEWAL PLAN -                                         PLAN NAME                                           PLAN NAME
Medical Benefits                                                      Network                Non-Network                    Network                Non-Network                  Network                Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
      Primary Care Physician (PCP)
      Specialist
      Out-Patient Surgical Expenses
      Lab & X-ray (CT, PET, MRI, etc)
      Preventive Care         (PCP/Specialist)
Hospital Care
      Hospital Services
      Urgent Care Services
      Emergency Room
Prescription Drugs

Monthly Rates                                                         Current                   Renewal                               Standard Rate                                       Standard Rate
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###

Monthly Total                                                          $0.00                      $0.00          ###                      $0.00                      ###                      $0.00
Annual Total                                                            $0                         $0                                      $0                                                  $0
% Difference                                                                        #DIV/0!                                              #DIV/0!                                             #DIV/0!

15% Rate Up                                                                                                                                 $0                                                  $0
30% Rate Up                                                                                                                                 $0                                                  $0
67% Rate Up                                                                                                                                 $0                                                  $0
Notes:
     •Many additinal options are available. Please request for more details
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.

     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the
     percentage copayments indicate what the insurance com
     •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment.

     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the
     services he/she plans to receive are covered
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year
     Website: www.humana.com
Medical Market Survey - 2011-2012 United Healthcare Age Rated Options
                                                                                RENEWAL PLAN -                                         PLAN NAME                                           PLAN NAME
Medical Benefits                                                      Network                Non-Network                    Network                Non-Network                  Network                Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
      Primary Care Physician (PCP)
      Specialist
      Out-Patient Surgical Expenses
      Lab & X-ray (CT, PET, MRI, etc)
      Preventive Care         (PCP/Specialist)
Hospital Care
      Hospital Services
      Urgent Care Services
      Emergency Room
Prescription Drugs

Monthly Rates                                                         Current                   Renewal                               Standard Rate                                       Standard Rate
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###

Monthly Total                                                          $0.00                      $0.00          ###                      $0.00                      ###                      $0.00
Annual Total                                                            $0                         $0                                      $0                                                  $0
% Difference                                                                        #DIV/0!                                              #DIV/0!                                             #DIV/0!

15% Rate Up                                                                                                                                 $0                                                  $0
30% Rate Up                                                                                                                                 $0                                                  $0
67% Rate Up                                                                                                                                 $0                                                  $0
Notes:
     •Many additinal options are available. Please request for more details
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.

     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the
     percentage copayments indicate what the insurance com
     •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment.

     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the
     services he/she plans to receive are covered
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year
     Website: www.humana.com
Medical Market Survey - 2011-2012 Assurant Age Rated Options
                                                                              RENEWAL PLAN -                                                          PLAN NAME                                        PLAN NAME
Medical Benefits                                              Network                                Non-Network                           Network             Non-Network                  Network             Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
      Primary Care Physician (PCP)
      Specialist

     Out-Patient Surgical Expenses

     Lab & X-ray (CT, PET, MRI, etc)
     Preventive Care     (PCP/Specialist)
Hospital Care
     Per Confinement Deductible

     Hospital Services

     Urgent Care Services
     Emergency Room
Prescription Drugs
Monthly Rates                                                 Current                                  Renewal                                       Standard Rate                                    Standard Rate
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###

Monthly Total                                                  $0.00                                    $0.00                   ###                     $0.00                     ###                     $0.00
Annual Total                                                     $0                                       $0                                              $0                                               $0
% Difference                                                                        #DIV/0!                                                             #DIV/0!                                          #DIV/0!
15% Rate Up                                                                                                                                               $0                                                $0
30% Rate Up                                                                                                                                               $0                                                $0
67% Rate Up                                                                                                                                               $0                                                $0
Notes:
     •Many additinal options are available. Please request for more details
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.

     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage
     copayments indicate what the insurance com
     •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment.

     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services
     he/she plans to receive are covered
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year
     Website: www.assurant.com
Medical Market Survey - 2011-2012 Assurant Age Rated Options (Page 2)
                                                                              RENEWAL PLAN -                                                          PLAN NAME                                        PLAN NAME
Medical Benefits                                              Network                                Non-Network                           Network             Non-Network                  Network             Non-Network
Individual Deductible
Coinsurance % Max
OOP Maximum
Family Deductible
Coinsurance % Max
OOP Maximum
Physician Office Visits
      Primary Care Physician (PCP)
      Specialist

     Out-Patient Surgical Expenses

     Lab & X-ray (CT, PET, MRI, etc)
     Preventive Care     (PCP/Specialist)
Hospital Care
     Per Confinement Deductible

     Hospital Services

     Urgent Care Services
     Emergency Room
Prescription Drugs
Monthly Rates                                                 Current                                  Renewal                                       Standard Rate                                    Standard Rate
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###
 ###

Monthly Total                                                  $0.00                                    $0.00                   ###                     $0.00                     ###                     $0.00
Annual Total                                                     $0                                       $0                                              $0                                               $0
% Difference                                                                        #DIV/0!                                                             #DIV/0!                                          #DIV/0!
15% Rate Up                                                                                                                                               $0                                                $0
30% Rate Up                                                                                                                                               $0                                                $0
67% Rate Up                                                                                                                                               $0                                                $0
Notes:
     •Many additinal options are available. Please request for more details
     •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount.
     •Copays and drug copays do not count toward deductible and coinsurance percentage.

     •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage
     copayments indicate what the insurance com
     •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment.

     •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services
     he/she plans to receive are covered
     •There must be a minimum of 75% of the eligible employees participating on the plan.
     •The employer must contribute a minimum of 50% or more of the employee only cost.
     On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year
     Website: www.assurant.com
Dental Market Options - 2011 - 2012

                                              PLAN NAME                                                        DENTAL COMPARISON
                                               Plan Name                Plan Name             Plan Name             Plan Name             Plan Name             Plan Name
                                        Network      Non-Network   Network Non-Network   Network Non-Network   Network Non-Network   Network Non-Network   Network Non-Network
Calendar Year Deductible
   Family Limit
Benefit Percentage
   Preventive Services
   Basic Services
   Major Services
Endo & Perio covered as:
Calendar Year Maximum
Rollover Amount
Orthodontia (Adult and/or Child)
   Benefit Percentage
   Lifetime Maximum

Non-Network Claims URC Percentile                 90%

                                                                                                                   PLAN YEAR
Monthly Premium                         Current         Renewal         CARRIER               CARRIER               CARRIER               CARRIER               CARRIER

   Employee Only                    0                                     $0.00                 $0.00                 $0.00                 $0.00                 $0.00

   Employee & Spouse                0                                     $0.00                 $0.00                 $0.00                 $0.00                 $0.00

   Employee & Children              0                                     $0.00                 $0.00                 $0.00                 $0.00                 $0.00

   Full Family                      0                                     $0.00                 $0.00                 $0.00                 $0.00                 $0.00


                 Monthly Total           $0.00           $0.00            0.00                  0.00                  0.00                  0.00                  0.00

                 Annual Total             $0              $0               $0                    $0                    $0                    $0                    $0

% increase from current rates                           #DIV/0!          #REF!                 #DIV/0!               #REF!                 #REF!                 #REF!
Vision Market Options - 2011 - 2012
                                          CARRIER                                                      VISION COMPARISON
                                         Plan Name             Plan Name             Plan Name              Plan Name            Plan Name             Plan Name
                                    Network Non-Network   Network Non-Network   Network Non-Network   Network Non-Network   Network Non-Network   Network Non-Network
Calendar Year Deductible
   Family Limit
Benefit Services
   Exams
   Lenses
      Single Vision
       Bifocals
       Trifocal
       Lenticular
   Contacts
   Frames


                                                                                                          PLAN YEAR
Monthly Premium                     Current   Renewal          CARRIER               CARRIER               CARRIER               CARRIER               CARRIER
  Employee Only                 0    $0.00     $0.00            $0.00                 $0.00                 $0.00                 $0.00                 $0.00
  Employee & Spouse             0    $0.00     $0.00            $0.00                 $0.00                 $0.00                 $0.00                 $0.00
  Employee & Children           0    $0.00     $0.00            $0.00                 $0.00                 $0.00                 $0.00                 $0.00
  Full Family                   0    $0.00     $0.00            $0.00                 $0.00                 $0.00                 $0.00                 $0.00

         Monthly Total                $0        $0                $0                    $0                    $0                    $0                    $0
         Annual Total                 $0        $0                $0                    $0                    $0                    $0                    $0

% increase from current rates                 #DIV/0!           #REF!                 #DIV/0!               #REF!                 #REF!                 #REF!
Short Term Disability Market Options - 2011-2012
              Benefit Description                    CURRENT PLAN            GUARDIAN     PRINCIPAL
            Benefits Begin - Accident
            Benefits Begin - Sickness
              Duration of Benefits
                 Weekly Benefit
   Definition of Disability / Own Occupation
                 Partial Benefit
   Waiting Period (Existing/New Employee)
             Pre-existing Limitation
               Contributory Status
             Minimum Participation
             Pre-existing Limitation

                                               Current             Renewal
Volume
Rate per $10 of Covered Payroll

Monthly Total
Annual Total
% Difference From Current Cost                           #DIV/0!              #DIV/0!      #DIV/0!
Long Term Disability Market Options - 2011-2012
              Benefit Description                    CURRENT PLAN            GUARDIAN     PRINCIPAL
               Elimination Period
               Benefit Percentage
           Monthly Benefit Maximum
             Guarantee Issue Limit
                   Integration
               Earnings Definition
                  Benefit Period
             Pre-existing Limitation
                Subjective Illness
   Definition of Disability / Own Occupation
                 Survivor Benefit
          Mental & Nervous Limitation
                Substance Abuse

                                               Current             Renewal
Volume
Rate per $100 of Covered Payroll

Monthly Total
Annual Total
% Difference From Current Cost                           #DIV/0!              #DIV/0!      #DIV/0!
Life and AD&D Market Survey - 2011-2012
Benefit Plan
                              Employee:
                                Spouse:
                                  Child:



               Volume $0


                  Carrier                   Life    AD&D     Dependent   Annual Total   Rate Guarantee

               Current Plan                $0.000   $0.000    $0.000         $0


                  Carrier                   Life    AD&D     Dependent   Annual Total   Rate Guarantee

                 Humana                    $0.000   $0.000    $0.000         $0


                  Carrier                   Life    AD&D     Dependent   Annual Total   Rate Guarantee

          United Healthcare                $0.000   $0.000    $0.000         $0


                  Carrier                   Life    AD&D     Dependent   Annual Total   Rate Guarantee

                 Guardian                  $0.000   $0.000    $0.000         $0


                  Carrier                   Life    AD&D     Dependent   Annual Total   Rate Guarantee

                 Principal                 $0.000   $0.000    $0.000         $0

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Client Proposal Template

  • 1. Company Name •••••••••••••••••• Annual Benefits Review December 30, 1899 Presented By: Agent BBVA Compass Insurance Agency, Inc. 9525 Katy Freeway, Suite 410 Houston, TX 77024 Phone - 713-461-3043/Fax - 713-461-5533 BBVA Compass Insurance Agency, Inc. is an affiliate of BBVA Compass Bank.
  • 2. CENSUS Company Name City State: Zip Code: Employee Spouse ZIP Employee Name M/F Date Of Birth Date Of Birth # OF CHILD(REN) CITY CODE OCCUPATION SALARY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 COVERAGE TOTALS SIC CODE / EMPLOYEE 0 Nature of Business EMPLOYEE / SPOUSE 0 EMPLOYEE / CHILD 0 Effective Date FAMILY 0 TOTALS 0 BBVA Compass Insurance 05/28/2011 713-461-3043
  • 3. Medical Market Survey - 2011-2012 Current/Renewal Options CURRENT PLAN - CURRENT PLAN - Medical Benefits Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Per Confinement Deductible Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Current Renewal Employee Only 0 Employee & Spouse 0 RATES ARE AGE RATED RATES ARE AGE RATED Employee & Child(ren) 0 Employee & Family 0 Monthly Total 0 $0.00 $0.00 Annual Total 0 $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! Notes: •Many additinal options are available. Please request for more details •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance company is required to pay after the deductible has been satisfied, unless otherwise noted. •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered health servicesand to determine what pre-certifications an/or notification requitements or limitations may apply. •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year Website: www.humana.com
  • 4. Medical Market Survey - 2011-2012 Aetna Options RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate Employee Only 0 Employee & Spouse 0 Employee & Child(ren) 0 Employee & Family 0 Monthly Total 0 $0.00 $0.00 $0.00 $0.00 Annual Total 0 $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance company pays. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered. •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. Website: www.aetna.com
  • 5. Medical Market Survey - 2011-2012 Aetna Options (Page 2) RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate Employee Only 0 Employee & Spouse 0 Employee & Child(ren) 0 Employee & Family 0 Monthly Total 0 $0.00 $0.00 $0.00 $0.00 Annual Total 0 $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she •Certain what the insurance company pays. plans to receive are covered. •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. Website: www.aetna.com
  • 6. Medical Market Survey - 2011-2012 Blue Cross & Blue Shield Options RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room (Facility/Phys. Charges) Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate Employee Only 0 Employee & Spouse 0 Employee & Child(ren) 0 Employee & Family 0 Monthly Total 0 $0.00 $0.00 $0.00 $0.00 Annual Total 0 $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. *Mandatory Generic (MG) - If the member or the physician requests brand when generic is available, the member pays the applicable copay plus the difference between the generic price and the brand price. •Many additional options are available. Please request for more details. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the health services haveis required torequirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to •Certain insurance company notification pay after the deductible has been satisfied, unless otherwise noted. receive are covered health services and to determine what pre-certifications and/or notification requirements or limitations may apply. •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. Website: www.bcbstx.com
  • 7. Medical Market Survey - 2011-2012 Blue Cross & Blue Shield Options (Page 2) RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate Employee Only 0 Employee & Spouse 0 Employee & Child(ren) 0 Employee & Family 0 Monthly Total 0 $0.00 $0.00 $0.00 $0.00 Annual Total 0 $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. *Mandatory Generic (MG) - If the member or the physician requests brand when generic is available, the member pays the applicable copay plus the difference between the generic price and the brand price. •Many additional options are available. Please request for more details. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the health services haveis required torequirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to •Certain insurance company notification pay after the deductible has been satisfied, unless otherwise noted. receive are covered health services and to determine what pre-certifications and/or notification requirements or limitations may apply. •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. Website: www.bcbstx.com
  • 8. Medical Market Survey - 2011-2012 Humana Age Rated Options RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate ### ### ### ### ### ### ### ### ### Monthly Total $0.00 $0.00 ### $0.00 ### $0.00 Annual Total $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Many additinal options are available. Please request for more details •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance company is required to pay after the deductible has been satisfied, unless otherwise noted. •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered health servicesand to determine what pre-certifications an/or notification requitements or limitations may apply. •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year Website: www.humana.com
  • 9. Medical Market Survey - 2011-2012 Humana Age Rated Options (Page 2) RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate ### ### ### ### ### ### ### ### ### Monthly Total $0.00 $0.00 ### $0.00 ### $0.00 Annual Total $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Many additinal options are available. Please request for more details •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance company is required to pay after the deductible has been satisfied, unless otherwise noted. •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered health servicesand to determine what pre-certifications an/or notification requitements or limitations may apply. •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year Website: www.humana.com
  • 10. Medical Market Survey - 2011-2012 United Healthcare Age Rated Options RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate ### ### ### ### ### ### ### ### ### Monthly Total $0.00 $0.00 ### $0.00 ### $0.00 Annual Total $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Many additinal options are available. Please request for more details •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance com •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year Website: www.humana.com
  • 11. Medical Market Survey - 2011-2012 United Healthcare Age Rated Options RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate ### ### ### ### ### ### ### ### ### Monthly Total $0.00 $0.00 ### $0.00 ### $0.00 Annual Total $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Many additinal options are available. Please request for more details •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance com •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year Website: www.humana.com
  • 12. Medical Market Survey - 2011-2012 Assurant Age Rated Options RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Per Confinement Deductible Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate ### ### ### ### ### ### ### ### ### Monthly Total $0.00 $0.00 ### $0.00 ### $0.00 Annual Total $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Many additinal options are available. Please request for more details •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance com •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year Website: www.assurant.com
  • 13. Medical Market Survey - 2011-2012 Assurant Age Rated Options (Page 2) RENEWAL PLAN - PLAN NAME PLAN NAME Medical Benefits Network Non-Network Network Non-Network Network Non-Network Individual Deductible Coinsurance % Max OOP Maximum Family Deductible Coinsurance % Max OOP Maximum Physician Office Visits Primary Care Physician (PCP) Specialist Out-Patient Surgical Expenses Lab & X-ray (CT, PET, MRI, etc) Preventive Care (PCP/Specialist) Hospital Care Per Confinement Deductible Hospital Services Urgent Care Services Emergency Room Prescription Drugs Monthly Rates Current Renewal Standard Rate Standard Rate ### ### ### ### ### ### ### ### ### Monthly Total $0.00 $0.00 ### $0.00 ### $0.00 Annual Total $0 $0 $0 $0 % Difference #DIV/0! #DIV/0! #DIV/0! 15% Rate Up $0 $0 30% Rate Up $0 $0 67% Rate Up $0 $0 Notes: •Many additinal options are available. Please request for more details •Out-of-Network coinsurance stop-loss amount will also apply toward the network coinsurance stop-loss amount. •Copays and drug copays do not count toward deductible and coinsurance percentage. •This is a partial description of benefits available. For more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what the insurance com •Rates are subject to underwriting should the actual covered members change more than 10% from current enrollment. •Certain health services have notification requirements and limitations that may vary based upon coverage option, insurance provider or state mandate. It is the participant's responsibility to confirm that the services he/she plans to receive are covered •There must be a minimum of 75% of the eligible employees participating on the plan. •The employer must contribute a minimum of 50% or more of the employee only cost. On the Rx plans, the copay maximum for level 4 drugs is $3,500 per member per calendar year Website: www.assurant.com
  • 14. Dental Market Options - 2011 - 2012 PLAN NAME DENTAL COMPARISON Plan Name Plan Name Plan Name Plan Name Plan Name Plan Name Network Non-Network Network Non-Network Network Non-Network Network Non-Network Network Non-Network Network Non-Network Calendar Year Deductible Family Limit Benefit Percentage Preventive Services Basic Services Major Services Endo & Perio covered as: Calendar Year Maximum Rollover Amount Orthodontia (Adult and/or Child) Benefit Percentage Lifetime Maximum Non-Network Claims URC Percentile 90% PLAN YEAR Monthly Premium Current Renewal CARRIER CARRIER CARRIER CARRIER CARRIER Employee Only 0 $0.00 $0.00 $0.00 $0.00 $0.00 Employee & Spouse 0 $0.00 $0.00 $0.00 $0.00 $0.00 Employee & Children 0 $0.00 $0.00 $0.00 $0.00 $0.00 Full Family 0 $0.00 $0.00 $0.00 $0.00 $0.00 Monthly Total $0.00 $0.00 0.00 0.00 0.00 0.00 0.00 Annual Total $0 $0 $0 $0 $0 $0 $0 % increase from current rates #DIV/0! #REF! #DIV/0! #REF! #REF! #REF!
  • 15. Vision Market Options - 2011 - 2012 CARRIER VISION COMPARISON Plan Name Plan Name Plan Name Plan Name Plan Name Plan Name Network Non-Network Network Non-Network Network Non-Network Network Non-Network Network Non-Network Network Non-Network Calendar Year Deductible Family Limit Benefit Services Exams Lenses Single Vision Bifocals Trifocal Lenticular Contacts Frames PLAN YEAR Monthly Premium Current Renewal CARRIER CARRIER CARRIER CARRIER CARRIER Employee Only 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Employee & Spouse 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Employee & Children 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Full Family 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Monthly Total $0 $0 $0 $0 $0 $0 $0 Annual Total $0 $0 $0 $0 $0 $0 $0 % increase from current rates #DIV/0! #REF! #DIV/0! #REF! #REF! #REF!
  • 16. Short Term Disability Market Options - 2011-2012 Benefit Description CURRENT PLAN GUARDIAN PRINCIPAL Benefits Begin - Accident Benefits Begin - Sickness Duration of Benefits Weekly Benefit Definition of Disability / Own Occupation Partial Benefit Waiting Period (Existing/New Employee) Pre-existing Limitation Contributory Status Minimum Participation Pre-existing Limitation Current Renewal Volume Rate per $10 of Covered Payroll Monthly Total Annual Total % Difference From Current Cost #DIV/0! #DIV/0! #DIV/0!
  • 17. Long Term Disability Market Options - 2011-2012 Benefit Description CURRENT PLAN GUARDIAN PRINCIPAL Elimination Period Benefit Percentage Monthly Benefit Maximum Guarantee Issue Limit Integration Earnings Definition Benefit Period Pre-existing Limitation Subjective Illness Definition of Disability / Own Occupation Survivor Benefit Mental & Nervous Limitation Substance Abuse Current Renewal Volume Rate per $100 of Covered Payroll Monthly Total Annual Total % Difference From Current Cost #DIV/0! #DIV/0! #DIV/0!
  • 18. Life and AD&D Market Survey - 2011-2012 Benefit Plan Employee: Spouse: Child: Volume $0 Carrier Life AD&D Dependent Annual Total Rate Guarantee Current Plan $0.000 $0.000 $0.000 $0 Carrier Life AD&D Dependent Annual Total Rate Guarantee Humana $0.000 $0.000 $0.000 $0 Carrier Life AD&D Dependent Annual Total Rate Guarantee United Healthcare $0.000 $0.000 $0.000 $0 Carrier Life AD&D Dependent Annual Total Rate Guarantee Guardian $0.000 $0.000 $0.000 $0 Carrier Life AD&D Dependent Annual Total Rate Guarantee Principal $0.000 $0.000 $0.000 $0