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EXHIBIT A <br /> ADMINISTRATIVE SERVICES AGREEMENT FEE SCHEDULE <br /> Renewed: July 1,2018 <br /> The Administrative Services Agreement entered into by Hall County and Mid-American Benefits, <br /> Inc.lists below the fees as required by The Employee Retirement Income Security Act of 1974(ERISA). <br /> The Claims Administrator will receive and pay, in accordance with the following schedule,fees, and <br /> commissions as reasonable compensation for services conducted in the ordinary course of business. <br /> For: Claims Administration Rates Paid To: <br /> Medical Admin Fee $19.00/EE/MO Claims Administrator <br /> Dental Admin Fee $ 2.50/EE/MO Claims Administrator <br /> Network Access Fee $ 5.00/EE/MO Claims Administrator <br /> Utilization Review(UR) Services $ 5.50/EE/MO Claims Administrator <br /> (Fees may change during a plan year depending upon access fees charged by PPO's and UR Companies) <br /> Prescription Drug Admin $ .73/Transaction PBM <br /> COBRA Admin Fee $ 1.25/EE/MO Claims Administrator <br /> UCS Claim Review 25%of Savings Review Vendor <br /> Subrogation Recovery Fee 25%of Recovery Subrogation Vendor <br /> Over Payment Recovery Fee 25%of Recovery Claims Administrator <br /> Out-of-Network Claim Negotiation 25%of Savings Negotiation Vendor <br /> Enrollment fee after 07/01/2018 $10.00/EE Claims Administrator <br /> COMMISSIONS: <br /> POLICY CARRIER % OF PREMIUM PAID TO <br /> Stop Loss Insurance Berkley Life Insurance Company None N/A <br /> I certify that the above represents a true and accurate disclosure of the distribution of fees and commissions <br /> for the Plan Year beginning July 1, 2018. <br /> Hall County Mid-American Benefits.Inc. <br /> 4 A-a etA 4Y1-41-8 0 1 <br /> VSignatur• Signature <br /> i <br /> i - hav S o /—t Matt Wullenwaber <br /> Printed N.me > Printed Name <br /> a� iL € _ .) President <br /> l itle Title <br /> / S72 June 14, 2018 <br /> Date Date <br /> 1 <br />