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EXHIBIT B: Administrative Fees <br /> <br />The following describes the standard and optional COBRA continuation services and fees. Choose your Pricing <br />Option below. <br />Employer Size (Number of benefit eligible): <br /> State Continuation: 2 1 <br /> COBRA & State Continuation: 20 <br /> COBRA & State s <br /> <br />STANDARD COBRA STATE CONTINUATION RETIREE/ACTIVE BILLING SERVICES <br />PER BENEFIT ELIGIBLE FEES (41 and more) <br /> <br />Description of Standard Service Fee <br />Set-Up Fee (waived with HSA/FSA administration) $250.00 <br />Annual Renewal Fee $40.00 <br />Take-over Notice & Coupon Book (per QB) Included <br />Participant Fee (# of benefit eligible employees) $0.75 <br />Monthly Minimum: billed when monthly service total is less than $30.00 $30.00 <br />MEDSURETY Retains the 2% premium administrative fee 2% <br />Per Qualifying Event $0 <br />Monthly Fee Per Active QB $0 <br />Initial Notifications (per new hire) $0 <br />Qualifying Event Notices $0 <br />Custom Letter Mailing $0 <br />COBRA Participant Termination Notice $0 <br />Rate Change Letters $0 <br />Continuation Carrier Notifications $0 <br />MN Life Continuation $0 <br />Subsidy Administration $0 <br />Online Services $0 <br />Real-Time & Monthly Reporting $0 <br />Reporting to Carrier $0 <br />Optional: Past Due Notices to Enrollees $2.00 <br />1 <br />Optional: Retro COBRA Initial Rights Notices $3.00 <br />1. COBRA General Rights Notification for all existing employees who may not have previously received <br />a notice or at the request of employer if proof of delivery cannot be demonstrated. Fee billed per <br />notice. <br /> <br />RETIREE-ACTIVE BILLING SERVICES <br />Annual Administration Fee $0 <br />Per Qualifying Event Included <br />Participant Fee: Per Enrolled Participant Per Month $5.00 <br />Participant Termination Notice Included <br />Online Services Included <br />Real-Time & Monthly Reporting Included <br />Past Due Notices to Enrollees Included <br />Eligibility Reporting to Carriers Included <br />Rate Change Letters Included <br /> <br /> <br /> <br />Continuation and/or Retiree Billing 13 <br />Administrative Agreement (public sector) <br /> <br />