d. Contract approval - Laserfiche WebLink

Attachment A Schedule Cass County Personnel Contract Period: January 1. 2008 through December 31,2008 Paid Claims Basis Stop-Loss insurance coverages are based on Plan Benefits incurred in the period January 1, 1984 through December 31, 2008 and paid during the Contract Period. Individual Stop-Loss Attachment Point is $65,000 per Member and the Aggregate Stop-Loss Attachment is 120% of expected Plan Benefits paid during the Contract Period. 1. Expected monthly enrollment levels: Single: Single Plus Dependent: Family: SC 100 8..()7 166 Contracts 76 Contracts 108 Contracts SC 100 OOA 8-07 1 Contracts o Contracts 2 Contracts DSC 225 193 Contracts 117 Contracts 2. Aggregate Stop-Loss Attachment Point per Subscriber: (x 12 for Contract Period) Single: $355.16 $366.88 Single Plus Dependent: 625.09 645.72 Family: 923.43 953.90 $52.80 137.70 3. Aggregate Stop-Loss Attachment Point. maximum administrative fees (net of BlueCardllP fees and compensation) and conversion coverage costs per Contract Period based on the figures shown in Section 1 and 2 above. Aggregate Stop-Loss Attachment Point: Maximum administrative fees and conversion coverage costs: $2,817,238 $194,389 (6.9% of Claims) 4. Monthly premium for stop-loss coverage (aggregate and individual): Single: $43.98 Single Plus Dependent: 77.38 Family: 114.32 $43.98 77.38 114.32 5. Summary of estimated Maximum Contract Period Cost at enrollment levels in Section 1 above: Aggregate Stop-Loss Attachment Point: Maximum administrative fees and conversion coverage costs: Stop-Loss coverage premium: Total Maximum Cost: $2,817,238 194,389 . 309,609 $3,321,236 In addition to the total maximum cost, applicable BlueCarcf'l fees and compensation will apply. The parties have caused thIs Agreement to be executed by their respective authorized officers. CASS COUNTY PERSONNEL Box 2806 Fargo, North Dakota 58108 BLUE CROSS BLUE SHIELD OF NORTH DAKOTA 4510 13th Avenue S Fargo. North Dakota 58121-0001 By: ~\\.^'"~ ....., ~k\o(:C~ Vice President, Actuarial Title; and Membership Services By: Title: Lh~rMon I Qu\\ CoLa~y Cbmtn;sr-;(Jr'I Date: RX: Creditable Group Numbers: 10033 Date: '6'" l"4 - O~ Includes all 2007 Rewrite