REQUEST FOR PROPOSALS MEDICAL COVERAGE

RFP SECTION VIII: MEDICAL PLANS REQUEST FOR PROPOSALS MEDICAL COVERAGE RFP #: 15-32025 RFP Issue Date: June 15, 2015 Medical Proposal Due Date: July 16, 2015 Effective Date: January 1, 2016 1

TABLE OF CONTENTS Page. A. Current Plan Information... 4 B. Proposed Plan Designs... 6 C. Medical ASO Questionnaire... 9 D. Fully Insured Medicare Advantage Plan Questionnaire... 13 E. Medical Questionnaire... 17 F. Mandatory Utilization Management Questionnaire... 20 G. Optional Disease Management Questionnaire... 24 H. Optional Wellness Programs Questionnaire... 25 I. Medical Response Exhibits... 27 J. Appendices... 27 2

MEDICAL APPENDICES Appendix 1: Performance Guarantees MEDICAL QUESTIONNAIRES Vendors MUST complete ALL of the Questionnaires applicable to the coverage(s) quoting and include them in the proposal(s). Medical ASO Questionnaire Fully Insured Medicare Advantage Questionnaire Medical Questionnaire Utilization Management Questionnaire Disease Management Questionnaire Wellness Programs Questionnaire Medical Proposal Exhibits MEDICAL RESPONSE EXHIBITS Vendors MUST complete ALL of the Exhibits applicable to the coverage(s) quoting and include them in the proposal(s). Exhibit 1: Exhibit 2: Exhibit 3: Exhibit 4: Exhibit 5: Exhibit 6: Exhibit 7: Exhibit 8: Exhibit 9: Exhibit 10: Exhibit 11: Exhibit 12: Proposal Response Form Submission Checklist Network Accessibility List of All New Mexico Hospitals Hospital Contracts Network Data Request - Professional Geo Access Report Disruption Analysis Proposed Cost Exhibits Self-Insured Plans: to include Stop Loss coverage. Proposed Cost Exhibits Fully Insured Medicare Advantage Plans Proposed Cost Exhibits- Fully Insured & Partial Self- Insured Plans Signature Page 3

A. Current Plan Information MEDICAL CURRENT PLANS / VENDORS / FUNDING ARRANGEMENTS Please refer to the charts below for an overview of San Juan College s medical plan information. Stop Loss Coverage. Stop loss will be a part of this RFP process. Prescription Drug Coverage. Prescription Drug coverage should be proposed as well. San Juan College Website: www.sanjuancollege.edu Medical Medical Rx Vendor Plans Tier Structure Funding Contributions Eligibility Presbyterian Health Plan 1. HMO Option 2. PPO Option Built into the Medical Premium Single EE + Spouse EE + Child(ren) Family Same as Medical Fully Insured Same as Medical Salary <50K 80% 50K-60K 70% >60K 60% Same As Medical Same as Medical Presbyterian Health Plan Preferred Care $1000/20% PPO Plan In- Network Out Of Network Annual Deductible $1000/$2000 $2000/$4000 Coinsurance 20% 40% PCP Office Visit $20 40% Specialist Office Visit $35 40% Preventive Care Charge 40% Annual OOP Limit $3500/$7000 $7000 ($14,000) Deductible included in OOP OOP includes coinsurance, copay and RX OOP includes coinsurance, copay and RX Lifetime Plan Maximum ne ne Inpatient Hospital 20% Coinsurance 40% Coinsurance Outpatient Surgery 20% Coinsurance 40% Coinsurance Emergency Room 20% Coinsurance 20% Coinsurance Urgent Care Facility $30 Copay $30 Copay RX Retail Generic/ Tier 1- $10 copay Preferred Brand Drugs Tier 2- $35 copay n-preferred Drugs Tier 3- $55 copay Specialty Tier 4-20% up to max. of $400 per prescription RX Mail Order Tier 1- $20 Tier 2- $87.50 Tier 3- $165 4

Presbyterian Health Plan Smart Care $750/$30 HMO Plan In- Network Annual Deductible $750/$1500 Coinsurance 20% PCP Office Visit $25 Specialist Office Visit $40 Preventive Care Charge Annual OOP Limit $3250/$6500 Deductible included in OOP Lifetime Plan Maximum ne OOP includes coinsurance, copay and RX Inpatient Hospital 20% Coinsurance subject to Deductible Outpatient Surgery 20% Coinsurance subject to Deductible Emergency Room $120 Urgent Care Facility $40 RX Retail Generic/ Tier 1- $10 copay Preferred Brand Drugs Tier 2- $35 copay n-preferred Drugs Tier 3- $55 copay Specialty Tier 4-20% up to max. of $400 per prescription RX Mail Order Tier 1- $20 Tier 2- $87.50 Tier 3- $165 CENSUS The Acknowledgment of RFP must be completed and submitted as instructed in order to receive the census. Once the Acknowledgment has been received the Census, Current Plan Information, Rates, and Claims Data will be sent to the Carrier. 5

B. Proposed Plan Design Options CONTRACT EFFECTIVE DATES The effective date of the new medical contracts will be: January 1, 2016 PROPOSED PLAN DESIGNS The College would consider offering one plan that at a minimum would parallel and duplicate the Smart Care $750 (HMO) combined with the Preferred Care $1000 (PPO). Dual Option Quotes should be based on giving the employee an option of two plans (HMO, PPO). The first option the employer would contribute based on current contribution strategy and the second buy-up option the difference in cost would be paid entirely by the employee. Medicare Advantage Plans should be quoted for post 65 retirees. Please include pharmacy options/quotes in your proposal. Please include COBRA administration fees. Self Insured Quotes- For Active and Retiree Population based on Census. Based on proposed plan designs above. Please quote specific and aggregate stop loss. Please include pharmacy options/quotes in your proposal. Please include COBRA administration fees. Partial- Self Insured Quotes- For Active and Retiree Population based on Census. Based on proposed plan designs above. This should include built in stop loss at the individual and aggregate levels. This should also summarize the premium saving/return options. Please include pharmacy options/quotes in your proposal. For all Medical carriers and eligible TPAs, fees and rates are requested for the coverages outlined above. In the event you are not able to provide all coverages requested, respond with those you are able to offer. Please include the difference in rates or ASO fees if two carriers are selected to provide benefits to the members of San Juan College. Please propose the ASO rates based on the participation requirement for the rates quoted. Please include COBRA administration fees. 6

Disease Management (Must be OPTIONAL only) 1. Do NOT include ANY Disease Management services in your core administrative fees. 2. Disease Management must be quoted as an optional service. San Juan College will decide on its own whether or not it wishes to select the DM package. It may be that they do not elect the DM package. 3. Your DM program must include the core package of DM conditions indicated below. This core package is an exclusive package (i.e., all of the conditions noted below must be included in your core DM program.) Other conditions/services may be offered, but should not be included in the cost of the core package Core DM Package must include all of the following conditions: a) Diabetes b) COPD c) Asthma d) CAD e) Chronic back f) Depression 4. Vendors can provide quotes for additional DM conditions/services; however, the fees for these additional/optional services should be provided separately (i.e., should NOT be included in the fee for the above-referenced, core DM package). Wellness Programs (Must be OPTIONAL only) 1. Do NOT include wellness services in your core administrative fees. 2. Wellness programs must be quoted as an optional service. San Juan College will decide whether or not it wishes to offer wellness services. It may be that they opt not to offer wellness services. 3. Please include pricing for at least each of the following services: a) Health Risk Assessments b) Biometric Screenings c) Aggregated Reporting of Biometric Screenings d) Health Coaching 4. Vendors can provide quotes for additional services; pricing for all services must be noted in your cost exhibit. 7

Fully Insured Medicare Advantage Plans. Quote the following plan options: 1. All Medicare Advantage Plans quoted must contain the following elements: a) State-Wide Coverage. San Juan College will accept proposals for plans with less than state-wide coverage. However, please ensure the service area is clearly identified. b) Prescription Benefits. All plans must offer at least an equivalent to Medicare Part D with any enhancements clearly noted. c) Program To Assist Special Needs Population. All plans must perform outreach to new members to identify and assist special needs members in receiving appropriate subsidies or aide. d) Disease Management and/or Wellness Programs. All plans must contain clinical programs to assist members in staying healthy and/or managing their chronic illnesses. 2. Plan Design Please provide fully insured quotes for the following types of plan designs: a) Please provide quotes for fully insured Medicare Advantage products that are close to the requirements listed above in the fully insured section. A minimum of two plans should be quoted: one that provides full prescription coverage through the doughnut hole and one that does not. If you are unable to provide exactly the same benefit structure, please quote a plan that is as close as is possible and clearly note the differences. b) Alternative Plan Designs. Up to two additional Medicare Advantage plan designs may be quoted at the discretion of the Offeror based on Offeror s knowledge of market trends and benchmarks to other public employee retiree health programs. For example, a plan quote could include a state-wide or national PPO option. Additional Information: Proposals will be accepted from carriers, and qualified TPAs capable of offering all of the following services provided under one contractual arrangement: claims administrative services, provider network, utilization management and large case management, as well as Disease Management and Wellness (if selected). Proposals that would require a separate contractual arrangement for any of the services listed will NOT be considered. Respondents may respond to all or some of the plan designs/coverages contained in the RFP. All responses meeting the minimum requirements will be evaluated. The College may modify current benefits for 2016/2017. It is expected that the plan designs will remain relatively the same to proposed plan designs. Proposals MUST itemize fees as indicated in the RFP Proposed Cost Exhibits. 8

C. Medical ASO Questionnaire VENDORS MUST COMPLETE THE FOLLOWING QUESTIONNAIRE. SPECIFICATIONS 1. The claims administrator agrees that the claims and accompanying eligibility data produced in connection with all the claim payment activities on behalf of the client is and will be the property of the client. And, that the client retains the right to request the full and complete data in electronic format with proper notice and at no additional cost. 2. For any non-incumbent vendor, the existing administrator will pay run-out claims. Your pricing should assume no run-in claims payment. 3. You must provide access to all files on request (e.g., a claims audit) at no additional cost. Agree Agree Agree Disagree Disagree Disagree FIRM / ORGANIZATION 4. How many trained examiners do you employ at the site where claims will be paid? What is their average length of experience? What is the volume of claims paid per day per examiner? What is your average annual turnover? % 5. Show the number of employer groups you service, at your claims office, in each of the size categories below: 1,000 5,000 EEs 5,000 10,000 EEs 10,000 + EEs 6. Does your organization participate on a private exchange for New Mexico Large Employers? If yes, what exchange? 9

CLAIMS ADMINISTRATION SERVICES 7. For services covered but not eligible for reimbursement, confirm that network discounts are applied to any portion of the claim paid by the member. 8. List general categories of services that are not covered but for which discounts are available to the member, along with the average discount percentage for each category. 9. Which provisions of the current / proposed benefit plans would require manual intervention? 10 Do you anticipate any major claim / eligibility / reporting system changes or upgrades planned in the next 12 to 24 months? 11 For 2015 YTD, what percentage of New Mexico claims have been auto-adjudicated through your claim system? % 12 What was the average turnaround time for New Mexico paid claims for the last two years? 2014 2015 YTD 13 Indicate the New Mexico claims error rates for the last two years? 2014 2015 YTD 14 You agree to reimburse services provided outside of the U.S. Agree Disagree 15 Please respond to the following questions regarding Coordination of Benefits: Do you outsource this service? Does your claim system readily identify potential possible COB opportunities prior to claim payment? Do you (1) pend and pursue or, (2) pay and pursue these types of claims? 1 2 Can each SJC establish its own COB procedures? 10

16 What is the standard percentile used as a basis to determine UCR? % How often is UCR updated? 17 Does the same person handle both claims processing and customer service functions? 18 Confirm that if you fail to meet timely payment requirements for innetwork providers, neither patients nor the Plan will be liable. 19 Confirm that your system integrates prescription drug data for case management. How frequently is data integrated? 20 Confirm you utilize a claims quality assurance or review process. Do you have reviews conducted by an outside agency? 21 Confirm your system has edits for identification of fraudulent claims and provide statistics as to the results for 2015. 22 Audits: Agree Disagree What is the frequency of your internal audits? What is the frequency of your external audits? 23 At what trigger point do you conduct / require a hospital claim audit? 24 Briefly describe what community outreach services you provide to promote screenings, health awareness, flu shots, etc. 11

25 In the event of contract termination and you are not renewed for a new contract term, please confirm your acceptance of the following terminal fee arrangement: Agree Disagree You must quote an all-inclusive terminal administrative services fee as a function of the PMPM fee in place for the 12-month period immediately prior to date of termination. Furthermore, it is the intent of SJC that the total terminal fee will be determined based on average enrollment for the three months immediately preceding termination, and be paid in three monthly installments, beginning with the month following the date of termination. 26 After the runout period, how will you handle the following: Claims in house, but not processed? Claims submitted after the runout period? 27 Confirm that you will provide final reports consistent with your standard reporting to the Plan. SUBROGATION Agree Disagree 28 Briefly list what is included in your subrogation services. 29 Do you perform subrogation internally? Or, do you use an outside vendor? 30 Under what circumstances, or at what dollar threshold do you send a subrogation claim to an outside vendor? 31 Are you willing to allow each SJC to establish its own subrogation procedures? Internal External List any terms and conditions. 12

D. Fully Insured Medicare Advantage Questionnaire VENDORS QUOTING INSURED MEDICARE ADVANTAGE PLANS MUST COMPLETE THE FOLLOWING QUESTIONNAIRE. 1. To the extent renewals are based on experience, will experience be based on actual paid claims (rather than incurred or estimated incurred)? 2. For the first year and each renewal year, what periods of time will be used as the basis for determining renewal recommendations? Specify weightings to be applied to applicable periods. 3. Confirm that any adjustment for reserves will be supported by / aligned with current triangulation studies. 4. For the first year, how will reserves be developed? 5. Is your quote fully pooled / experience rated or have you proposed both? Pooled Experience Rated Blended Both If blended, specify percentage attributed to group's experience. % 6. In the event the account produces a deficit in any one year, will your company seek in any way or any amount to recoup the deficit? 7. How will received / anticipated Medicare premiums be reflected / accounted for in your renewal submission? 8. Relating to prescription drug coverage, how will received / anticipated Rx premiums be reflected / accounted for in your renewal submission? How will manufacturer's rebates and other payments be reflected / accounted for in your renewal submission? 9. With regard to any insured arrangements for Medicare-eligible retirees, confirm that you will include the following (as applicable) in your annual Renewal Rate Calculation: Paid claims amounts Benefit adjustment to current period Completion adjustment (paid to incurred) Member months exposed 13

Adjusted experience period incurred claims PMPM Trend Projected incurred claims PMPM Total retention Gross premium required PMPM Less CMS medical payments / premiums Less CMS Rx payments / premiums Less CMS Rx rebates Member premium PMPM Licensure / Accreditation 10. For your MA plan, please provide a copy of CMS accreditation. Confirm that the plan meets applicable NM and federal laws and regulations Copy of accreditation provided? Confirmed t confirmed Administration 11. MA plan commits to a January 1, 2016 effective date of coverage. 12. MA plan will have a designated account representative for SJC 13. MA plan understands that the SJC is singularly responsible for determining a member's eligibility to participate in retiree health plans. 14. Dual eligible individuals shall be enrolled as individuals as consistent with CMS requirements. 15. MA plan agrees that SJC may terminate a member due to failure to pay premiums or upon member request per CMS rules. 16. MA plan agrees to comply and perform CMS requirements of the Low Income Premium (LIPS) and Low Income Cost Sharing (LICS) programs. Agree Agree Agree Agree Disagree Disagree Disagree Disagree 14

Marketing 17. MA plan will be responsible for all marketing and enrollment costs and materials must be pre-approved by the SJC. Agree Disagree Coverages/Networks 18. MA plan will be responsible for the administration of Medicare Part D covered drugs and meet minimal CMS requirements. 19. MA plan will provide clinical preventative services consistent with CMS standards and US Preventative Services Task force recommendations. 20. MA is to provide Disease Management services consistent with CMS standards and provide a list of those programs offered in its proposal. 21. MA plan agrees to provide provider networks with a sufficient number of providers in the geographic locations that it serves consistent with CMS standards. 22. If MA offers a PPO plan, it agrees to meet the minimum CMS requirements for board certified physicians. 23. MA agrees to comply with CMS member-to-provider ratios and travel time requirements. 24. If MA must contact CMS due to a significant network change, it agrees to also report this to the SJC. Quality Management Agree Agree Agree Agree Agree Agree Agree Disagree Disagree Disagree Disagree Disagree Disagree Disagree 25. MA plan agrees to develop internal complaint and grievance procedures consistent with State, Federal and CMS standards. 26. MA agrees to comply with all aspects of HIPAA privacy and security standards. 27. MA agrees to have operational utilization review programs consistent with CMS requirements as well as have programs to address specific targeted cost control issues. 28. MA plan agrees to have patient care management and coordination protocols consistent with CMS standards. 29. MA plan agrees to have chronic care improvement plans in place consistent with CMS standards. Agree Agree Agree Agree Agree Disagree Disagree Disagree Disagree Disagree 15

30. MA plan agrees to provide operational, utilization and financial reports to the SJC consistent with CMS standards. Agree Disagree Plan Design 31. Indicate the type(s) of MA plans you are proposing. HMO New Mexico Other States PPO POS PFFA Other (specify) In how many states do you have one or more licensed MA plans? 16

E. Medical Questionnaire VENDORS MUST COMPLETE THE FOLLOWING QUESTIONNAIRE. GENERAL 1. Indicate any minimum requirement for employee / retiree and dependent participation. MEDICAL PLANS 2. Does your HMO / PPO plan require a referral from the PCP to a specialist? Does your network include the San Juan IPA? 3. Has your HMO / POS / PPO received NCQA / URAC accreditation? If yes NCQA URAC When? NCQA URAC Accreditation expiration date? NCQA URAC 4. Do your network hospitals participate in the Leapfrog Project? 5. Do you have established procedures for when a physician terminates, and a member is in mid-treatment with that physician? 6. Identify your HMO by type (e.g., IPA, Group, etc.). 7. Do you offer E-Visit or Telehealth services? If yes, please briefly answer the following: Average allowable fee? Usage in 2014, on a PMPY basis? Flexibility regarding copays and cost sharing? Please confirm if these services are subject to negotiated provider discounts. 17

8. Will you accept an enrollment form designed by the SJC? 9. How are your New Mexico Inpatient and Outpatient hospital providers reimbursed? Check ALL that apply INPATIENT Per diem Discounted fee for service Diagnostic Related Group Other (Describe) OUTPATIENT Per diem Discounted fee for service Diagnostic Related Group Other (Describe) 10. How are New Mexico physicians reimbursed? Check ALL that apply: Salary Per Capita Discounted fee for service Other (Describe) Is there any withhold on their payments? If yes, briefly describe how and when it is to be paid to them. 11. When the patient is referred outside the managed care network are claims paid at In-Network or Out-of-Network levels? In Network Out of Network NETWORK QUESTIONS 12. Do you anticipate network expansion or contraction in New Mexico to occur in 2015? If yes, briefly describe. 13. Do your New Mexico HMO / POS networks include the same providers (and hospitals)? Providers Hospitals 14. In 2013 YTD: How many providers chose to terminate participation? How many providers were terminated by you? 15. What was your New Mexico provider retention rate for 2014? 18

16. Are there any New Mexico locations where you are not able to support a PPO plan design? Please list. 17. Do participating network providers have a contractual agreement not to "balance bill" the patient? 18. With regard to network directories, please respond to the following items. Is your directory available on the Internet or in a website? If so, how often is the directory updated? How are members and plan sponsors notified of changes in the network? 19. Are you willing, in the future, to unbundle your New Mexico provider network should the SJC create its own provider network? 20. Please answer the following in relation to Provider Network Management: Do you provide Provider specific data / metrics in comparison to norms / best practices? If yes, how often Do you conduct outreach / education to providers identified as outliers? Do you monitor complaints / sanctions received by regulatory agencies? Do you develop and implement corrective action plans to address complaints and outlier providers? Do you supply your providers with tools and education relative to clinical best practices? 19

F. Utilization Questionaire VENDORS MUST COMPLETE THE FOLLOWING QUESTIONNAIRE. GENERAL QUESTIONS 1. Are your services local, national or international? (Check [X] only ONE.) Local only National, some states National, all states National, all states + international From what location(s) are services provided? 2. Does your UM program have an accreditation separate from your provider network? If yes, check all that apply Expiration Date URAC NCQA Other 3. Do you have educational material which informs enrollees regarding your UM services & procedures? (Check [X] only ONE.) All costs for such materials must be reflected on the Utilization Management Cost Exhibit. 20

PRE SERVICE REVIEW (PRECERTIFICATION) 4. Indicate the category of staff who can make final disapproval for a pre-service request. 5. Do you have a standard pre-certification requirement for any of the following? Clerical LPN / LVN RN Physician If, check [X] all applicable to your program: Hospitalizations Outpatient Surgery Specified Diagnostic Procedures Durable Medical Equipment Corrective Appliances / Prosthetics Skilled Nursing Facility Home Health Care Musculoskeletal Services (e.g., chiropractic) Medical Services (e.g., physical therapy) Inpatient Mental Health / Substance Abuse Outpatient Mental Health/Substance Abuse Other 6. Precertification includes the analysis & determination of which of the following (may check [X] more than one). Appropriate level of care (e.g., IP vs. OP) Reasonable length of stay of IP confinement Actual medical necessity & appropriateness of surgery or service being requested (e.g., does service require performance?) Necessity for the services of an assistant surgeon with each operative procedure analysis Necessity for a proposed preoperative hospital day Necessity for a proposed 23-hour observation stay following OP surgery Other (Explain) APPEAL / GRIEVANCE RECONSIDERATION PROCESS 7. Does your UM program comply with New Mexico Patient Protection Act? 21

CONCURRENT / CONTINUED STAY REVIEW 8. Does your firm perform concurrent review services? 9. Concurrent review staff are: New Mexico employees only National (non-new Mexico) employees only Combination of New Mexico and non-new Mexico employees CASE MANAGEMENT 10. Do you subcontract catastrophic case management services? If so, identify vendor. 11. During case management, does your staff negotiate fee reductions with providers and vendors? 12. Catastrophic case management staff are: New Mexico employees only National (non-new Mexico) employees only Combination of New Mexico and non-new Mexico employees REPORTING 13. What is the frequency of your standard reports? Monthly Quarterly Semi-Annually Annually Other 22

G. Disease Management Questionnaire DISEASE MANAGEMENT 1. Are your services local, national or international? (Check [X] only ONE.) Local only National, some states National, all states National, all states + international From what location(s) are services provided? 2. Does your DM program have an accreditation separate from your provider network? If yes, check all that apply URAC NCQA Other Expiration Date 3. Are the following reports available at no additional cost to the client? If so, indicate frequency next to your response. Cost savings reports Frequency: Utilization reports Frequency: 4. Provide three (3), preferably public sector, DM service references. 5. Do you proactively contact potential DM candidates without waiting for them to contact you? If so, how? (check ALL that apply) Telephone Email Letter 6. What DM interventions does your organization propose to provide? (Check [X] ALL that apply) Written communications Group education One-on-one interventions Telephone monitoring Clinical interventions Other proposed interventions (describe) 23

7. ASO carriers and TPAs providing bundled proposals must allow for DM services to be carved out. Agree Disagree If DM services are carved out, the vendor agrees to the carveout with no increase to the quoted administrative fees. Agree Disagree 8. Is your DM program developed internally, or provided through an outside vendor? Internally Outside Vendor Both If an outside vendor, indicate the name(s) and location(s) of the firm(s). 9. Are any in- or out-of-state Centers of Excellence required by your plans? If yes, provide details on the providers and locations. 10. What is the frequency of your program reports? Monthly Quarterly Semi-annually Annually Other 11. It is desired to establish ROI guarantees relative to disease management performance, whereby demonstrable savings will be measured and compared to a minimum threshold. Please respond to the following items: Confirm your ability and willingness to enter into a ROI guarantee. This metric would be expected to be measured / assessed annually. Agree Disagree Indicate the level of savings that you will be willing to guarantee, in the form of a ratio of savings (ROI) to disease management fees. Provide a brief description of the methodology that you will use in the measurement of savings along with an external validation of that methodology. 12. Has your DM program been audited by any outside firm for effectiveness? If yes, by whom and what date? 24

13. Number of your DM programs currently in effect? Nationally New Mexico H. Wellness Program Questionnaire 1 Confirm that no wellness programs are included in your basic ASO / TPA fees. If no, please provide details. 2 Optional wellness services must be noted, and associated PMPM fees quoted on the Wellness Cost Exhibit. Agree Disagree 3 List any accreditations or certifications that your wellness program currently has available. 4. If your program offers biometric screening, are you able to aggregate data and provide consolidated reports to clients for both external network providers and internal employees or outside contractors who administer required tests under your health plan? 5. Is onsite biometric screening done by an outside vendor? If yes, please identify. 6. Please indicate if the wellness services you are quoting include the following (check all that apply). Any additional costs must be reflected on the Wellness Cost Exhibit. Health Coaching (telephonic and/or online) Customized health risk assessment Premium web content and tools Advanced communications materials Discounted gym memberships Outbound calling to top 5% of high risk population Comprehensive reporting, including incentive reporting 25

7. Comprehensive promotion and communications materials and campaign support Please indicate if your Biometric Screening services include the following (check all that apply). Any additional costs must be reflected on the Wellness Cost Exhibit. Onsite screening events Includes clinical and educational staff Includes all travel considerations Educational materials and resources Includes all reports and data Integrates with Coaching and HRA Measures taken include Cholesterol, Blood Glucose, Blood Pressure, Body Fat and Tobacco Use 26

I. Medical Response Exhibits PROPOSAL RESPONSE FORM Complete Exhibit 1. SUBMISSION CHECKLIST Complete Exhibit 2. NETWORK ACCESS (PHYSICIANS AND HOSPITALS) Complete Exhibit 3 (3a, 3b, 3c). ALL NEW MEXICO HOSPITALS Complete Exhibit 4. HOSPITAL CONTRACTUAL PAYMENT FORM Complete Exhibit 5 (5a, 5b). NETWORK DATA REQUEST - PROFESSIONAL Complete Exhibit 6. GEO-ACCESS Provide a geo access as outlined in Exhibit 7. DISRUPTION ANALYSIS Complete Exhibit 8. COST ANALYSIS- SELF INSURED Complete Exhibit 9. (9a, 9b, 9c, 9d, 9e, 9f) COST ANALYSIS- MEDICARE ADVANTAGE Complete Exhibit 10 (10a). COST ANALYSIS- FULLY & PARTIAL SEF FUNDED Complete Exhibit 11. (11a, 11b, 11c, 11d) MEDICAL SIGNATURE PAGE Complete Exhibit 12. J. Appendices Medical Performance Guarantees Complete Appendix 1 27

MEDICAL RFP SECTION VIII EXHIBIT 1 Medical RFP Proposal Response Form VENDORS MUST COMPLETE THIS SECTION. Please check (X) the boxes for the coverages / services included in your proposal. Self-Insured Medical Plans Self-insured medical coverage for Active Employees and pre-medicare Retirees. Quote to include: administrative services, provider network, UM, LCM and Rx Self-Insured Medicare Supplement plan for Medicare Retirees Stop Loss Coverage RX Plans Disease Management Program for ALL Members Core DM Package Additional DM Services Wellness Services for ALL Members HRA Biometric Screening Additional Wellness Services Fully Insured Medical Advantage Plans for Medicare Retirees Fully Insured Medicare Advantage Plans Proposed Plan Designs Up to two (2) additional plan designs RX Plans Fully Insured Plans PPO Offerings based on Proposed Plans EPO/HMO Offerings based on Proposed Plans Dual Option Offerings (PPO & HMO) Up to two (2) additional plan designs RX Plans Partial Self Insured Plans PPO Offerings based on Proposed Plans EPO/HMO Offerings based on Proposed Plans Proposal includes quotes for the following: Dual Option Offerings (PPO & HMO) Up to two (2) additional plan designs Stop Loss Amounts/Rates Premium Saving Opportunity

MEDICAL RFP SECTION VIII EXHIBIT 1 Company Name / Title Date NOTE: Your typed name and date above will be considered a valid signature for this RFP. Contact information for questions related to your proposal. To whom should questions related to your proposal be directed? Name / Title Email Address Phone Number

Medical Submission Checklist MEDICAL RFP SECTION VIII EXHIBIT 2 This Submission Checklist is a summary of the forms and materials required as part of your proposal. You are urged to thoroughly read the entire RFP and complete the checklist to ensure compliance with the submission requirements. APPLICABLE TO ALL LINES OF COVERAGE Refer to Proposal Organization RFP Section III.A.1 Consideration RFP Section Reference Check if Included 1. Acknowledgement of RFP Form RFP Section II.A, and Appendix A 2. Included signed Letter of Transmittal RFP Section III. A 2 3. Included signed Campaign Disclosure Form RFP Section III.A and Appendix C 4. Provided all required materials As requested throughout RFP Sections I-V 5. Completed Minimum Requirements RFP Section VI 6. Completed General Questionnaire RFP Section VII APPLICABLE TO MEDICAL RFP (SECTION VIII) Consideration RFP Section Reference Check if Included 1. Completed and signed Medical Proposal Medical RFP, Exhibit 1 Response Form 2. Completed and signed Medical Submission Checklist (this document) Medical RFP, Exhibit 2 3. Reviewed and completed all Questionnaires as outlined in the Table of Contents Medical RFP, Questionnaires 4. Completed All Medical Response Exhibits as outlined in the Table of Contents Medical RFP, Response Exhibits 1-13 5. Reviewed and signed all Addenda Addenda as released 6. Formal proposal, including all items indicated above and all requested information. As requested in RFP Sections I-V, and Section VIII 7. Proposal copies submitted and distributed as RFP Section II, B 5 requested. 8. Provided all required materials, such as: As requested throughout the Website location for Provider directory Medical RFP Implementation plan 9. Medical Proposal submitted by deadline: 12:00 on M.D.T. on July 16, 2015. As requested in RFP Section II, A 10. CD of Reporting Samples RFP Section II, B 5 Company Date Name / Title

NETWORK ACCESS (PRIMARY CARE PHYSICIANS - PCPs) MEDICAL RFP SECTION VIII EXHIBIT 3a Please complete the yellow shaded areas of the chart by providing the number of Primary Care Physicians in each location. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration! Responding Company Name: PHYSICIANS (PCPs) HMO PPO # of PCPs # w/closed Practices # of PCPs # w/closed Practices Albuquerque, NM - Zip Code - 871 & 870 Farmington, NM - Zip Code - 874 Gallup, NM - Zip Code - 873 Las Vegas, NM - Zip Code - 877 Los Alamos, NM - Zip Code - 875 Santa Fe, NM - Zip Code - 875 Durango, CO - Zip Code - 813 Tucson, AZ - Zip Code - 857

NETWORK ACCESS (PHYSICIANS - SPECIALISTS) MEDICAL RFP SECTION VIII EXHIBIT 3b Please complete the yellow shaded areas of the chart by providing the number of Specialist Physicians in each location. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration! Responding Company Name: PHYSICIANS (SPECIALISTS) HMO PPO # of Specs # w/closed Practices # of Specs # w/closed Practices Albuquerque, NM - Zip Code - 871 & 870 Farmington, NM - Zip Code - 874 Gallup, NM - Zip Code - 873 Las Vegas, NM - Zip Code - 877 Los Alamos, NM - Zip Code - 875 Santa Fe, NM - Zip Code - 875 Durango, CO - Zip Code - 813 Tucson, AZ - Zip Code - 857

NETWORK ACCESS (HOSPITALS) MEDICAL RFP SECTION VIII EXHIBIT 3c Please complete the yellow shaded areas of the chart by providing the number of participating hospitals in each location. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration! Responding Company Name: HOSPITALS HMO PPO # of Hospitals # of Hospitals Albuquerque, NM - Zip Code - 871 & 870 Farmington, NM - Zip Code - 874 Gallup, NM - Zip Code - 873 Las Vegas, NM - Zip Code - 877 Los Alamos, NM - Zip Code - 875 Santa Fe, NM - Zip Code - 875 Durango, CO - Zip Code - 813 Tucson, AZ - Zip Code - 857 Mayo Clinic in Scottsdale/Phoenix, AZ - 85260

NEW MEXICO NETWORK HOSPITALS Please provide a list of all New Mexico hospitals participating in your network. List in alphabetical order. MEDICAL RFP EXHIBIT 4 Responding Company Name: Hospitals Currently in Network Street Address City Zip Code Will hospital be in network in 2016? = "x" Month/Year of next HMO PPO Network contract renewal

MEDICAL RFP EXHIBIT 5a Network Inpatient Hospital Data Request - By Area Based on your commercial book of business, provide Inpatient Hospital (in-network only) statistics as requested for markets indicated below BASED ON LOCATION OF SERVICE. Data should be provided on a PAID basis (i.e. regardless of incurred date) and should represent TOTAL charges and claims. Under no circumstance should any charges or claims be netted due to outlier provisions in your hospital contracts. In addition, the data to be provided should correlate to the product (e.g. PPO) you are proposing. Put simply, do not mix products that have different contractual allowances. Eligible Charges are total charges, less non-covered expenses, less duplicate charges, etc. (all net charges prior to contractual discounts). Allowable Charges represents the net claim payable (eligible charges less contractual discounts). This should be the gross amount payable by the plan/employer, employee, or other third parties (COB/Subrogation). Complete all yellow shaded areas. (DO NOT ALTER THIS DOCUMENT) te: There are multiple worksheets and multiple sections within each worksheet; ALL must be completed. Responding Company Name: Calendar Year 2015 (YTD) Inpatient Hospital Data 3 Digit Network Area Network Area Hospital Metropolitan Area Zip Code Eligible Charges Allowable Charges Bed Days Albuquerque, NM 870 & 871 Carlsbad, NM 882 Clovis, NM 881 Farmington, NM 874 Gallup, NM 873 Las Cruces, NM 880 Las Vegas, NM 877 Los Alamos, NM 875 Roswell, NM 882 Santa Fe, NM 875 Silver City, NM 880 Amarillo, TX 791 Dalhart, TX 790 El Paso, TX 799 Lubbock, TX 793

Calendar Year 2015 (YTD) Inpatient Hospital Data 3 Digit Network Area Network Area Hospital Metropolitan Area Zip Code Eligible Charges Allowable Charges Bed Days Durango, CO 813 Tucson, AZ 857 MEDICAL RFP EXHIBIT 5a Calendar Year 2014 Inpatient Hospital Data 3 Digit Network Area Network Area Hospital Metropolitan Area Zip Code Eligible Charges Allowable Charges Bed Days Albuquerque, NM 870 & 871 Carlsbad, NM 882 Clovis, NM 881 Farmington, NM 874 Gallup, NM 873 Las Cruces, NM 880 Las Vegas, NM 877 Los Alamos, NM 875 Roswell, NM 882 Santa Fe, NM 875 Silver City, NM 880 Amarillo, TX 791 Dalhart, TX 790 El Paso, TX 799 Lubbock, TX 793 Durango, CO 813 Tucson, AZ 857 Signature Date Print Name Title

Network Outpatient Hospital Data Request - By Area MEDICAL RFP SECTION VIII EXHIBIT 5b Based on your commercial book of business, provide Outpatient Hospital (in-network only) statistics as requested for markets indicated below BASED ON LOCATION OF SERVICE. Data should be provided on a PAID basis (i.e. regardless of incurred date) and should represent TOTAL charges and claims. Under no circumstance should any charges or claims be netted due to outlier provisions in your hospital contracts. In addition, the data to be provided should correlate to the requested product (e.g. PPO) you are quoting. Put simply, do not mix products that have different contractual allowances. Eligible Charges are total charges, less non-covered expenses, less duplicate charges, etc. (all net charges prior to contractual discounts). Allowable Charges represents the net claim payable (eligible charges less contractual discounts). This should be the gross amount payable by the plan/employer, employee, or other third parties (COB/Subrogation). Complete all yellow shaded areas. (DO NOT ALTER THIS DOCUMENT) te: There are multiple worksheets and multiple sections within each worksheet; ALL must be completed. Responding Company Name: Calendar Year 2015 (YTD) Outpatient Hospital Data 3 Digit Network Area Network Area Number Metropolitan Area Zip Code Eligible Charges Allowable Charges of Claims Albuquerque, NM 870 & 871 Carlsbad, NM 882 Clovis, NM 881 Farmington, NM 874 Gallup, NM 873 Las Cruces, NM 880 Las Vegas, NM 877 Los Alamos, NM 875 Roswell, NM 882 Santa Fe, NM 875 Silver City, NM 880 Amarillo, TX 791 Dalhart, TX 790 El Paso, TX 799

MEDICAL RFP SECTION VIII EXHIBIT 5b Calendar Year 2015 (YTD) Outpatient Hospital Data 3 Digit Network Area Network Area Number Metropolitan Area Zip Code Eligible Charges Allowable Charges of Claims Lubbock, TX 793 Durango, CO 813 Tucson, AZ 857 CY 2014 Outpatient Hospital Data 3 Digit Network Area Network Area Number Metropolitan Area Zip Code Eligible Charges Allowable Charges of Claims Albuquerque, NM 870 & 871 Carlsbad, NM 882 Clovis, NM 881 Farmington, NM 874 Gallup, NM 873 Las Cruces, NM 880 Las Vegas, NM 877 Los Alamos, NM 875 Roswell, NM 882 Santa Fe, NM 875 Silver City, NM 880 Amarillo, TX 791 Dalhart, TX 790 El Paso, TX 799 Lubbock, TX 793 Durango, CO 813 Tucson, AZ 857 Signature Date Print Name Title

Network Data Request - Professional MEDICAL RFP SECTION VIII EXHIBIT 6 For your in-network commercial book of business utilization, please provide your achieved (responding company's allowable charge) relationship to Medicare's CURRENT allowable charge for services received in the Zip Code areas shown. The data to be provided should correlate to the product (e.g. PPO) you are quoting. Put simply, do not mix products that have different contractual allowances. Eligible Charges are total charges, less non-covered expenses, less duplicate charges, etc. (all net charges prior to contractual discounts). Allowable Charges represents the net claim payable (eligible charges less contractual discounts). This should be the gross amount payable by the plan/employer, employee, or other third parties (COB/Subrogation). For example, if your professional allowable charges were $1,000,000 and the allowable charge under Medicare was $800,000, then the achieved relationship is 1.25 or 125% of Medicare. Complete all yellow shaded areas. (DO NOT ALTER THIS DOCUMENT) Responding Company Name: Calendar Year 2015 (YTD) Professional Services 3 Digit Achieved Number of Metropolitan Area Zip Code Relationship Claims Albuquerque, NM 870 & 871 Carlsbad, NM 882 Clovis, NM 881 Farmington, NM 874 Gallup, NM 873 Las Cruces, NM 880 Las Vegas, NM 877 Los Alamos, NM 875 Roswell, NM 882 Santa Fe, NM 875 Silver City, NM 880 Amarillo, TX 791 Dalhart, TX 790 El Paso, TX 799 Lubbock, TX 793 Durango, CO 813 Tucson, AZ 857

Calendar Year 2014 Professional Services 3 Digit Achieved Number of Metropolitan Area Zip Code Relationship Claims Albuquerque, NM 870 & 871 Carlsbad, NM 882 Clovis, NM 881 Farmington, NM 874 Gallup, NM 873 Las Cruces, NM 880 Las Vegas, NM 877 Los Alamos, NM 875 Roswell, NM 882 Santa Fe, NM 875 Silver City, NM 880 Amarillo, TX 791 Dalhart, TX 790 El Paso, TX 799 Lubbock, TX 793 Durango, CO 813 Tucson, AZ 857 MEDICAL RFP SECTION VIII EXHIBIT 6 Signature Date Print Name Title

Geo- Access Request MEDICAL RFP SECTION VIII EXHIBIT 7 VENDORS ARE TO PROVIDE A GEO-ACCESS REPORT AS OUTLINED BELOW: Using the census provided for San Juan College conduct an open practice geo-access analysis with the following assumptions. 1. Provide a geo-access analysis, by zip code, 2. Provider access standards are as follows: PCPs (to include: internists, family practitioners, OB/GYN, pediatricians and generalists) - 2 PCPs within 15 miles Specialists 1 Specialist within 15 miles Hospitals 1 Hospital within 30 miles PLEASE ALSO PROVIDE THE FOLLOWING REGARDING MENTAL HEALTH PROVIDERS: 1. Number of PhDs, MDs (Psychiatrists), LCSWs, RNs, and all Others. Provide number of each, broken out by Farmington Metro Area, and Overall (statewide). 1

DISRUPTION ANALYSIS - MEDICAL PROVIDERS MEDICAL RFP EXHIBIT 8 NETWORK COMPARISON OF MOST HIGHLY UTILIZED MEDICAL PROVIDERS Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration! Please complete by marking "x" each physician below who is currently in your network and who you expect to remain in your network in 2016. For those not in your network, please indicate at the bottom of the page, what steps you will take to add them to your network, along with time frames and guarantees. te: It is our assumption that any additional providers will be contracted at reimbursement rates comparable to those reflected by existing arrangements. Responding Company Name: Current Vendor - Presbyterian Health Plan Top Medical Providers Is physician currently in your Will physician be in network in network? = "x" 2016? = "x" Provider Name Provider ID # Address City State Zip HMO PPO HMO PPO NEED THIS INFORMATION FROM Presbyterian- REQUESTED

MEDICAL RFP EXHIBIT 8 Totals 0 0 0 0

PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLANS FOR ACTIVE EMPLOYEES, PRE-MEDICARE RETIREES & MEDICARE SUPPLEMENT RETIREES VENDORS INSTRUCTIONS This workbook contains multiple worksheets. Vendors are expected to complete all worksheets applicable to the plans / coverages being quoted. MEDICAL RFP SECTION VIII EXHIBIT 9 SELF-INSURED MEDICAL PLANS 1) Quote ALL fees on a per member per month (PMPM) basis. Do NOT quote on a per employee per month (PEPM) basis. PMPM = per member per month. A member is defined as any one individual or covered person such as an employee, retiree, spouse or child. DISEASE MANAGEMENT 1) Do NOT include ANY Disease Management services in your core administrative services fees. 2) Quote DM on an optional basis. 3) Your DM program must include the core package of DM conditions as outlined in the Medical RFP under "Proposed Plan Designs." - Additional DM services may be quoted; however, these fees must be provided separately. WELLNESS PROGRAMS 1) Do NOT include ANY wellness services in your core administrative services fees. 2) Quote wellness on an optional basis. 3) Quote wellness as outlined in the Medical RFP under "Proposed Plan Designs." SUBROGATION 1) Indicate if subrogation can be carved out. 2) Indicate the basis, fees, and or % of savings withheld for providing subrogation as part of the medical plan. REQUIRED TERMINAL RUN-OUT (NOTE: Will NOT apply if contract/agreement is awarded immediately after current term expires) Methodology: 1) Please quote your all-inclusive terminal administrative services fee, as a function of the PMPM fee in place for the 12-month period immediately prior to date of termination. (For example: terminal fee will be 2.0 times PMPM fee in effect for the month immediately prior to termination.) 2) Further, it is the intent of San Juan College that the total terminal fee will be determined based on average enrollment for the three months immediately prior to termination, and be paid in three equal installments for each of the three months, beginning with the month following the date of termination. ** FULLY INSURED MEDICARE ADVANTAGE PLANS. The fully insured Medicare Advantage plans are included in a separate Excel workbook.

PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLANS CORE ASO / TPA SERVICES MEDICAL RFP SECTION VIII EXHIBIT 9a Vendors must sign the spreadsheet below to indicate quotes comply with all of the following requirements: 1) Core administrative service fees are quoted on a Per Member Per Month (PMPM) basis. 2) Core administrative service fees must be fully bundled to include ALL of the services outlined below. 3) Do NOT include fees for Disease Management services in the core administrative fees. 4) Do NOT include fees for Wellness services in the core administrative fees. 5) Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration. CONFIRM THAT YOUR CORE ADMINISTRATIVE SERVICES FEE IS BUNDLED TO INCLUDE ALL OF THE FOLLOWING COMPONENTS Confirm by Checking [X] each cell Comments SET-UP FEE ADMINISTRATION FEES (PMPM) 1 Claims Administration Fee 2 Network Access Fees 3 Account Management 4 Customer Services 5 Member Services 6 Banking Fees / Financial Services 7 Information Technology 8 Utilization Management 9 Catastrophic Case Management 11 SPDs / Plan Documents 12 Claim Forms 13 Check Stock 14 EOBs 15 Reports (1) 16 HIPAA certificates (1) 17 ID Cards (1) 18 Postage 19 Printing 20 Preparation of information required for federal disclosure forms 21 Long Distance Phone Calls 22 Compliance 23 Corporate Profit/Surplus 24 Communications Costs (1) 25 Meeting Attendance (1) 26 Commissions NET 27 PPACA Appeals Process (Internal & External) 28 Other (Define) (1) As per Minimum Requirements We certify that our core administrative services fees include all services outlined above. Company Name Individual's Name & Title Signature

PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLANS PROPOSED PLAN DESIGN, FUNDING & CONTRIBUTION STRUCTURE MEDICAL RFP SECTION VIII EXHIBIT 9b 1) 2) 4) 5) 6) 7) Provide self-insured quotes for Active Employees, Pre-Medicare Retirees and Medicare Retirees - Provide CORE administrative service fees on a Per Member Per Month (PMPM) basis. PMPM rates MUST include ALL service components outlined in the prior exhibit. Medicare Advantage Retirees. A separate exhibit is provided for Fully Insured Medicare Advantage Plan Options. Disease Management. Do NOT include fees for Disease Management services in the core administrative fees. Wellness Services. Do NOT include fees for Wellness services in the core administrative fees. Plan Design. Quote should assume plans that are identical to, or very similar to, the current plans. Provide a separate worksheet outlining any plan deviations. & Additional Options Fee/Rate Guarantees. Fees/rates must be guaranteed for a minimum of two years. Fees/rates for Years 1 & 2 must be the same (i.e., there cannot be a rate increase in Year 2). - Maximum fee/rate increase caps must be provided for Years 3 & 4. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration. FUNDING ELIGIBLE MEMBERS CONFIRM THE FOLLOWING: Confirm that you do NOT charge a 1-time implementation/set-up fee Confirm that NO Disease Management services are included in your CORE admin fees Confirm that NO wellness services are included in your CORE admin fees RATES / FEES Single Carrier Self-insured Active Employees and Pre & Post Medicare Retirees (EXCLUDES SJC HDHP) * PMPM Fee (Includes all components outlined in prior exhibit) YEARS 1 & 2 YEAR 3 Active EEs & Pre & Post Medicare Retirees Active EEs & Pre & Post Medicare Retirees YEAR 4 Active EEs & Pre & Post Medicare Retirees PMPM Fee Stop Loss- Individual Amount / Cost Stop Loss- Aggregate Amount / Cost Dual Carrier PMPM Fee Stop Loss- Individual Amount / Cost Stop Loss- Aggregate Amount / Cost MULTIPLE LINES OF COVERAGE - DISCOUNT Self-insured fees? Fully insured premiums? If you are selected as the vendor for the medical plans as well as dental and/or vision, what if any, impact will this have on your:

PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLANS MANDATORY UTILIZATION MANAGEMENT MEDICAL RFP SECTION VIII EXHIBIT 9c UTILIZATION MANAGEMENT - EDUCATIONAL MATERIALS: COSTS Respond to the following questions regarding possible fees associated with Utilization Management. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration. UM QUESTIONS / POSSIBLE FEES Educational Materials Do you have educational material which informs enrollees regarding your UM services & procedures? (Check [X] only ONE.) Check [X] only ONE Cost Comments, available at no additional cost, available with an added cost (indicate cost to right) Cost = $, but can develop at no added cost, but can develop with an added cost (indicate cost to right) Cost = $, not available

PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLANS DISEASE MANAGEMENT MEDICAL RFP SECTION VIII EXHIBIT 9d 1) Quote DM Services for self insured plans 2) PMPM Fees. Provide CORE DM administrative service fees on a Per Member Per Month (PMPM) basis. 3) Optional Program. You must provide a quote for DM services; however, it is an optional service. 4) Core DM Package. The DM program must include the core package of DM conditions as outlined in the Medical RFP - "Proposed Plan Designs. " - This is an exclusive package to include services for the following conditions: (1) Diabetes, (2) COPD, (3) Asthma, (4) CAD, (5) Chronic back and (6) Depression. - Other DM conditions/services may be offered, but these should NOT be included in the cost of the core package and must be quoted separately. 5) Wellness Services. Do NOT include fees for Wellness services in the Disease Management fees. 6) Fee/Rate Guarantees. Fees/rates must be guaranteed for a minimum of two years. Fees/rates for Years 1 & 2 must be the same (i.e., there cannot be a rate increase in Year 2). - Maximum fee/rate increase caps must be provided for Years 3 & 4. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration. DISEASE MANAGEMENT FUNDING ELIGIBLE MEMBERS CONFIRM THE FOLLOWING: Confirm that you do NOT charge a 1-time implementation/set-up fee Confirm that NO DM services are included in your CORE admin fees CORE DM PACKAGE: TO INCLUDE THE SIX (6) CONDITIONS OUTLINED ABOVE RATES / FEES Services available to ALL Members covered under self-insured medical plans Active Employees, Pre- & Post Medicare Retirees YEARS 1 & 2 YEAR 3 YEAR 4 Active EEs & Pre & Post Medicare Retirees Active EEs & Pre & Post Medicare Retirees Active EEs & Pre & Post Medicare Retirees Single Carrier PMPM Fee Dual Carrier PMPM Fee ADDITIONAL DM SERVICES List below any additional conditions/services you offer. These services should NOT be included in the above-quoted rates and must be quoted separately. YOU MAY ADD/INSERT ROWS AS NEEDED

PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLANS WELLNESS PROGRAMS MEDICAL RFP SECTION VIII EXHIBIT 9e 1) Quote Wellness Services for ALL self-insured plans 2) PMPM Fees. Provide wellness service fees on a Per Member Per Month (PMPM) basis. 3) Optional Program. Wellness must quoted as an optional service. 4) Wellness Services. Include pricing for at least the following services: (1) Health Risk Assessments and (2) Biometric Screenings. - Other conditions/services may be also be offered/quoted. 5) Disease Management. Do NOT include fees for DM services in the Wellness fees. 6) Fee/Rate Guarantees. Fees/rates must be guaranteed for a minimum of two years. Fees/rates for Years 1 & 2 must be the same (i.e., there cannot be a rate increase in Year 2). - Maximum fee/rate increase caps must be provided for Years 3 & 4. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration. WELLNESS SERVICES FUNDING ELIGIBLE MEMBERS CONFIRM THE FOLLOWING: Confirm that you do NOT charge a 1-time implementation/set-up fee Confirm that NO wellness services are included in your CORE admin fees WELLNESS SERVICES/FEES RATES / FEES Available to ALL Members covered under self-insured medical plans Active Employees, Pre & Post Medicare Retirees YEARS 1 & 2 YEAR 3 YEAR 4 Active EEs & Pre & Post Medicare Retirees Active EEs & Pre & Post Medicare Retirees Active EEs & Pre & Post Medicare Retirees Health Risk Assessments Biometric Screenings Aggregated Reporting Health Coaching ADDITIONAL WELLNESS SERVICES What optional wellness services are available and what are the PMPM costs for these services? YOU MAY ADD/INSERT ROWS AS NEEDED

PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLANS MISCELLANEOUS / ADD-ON ADMINISTRATIVE SERVICES MEDICAL RFP SECTION VIII EXHIBIT 9f Miscellaneous / Add-On Administrative Service Fees. Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration. MISCELLANEOUS SERVICES SUBROGATION 1) Confirm that subrogation is included in your core services. 2) What is the fee structure (e.g., percentage of savings, built into ASO fee, etc.) and amount of your standard subrogation procedures? 3) If the SJC elects to have an outside agency perform the subrogation services (i.e., it is carve out), how will this impact your admin fees? TERMINAL RUN-OUT (See vendor instructions for details.) 1) Factor Terminal run-out fee will equal your factor multiplied by applicable PMPM fee. ON-LINE ELIGIBILITY MAINTENANCE 1) If you offer on-line eligibility maintenance, is there an additional charge? If so, provide fees. 2) Is there a charge for hard copy maintenance? If so, provide fee(s). ID CARDS 1) Is there a charge for replacement cards? If so, provide fee(s). 2) Additional cost to add Client Name and Logo? If so, provide fee(s). Comments

PROPOSED COST EXHIBITS: FULLY INSURED MEDICARE ADVANTAGE PLANS VENDORS INSTRUCTIONS MEDICAL RFP SECTION VIII EXHIBIT 10 This workbook contains multiple worksheets. Vendors are expected to complete all worksheets applicable to the plans / coverages being quoted. MEDICARE ADVANTAGE PLANS: FULLY INSURED MEDICARE ADVANTAGE PLANS All Medicare Advantage Plans quoted must contain the following elements: a) Prescription Benefits. All plans must offer at least an equivalent to Medicare Part D with any enhancements clearly noted. b) Program To Assist Special Needs Population. All plans must perform outreach to new members to identify and assist special needs members in receiving appropriate subsidies or aide. c) Disease Management and/or Wellness Programs. All plans must contain clinical programs to assist members in staying healthy and/or managing their chronic illnesses. Plan Design Please provide fully insured quotes for the following types of plan designs: b) Plan Design Options. Up to two Medicare Advantage plan designs may be quoted at the discretion of the offeror based on offeror s knowledge of market trends and benchmarks to other public employee retiree health programs. For example, a plan quote could include a state-wide or national PPO option.

PROPOSED COST EXHIBITS - MEDICARE ADVANTAGE OPTIONS FOR RETIREES FULLY INSURED MEDICARE ADVANTAGE PLANS: VENDOR CHOICE OF PLAN DESIGN MEDICAL RFP SECTION VIII EXHIBIT 10a Provide fully insured quotes for up to two (2) Medicare Advantage plan designs of your choice. 1) Provide a Plan Description for each proposed plan. 2) Quotes are for plan year (1/1/2016 through 12/31/2016). 3) If you are able to provide a guaranteed multi-year rate, please indicate so and provide the rates. FUNDING ELIGIBLE MEMBERS PREMIUMS FULLY INSURED MEDICARE ADVANTAGE [VENDOR CHOICE] PLANS 1/1/2016 through 12/31/2016 Additional rate guarantee period Fully insured Medicare Retirees Comments 1) PLAN 1 Your Plan's Name: Monthly Premium Single Rate (Whether Retiree, Spouse or Child) 2) PLAN 2 Your Plan's Name: Monthly Premium Single Rate (Whether Retiree, Spouse or Child) QUESTIONS: 1) Retention Illustration (Year 1) PMPM % of Premium Indicate to what degree you are willing to guarantee retention: Program Administration a) In subsequent years, as a percentage Network Access Fees b) Actual caps after being converted to PMPM amounts Premium Taxes Required Employee Communications Required Meeting Attendance Contracts / SPDs Commissions NET of commissions NET of commissions Risk Charge Profit Other (explain) TOTAL * If premiums are impacted, please duplicate this worksheet and complete with the discounted premiums. Please label the worksheet as appropriate. Be specific and address variations by enrollment brackets.

PROPOSED COST EXHIBITS: FULLY INSURED MEDICAL PLANS VENDORS INSTRUCTIONS MEDICAL RFP SECTION VIII EXHIBIT 11 This workbook contains multiple worksheets. Vendors are expected to complete all worksheets applicable to the plans / coverages being quoted. MEDICAL PLANS: FULLY INSURED All Medicare Advantage Plans quoted must contain the following elements: a) Proposed Plan Design b) Prescription Benefits c) Disease Management and/or Wellness Programs. All plans must contain clinical programs to assist members in staying healthy and/or managing their chronic illnesses. Plan Design Please provide fully insured quotes for the following types of plan designs: b) Plan Design Options. Up to two additional plan designs may be quoted at the discretion of the offeror based on offeror s knowledge of cost saving measures while limiting employees out of pocket at time of service.

PROPOSED COST EXHIBITS - FULLY INSURED PROPOSED PLAN DEIGNS FULLY INSURED PLANS: PROPOSED PLAN DESIGN MEDICAL RFP SECTION VIII EXHIBIT 11a Provide fully insured quotes for the two PROPOSED PLAN DESIGNS 1) Provide a Plan Description for each proposed plan. 2) Quotes are for 1/1/2016 through 12/31/2016. 3) If you are able to provide a guaranteed multi-year rate, please indicate so and provide the rates. FUNDING ELIGIBLE MEMBERS PREMIUMS FULLY INSURED PROPOSED PLANS Fully insured ALL MEMBERS- May or May not Include Over 65 Retirees 1/1/2016 through 12/31/2016 Additional rate guarantee period Comments 1) EPO/ HMO Plan Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family 2) PPO Plan Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family QUESTIONS: 1) Retention Illustration (Year 1) PMPM % of Premium Indicate to what degree you are willing to guarantee retention: Program Administration a) In subsequent years, as a percentage Network Access Fees Premium Taxes Required Employee Communications Required Meeting Attendance Contracts / SPDs Commissions NET of commissions NET of commissions Risk Charge Profit Other (explain) TOTAL * Please Provide Copies of Summary of Benefiits on all Plans Quoted

PROPOSED COST EXHIBITS - FULLY INSURED PLAN DESIGNS FULLY INSURED PLANS: VENDOR CHOICE OF PLAN DESIGN MEDICAL RFP SECTION VIII EXHIBIT 11b Provide fully insured quotes for up to two (2) VENDOR CHOICE PLAN DESIGNS 1) Provide a Plan Description for each proposed plan. 2) Quotes are for 1/1/2016 through 12/31/2016. 3) If you are able to provide a guaranteed multi-year rate, please indicate so and provide the rates. FUNDING ELIGIBLE MEMBERS PREMIUMS FULLY INSURED PROPOSED PLANS Fully insured ALL MEMBERS- May or May not Include Over 65 Retirees 1/1/2016 through 12/31/2016 Additional rate guarantee period Comments 1) OPTION 1 Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family 2) OPTION 2 Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family QUESTIONS: 1) Retention Illustration (Year 1) PMPM % of Premium Indicate to what degree you are willing to guarantee retention: Program Administration a) In subsequent years, as a percentage Network Access Fees Premium Taxes Required Employee Communications Required Meeting Attendance Contracts / SPDs Commissions NET of commissions NET of commissions Risk Charge Profit Other (explain) TOTAL * Please Provide Copies of Summary of Benefiits on all Plans Quoted

PROPOSED COST EXHIBITS - PARTIAL SELF INSURED PLAN DEIGNS PARTIAL SELF INSURED PLANS: PROPOSED PLAN DESIGNS MEDICAL RFP SECTION VIII EXHIBIT 11c Provide partial self insured quotes for two PROPOSED PLAN DESIGN 1) Provide a Plan Description for each proposed plan. 2) Quotes are for 1/1/2016 through 12/31/2016. 3) If you are able to provide a guaranteed multi-year rate, please indicate so and provide the rates. FUNDING ELIGIBLE MEMBERS PREMIUMS PARTIAL SELF INSURED PROPOSED PLANS Partial Self Insured ALL MEMBERS- May or May not Include Over 65 Retirees 1/1/2016 through 12/31/2016 Additional rate guarantee period Comments 1) EPO/ HMO Plan Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family 2) PPO Plan Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family QUESTIONS: 1) Retention Illustration (Year 1) PMPM % of Premium Indicate to what degree you are willing to guarantee retention: Program Administration a) In subsequent years, as a percentage Network Access Fees Premium Taxes Required Employee Communications Required Meeting Attendance Contracts / SPDs Commissions NET of commissions NET of commissions Risk Charge Profit Other (explain) TOTAL 2) Premium Saving Return 3) Individual Stop Loss 4) Aggregate Stop Loss * Please Provide Copies of Summary of Benefiits on all Plans Quoted

PROPOSED COST EXHIBITS - PARTIAL SELF INSURED PLAN DEIGNS PARTIAL SELF INSURED PLANS: VENDOR CHOICE MEDICAL RFP SECTION VIII EXHIBIT 11d Provide partial self insured quotes for the two VENDOR CHOICE PLANS 1) Provide a Plan Description for each proposed plan. 2) Quotes are for 1/1/2016 through 12/31/2016. 3) If you are able to provide a guaranteed multi-year rate, please indicate so and provide the rates. FUNDING ELIGIBLE MEMBERS PREMIUMS PARTIAL SELF INSURED VENDOR CHOICE PLANS Partial Self insured ALL MEMBERS- May or May not Include Over 65 Retirees 1/1/2016 through 12/31/2016 Additional rate guarantee period Comments 1) OPTION 1 Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family 2) OPTION 2 Your Plan's Name: Monthly Premium Employee Only Rate Employee + Spouse Rate Employee + Child(ren) Family QUESTIONS: 1) Retention Illustration (Year 1) PMPM % of Premium Indicate to what degree you are willing to guarantee retention: Program Administration a) In subsequent years, as a percentage Network Access Fees Premium Taxes Required Employee Communications Required Meeting Attendance Contracts / SPDs Commissions NET of commissions NET of commissions Risk Charge Profit Other (explain) TOTAL 2) Premium Saving Return 3) Individual Stop Loss 4) Aggregate Stop Loss * Please Provide Copies of Summary of Benefiits on all Plans Quoted

MEDICAL RFP SECTION VIII EXHIBIT 12 MEDICAL SIGNATURE PAGE VENDORS MUST COMPLETE THIS SECTION. All deviations from the specifications and other standards included in the RFP MUST be specifically outlined and defined in this section of the RFP. An Officer of your organization must sign this Signature Page. In the absence of any identified deviations, your organization will be bound to all of the terms and conditions outlined in the RFP. We certify that our proposal complies with the contents of this Request for Proposal, unless noted in the following list of exceptions. 1. 2. 3. 4. 5. 6. Company Name: Name: Title: Phone Number: E-mail Address: Signature: Date: NOTE: In the case of an electronic proposal submission, your typed name and date above, will be considered a valid signature for this RFP. 1

PERFORMANCE GUARANTEES - MEDICAL MEDICAL RFP SECTION VIII APPENDIX 1 Performance standards are to be San Juan College specific and not include the entire block of the contractor s business. The Performance Guarantee penalties apply to self-funded plans. The penalty assessments for fully insured plans will be determined upon negotiation of final contract terms. San Juan College reserves the right to verify the information provided. Measurements, criteria, and penalties shown here are Proposed only. Permanent measurements, criteria, and penalties will be based on RFP and final negotiations. PROPOSED PERFORMANCE GUARANTEES - MEDICAL PERFORMANCE SERVICE AREA STANDARD DEFINITION MEASUREMENT FREQUENCY/ CRITERIA PENALTY Medical Claims Processing Self-Funded Claims processing accuracy 95% The percentage of audited SJC claims processed accurately. Calculated as the total number of audited claims processed with error, divided by the total number of audited claims. Definition of error includes any type of error (e.g., procedural, system, payment (etc.), whether a payment or nonpayment error. Each type of error is counted as one full error and no more than one error can be assigned to one claim. Quarterly, with monthly reporting to SJC. Based on randomly selected statistical audit sample results..5% of quarterly ASO fee E:\RFP-Request for Proposals\RFP\Health Care Insurance\15-32025\Appendix 1 - Medical+Performance+Guarantees.docx 1

PERFORMANCE SERVICE AREA STANDARD DEFINITION MEDICAL RFP SECTION VIII APPENDIX 1 MEASUREMENT FREQUENCY/ CRITERIA PENALTY Financial payment accuracy Turnaround time (TAT) Telephone response time Abandonment rate Timely and accurate report delivery. Medical Claims Processing 99.00% The percentage of audited SJC claims dollars paid accurately. Calculated as total audited paid dollars minus the absolute value of over- and underpayments, divided by total audited paid dollars 93% of all claims processed within 14 days with payment to providers, Members within the next 7 days Average speed of answer within 30 seconds or less t to exceed 5% SJC will identify reports that are to be supplied, month, quarterly, and annually. Should require a monthly report of all claims affected by retroactive terminations or other eligibility changes. The percentage of claims processed within a specified number of calendar days. TAT is measured from the date the claim is received by Contractor to the date it is processed (i.e., paid, denied, or pended for external information) Customer Service The amount of time that elapses between the time a call is received into the phone system to the time answered by a representative (live voice answer). Percentage of calls that are unanswered calls (i.e., caller hangs up. Account Management Quarterly, with monthly reporting to SJC. Based on randomly selected statistical audit sample results. Quarterly, with monthly reporting by computer generated report to SJC. Quarterly, with monthly reporting to SJC with specific results Quarterly, with monthly reporting to SJC with specific results Self-Funded.5% of quarterly ASO fee.5% of quarterly ASO fees All Funding Types.5% of quarterly ASO fees.5% of quarterly ASO fees All Funding Types SJC receipt TBD $500 per late OR incorrect report E:\RFP-Request for Proposals\RFP\Health Care Insurance\15-32025\Appendix 1 - Medical+Performance+Guarantees.docx 2

MEDICAL RFP SECTION VIII APPENDIX 1 PERFORMANCE SERVICE AREA ID card turnaround time STANDARD 100% Within 10 working days of receipt of the eligibility information DEFINITION The amount of time elapsed from the date of receipt of eligibility information to the date ID cards are mailed to members. MEASUREMENT FREQUENCY/CRITERIA Quarterly TBD PENALTY E:\RFP-Request for Proposals\RFP\Health Care Insurance\15-32025\Appendix 1 - Medical+Performance+Guarantees.docx 3