Committed to Helping You Better Meet Your Clients Needs Broker Guide

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Committed to Helping You Better Meet Your Clients’ Needs

2020 Broker Guide

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We want our brokers to know we care about their needs too. The programs and tools outlined in this guide demonstrate our commitment to helping you better serve your clients and grow your business.

These are just some of the many ways we’re here to help you along the way:

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A commission for Individuals, Small and Large Gr oup medical and dental contracts, Rx Program for Claims Based Business, in addition to Medicare employer contracts and Medicare Direct Pay Referral Bonus.

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Commissions on all new and existing Medicar e Advantage Group plan with prior certification and product training is required.

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Pharmacy Concierge Br oker Commission Program

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For every Small Gr oup plan, our enhanced online Univera on Demand

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comparison tool allows you to easily find and compare plans with suggested dental plans.

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More web tools to help you manage your business – monthly commission

reports, electronic Broker of Record submission option, online group enrollment & account maintenance, online bill pay, forms & applications, and much more.

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A steady stream of communications – including newsletters, tutorials, and industry updates – to help you stay informed about the latest news and product updates.

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Special pricing on life insurance pr oducts and Employee Assistance Programs.

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Impr ovements to our processes, including our new Annual Group Information Tool and streamlined processing with simpler underwriting guidelines and less paperwork.

Thank you for your continued support.

Best regards,

Arthur Wingerter President

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As healthcare continues to change and become more complex, we know your clients need more from their health plan

to meet the needs of their employees.

We care about helping you make the right choices to best meet those

ever-changing needs.

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Finding the right plan for your clients is easy with the online Univera on Demand

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tool

What’s new for 2020

• All Small Business quotes include Ancillary Products, including Dental, Lifetime Benefit Solutions Reimbursement Accounts and Vision. (image showing)

As part of our commitment to making your job easier, we provide the Univera on Demand Plan Comparison Tool – an online resource that allows you to view and compare medical and dental plan options in just a few clicks.

Univera on Demand includes packages for small businesses and direct pay members, including individuals &

families and sole proprietors. Features include:

• Administrative and COBRA services provided by our partner, Lifetime Benefit Solutions

• Shop our Univera Access plans for small groups

• Enhanced features on the Data Export Tool

• Less clicks required to Print your Package selections For Small Business

• Product type, metal levels, and other key variables

• Access Summary of Benefits & Coverage (SBC) for all Plan IDs and Mid-Segment Packages (MSPs)

• Package-level mapping and side-by-side comparisons

• Pre-populated rate sheets with Plan IDs and enrollment codes

• Print detailed benefit summaries and rates

• Obtain forms and other resources to request a rate quote & implement a group

• Easily search by either the type of plan or price range you’re looking for, and a number of plan options will instantly appear for a simple, side-by-side comparison

To use Univera on Demand, visit Broker.UniveraHealthcare.com Access detailed 2020

plan benefits and view side-by-side comparisons.

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Eligibility & Underwriting

• View group eligibility guidelines and what’s needed to enroll a new group

• View Annual Group Information Forms for your groups (must have broker access)

Training & Resources

• Sign up to attend a broker information session

• Register as Broker of Record and e-submit

• Learn about our new broker training Engage Members

• Download brochures, posters, online tours and more Our broker website also offers the following features and tools to help you manage your business.

Online Enrollment & Account Maintenance

• Enroll a new subscriber, add/remove family members, change coverage, view member roster, order ID cards, or reinstate a canceled policy

• Get applications, forms and instructions

• Get answers to membership and billing questions Commission & Reporting

• View our commission payment schedule

• Learn about our account reporting tools for small and large groups

Online Bill Pay

• View invoices & payment activity

• Get email notification of new invoices

• Create customized reports

• Pay invoices online with checking or savings accounts

When information comes to you, it’s easier to do business

With your busy schedule, it can be hard to stay up-to-date with the latest products, regulatory changes and industry news.

That’s why Univera Healthcare makes it easier to stay informed with ongoing communications and tools, including:

• Broker eblasts monthly

• Online product tutorials

• Product brochures, posters, toolkits and flyers

• Interactive sales tools like Univera on Demand^SM

• Dedicated Web site, including group enrollment tools

• Training and Information Sessions to help grow your business

More web tools

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Contact your Account Consultant or visit Broker.UniveraHealthcare.com 5

Information Consulting – better partnerships through better information

Our Information Consulting team is dedicated to providing easily accessible group reporting that supports an understanding of health plan experience, and helps target actionable improvement opportunities. Most reports are available online and can be scheduled monthly, quarterly, or annually based on group needs. Report eligibility varies with group size and funding, but can include the following:

• 50+ contract groups - utilization-based (non-financial) reports including topics such as emergency room utilization, prevalence of chronic conditions, telemedicine utilization, and generic fill rates

• 100+ contract experience rated groups – designated Information Consultant, utilization and financial reports, enrollment census reporting, out of pocket costs reports, claims vs. premium reporting, high cost claimant reports, online data cube for custom reporting on demand

• Claims based billing groups – all of the above, plus weekly billing detail, high claim early alerts, and detailed financial reports

• 50+ contract dental groups - financial and enrollment reports, claims vs premium reports, utilization reports including services by dental class and member utilization

• Claims based billing dental groups - all of the above and monthly claim detail to support billing

Additional online tools are available specifically for brokers, including a multigroup dashboard and multigroup data cube to support analysis, and a Monthly Rate Summary Report for community rated groups. For additional information contact us at general.ic@lifethc.com.

2020 Commission schedule

Base Medical Commission: Small Group (Includes HMO Business)

Product Description Commission

Off NY State of Health Exchange: Univera Access,

Univera Preferred Access, Healthy New York EPO 4%

On NY State of Health Exchange: Univera Access 4%

Base Medical Commission: Large Group (excludes HMO business)

Cumulative YTD Premium Commission

First $500,000 4.5%

$500,001 - $1,000,000 4.0%

$1,000,001 - $1,500,000 3.5%

$1,500,001 - $2,000,000 2.5%

$2,000,001 - $5,000,000 1.5%

$5,000,001 + 1.0%

Base Medical Commission: Individual Market

Off/On NY State of Health Exchange: Direct Pay Metal

Plans and Base $25 Per Contract Per Month (PCPM)

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6 Contact your Account Consultant or visit Broker.UniveraHealthcare.com

2020 Commission schedule (continued)

Base Dental Commission: New and Existing Community and Experience Rated Business

Cumulative YTD Premium Commission

First $20,000 12%

$20,001 - $30,000 10%

$30,001 - $40,000 8%

$40,001 - $50,000 6%

$50,001 - $100,000 5%

Greater than $100,000 2%

Bonus program

Medical Override Commission: New Business

New Medical Contracts New Medical Group Minimum Applicable Payout

100 - 249 contracts 2 new groups $15,000

1,000 - 1,499 contracts 4 new groups $100,000

1,500 or more contracts 5 new groups $150,000

• Broker must attain both new medical contract and new medical group minimum targets to qualify

• Qualifying new contracts are from prospect medical clients only; “growth on existing” does not count toward goal

• Quarterly payouts based on year-to-date performance and paid on Large Group (non-HMO) business only

• LBS business will be included in the calculation

Medical Override Commission: Retention of Business

Percentage of Medical Contracts Retained Applicable Payout Maximum Payout

95.0% 0.50% of in-force premium $50,000 per agency

98.0% 0.75% of in-force premium $75,000 per agency

• Calculation to include new medical business

• Annual payout based on year-end retention performance and paid on Large Group (non HMO) business only

Dental Override Commission: New Business

New Dental Contracts New Dental Group Minimum Applicable Payout

100 - 199 contracts 1 new group $2,000

500 or more contracts 1 new group $30,000

• Broker must attain both new dental contract and new dental group minimum targets to qualify

• Qualifying new contracts are from prospect dental clients only; “growth on existing” does not count toward goal

• Quarterly payouts based on year-to-date performance

Dental Override Commission Schedule: Retention of Business

Percentage of Dental Contracts Retained Applicable Payout Maximum Payout

95.0% 3% of in-force premium $20,000 per agency

98.0% 5% of in-force premium $40,000 per agency

• Calculation to include new dental business • Annual payout based on year-end retention performance

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Contact your Account Consultant or visit Broker.UniveraHealthcare.com 7

Claims Based Business Pharmacy Broker Commission Program

Commission Structure

Pharmacy Effective Date Commission (Per Script Per Month)

Prior to January 1, 2017 $ 0.60

Between January 1, 2017 and December 31, 2017 $ 0.85 Between January 1, 2018 and December 31, 2020 $ 1.00

Percent of Pharmacy Contracts Retained Applicable Payout

95.0% $ 0.10

• Book of business retention measurement will be calculated on a calendar year basis for each year following the initial qualification year for the commission payment. Brokers agencies would need to requalify for this additional payment annually.

Pharmacy Concierge Broker Commission Program

Commission Structure

Pharmacy Effective Date Commission (Per Member Per Month) Rx Concierge Level 1: Physician Detailing $ 0.25

Rx Concierge Level 2: Specialty Care Rx Management $ 0.25 Rx Concierge Level 3: Physician Detailing & Specialty

Care Rx Management $ 0.50

• Broker agencies appointed with the Univera Healthcare will be eligible for a per member per month commission for any self-funded and minimum premium groups who purchase the program.

• Schedule Effective January 1, 2020

• Pending DFS approval for minimum premium groups only

Medicare Group Commission

Medicare Supplemental 5% paid premium

Simply Prescription $5 per contract per month (PCPM)

• Applies to contracts for new and existing Medicare Supplemental and Simply Prescription plans

• To be eligible brokers must be appointed, state licensed, and trained on our products

Medicare Advantage $12.50 per contract per month (PCPM)

• Applies to new and existing Medicare Advantage Group contracts

• Small Group or Large Group plans are paid the same PCPM commission

• Prior certification and product training is required. Contact BrokercontractsUnivera@univerahealthcare.com for more information.

Medicare Direct Pay Referral Bonus

Product Description Referral Payment

Medicare Advantage (HMO/PPO) $100

Prescription Drug Plan $25

• Referral will be paid on new enrollment

• Referral payment will be a one time payment

• Referral must be enrolled within 5 months from date of scope of appointment form to receive payment

• Scope of appointment form must be completed and submitted to designated Sales Rep

• Medicare group business is excluded

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General program terms

Monthly commission payments are paid based on the prior month’s premium receipts and are targeted for issue by the 15th business day. Dental and experience rated medical commissions are paid on an accumulated premium formula. Each monthly premium payment is added to the effective year-to-date cumulative received premium and the appropriate commission schedule applied. Override program payments will be issued in the quarter following the close of the measurement period.

A $150,000 commission cap applies to existing medical business. Existing medical business classification applies to groups that were unbrokered with the health plan at the time of the sale, and added a broker at a later date.

Broker of Record (BOR) on group accounts is eligible to receive commission according to the terms of the applicable Schedule A on the BOR effective date. A valid BOR letter must be presented on the account’s letterhead and signed by an officer of the account. BOR’s will be considered effective on the first of the month following receipt of the valid BOR.

Qualifying Agent/Brokers must have signed Agent/Broker and Business Associate agreements on file with Univera Healthcare including a current NYSID appointment to be eligible to represent Univera Healthcare products and receive commission payments. Agent/Broker must maintain all standards and provisions of the Agent/Broker Agreement.

Discrepancies in commission statements and other Agent/Broker reports must be raised promptly. Univera Healthcare will review commission questions and consider adjustments no longer than 90 days retroactively from the current month’s commission statement. For more information contact us at BrokerContractsUnivera@

univerahealthcare.com.

Producers must be appointed by Univera Healthcare.

Commissions, bonuses and the value of prizes will be reported to all groups of 100 or more contracts for their preparation of ERISA 5500 form whether or not they are required to submit a form. Only the amount applicable to that group will be reported to them.

Health Plan may change the rate of commission applicable to specific contract forms upon 30 days’ written notice and may impose rates of commission on new contract forms by written notice to Agent/Broker.

Note: Univera Healthcare reserves the right to alter or void the compensation program at any time in response to issues and conditions that affect the corporation, business, marketplace or economy. Entitlement to commissions and bonuses is subject to terms and conditions contained in the Agent/Broker Agreement.

Univera Healthcare reserves the right to make final determination of eligibility for case (group/contract) credit, premium credit, and commission/bonus payments.

Committed to Helping You Better Meet Your Clients Needs Broker Guide