Okaloosa County BOCC — August 5, 2014 — RFP #44-14 -Life and AD&D Insurance - Standard Insurance Proposal Exhibit A — reading text

Covered Members An active employee of the Employer working 32 hours per week An active elected official employee of the Employer Plan Benefit Formula Increments of $5,000 Rounding Up to next $0 Maximum Benefit $250,000 Minimum Benefit $5,000 To 65% at age 65; To 40% at age 70; To 25% at age 75; To 15% at age 80 Guarantee Issue $25,000 Employer Contribution | 0% Age Based Benefit Reduction e Spouse age based on Member's age. Cost Members Age Rate: Per $1,000 xX Volume = pronase remium All Enrolled 0) <= 29 0.060 $0 $0 4 30-34 0.070 $125,000 $9 8 35-39 0.100 $175,000 $18 7 40-44 0.150 $175,000 $26 11 45-49 0.260 $425,000 $111 24 50-54 0.410 $725,000 $298 27 55-59 0.560 $850,000 $476 15 60-64 0.930 $450,000 $419 1 65-69 1.450 $25,000 $36 2 70-74 2.340 $20,000 $47 0 75+ 4.660 $0 $0 Total $1,440 e We provide policyholders with a 60-day notice of rate change. Standard Insurance Company 1381309 8 Employee Benefits Proposal and Cost Summary Prepared for Okaloosa County Board of County Commissioners on May 9, 2014 Proposed Effective Date of October 1, 2014 Presented By: Corporate Benefits of the Emerald Coast, Features Portability of insurance is included. This lets terminating members continue their dependents life amount without providing evidence of insurability with the continuation of their life amount. If AD&D is included in the plan it may also be ported. Dependents Life insurance continues automatically, without premium payment, for five months after the death of the insured member. Plan Notes We require evidence of insurability for spouses who enroll more than 31 days after they are first eligible for coverage. The plan includes a conversion option. The members' benefit amounts under the current plan are carried forward to this plan. Evidence of insurability is required in order to increase elected benefit amounts from the current plan to this plan. Waiver of Premium and Accelerated Benefit provisions are not included. Conditions Rates assume 20% enrollment. Until coverage has been in force for two years (one year in Colorado, Missouri and North Dakota), death which results from suicide or other intentional self-inflicted injury is not covered. This exclusion does not apply to plans written in Washington. Time insured under the current plan will be credited toward this time period. Member must be enrolled in Additional Life to enroll in the Spouse Life plan. Spouse Life can't exceed 50% of member's enrolled benefit for Additional Life. No increases without evidence of insurability for those whose evidence of insurability was not approved by us under any policy issued by us to the policyholder or an employer covered under the policy We will require evidence of insurability in order to increase the benefit amount for any member whose evidence of insurability was not approved by us under any policy issued by us to the policyholder or to an employer covered under the policy. Evidence of insurability is required in order to increase elected benefit amounts from the current plan to this plan. The proposed rates assume that only participants are included in the census provided. Standard Insurance Company 1381309 9 Employee Benefits Proposal and Cost Summary Prepared for Okaloosa County Board of County Commissioners on May 9, 2014 Proposed Effective Date of October 1, 2014 Child Dependents Life Plan 1 Covered Members Presented By: Corporate Benefits of the Emerald Coast, An active employee of the Employer working 32 hours per week An active elected official employee of the Employer working 0 hours per week Plan Child Benefit Formula: Under 6 Increments of months $1,000 Child Benefit Formula: 6 months or | Increments of more $1,000 Maximum Benefit $10,000 Minimum Benefit $1,000 Cost Rates: Per $1,000 : : . . Elective: Paid by each . Composite: Paid for each | Required: Paid for each A Members: member member with dependents member‘electing coverage All Enrolled $0.20 $0.20 $0.20 e We provide policyholders with a 60-day notice Features of rate change. e Portability of insurance is included. This lets terminating members continue their dependents life amount without providing evidence of insurability with the continuation of their life amount. If AD&D is included in the plan it may also be ported. e Dependents Life insurance continues automatically, without premium payment, for five months after the death of the insured member. Plan Notes e The plan includes a conversion option. e The members' benefit amounts under the current plan are carried forward to this plan. Standard Insurance Company 1381309 10 Employee Benefits Proposal and Cost Summary Prepared for Okaloosa County Board of County Commissioners on May 9, 2014 Proposed Effective Date of October 1, 2014 Presented By: Corporate Benefits of the Emerald Coast, Conditions e Rates assume 20% enrollment. e Member must be enrolled in Additional Life to enroll in the Child Life plan. e Child Life can't exceed 100% of member's enrolled benefit for Additional Life. e We require evidence of insurability for children who are eligible under the current plan but are not enrolled. e Elective increases require evidence of insurability. e No increases without evidence of insurability for those whose evidence of insurability was not approved by us under any policy issued by us to the policyholder or an employer covered under the policy e The proposed rates assume that both participants and non-participants are included in the census provided. e We will require evidence of insurability in order to increase the benefit amount for any member whose evidence of insurability was not approved by us under any policy issued by us to the policyholder or to an employer covered under the policy. e Evidence of insurability is required in order to increase elected benefit amounts from the current plan to this plan. e Evidence of insurability is required in order to increase elected benefit amounts from the current plan to this plan. e Dependents coverage includes unmarried child(ren) from live birth through age 20, or through age 24 if the child is a full-time registered student. Standard Insurance Company 1381309 11 Employee Benefits Proposal and Cost Summary Prepared for Okaloosa County Board of County Commissioners on May 9, 2014 Proposed Effective Date of October 1, 2014 Presented By: Corporate Benefits of the Emerald Coast, Producer Compensation Disclosure We recognize the valuable role of Insurance advisors, consultants and brokers ("producers") in helping their clients design an employee benefits program, and we support reasonable and fair compensation for these services. Producers may be eligible to receive compensation from The Standard. Any questions regarding the compensation connected with this proposal should be directed to the producer. Please visit our website at www.standard.com/compensation/eb/ to view our normal commission scales. If this proposal is quoted with a non-standard scale or override it is noted below. An override if noted is compensation paid in addition to or in lieu of commissions. Please consult with your producer for details. Non-standard commission scale: N/A Override: N/A Unless participation is declined by the producer or client, contingent compensation is additional compensation that may also be paid and is contingent on the satisfaction of one or more minimum requirements, such as a specified amount of new premium volume or persistency in connection with the producer's block of business. For information about our customary producer rewards program visit www.standard.com/compensation/eb/. Some producers may have a contingent compensation arrangement that differs from our customary program. Please consult with your producer for additional details. Additionally, fees for administrative, marketing or consulting services may apply. If applicable, fees are noted below. Fees: N/A Standard Insurance Company 1381309 12 Employee Benefits Proposal and Cost Summary Prepared for Okaloosa County Board of County Commissioners on May 9, 2014 Proposed Effective Date of October 1, 2014 Presented By: Corporate Benefits of the Emerald Coast, We appreciate the opportunity to provide you with this benefit and cost summary proposal from The Standard. This document outlines certain important features of the group insurance coverages available. This is not a contract or an offer to contract for such coverages. Detailed information about other important features of the coverage proposed is available on request. Just ask your broker/consultant or Standard representative. A completed application must be submitted before a group can be considered for coverage. Insurance will be effective after the application is accepted by The Standard. If approved, we will issue a contract containing our customary language. It will not duplicate existing policy language, if any. The group contract will contain provisions and defined terms not described in this Benefit and cost summary proposal. The group contract will control if there are discrepancies between it and this proposal. The proposed premium rate and plan design for each coverage are based on the underwriting data received by The Standard. Final premium rates and plan provisions will be determined by The Standard on the basis of: applicable state laws, policyholder contributions, confirmation of occupations, the actual composition of the group of persons who will become insured, and our current underwriting rules and practices. This benefit and cost summary proposal expires on August 7, 2014, unless replaced or withdrawn by The Standard. Standard Insurance Company 1381309 13 Required Information: Proposals must include answers to the following questions. Required Inf donifore all Products: 1. Give the location of the nearest company group sales and claims offices that will handle this contract. Group Office: 4350 West Cypress Suite 920 Tampa, FL 33607 Life & Disability Claims Office: Employee Benefits Department 900 SW Fifth Avenue Portland, OR 97204 Dental Claims Office: Dental claims are processed and customer service is provided from our office in Lincoln, Nebraska or the satellite claims offices in Wayne, Nebraska and San Antonio, Texas. Give the name and location of the company group representative who will service this contract. Your Account Manager, Alison Brogan, is located in our Tampa Florida office located at: 4350 West Cypress Suite 920 Tampa, FL 33607 Toll free: 800.325.5757 Direct number: 813.878.0286 Will one or more claims handlers be assigned this contract in your claims office? Life/LTD: Yes. Okaloosa County Board of County Commissioners’ account will be assigned to a specific LTD and Life claim team. Our claim teams are designated not dedicated. This allows your organization to have team members who are intimately familiar with your program, but also allows for ample coverage. Dental: The claims customer service team is trained to handle the specific contract provisions of the account. The customer doesn’t have to wait for an assigned team member to handle their questions because all members of the team have been trained to assist. Will toll free service be available from the entire county to your claims office or servicing agent? Yes, Customer Service Representatives will be available to the employees of Okaloosa County Board of County Commissioners. The following are our toll free numbers for each department: Disability: 800.368.1135 Life: 800.628.8600 Dental Customer Service and Policy Administration: 877.490.9991 Give the name, location and affiliation to your company of the agent or broker of record. Disclose commissions and all other remuneration that will be paid to the broker. Kevin Locht, Corporate Benefits of the Emerald Coast Fort Walton Beach, Florida Licensed agent Normal graded commissions scale. List 5 references of similarly sized current clients.