HomeMy WebLinkAboutBenefit Administrative Fees BENEFIT ADMINISTRATIVE SYSTEMS SCHEDULE B
Administrative & Ancillary Service Fees:
Contract Year 01/01/13- 12/31/13- City of Carmel
,COVERAGE" ,gn.. inPREMIUM 1,?431
Specific S/L, $150,000
Single Standard Security $43.85 per single, per month
Family Standard Security $119.89 per family, per month
(12.50%commission payable to Detrude; 2.50%to BAS)
Aggregate Premium Standard Security $8.70 per employee, per month
Specific Advance Fee BAS $1.00 per employee, per month
Aggregate Factors:
Single Standard Security $837.24 per single, per month
Family Standard Security $2,200.83 per family, per month
Administrative Fees:
Medical BAS $22.00 per employee, per month
Dental BAS $2.25 per employee, per month
Vision VSP $7.34 per employee, per month
Vision VSP $11.20 per employee+ 1, per month
Vision VSP $20.80 per family, per month
PPO Fee Sagamore& Beech Street$7.10 per employee, per month
U,R. Fee ACS Included Above
Flex BAS $5.50 per employee, per month
Debit Card BAS $2.00 per employee, per month
Debit Card Set-Up Fee BAS $500.00 Annual
Administrative Fee BAS $3,000.00 Annual
Benefit Informatics Platinum BAS $2.75 per employee, per month
Banking Fee BAS $100.00 per month
Subrogation Fee BAS 10% of Recovery
Signature Page Attached
Plan Sponsor: Date:
CITY OF CARMEL, INDIANA
By and throu• its Board of Public Works and Safety
-/ 9-/,2,
fine Brai ard, Presiding Offic- Date
/ _ L b 9-) 2
Mary An g ke, Bs-rd Member Date
/ /3 ,a71
Lori Watso :oard Member Date
ATTEST:
Di prly24,4414110
a Cordray, IA C, • lerk-Treasurer Date