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R-2023-303 - 9/28/2023 RESOLUTION NO. R-2023-303 WHEREAS, United Healthcare Insurance Company ("United Healthcare") has submitted a proposal for critical illness, accident, and hospital indemnity coverage for City of Round Rock("City") employees commencing January 1, 2024; and WHEREAS, critical illness, accident, and hospital indemnity coverage are voluntary employee benefits with no cost to the City; and WHEREAS, United Healthcare's proposal has been determined to be the most advantageous to the City; and WHEREAS, the City Council desires to accept the proposal of United Healthcare and authorize the Mayor to execute any related documents required for the implementation of said benefits, Now Therefore BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ROUND ROCK, TEXAS: That the proposal of United Healthcare for provision of critical illness, accident, and hospital indemnity coverage is hereby accepted. That the Mayor is hereby authorized and directed to execute on behalf of the City any related documents required for the implementation of said benefits. The City Council hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to the public as required by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended. 0112.22032;4879-1158-4640 RESOLVED this 28th day of September, 2023. 14AI CRAIG RGOK, Mayor City of Round Texas ATTEST: MEAGAN INKS City Clerk 9 Benefits Proposal for City of Round Rock Issued on: February 28, 2023 lioo United Healthcare UnitedHealthcare Company Overview for City of Round Rock Effective Date: 01/01/2024 Why Choose U n ited Healthcare? Cost Savings Get administrative credits when purchasing more than one plan from United Healthcare. The more you bundle, the more you save. Convenience -One account management team -Simplified eligibility and enrollment process -Consolidated billling -One dedicated customer service line and member website Better Health To help your employees make better health care decisions, all members receive actionable health and wellness education. When you purchase medical and specialty products together, we leverage employee claims data to provide personalized recommendations. We call that approach Bridge2Health. - For individuals with specifc chronic illnesses, our targeted outreach encourages them to receive care that can improve their health and reduce costs. - For members who file disability claims, case managers help manage their recovery so they can return to health and return to work. Bridge2Health is available to groups with medical coverage and one or more specialty products. Ask your consultant or United Healthcare representative for participation requirements. Where else can you find as much value from one organization? Now is the time to discover the strength of our United Healthcare Specialty Benefits product portfolio. About UnitedHealth Group® UnitedHealth Group is a diversified health and well-being company dedicated to helping the health care system work better. UnitedHealth Group's mission is to help people live healthier lives by: -Seeking to enhance the performance of the health system and improve the overall health and well-being of the people the company serves and their communities; -Working with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price; and -Supporting the physician/patient relationship and empowering people with the information, guidance and tools they need to make personal health choices and decisions. UnitedHealthcare Accident Protection Plan Proposal for City of Round Rock Effective Date: 01/01/2024 Ardent Protection Plan v2 Custom CompanyLegal Entity U n ited Healthcare Insurance Eligibility All Active Full Time Employees working a minimum of 30 hours per week Plan Design 24 Hour Waiver of Premium Included Portability Included Tele honic Claim Submission Included Accidental Death&Dismemberment Life $20,000 Both hands or both feet $20,000 One hand and one foot $20,000 One hand or one foot $10,000 Two or more fingers or toes $4,000 One finger or one toe $2,000 Accidental Death Common Carrier Life $80,000 Child benefit 50%of employee/spouse) Initial Care Ground Ambulance $300 Air Ambulance $1,800 Emerqencv Room Treatment $150 Physician Office/Urgent Care(per visit $150 Hospital Care Hospital Admission $1,200 Hospital Confinement $250 Hospital ICU Admission $2,400 Hospital ICU Confinement $750 Follow Up Care Appliances Benefit Wheelchair $225 Knee Scooter $225 Knee Immobilizer $225 Lumbar Spine Brace $225 Walking Boot $150 Walker $150 Crutches $150 Leg Brace $150 Cervical Collar $150 Cane $75 Ankle Brace $75 -Ankle Boot $75 -Air Cast $75 Follow up Physician Visit $75 Major Diagnostic Exam $250 Minor Diagnostic Exam $75 Prosthetic One Device $750 Two or More Devices $1,500 Rehabilitation Facility(per day/Up to 30 days) $150 Rehabilitation Thera (per visit/up to 10 Visits $30 Common In•uries Abdominal/Thoracic Surgery Surgery to repair $1,500 Exploratory without repair $150 Cranial Surgery $300 Eye Surgery Removal of foreign body $150 Surgical Repair $300 Hernia Surgery $300 UnitedHealthcare Accident Protection Plan Proposal for City of Round Rock Effective Date: 01/01/2024 Ardent Protection Plan v2 Custom Legal Entity Arthroscopic Surgery $300 Non-Specific Surgery General Anesthesia $300 Conscious Sedation $150 Tendon/Ligament/Shoulder Cartilage/Rotator Cuff /Knee Cartilage Surgery Sur_qery to repair one $600 Surgery to repair more than one $1,200 Exploratory without repair $200 Blood/Plasma/Platelets $400 Bums 2nd Degree(at least 36%of body surface) $750 3rd Degree 9 to 34 sq.inches $1,500 3rd Degree 35 or mores .inches $12,000 Skin Graft=25%of burn benefit Coma $15,000 Concussion $200 Lacerations Greater Than 15 cm $600 5 cm-15 cm $300 Less Than 5 cm $75 Not Requiring Sutures $45 Paralysis Quadriplegia $15,000 Hemi le is $7,500 Paraplegia $7,500 Ruptured/Herniated Disc $600 Emergency Dental Work Crowns $300 Extractions $150 Medical Supplies/Over-the-counter(one time per Ian ear) $20 Family Child Daycare(per da up to 30 da s $45 Lodging(per day up to 30 days) $225 Transportation(for special treatment more than 100 miles away,maximum of 3 tris per accident) $300 Fractures Oen Reduction/Closed Reduction Skull(Depressed,except bones of face or nose $6,000/$3,000 Sternum $6,000/$3,000 Hip,Thigh(Femur) $6,000/$3,000 Skull(Simple,except bones of face or nose) $3,250/$1,625 Le from top of tibia to ankle joint $3,250/$1,625 Pelvis(Excluding Coccyx) $3,250/$1,625 Vertebrae(body o $3,250/$1,625 Sacral/Sacrum $1,200/$600 Face or Nose(except teeth $1,200/$600 Upper Arm Elbow to Shoulder $1,200/$600 Upper Jaw(except Alveolarprocess) $1,200/$600 Ankle $1,200/$600 Foot(except Toes) $1,200/$600 Forearm, Hand,Wrist(except Fingers) $1,200/$600 Kneecap $1,200/$600 Lower Jaw(except Alveolar process) $1,200/$600 Shoulder Blade or Collarbone $1,200/$600 Vertebral Process $1,200/$600 Coccyx $1,000/$500 Finger or Toe $450/$225 Chip Fractures: 25%of amounts shown for Closed Reduction Dislocations Oen Reduction/Closed Reduction UnitedHealthcare Accident Protection Plan Proposal for City of Round Rock Effective Date: 01/01/2024 Ardent Protection Plan v2 Custom Legal Entity .. Hi $6,000/$3,000 Elbow $1,350/$675 Ankle $2,250/$1,125 Collar Bone Sternoclavicular $1,350/$675 Foot(except toes $2,250/$1,125 Hand $1,350/$675 Knee Ca Patella $3,400/$1,700 -Lower Jaw $1,350/$675 Shoulder Blade $1,350/$675 Wrist $1,350/$675 Collerbone Acromioclavicular separation) $750/$375 Finger or Toe $750/$375 Organized Sporting Activity Injury Increases amounts payable under Follow Up Care and Common Injuries sections by 25% Additional Wellness Benefit Rider $50, Employee and Insured Spouse 'Quoted Monthly Rates Voluntary FEe $7.94 m to ee+Spouse $12.54 Employee+Child ren $15.42 Em to ee+Spouse+Child ren $23.72 Number of Eligible Employees 986 Employer Contribution-Employee Coverage 0% Employer Contribution-Dependent Coverage 0% Participation Requirements-Employee Coverage Waived Broker Commissions Flat 15.0% Rate Guarantee in months 36 Implementation/MarketingImplementation/Marketing Credit One time implementation credit up to$850 UnitedHealthcare Assumptions for City of Round Rock Effective Date:01/01/2024 General Assumptions -We reserve the right to change rates and/or plan provisions if the number of lives or volume of insurance change by more than 15%before,on,or after the effective date listed above or if factors used to generate this quote such as group demographics or effective date are changed,found to be incomplete or incorrect. -Rates assume no changes in legislation or regulation that affects the benefits payable,eligibility or contract. -Rates assume standard administrative services including Claims&Data processing,Enrollment&Billing,Customer Service,Case Management,Provider Relations,and Reporting -Assumed contract situs is Texas. -Employees must be U.S.citizens or residents regularly working and living in the U.S. Coverage for U.S.citizens working outside of the U.S.must be approved in writing by us. Approval depends on locale and length of assignment. -Employers assumed primary business is classified as 9111 SIC code. -Rates may change on renewal in accordance with the terms of the policy. Accident Protection Assumptions Dependent children are covered to age 26 Quote includes a one-time implementation credit up to$850.This amount shall not exceed 3.0%of the third month of billed premium following the effective date of this proposal,annualized (3rd month of billed premium x 12).Satisfactory documentation will be required within one year of the effective date for the costs incurred in connection with the transfer or ongoing administrative expenses of the plan(s).Paid premium must be current to receive credit. We will not pay a benefit for a loss contributed to or caused by: 1. disease,bodily or mental infirmity,or medical or surgical Treatment of these(except pyogenic infections through an Accidental wound), 2. suicide or intentionally self-inflicted Injury, 3.active participation in a riot, 4.committing or attempting to commit a crime,or participating or attempting to participate in a crime, 5.taking part in the commission of an assault or being engaged in an illegal activity, 6.an act or accident of war,declared or undeclared,whether civil or international,or any substantial armed conflict between organized forces of a military nature, 7.use of alcohol orthe non-medical use of narcotics,sedatives,stimulants,hallucinogens,or any other such substance,unless prescribed for You by a Physician and taken as prescribed, 8.driving or in physical control of a Motor Vehicle while Intoxicated, 9.engaging in the following hazardous activities,including skydiving,hang gliding,auto racing,dirt bike riding,mountain climbing,Russian Roulette,autoerotic asphyxiation,bungee jumping,base jumping or using off-road vehicles that are not registered for use on-road based on applicable state law, 10.riding in or driving any motor-driven vehicle in a race,stunt show or speed test, 11.travel or flight in,or descent from any aircraft,unless as a fare-paying passenger on a commercial airline flying between established airports on: a)a scheduled route,or b)a charter flight seating 15 or more people, 12.travel or flight in,or descent from any aircraft,except if employment duties require You to be a pilot and/or passenger in a privately owned aircraft,or as a fare-paying passenger on a commercial airline flying between established airports on: a)a scheduled route,or b)a charter flight seating 15 or more people, 13.practicing for or participating in any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received,or 14.Injury arising out of or in the course of any occupation or employment for pay or profit,or any Injury or Sickness for which You or Your Dependent are entitled to benefits under any Workers'Compensation Law,Employers'Liability Law or similar law,unless this insurance is issued on an 24 hour basis as shown in the Schedule, 15.an Accident that occurs outside of the United States. In addition to the exclusions shown above,no payment will be made for Treatment received outside of the United States. UnitedHealthcare Disclaimers for City of Round Rock Effective Date: 01/01/2024 This proposal is valid for 90 days from the issued date, unless otherwise noted within this document. Brokers and agents may receive commissions, bonuses and other compensation for selling the products presented in this proposal. The cost of this compensation may be directly or indirectly reflected in the premium or fees for those products. Contact your broker and/or agent if you have questions regarding their compensation relating to products in this proposal. This proposal is subject to negotiation and execution of a written agreement, which will supersede the proposal contents. This proposal does not constitute an agreement, and is based on assumptions made from the written information in our possession and provided by you. We retain the right to modify our proposal if the information upon which this proposal is based is changed or is supplemented. We consider much of the information contained in the proposal to be proprietary or otherwise confidential, and are releasing this proposal to you on the understanding that you and your representatives will only use it, and any data included in the proposal, for the specific purpose of evaluating its content. If this is not consistent with your understanding, please notify us before reviewing the proposal. In addition, by accepting and reviewing the contents of this proposal, you and your agents or other designees agree, to the extent permitted by law, that certain information contained herein, or other information provided to you in connection with this proposal response or associated request for proposal (RFP), is proprietary and/or confidential to United Healthcare and its related entities, and may not be copied, used, distributed or disclosed without prior written consent from an authorized representative of United Healthcare and its related entities, other than is necessary to evaluate this proposal. /0 ©2021 United HealthCare Services, Inc. All Rights Reserved 9 Benefits Proposal for City of Round Rock Issued on: February 28, 2023 00 United Healthcare UnitedHealthcare Company Overview for City of Round Rock Effective Date: 01/01/2024 Why Choose U n ited Healthcare? Cost Savings Get administrative credits when purchasing more than one plan from UnitedHealthcare. The more you bundle, the more you save. Convenience The advantages available when purchasing multiple products include: -One account management team -Simplified eligibility and enrollment process -Consolidated billling -One dedicated customer service line and member website Better Health To help your employees make better health care decisions, all members receive actionable health and wellness education. When you purchase medical and specialty products together, we leverage employee claims data to provide personalized recommendations. We call that approach Bridge2Health. - For individuals with specifc chronic illnesses, our targeted outreach encourages them to receive care that can improve their health and reduce costs. - For members who file disability claims, case managers help manage their recovery so they can return to health and return to work. Bridge2Health is available to groups with medical coverage and one or more specialty products. Ask your consultant or UnitedHealthcare representative for participation requirements. Where else can you find as much value from one organization? Now is the time to discover the strength of our UnitedHealthcare Specialty Benefits product portfolio. About UnitedHealth Group® UnitedHealth Group is a diversified health and well-being company dedicated to helping the health care system work better. UnitedHealth Group's mission is to help people live healthier lives by: -Seeking to enhance the performance of the health system and improve the overall health and well-being of the people the company serves and their communities; -Working with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price; and -Supporting the physician/patient relationship and empowering people with the information, guidance and tools they need to make personal health choices and decisions. UnitedHealthcare Critical Illness Plan Proposal for City of Round Rock Effective Date:01/01/2024 Prospect Name City of Round Rock Proposed Effective Date 1/1/2024 Eligibility All active,full time employees working a minimum of 30 hours per week Funding Type Voluntary Covered Conditions Base Conditions,Additional Conditions,Child-Only Conditions Benefits Payable Voluntary Benefits Employee Guarantee Issue $20,000 Spouse Guarantee Issue $10,000 Child(ren)Guarantee Issue $5,000 Employee must purchase coverage in order to purchase dependent coverage. *If employee elects these coverage options for themselves,they may also choose from lower coverage options for Spouse and Children Portability Included at Employer's group rate with age limit of 75. Telephonic Claim Submission Included 50%of maximum benefit amount payable upon the subsequent diagnosis of a Covered Condition for which we have paid a benefit.Diagnosis dates must be Reoccurrence Benefit separated by at least 6 months,during which time there has been no treatment for that condition. 100%of maximum benefit amount payable per covered employee or dependent Additional Occurrence Benefit for a different covered condition.Diagnosis dates must be separated by at least 90 Days. Limitations and Exclusions Benefit Reduction 50%benefit reduction at age 70 Coverage Termination At Retirement Optional Wellness Benefit Rider $50 Number of Eligible Lives 986 Rating Basis Attained Age Rate Type-Employee/Spouse Voluntary Age Banded Uni-Tobacco rates per$1,000 Benefit Rate Type-Child(ren)Voluntary Benefit Composite Rate per$1,000 Monthly Rate-Employee soon" Under25 $0.21 25-29 $0.28 30-34 $0.35 35-39 $0.48 40-44 $0.73 45-49 $1.18 50-54 $1.67 55-59 $2.21 60-64 $2.98 65-69 $4.22 70-74 $6.03 75+ $6.45 Monthly Rate-SpouseAge Range Uni-Tobacco Under25 $0.20 25-29 $0.27 30-34 $0.35 35-39 $0.47 40-44 $0.70 45-49 $1.03 50-54 $1.42 55-59 $1.90 60-64 $2.89 65-69 $3.79 70-74 $4.60 75+ $7.30 Monthly Rate-Child(ren) $0.13 Employer Contribution-Employee 0% Participation Requirements Waived Broker Commissions Flat 15.0% Rates Guaranteed For 36 months Implementation/Marketing Credit One time implementation credit up to$850 United Healthcare Proposed Critical Illness Plan Monthly Premium for City of Round Rock Effective Date: 01/01/2024 Voluntary Offer Employee Paid Option 1: EE$20,000/SP$10,000/CH$5,000 Monthl PremiumEE Only EE+SP EE+CH EE+SP+CH Age Range Uni- Tobacco Tobacco Tobacco Tobacco Under 25 $4.20 $6.20 $4.85 $6.85 25-29 $5.60 $8.30 $6.25 $8.95 30-34 $7.00 $10.50 $7.65 $11.15 35-39 $9.60 $14.30 $10.25 $14.95 40-44 $14.60 $21.60 $15.25 $22.25 45-49 $23.60 $33.90 $24.25 $34.55 50-54 $33.40 $47.60 $34.05 $48.25 55-59 $44.20 $63.20 $44.85 $63.85 60-64 $59.60 $88.50 $60.25 $89.15 65-69 $84.40 $122.30 $85.05 $122.95 70-74* $60.30 1 1 $83.30 1 1 $60.95 1 1 $83.95 75+* $64.50 1 1 $101.00 1 1 $65.15 1 1 $101.65 * 50%of benefits reduction is applied for age 70+ UnitedHealthcare Proposed Critical Illness Plan Designs for City of Round Rock Effective Date: 01/01/2024 Base + Additional + Child-Only Conditions Base Covered Conditions 'qmmmmq7o6,i Maximum Benefit Amount Payable• - Benign Brain Tumor 100% Cancer- Invasive 100% Cancer- Non-Invasive 25% Chronic Renal Failure 100% Coma 100% Coronary Artery Disease 25% Heart Attack 100% Heart Failure 100% Major Organ Failure 100% Permanent Paralysis 100% Ruptured Aneurysm 100% Stroke 100% Additional Amyotrophic lateral sclerosis (ALS) 100% Complete Blindness 100% Complete Loss of Hearing 100% Advanced Alzheimer's 100% Advanced Multiple Sclerosis 100% Advanced Parkinson's 100% Child Only Covered Conditions Cerebral Palsy 25%of Employee's Amount Cleft Lip/Palate 25%of Employee's Amount Cystic Fibrosis 25%of Employee's Amount Down Syndrome 25%of Employee's Amount Muscular Dystrophy 25%of Employee's Amount Spina Bifida 25%of Employee's Amount UnitedHealthcare Critical Illness Plan Assumptions for City of Round Rock Effective Date: 01/01/2024 General Assumptions -United Healthcare reserves the right to change rates and/or plan provisions if the number of lives or volume of insurance change by more than 15%before,on,or after the effective date listed above or if factors used to generate this quote such as group demographics or effective date are changed,found to be incomplete or incorrect. Rates assume no changes in legislation or regulation that affects the benefits payable,eligibility or contract. Rates assume standard administrative services including Claims&Data processing,Enrollment&Billing,Customer Service,Case Management,Provider Relations,and Reporting Assumed contract situs is Texas Employees must be U.S.citizens or residents regularly working and living in the U.S. Coverage for U.S.citizens working outside of the U.S.must be approved in writing by us. Approval depends on locale and length of assignment. Employers assumed primary business is classified as 9111 SIC Code. Rates may increase on renewal in accordance with the terms of the policy. Critical Illness Protection Plan Assumptions Dependent children are covered to age 26 Quote includes a one-time implementation credit up to$850.This amount shall not exceed 2.2%of the third month of billed premium following the effective date of this proposal,annualized (3rd month of billed premium x 12). Satisfactory documentation will be required within one year of the effective date for the costs incurred in connection with the transfer or ongoing administrative expenses of the plan(s).Paid premium must be current to receive credit. The Employee must be approved for coverage in order for dependent coverage to be available. We will not cover a Critical Illness under the Policy if it is due to: 1. an act[or accident of war,declared or undeclared,whether civil or international,and any substantial armed conflict between organized forces of a military nature]; 2. loss sustained while on active duty as a member of the armed forces of any nation[except during any time period coverage is extended under the Continuation during Leave of Absence provision]; 3. any intentionally self-inflicted Injury; 4. active participation in a riot; 5. committing or attempting to commit a felony,or participating or attempting to participate in a felony; 6. use of alcohol or the non-medical use of narcotics,sedatives,stimulants,hallucinogens,or any other such substance,whether or not prescribed by a Physician; 7. cosmetic or elective surgery;or 8. attempted suicide,while sane or insane. -We also will not pay a benefit for a Critical Illness: 1. for which the Covered Person's Date of Diagnosis for any type of Critical Illness,as defined in the Policy,was prior to his Effective Date of insurance; 2. that was diagnosed outside of the United States or Canada,unless the diagnosis was confirmed by a Physician practicing within the United States or Canada. UnitedHealthcare Critical Illness Plan Disclaimers for City of Round Rock Effective Date: 01/01/2024 This proposal is valid for 90 days from the issued date, unless otherwise noted within this document. Brokers and agents may receive commissions, bonuses and other compensation for selling the products presented in this proposal. The cost of this compensation may be directly or indirectly reflected in the premium or fees for those products. Contact your broker and/or agent if you have questions regarding their compensation relating to products in this proposal. This proposal is subject to negotiation and execution of a written agreement, which will supersede the proposal contents. This proposal does not constitute an agreement, and is based on assumptions made from the written information in our possession and provided by you. We retain the right to modify our proposal if the information upon which this proposal is based is changed or is supplemented. We consider much of the information contained in the proposal to be proprietary or otherwise confidential, and are releasing this proposal to you on the understanding that you and your representatives will only use it, and any data included in the proposal, for the specific purpose of evaluating its content. If this is not consistent with your understanding, please notify us before reviewing the proposal. In addition, by accepting and reviewing the contents of this proposal, you and your agents or other designees agree, to the extent permitted by law, that certain information contained herein, or other information provided to you in connection with this proposal response or associated request for proposal (RFP), is proprietary and/or confidential to United Healthcare and its related entities, and may not be copied, used, distributed or disclosed without prior written consent from an authorized representative of United Healthcare, other than is necessary to evaluate this proposal. /J 0 2021 United HealthCare Services, Inc. All Rights Reserved Benefits Proposal for City of Round Rock Issued on: February 28, 2023 United Healthcare UnitedHealthcare Company Overview for City of Round Rock Effective Date: 01/01/2024 Why Choose U n ited Healthcare? Cost Savings Get administrative credits when purchasing more than one plan from United Healthcare. The more you bundle, the more you save. Convenience The advantages available when purchasing multiple products include: -One account management team -Simplified eligibility and enrollment process -Consolidated billling -One dedicated customer service line and member website Better Health To help your employees make better health care decisions, all members receive actionable health and wellness education. When you purchase medical and specialty products together, we leverage employee claims data to provide personalized recommendations. We call that approach Bridge2Health. - For individuals with specifc chronic illnesses, our targeted outreach encourages them to receive care that can improve their health and reduce costs. - For members who file disability claims, case managers help manage their recovery so they can return to health and return to work. Bridge2Health is available to groups with medical coverage and one or more specialty products. Ask your consultant or United Healthcare representative for participation requirements. Where else can you find as much value from one organization? Now is the time to discover the strength of our United Healthcare Specialty Benefits product portfolio. About UnitedHealth Group® UnitedHealth Group is a diversified health and well-being company dedicated to helping the health care system work better. UnitedHealth Group's mission is to help people live healthier lives by: -Seeking to enhance the performance of the health system and improve the overall health and well-being of the people the company serves and their communities; -Working with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price; and -Supporting the physician/patient relationship and empowering people with the information, guidance and tools they need to make personal health choices and decisions. United Healthcare Hospital Indemnity Protection Plan Proposal for City of Round Rock Effective Date: 01/01/2024 Hospital Indemnity Protection Plan (HIPP) Voluntary Legal . . All Active Full Time Employees working a minimum of 30 Eligibility hours per week Plan Design HIPP HSA Plan Coverage Level Base+ Enhanced Pre-existing Conditions Exclusion None Portability Included Maternity Included without a waiting period Enhancedbase+ • . . Hospital Admission $500 (1 day/plan year) Hospital Confinement $100 (up to 364 days/plan year) ICU Confinement $100 (up to 364 days/plan year) ICU Admission $500 (1 day/plan year) Monthly Rates • . . Employee Only $5.12 With Spouse $11.94 With Children $10.68 With Spouse &Children $18.68 Number of Eligible Employees 986 Employer Contribution- Employee Coverage 0% Employer Contribution-Spouse Coverage 0% Employer Contribution-Children Coverage 0% Participation Requirements- Employee Coverage Waived Broker Commissions Flat 15.0% Rate Guarantee 36 months Implementation/Marketing Credit One time implementation credit up to$850 UnitedHealthcare Plan Designs for City of Round Rock Effective Date: 01/01/2024 Benefits Payable Descriptions Base + Enhanced Plan Benefits Hospital Admission 1 day per plan year per insured. Hospital Confinement Up to 364 days per plan year per insured. ICU Confinement Up to 364 days per plan year per insured. ICU Admission 1 daV per plan Vear per insured. UnitedHealthcare Assumptions for City of Round Rock Effective Date: 01/01/2024 General Assumptions -We reserve the right to change rates and/or plan provisions if the number of lives or volume of insurance change by more than 15% before, on, or after the effective date listed above or if factors used to generate this quote such as group demographics or effective date are changed, found to be incomplete or incorrect. - Rates assume no changes in legislation or regulation that affects the benefits payable, eligibility or contract. - Rates assume standard administrative services including Claims&Data processing, Enrollment&Billing, Customer Service, Case Management, Provider Relations, and Reporting - Employees must be U.S. citizens or residents regularly working and living in the U.S. Coverage for U.S. citizens working outside of the U.S. must be approved in writing by us. Approval depends on locale and length of assignment. - Rates may change on renewal in accordance with the terms of the policy. - Employers assumed primary business is classified as 9111 SIC code. -Telephonic Claims Support Included. -Situs state indicated is Texas. Hospital Indemnity Protection Plan Assumptions Dependent children are covered to age 26 Quote includes a one-time implementation credit up to$850. This amount shall not exceed 4.7%of the third month of billed premium following the effective date of this proposal, annualized (3rd month of billed premium x 12). Satisfactory documentation will be required within one year of the effective date for the costs incurred in connection with the transfer or ongoing administrative expenses of the plan(s). Paid premium must be current to receive credit. The Employee must be approved for coverage in order for dependent coverage to be available. Exclusions and Limitations This Certificate does not cover any loss caused by or resulting from (directly or indirectly): 1. an act or Accident of war, declared or undeclared, whether civil or international, and any substantial armed conflict between organized forces of a military nature; 2. loss sustained while on active duty as a member of the armed forces of any nation [except during any time period coverage is extended under the Continuation during Leave of Absence provision]; 3. any intentionally self-inflicted Injury; 4. active participation in a riot; 5. committing or attempting to commit a felony, or participating or attempting to participate in a felony; 6. taking part in the commission of an assault or being engaged in an illegal activity; 7. use of alcohol or the non-medical use of narcotics, sedatives, stimulants, hallucinogens, or any other such substance, whether or not prescribed by a Physician; this exclusion does not apply to the Drug and Alcohol Treatment Benefit(Inpatient)if covered under this Policy; 8. cosmetic or elective surgery; or 9. treatment received outside the United States or its territories; 10. the reversal of a tubal ligation or vasectomy; 11. artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications or Physician services, unless required by law; 12. participation in any form of aeronautics(including parachuting and hang gliding)except as a fare-paying passenger in a licensed aircraft provided by a common carrier and operating between definitely established airports; 13. a newborn child's routine nursing or routine well baby care during the initial Confinement in a Hospital; 14. driving in any organized or scheduled race or speed test or while testing an automobile or any motorized vehicle on any racetrack or speedway; 15. mental and Nervous Disorders; this exclusion does not apply to the Mental and Nervous Disorder Treatment Benefit(Inpatient)if covered under this Policy; 16. dental or plastic surgery for Cosmetic purposes except when such surgery is required to: (a)treat an Injury; or(b)correct a disorder of normal bodily function; and 17. practicing for or participating in any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received. UnitedHealthcare Disclaimers for City of Round Rock Effective Date: 01/01/2024 This proposal is valid for 90 days from the issued date, unless otherwise noted within this document. Brokers and agents may receive commissions, bonuses and other compensation for selling the products presented in this proposal. The cost of this compensation may be directly or indirectly reflected in the premium or fees for those products. Contact your broker and/or agent if you have questions regarding their compensation relating to products in this proposal. This proposal is subject to negotiation and execution of a written agreement, which will supersede the proposal contents. This proposal does not constitute an agreement, and is based on assumptions made from the written information in our possession and provided by you. We retain the right to modify our proposal if the information upon which this proposal is based is changed or is supplemented. We consider much of the information contained in the proposal to be proprietary or otherwise confidential, and are releasing this proposal to you on the understanding that you and your representatives will only use it, and any data included in the proposal, for the specific purpose of evaluating its content. If this is not consistent with your understanding, please notify us before reviewing the proposal. In addition, by accepting and reviewing the contents of this proposal, you and your agents or other designees agree, to the extent permitted by law, that certain information contained herein, or other information provided to you in connection with this proposal response or associated request for proposal (RFP), is proprietary and/or confidential to United Healthcare and its related entities, and may not be copied, used, distributed or disclosed without prior written consent from an authorized representative of United Healthcare and its related entities, other than is necessary to evaluate this proposal. 0 2021 United HealthCare Services, Inc. All Rights Reserved