Exhibit 10.26
*** INDICATES MATERIAL HAS BEEN OMITTED PURSUANT TO A CONFIDENTIAL TREATMENT
REQUEST FILED WITH THE SECURITIES AND EXCHANGE COMMISSION. A COMPLETE COPY OF
THIS AGREEMENT HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE
COMMISSION.
AMENDMENT TO VARIOUS AGREEMENTS BETWEEN UNITED
HEALTHCARE INSURANCE COMPANY AND ADMINISTAFF OF TEXAS, INC.
WHEREAS, United HealthCare Insurance Company ("United HealthCare") and
Administaff of Texas, Inc. ("Administaff") entered into certain agreements
establishing a minimum premium arrangement ("Minimum Premium Arrangement") for
the provision of medical and dental benefits to Administaff Inc.'s employees;
and
WHEREAS, those agreements were the Security Deposit Agreement (effective
December 21, 2001), the Minimum Premium Administrative Services Agreement ("MP
Services Agreement") (effective January 1, 2002), and the Minimum Premium
Financial Agreement ("MP Financial Agreement") (effective January 1, 2002); and
WHEREAS, United HealthCare and Administaff have agreed to amend the Agreements;
NOW THEREFORE, the Security Deposit Agreement, the MP Services Agreement and MP
Financial Agreement are amended as follows effective as of the dates indicated
below:
The Security Deposit Agreement
1. Section 1 of the Security Deposit Agreement is amended to delete the third
sentence and substitute the following:
Effective December 31, 2003, the required Security Deposit shall be
Seventeen Million, Five Hundred Thousand and No/100 Dollars ($17,500,000).
On or before January 31, 2004, United HealthCare shall remit to
Administaff the excess of the actual Security Deposit as of December 31,
2003 over the required $17,500,000.
2. Effective June 20, 2003, Section 1 of the Security Deposit Agreement is
amended to add the following as a new paragraph at the end of Section 1.
Upon Administaff's request, United HealthCare and Administaff will
negotiate in good faith the terms of an agreement under which a premium
stabilization reserve or its equivalent ("PSR") held by United HealthCare
would be substituted for all or some of the Security Deposit provided for
herein. Any such PSR would, when combined with the remaining Security
Deposit, if any, provide United HealthCare the same overall level of risk
protection as the Security Deposit existing at the time of such PSR
negotiation.
The MP Financial Agreement
1. Effective April 1, 2002, section 1(s) of the MP Financial Agreement is
amended by adding the following sentence at the end:
The additions, deletions and substitutions agreed to by the Employer and
the Company shall be reflected on Exhibit D.
2. Effective January 1, 2004, the MP Financial Agreement is amended by adding
a new section 2(e) to provide as follows:
(e) Removal of Dental Benefits. Effective January 1, 2004, the Agreement
shall not include or provide dental benefits under the Minimum
Premium Arrangement, and shall be construed to be so amended,
including the following changes: (i) the definition of "Health
Benefits" in section 1(i) shall not include dental benefits, (ii)
the Maximum Monthly Employer Benefit Obligation described in section
1(m) shall be calculated without including the Dental Policy, (iii)
"Policy" as defined in section 1(s) shall not include the Dental
Policy or any other policy providing dental benefits to Employees,
(iv) "Non-MP Policy as defined in section 1(p) shall not include the
Dental Policy or any other policy providing dental benefits to
Employees, and (v) the MP Premium described in section 3(a) shall be
calculated without including the Dental Policy. The Company shall
cause the dental benefits to be so removed in a manner consistent
with funding and accounting actions required upon termination of the
Agreement as set forth in Exhibit A, including the Company's (I)
funding of dental claims incurred under the Dental Policy prior to
January 1, 2004, but paid on or after such date, (II) issuance of a
final accumulated surplus/deficit accounting with respect to the
Dental Policy as a Final Termination Review within 195 calendar days
of December 31, 2003, and (III) adjustment of the IBNR Reserve in a
manner consistent with the Final Termination Review with respect to
the Dental Policy; provided that the Company shall issue an
accumulated surplus/deficit accounting with respect to the Dental
Policy as an Initial Termination Review by February 15, 2004.
(f) After December 31, 2003, the Dental Policy (or any policy providing
dental benefits) shall not be included in any determination of
Accumulated Surplus or Accumulated Deficit or in any Initial or
Final Termination Review required under Exhibit A, except for the
Initial and Final Termination Reviews with respect to the Dental
Policy described in section 2(e).
3. Section 1(m) of the MP Financial Agreement is amended effective January 1,
2003, by deleting the provisions of section 1(m) in their entirety and
substituting the following provision:
2
(m) "Maximum Monthly Employer Benefit Obligation" for an Arrangement
Month shall be the amount determined in Exhibit D hereto. The
Maximum Monthly Employer Benefit Obligation for an Arrangement Month
(other than the first Arrangement Month of an Arrangement Quarter)
shall be increased by the amount by which the Maximum Employer
Benefit Obligation in the prior Arrangement Month exceeded the
Health Benefits Paid in that Month.
4. Section 3(a) of the MP Financial Agreement is amended effective January 1,
2003, by deleting the provisions of section 3(a) in their entirety and
substituting the following:
(a) MP Premium. The MP Premium for the Policies for the Arrangement
Month shall be the amount determined pursuant to Exhibit D hereto.
The MP premium is due on the first day of the Arrangement Month to
which it applies. As provided in section 1(v) of the Agreement, the
MP Premium may include any adjustments authorized in Exhibit E of
the MP Administrative Services Agreement in respect of previous
Arrangement Months including any additions, terminations or changes
in coverage not known at the beginning of the Arrangement Month to
which such MP Premium applies.
5. Effective January 1, 2004, Exhibit A to the MP Financial Agreement is
amended by deleting section 1 and substituting the following:
The Policies. The Employer has entered into a Minimum Premium Arrangement
covering certain of the Company's insurance policies or HMOs. The
Arrangement covers those Policies identified in section 1(s) of the
Agreement. The Company has also issued Non-MP Policies to the Employer
which policies are not subject to the Minimum Premium Arrangement; these
policies are identified in Exhibit B.
6. Effective January 1, 2004, Exhibit A to the MP Financial Agreement is
amended by adding a new Appendix II, and by deleting the first sentence in
section 2.a and substituting the following:
A monthly composite rate for the Policies and the Non-MP Policies
collectively ("Monthly Payable Rate") is established for each Arrangement
Quarter as provided in this Exhibit A, and effective January 1, 2004, as
further provided in Appendix II to this Exhibit.
7. Effective January 1, 2004, Exhibit A to the MP Financial Agreement is
amended by adding the following provisions after the first paragraph of section
4.a:
In addition, effective January 1, 2004, in setting the Monthly Payable
Rate, the Company shall take into account an Accumulated Deficit or
Accumulated Surplus no earlier than the first Arrangement Quarter
beginning 90 days after the
3
Quarterly Review. In the case of an Accumulated Deficit, the Company shall
recover such Accumulated Deficit over no fewer than *** successive
Arrangement Quarters beginning at least 90 days after the Quarterly
Review; provided, however, that if the Accumulated Deficit as of the end
of an Arrangement Quarter that is the subject of the Quarterly Review
exceeds *** of the "Aggregate Premiums" for such Arrangement Quarter, the
Company may recover such Accumulated Deficit over fewer than ***
Arrangement Quarters. For this purpose, "Aggregate Premiums" for an
Arrangement Quarter shall be the product of (A) the Monthly Payable Rate
for such quarter, (B) the number of Employees covered under the Policies
and Non-MP Policies as of the 15th of the last month of the preceding
Arrangement Quarter, and (C) three (3).
8. Effective October 1, 2003, section 6.h of Exhibit A to the MP Financial
Agreement is amended by deleting the second and third sentences thereof and
substituting the following sentence:
The Expense Percentage for the Policies and the Non-MP Policies is set
forth in Exhibit D to the Agreement.
9. Effective January 1, 2003, the MP Financial Agreement is amended by adding
new Exhibit D, attached hereto.
MP Services Agreement
1. Effective January 1, 2004, the MP Services Agreement is amended by
deleting section 6(b)(iii) and substituting the following:
except as provided in Exhibit F to the Agreement, each Employee is offered
concurrently no more than *** option in addition to the Company's dental
benefit plan (where offered);
2. Effective January 1, 2004, section 6 of the MP Services Agreement is
amended to add the following sentence at the end of subsection (b).
For purposes of this section (6)(b), "the Plan" shall mean the plan of
benefits provided by the Employer under both the Policies and the Non-MP
Policies.
3. Effective January 1, 2004, the MP Services Agreement is amended by
deleting section 8(b) and substituting the following:
In the event that a state or other jurisdiction, in accordance with
existing or future law, imposes upon the Company the duty to act as agent
for collection of any Tax imposed on the Plan or the Employer or with
respect to any aspect of the Plan, a Policy, a Non-MP Policy, the MP
Financial Agreement, or the Agreement, the Employer will pay over any such
amount to the Company when requested to do so by the Company, subject to
receipt by the Employer from the Company of
4
prompt notice concerning such matter and exercise by the Employer of its
rights as stated under subsection 8(a) above.
4. Effective January 1, 2004, Exhibit F of the MP Services Agreement is
amended to add the following to the end of section A:
For purposes of this Exhibit F, "Employees" shall include employees of the
Employer covered under Non-MP Policies as well as the Policies.
5. Effective June 20, 2003, Exhibit F of the MP Services Agreement is amended
by adding the following new section 8:
8. Process for Considering Alternative Vendors in Special Markets
a. Effective January 1, 2004, the special procedures for alternate
vendors described in this section 8 shall apply to the following
markets ("Special Markets"):
i. ***
ii. ***
iii. ***
iv. ***
v. ***
vi. ***
b. The Employer and the Company shall discuss in detail whether and
upon what terms the offering of vendors other than the Company
("Alternate Vendors") in the Special Markets would be a viable
alternative to the current approach in any or all of the Special
Markets, including but not limited to, the following:
i. pricing, product and other competitive information;
ii. the specific advantages expected to be gained from
offering an Alternate Vendor;
iii. the anticipated process and terms for introducing and
offering an Alternate Vendor's product, including price,
contribution, product and benefit plan design
differences, and employee vs Client selection process;
and
iv. whether some combination of different or additional
Company offerings would best serve the Employer,
5
c. Following these discussions, the Employer may offer an Alternate
Vendor in a Special Market without regard to notice and cure
provisions of section 5 of this Exhibit F. Any vendor changes made
by the Employer pursuant to this section shall be memorialized in an
amendment to this Exhibit F. Taking into account the discussions
with the Employer, the Company's existing offerings, and the size
and product distribution of the existing membership in the Special
Market, the Company shall elect one of the following:
i. Continue to offer to the Employer an *** and/or ***
option at the Client level. (All co-employees of a
Client would be offered ***.);
ii. Continue to offer to the Employer an *** and/or ***
option at the employee level, where Clients may elect
more ***.
iii. Discontinue offering any option to the Employer in the
Special Market.
d. If the Employer offers one or more Alternate Vendors in a Special
Market, this change in product offering may result in changes in the
Monthly Payable Rate, Quoted Premiums or premiums of Non-MP
Policies; provided however that any such rate or premium change for
a Special Market would not be effective before the later of (i) the
date the Alternate Vendor's coverage becomes effective and (ii) the
first of the month following 30 days advance written notice of such
rate or premium change by the Company to the Employer.
UNITED HEALTHCARE ADMINISTAFF OF
INSURANCE COMPANY TEXAS, INC.
By: /s/ Simeon Schindelman By: /s/ Richard Rawson
------------------------------ -----------------------------
Authorized Signature Authorized Signature
Name: Simeon Schindelman Name: Richard Rawson
Title: President, Small Business Title: President
Date:11/9/04 Date: December 3, 2004
6
EXHIBIT A
APPENDIX II
METHODOLOGY FOR ESTABLISHING MONTHLY PAYABLE RATES
1. Paragraph 2 of Exhibit A of the MP Financial Agreement provides that the
Company will establish for each Arrangement Quarter the Monthly Payable
Rate, a monthly *** rate for the Policies and the Non-MP Policies
collectively (for purposes of this Appendix II, the "MPR"), which rate
will then be used to establish the monthly premiums for the Policies and
Non-MP Policies. Certain components of the Company's methodology for
determining the MPR for an Arrangement Quarter are reflected in a rate
calculation worksheet that is provided by the Company to the Employer when
the Company communicates the new MPR to the Employer pursuant to section
4.a of Exhibit A ("Rate Calculation Worksheet"),
2. Effective for the Arrangement Quarter beginning January 1, 2004, the
methodology used by the Company for establishing the MPR shall include the
following components:
a. In estimating future PEPM claims, the Company shall utilize (i) the
claims paid in the *** months preceding the month in which the MPR
is established, and (ii) the covered Employee headcount for the ***
month period beginning two months before the *** month period used
in item (i) (such two-month earlier period hereinafter referred to
as the "Base Period"). For example, assuming the MPR for the second
Arrangement Quarter of 2004 is established by the Company in
December 2003, the Company would use the paid claims experience from
*** through ***, and the covered Employee headcount for the period
*** through ***.
b. Any adjustment to the MPR due to changes in health cost risk factors
shall be actuarially justifiable (i.e., using credible database and
tools agreed upon by Employer and Company). The Company's tabular
data used to make the adjustments shall be documented and discussed
in the
Rate Calculation Worksheet, and the Company shall not change such
tabular data more frequently than annually.
c. The Company shall apply rate adjustments to reflect changes in the
following health cost risk factors between the Base Period and the
Arrangement Quarter for which the MPR is being developed.
(Continuing the example from subparagraph (a), the base period is
*** through *** and Arrangement Quarter for which the MPR is being
developed is the second Arrangement Quarter of 2004.)
i. Age
ii. Gender distribution
iii. Family size distribution
iv. Geographic distribution
v. Enrollment distribution by plan type (HMO, PPO, etc)
vi. Plan design changes
d. In estimating future PEPM claims, the Company shall apply cost
change trend factors for medical claims and prescription drug claims
separately. In addition, the trend period will be the period between
the mid-point of the Base Period and the mid-point of the
Arrangement Quarter for which the MPR is being developed.
e. The Company shall establish trend factors based on a reasonable
assessment of risk and cost changes in projecting future medical and
prescription drug claims. The Company shall limit the change in
trend factors used to project medical and prescription drug claims
to an increase of *** above the trend factors used to establish the
Monthly Payable Rate for the prior Arrangement Quarter. This change
in trend factor limitation will not be applicable if:
(i) the Employer modifies its management practices such that, for
the Arrangement Month in which the
trend factor is established, there has been (a) more than a
*** increase in the number of Clients (as defined in the MP
Services Agreement) with less than *** enrollees over the
number of such Clients in the last month of the immediately
preceding Arrangement Quarter, or (b) more than a *** increase
in the number of COBRA enrollees over the number of COBRA
enrollees covered in the last month of the immediately
preceding Arrangement Quarter , or
(ii) for the Arrangement Month in which the trend factor is
established, the age/gender factor has increased more than ***
over the factor for the last month of the immediately
preceding Arrangement Quarter.
In the event the threshold in any of the conditions listed in (i) or (ii)
above is exceeded, the trend factors used to project medical and
prescription drug claims may be increased up to *** above the trend
factors used in the immediately preceding Rate Calculation Worksheet.
f. The Company shall reflect administration, profit/risk charge, and
premium tax as separate items in the Rate Calculation Worksheet.
3. The Company may change the rate setting methodology described in this
Appendix II upon 180 days notice to the Employer.
4. The Company shall report to the Employer in detail on the establishment of
the MPR in the Rate Calculation Worksheet.
EXHIBIT B - NON-MP POLICIES
The insurance policies, HMO contracts and similar arrangements on the following
list are considered "Non-MP Policies" for purposes of the Agreement. Such list
shall be deemed modified by the Current Policy List provided by the Company as
part of the Quarterly Review, unless the Employer objects within 30 calendar
days of receipt.
UNET POLICY
NUMBER MARKET EFFECTIVE DATE TERMINATION DATE
- --------------------------------------------------------------------------------------------------
Select HMO - Downstate New York
701648AA ACTIVE 01/01/02
701648AB COBRA 01/01/02
701648B ACTIVE w/o Dental 01/01/04
701648BQ COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Select HMO - New Jersey
701648AC ACTIVE 01/01/02
701648AD COBRA 01/01/02
701648BR ACTIVE w/o Dental 01/01/04
701648BS COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Select HMO - Illinois
701648AE ACTIVE 01/01/02
701648AF COBRA 01/01/02
701648BT ACTIVE w/o Dental 01/01/04
701648BU COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Select HMO - Texas
701648AG ACTIVE 01/01/02 12/31/03
701648AH COBRA 01/01/02 12/31/03
- --------------------------------------------------------------------------------------------------
Select HMO - Upstate New York
701648BJ ACTIVE 01/01/02
701648BK COBRA 01/01/02
701648DS ACTIVE w/o Dental 01/01/04
701648DT COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Florida
701648AI ACTIVE 01/01/02
701648AJ COBRA 01/01/04
- --------------------------------------------------------------------------------------------------
UNET POLICY
NUMBER MARKET EFFECTIVE DATE TERMINATION DATE
- --------------------------------------------------------------------------------------------------
701648BZ ACTIVE w/o Dental 01/01/04
701648C COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Arizona
701648AP ACTIVE 01/01/02
701648AT COBRA 01/01/02
701648CS ACTIVE w/o Dental 01/01/04
701648CT COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Ohio
701648AX ACTIVE 01/01/02
701648BA COBRA 01/01/02
701648CU ACTIVE w/o Dental 01/01/04
701648CV COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Georgia
701648BB ACTIVE 01/01/02
701648BC COBRA 01/01/02
701648CY ACTIVE w/o Dental 01/01/04
701648CZ COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Kentucky
701648BD ACTIVE 01/01/02
701648BE COBRA 01/01/02
701648D ACTIVE w/o Dental 01/01/04
701648DL COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Texas
701648BF ACTIVE 01/01/02
701648BG COBRA 01/01/02
701648DN ACTIVE w/o Dental 01/01/04
701648DP COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Utah
701648BL ACTIVE 01/01/02
701648BN COBRA 01/01/02
701648DU ACTIVE w/o Dental 01/01/04
701648DV COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Missouri
- --------------------------------------------------------------------------------------------------
UNET POLICY
NUMBER MARKET EFFECTIVE DATE TERMINATION DATE
- --------------------------------------------------------------------------------------------------
701648BP ACTIVE 01/01/02
701648BX COBRA 01/01/02
701648DX ACTIVE w/o Dental 01/01/04
701648DY COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Arkansas
701648CA ACTIVE 01/01/02
701648CB COBRA 01/01/02
HMO Choice - Arkansas
701648DZ ACTIVE w/o Dental 01/01/04
701648E COBRA w/o Dental 01/01/04
- ------------------------------------------------------------- ------------------------------------
Choice HMO - Mississippi
701648CC ACTIVE 01/01/02
701648CD COBRA 01/01/02
701648EA ACTIVE w/o Dental 01/01/04
701648EB COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - District of Columbia
701648CG ACTIVE 01/01/02
701648CH COBRA 01/01/02
701648EE ACTIVE w/o Dental 01/01/04
701648EF COBRA w/o Dental 01/01/04
- ---------------------------------------------------------------- ---------------------------------
Choice HMO - Virginia
701648CI ACTIVE 01/01/02
701648CJ COBRA 01/01/02
701648EG ACTIVE w/o Dental 01/01/04
701648EH COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Tennessee
701648CE ACTIVE 01/01/02
701648CF COBRA 01/01/02
701648EC ACTIVE w/o Dental 01/01/04
701648ED COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Louisiana
701648BH ACTIVE 01/01/02
701648BI COBRA 01/01/02
- --------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------
UNET POLICY
NUMBER MARKET EFFECTIVE DATE TERMINATION DATE
- --------------------------------------------------------------------------------------------------
701648DQ ACTIVE w/o Dental 01/01/04
701648DR COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Colorado
701648AK ACTIVE 01/01/02
701648AN COBRA 01/01/02
701648CQ ACTIVE w/o Dental 01/01/04
701648CR ACTIVE w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Alabama
701648CN ACTIVE 01/01/02
701648CP COBRA 01/01/02
701648EK ACTIVE w/o Dental 01/01/04
701648EL COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Select EPO - Wisconsin
701648DI ACTIVE & COBRA 01/01/02
701648DI ACTIVE & COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Fairfax VA
701648CK ACTIVE 01/01/02
701648CL COBRA 01/01/02
701648EI ACTIVE w/o Dental 01/01/04
701648EJ COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Select EPO - South Carolina
701648DH ACTIVE & COBRA 01/01/02
701648DH ACTIVE & COBRA 01/01/04
w/o Dental
- --------------------------------------------------------------------------------------------------
Choice HMO - Iowa
701648AS ACTIVE 02/01/03
701648AU COBRA 02/01/03
701648EQ ACTIVE w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
UNET POLICY
NUMBER MARKET EFFECTIVE DATE TERMINATION DATE
- --------------------------------------------------------------------------------------------------
701648ER COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
Choice HMO - Rhode Island
701648AV ACTIVE 05/01/03
701648AY COBRA 05/01/03
701648ES ACTIVE w/o Dental 01/01/04
701648ET COBRA w/o Dental 01/01/04
- --------------------------------------------------------------------------------------------------
701648AZ Choice EPO - Indiana
ACTIVE & COBRA 08/01/03
- --------------------------------------------------------------------------------------------------
PRIME EFFECTIVE TERMINATION
POLICY # POLICYHOLDER DATE DATE
- ---------- -------------- ----------- -----------
247936 *** 1/1/2002
247974 *** 1/1/2002 5/28/2003
247977 *** 1/1/2002 3/1/2002
247989 *** 1/1/2002 5/27/2003
247996 *** 1/1/2002 9/1/2002
248003 *** 1/1/2002 3/1/2003
248006 *** 1/1/2002 1/22/2002
248026 *** 1/1/2002
248030 *** 1/1/2002
248035 *** 1/1/2002 1/1/2002
248041 *** 1/1/2002 2/1/2004
248056 *** 1/1/2002 1/11/2002
248063 *** 1/1/2002 1/1/2004
248110 *** 1/1/2002
248128 *** 1/1/2002
248131 *** 1/1/2002 10/1/2003
248133 *** 1/1/2002
248135 *** 1/1/2002 2/22/2002
248144 *** 1/1/2002 8/15/2003
248151 *** 1/1/2002 8/1/2002
PRIME EFFECTIVE TERMINATION
POLICY # POLICYHOLDER DATE DATE
- -------- ------------ --------- -----------
248163 *** 1/1/2002 1/1/2002
248165 *** 1/1/2002 7/1/2002
248180 *** 1/1/2002 6/1/2002
248197 *** 1/1/2002 11/1/2002
248208 *** 1/1/2002 6/16/2002
248241 *** 1/1/2002
248263 *** 1/1/2002 11/22/2002
248271 *** 1/1/2002
248291 *** 1/1/2002 3/4/2003
248306 *** 1/1/2002 5/1/2003
248314 *** 1/1/2002 9/4/2002
248324 *** 1/1/2002
248325 *** 1/1/2002 5/31/2002
248339 *** 1/1/2002 9/8/2003
248346 *** 1/1/2002
248352 *** 1/1/2002 3/30/2002
248370 *** 1/1/2002 6/1/2002
248371 *** 1/1/2002 4/28/2002
248372 *** 1/1/2002
248373 *** 1/1/2002 2/25/2002
248374 *** 1/1/2002
248375 *** 1/1/2002
248376 *** 1/1/2002 11/1/2002
248379 *** 1/1/2002 5/31/2002
248382 *** 1/1/2002
248384 *** 1/1/2002
248388 *** 1/1/2002
248390 *** 1/1/2002 6/26/2002
248396 *** 1/1/2002 4/15/2003
248399 *** 1/1/2002
248404 *** 1/1/2002 7/1/2002
248405 *** 1/1/2002
248407 *** 1/1/2002 12/2/2002
248408 *** 1/1/2002
248409 *** 1/1/2002
248410 *** 1/1/2002 7/1/2002
248411 *** 1/1/2002
248412 *** 1/1/2002 3/1/2002
248413 *** 1/1/2002 6/1/2003
248414 *** 1/1/2002
248415 *** 1/1/2002
248416 *** 1/1/2002
248417 *** 1/1/2002 6/12/2003
PRIME EFFECTIVE TERMINATION
POLICY # POLICYHOLDER DATE DATE
- -------- ------------ --------- -----------
248418 *** 1/1/2002
248421 *** 1/1/2002 6/1/2002
248429 *** 1/1/2002
248433 *** 1/1/2002 1/1/2002
248442 *** 1/1/2002
248457 *** 1/1/2002 1/1/2003
248463 *** 1/1/2002 10/26/2002
248466 *** 1/1/2002
248473 *** 1/1/2002
248474 *** 1/1/2002 6/15/2002
248478 *** 1/1/2002 8/8/2002
248480 *** 1/1/2002
248486 *** 1/1/2002
248494 *** 1/1/2002 4/1/2003
248495 *** 1/1/2002 7/1/2002
248497 *** 1/1/2002
248501 *** 1/1/2002
248516 *** 1/1/2002 1/1/2003
248519 *** 1/1/2002
248521 *** 1/1/2002 1/1/2003
248524 *** 1/1/2002 10/16/2002
248528 *** 1/1/2002
248532 *** 1/1/2002 2/1/2003
250136 *** 1/1/2002 7/1/2002
250197 *** 1/7/2002 7/1/2003
250201 *** 1/1/2002
250656 *** 1/1/2002 6/1/2003
250657 *** 1/1/2002 1/1/2003
250658 *** 2/1/2002
250659 *** 2/1/2002 2/1/2004
250660 *** 1/1/2002
250669 *** 2/15/2002 12/9/2002
252657 *** 3/1/2002
252926 *** 3/1/2002 6/1/2002
253683 *** 3/4/2002 3/18/2002
253774 *** 3/1/2002 2/19/2003
253775 *** 3/1/2002
253778 *** 2/27/2002 8/28/2002
254553 *** 4/1/2002 5/21/2002
254678 *** 4/1/2002 5/31/2002
254741 *** 4/1/2002
255675 *** 4/1/2002 10/9/2002
255701 *** 4/1/2002
PRIME EFFECTIVE TERMINATION
POLICY # POLICYHOLDER DATE DATE
- -------- ------------ --------- -----------
255709 *** 4/1/2002 4/1/2002
256410 *** 2/4/2002 2/4/2002
256498 *** 2/4/2002 8/12/2002
256505 *** 4/1/2002 1/2/2004
257668 *** 4/15/2002 5/2/2003
261873 *** 6/1/2002
262606 *** 7/1/2002 1/1/2003
262614 *** 6/1/2002
262616 *** 6/1/2002
262666 *** 6/1/2002 3/6/2003
263961 *** 6/7/2002 8/1/2002
264562 *** 7/1/2002
264565 *** 7/1/2002
266459 *** 7/28/2002 5/2/2004
266473 *** 7/28/2002
267825 *** 9/1/2002 3/3/2004
268747 *** 9/1/2002 1/15/2004
271606 *** 10/1/2002 1/1/2003
272924 *** 11/1/2002 5/1/2003
273651 *** 10/16/2002
274488 *** 11/20/2002 1/1/2003
277124 *** 1/1/2003
278257 *** 12/1/2002
279171 *** 1/1/2003 7/1/2003
279197 *** 1/6/2003 2/12/2004
279225 *** 12/15/2002 4/15/2003
281742 *** 1/1/2003
282005 *** 1/1/2003 12/1/2003
282007 *** 1/1/2003
282062 *** 1/6/2003 3/1/2004
286373 *** 2/1/2003
288802 *** 3/1/2003 3/2/2004
303058 *** 7/1/2003
303075 *** 5/1/2003
303083 *** 5/1/2003
310924 *** 5/22/2003
311776 *** 8/11/2003
314764 *** 7/1/2003
314770 *** 7/1/2003
315038 *** 7/1/2003 4/1/2004
326974 *** 9/1/2003
334639 *** 9/14/2003
338429 *** 10/1/2003
PRIME EFFECTIVE TERMINATION
POLICY # POLICYHOLDER DATE DATE
- -------- ------------ --------- -----------
345349 *** 9/1/2003
348740 *** 10/1/2003 3/1/2004
348746 *** 10/1/2003 3/1/2004
353316 *** 11/1/2003
369064 *** 1/1/2004
378384 *** 1/1/2004 1/1/2004
391528 *** 3/1/2004
395396 *** 3/1/2004
399283 *** 2/16/2004
400182 *** 2/16/2004
420189 *** 5/3/2004
421616 *** 6/1/2004
250579 *** 1/16/2002 5/1/2002
250671 *** 1/22/2002 3/4/2002
251016 *** 1/13/2002
256129 *** 3/1/2002 7/1/2002
256904 *** 1/1/2002 6/1/2002
256960 *** 3/20/2002 6/1/2002
257422 *** 3/26/2002 6/1/2002
257424 *** 4/9/2002 4/9/2002
259230 *** 4/2/2002 11/1/2002
259740 *** 4/14/2002 7/9/2002
260298 *** 4/2/2002 8/2/2002
260303 *** 4/16/2002 7/16/2002
263976 *** 4/3/2002 6/26/2002
265506 *** 6/20/2002 3/24/2003
265510 *** 6/1/2002 11/1/2002
265515 *** 6/1/2002 9/21/2002
265560 *** 6/1/2002 10/12/2002
268687 *** 7/1/2002 7/1/2002
268689 *** 8/8/2002 11/1/2002
268694 *** 7/24/2002 11/24/2002
269888 *** 8/1/2002 8/1/2002
269896 *** 8/1/2002 8/1/2002
269898 *** 8/1/2002 8/1/2002
269899 *** 7/18/2002 11/17/2002
274864 *** 10/15/2002 4/15/2003
274873 *** 10/16/2002 1/13/2003
274875 *** 10/16/2002 12/1/2002
274880 *** 10/16/2002 11/16/2002
274914 *** 10/16/2002 11/16/2002
275044 *** 9/12/2002 11/30/2002
280221 *** 12/1/2002 3/1/2003
PRIME EFFECTIVE TERMINATION
POLICY # POLICYHOLDER DATE DATE
- -------- ------------ --------- -----------
280224 *** 11/1/2002 2/1/2003
280225 *** 1/1/2003 7/1/2003
280327 *** 12/4/2002 6/4/2004
281701 *** 1/1/2003 10/3/2003
282549 *** 12/10/2002 2/10/2004
283649 *** 11/20/2002 2/20/2004
286556 *** 12/27/2002 9/1/2003
288804 *** 1/21/2003 6/4/2004
293814 *** 2/1/2003 5/27/2003
293891 *** 2/27/2003 12/1/2003
310933 *** 5/1/2003 11/1/2003
315060 *** 6/12/2003 7/1/2003
315099 *** 6/12/2003 10/1/2003
315132 *** 6/2/2003 10/1/2003
343286 *** 8/21/2003 12/17/2003
355898 *** 9/15/2003
360528 *** 9/1/2003 2/1/2004
373490 *** 11/11/2003
375159 *** 12/3/2003
386745 *** 2/1/2004
388711 *** 11/26/2003 1/1/2004
390767 *** 2/1/2004
390903 *** 2/6/2004
390937 *** 1/7/2004
397824 *** 3/3/2004
397852 *** 3/3/2004
397859 *** 3/3/2004
397876 *** 3/3/2004
397881 *** 3/3/2004 5/4/2004
398067 *** 3/3/2004
398089 *** 3/15/2004
398122 *** 3/3/2004
398159 *** 3/3/2004
406144 *** 2/19/2004
421429 *** 4/16/2004
421796 *** 5/6/2004
EXHIBIT D - POLICIES, RATES AND FACTORS
I. The definition of "Policy" for purposes of section 1(s) shall be as
follows:
- Effective January 1, 2002:
(i) Policy No. 701648 (Medical DA, DB, DC, DD, CX, DK)("Medical
Policy")
(ii) Policy No. 701648 (Dental DA)("Dental Policy")
- Effective April 1, 2002:
(i) Policy No. 701648 (Medical DA, DB, DC, DD, CX, DK)("Medical
Policy")
(iii) Policy No. 701648 (Dental DA)("Dental Policy")
- Effective January 1, 2003:
(i) Policy No. 701648 (Medical DA, DC, DD, CX, DK, AQ,
AR)("Medical Policy")
(ii) Policy No. 701648 (Dental DA)("Dental Policy")
- Effective January 1, 2004:
(i) Policy No. 701648 (Medical DA, DC, DD, CX, DK, AQ,
AR)("Medical Policy")
II. The "Maximum Monthly Employer Benefit Obligation" shall be the sum of the
following:
- Effective January 1, 2003:
- *** of the Quoted Premium for each Medical Policy
- *** of the Quoted Premium for each Dental Policy
- Effective October 1, 2003:
- *** of the Quoted Premium for each Medical Policy
- *** of the Quoted Premium for each Dental Policy
- Effective January 1, 2004:
- *** of the Quoted Premium for each Medical Policy
- Not applicable for any dental policy issued by the Company to
the Employer
III. The "MP Premium" shall be the sum of the following:
- Effective January 1, 2003:
- *** of the Quoted Premium for each Medical Policy
- *** of the Quoted Premium for each Dental Policy
- Effective October 1, 2003:
- *** of the Quoted Premium for each Medical Policy
- *** of the Quoted Premium for each Dental Policy
- Effective January 1, 2004:
- *** of the Quoted Premium for each Medical Policy
- Not applicable for any dental policy issued by the Company to
the Employer
IV. Effective October 1, 2003, the "Expense Percentage" shall be *** for the
Dental Policies, the Medical Policies and the Non-MP Policies providing
medical or dental benefits.