Confidential

Presented by:

Elizabeth Patterson, Managing Consultant

November 2017

Alternative Funding:

Follow the Money

Agenda

• Funding… What’s Changed?

• Plan Expenses

• Fixed Costs

• Claim Costs

• Trend

• High Claimants

• Alternative Funding Spectrum

• Cash Flow

• Carrier Models

• Risk Management

1

Funding… What’s Changed?

• Increasing Costs

• Willingness to assume risk for potential savings

• Desire to control what has historically been uncontrollable

• Appetite to manage cash flow and budget process

• Demand to take advantage of plan and cultural changes that lower trend

• Taxes

• State taxes (2.5%)

• ACA taxes (5%)

• Demographic rating and essential benefits under 100 employees

• Regression to the mean

• Inability to escape a trend increase

• Increased variety of risk sharing options to meet diverse

employer risk profiles

2

Plan Expenses

No matter what funding or risk mechanism you use,

Total Annual Cost of Your Medical Plan

Less High Claimants

Plus Expected Claims

Fixed Costs

3

Fixed Costs

4

Potential Taxes2.5% - 6.5%

Commisions4.0%

Risk Charge3.0%

Operating Expenses 9.5%

Profit 1.0%

Defining Operating Expenses

Cost of Doing Business:

• Salaries

• Electricity

• Network development

• Report preparation

• Customer service

• Wellness programs

• Rent

• Technology

• Claim processing

• Eligibility maintenance

• Disease management

• Taxes, etc.

5

Nothing is “free” – it is in the rates!

Claim Costs

6

Expected Claims

Pooling Charge

High Claimants

Incurred but Not

Revealed (Reserve)

Network Discounts

and Utilization

Mix

Expected Claims

When a medical plan is experience rated, the general underwriting

rule of thumb is:

The most recent 12 months of

mature claim data

Trend

The best predictor of

the new plan year’s claims

7

Defining Claims

Paid claims are the actual dollars paid to doctors, hospitals,

pharmacies and other providers during the time period under study

“Paid claims” does not include:

• What the employee pays for care

• Denied claims

• Network discount adjustment

Incurred but not revealed (IBNR)

• Services that occurred during the period under study for which no claim has

been submitted

• High claimant can skew reserve levels because it takes longer for a large

hospital claim to be submitted

8

IBNR – Why Is There a Claim Lag?

15 – 45

Days

Doctor

Visit

PaymentClaim

Approved

Claim

Submitted

9

Defining Trend

Insurance companies use medical cost trends to estimate what

the same plan would cost in the next year

In the simplest example, a plan with the same members that cost

$8,000 last year with 10% trend will cost $8,800 next year

• Trend is typically discussed as an annual number

• When your renewal is determined, claims are moved more than 12 months into the future, so the actual trend used is higher

• The earlier your renewal is delivered, the more trend impacts the final numbers

10

Defining Claims – High Claimants

• High claim activity is not predictable from year to year until the group of covered

persons becomes quite large – typically over 5,000 employees

• The premium rate includes a “pooling charge” and self-funding includes “specific

reinsurance”

• In return for this charge, the insurance company ignores claims for any one person that

are higher than your “pooling point”

$1.2 million pooled to

pay for high claimants

$300,000

$275,000

$400,000

$150,000

$75,000

Pooling Charges (or specific

reinsurance premium)

create a pool of money that

the insurance company

uses to pay for claims over

the pooling point.

In this example, the pooling

charge from five employers

create a pool of $1.2 million

to pay for that group’s high

claimants.

11

Incurred claims for the last 12

months

Plus IBNR calculation

Less claim amounts

greater than the

individual pooling point

Multiplied by trend

Plus the pooling charge

Developing Expected Claims

12

Why Assume Additional Risk

13

Employers typically

want more risk if

Group is young & healthy

Insurance companies are over-charging

Accessibility of detailed claims data

Positiveimpact to cash flow

Control of own destiny

Simplify plan design -

Fewer state laws

Achieve cost transparency

Spectrum of Rating Methods

14

Potential savings

Potential annual risk

Small Group Rated and Demographic Rated

Experience Rated: Not Credible, Credible and Participating Policies

Level Funded, Minimum Premium and Retrospective Funded

Self-Funding via a Captive/Consortium

Traditional Self-Funding

Follow the Money – How Costs Flow

15

• Claims are lower than the monthly average in the first 3 months and continue after the plan year ends

• Run-out claims can occur as much as 12 months after the plan year ends, but 90%+ are expected in the

first 3 months

• Fixed costs can all be paid in the first 12 months to cover all claims incurred in that plan year or can be

paid to just cover the activity that occurs in the first 12 months

• 12 month costs are called “immature” An estimate the covers all the activity of the first 12 months is called

“mature”

• A high claimant who incurred $700,000 in claims hit in August and September. Amounts above the

individual stop loss are either paid by employer and reimbursed or paid by carrier and not used at next

renewal

Admnistrative and High

Claimant Fees Cover

Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414

High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

Admnistrative and High

Claimant Fees Do Not

Cover Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Administrative Costs $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131

High Claimant Protection $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 TBD TBD TBD

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

Follow the Money – Cash Flow if Insured

16

• A fully insured client pays the same amount each month no matter what the claims are for that

month

• A small group client, under 100 employees, has rates based on each covered person’s age and

geography

• A group under 500 employees enrolled has rates that blend their claim experience with the claim

experience of other employers. This is done to stabilize rates because claims year to year can

fluctuate by plus or minus 20% in mid-size groups. This is called credibility

• Ideally over a 3 to 5 year period, credibility should have a neutral impact on costs. However, in any

given year, it can raise increase or decrease a renewal (vs what the renewal would have been on

that employers claims)

15 Month Flow of

Costs

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Administrative Costs $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131

High Claimant Protection $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 TBD TBD TBD

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

Insured 15 Month Flow

of Cash

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Premium $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $0 $0 $0

Follow the Money – Monthly Rate Risk Sharing

• Settlement is performed 3 to 6 months after the end of the liability period

• In the above example a portion of the premium will be refunded to the employer.

• If actual costs were above premium, some carriers forgive this deficit. Other carriers use it to

offset the refund in a future, good claims year

17

Admnistrative and High

Claimant Fees Cover

Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414

High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

Admnistrative and High

Claimant Fees Do Not

Cover Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Premium $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $0 $0 $0

Year End Settlement Premium is +3% higher than standard fully insured, but if claims are lower, money is returned

Fixed Costs

Paid Claims This arrangement can be fully insured and is called either participating or retrospective rated.

Total Paid

This arrangement can be self-funded and is called level funding

Paid Premium

Difference

$616,824

$2,976,000

$3,592,824

$3,725,304

$132,480

Aetna IBC Cigna

Product Funding Advantage Participating or

Retrospective

50% Dividend Eligible

Employer Size 100 – 500 employees 250 + employees 250 – 500 employees

Billing Pay fixed monthly rate

set at +10% of expected

claims

Pay fixed monthly rate

set at +3% to +7% of

expected claims

Pay fixed monthly rate

often set at expected

Margin/Deficit Aetna retains 1/3 of

surplus at end of year;

Client retains 2/3 of

surplus to carry over as

credit to next year (New

business is 50/50 split)

Margin/deficit at year end

settlement. Percentage

returned to client based

on risk corridor

At end of year, 50% of

surplus is returned to

client

Examples

18

Follow the Money – Monthly Rate Risk Sharing

Be sure to understand if your plan is rated on a mature or an

immature basis

19

Admnistrative and High

Claimant Fees Cover

Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414

High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

Admnistrative and High

Claimant Fees Do Not

Cover Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Premium $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $323,093 $323,093 $323,093

Year End Settlement

Fixed Costs Rates are set at 80% of expected costs because they only account for 12 months of expense activity.

Paid Claims

Total Paid

Paid Premium

Difference The second year settlement includes claims incurred in year 1, but paid in year 2. Year 3 is a normal renewal.

$616,824

$2,380,800

$2,997,624

$2,982,396

$15,228

The simple renewal estimate is that rates increase by 20% to cover 12 months of expenses and 15 months of activity. In

addition, 10% trend is applied. This means if claims run as expected in year 1, the renewal is +30%.

Pay As You Go – Minimum Premium /Self Funded

• In August and September claims of $700,000 are paid on one individual. If you assume a $200,000 pooling

point, then $500,000 will be refunded to the employer

• In some models, the employer never pays the $500,000 - the reinsurance carrier pays it. In other models it can

take 5 business days to over 5 months to recoup this money

• The employer needs to understand whether estimated annual costs are based on 12 months or 15 months of

activity (Immature or mature) in order to anticipate the next year's renewal

• Many employers take a cash flow advantage in the first year of self-funding by paying for 12 months of activity in

the fixed costs during the first year, knowing:

• They must pay for extra months of claims administration and reinsurance protections when they terminate

either the financial arrangement or the current claims administrator

• They must be prepared for a large increase in year two

• Minimum Premium plans typically require a reserve that covers 15 months of activity, so no cash flow advantage

20

Admnistrative and High

Claimant Fees Cover

Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414

High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

Admnistrative and High

Claimant Fees Do Not

Cover Run Out

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Administrative Costs $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131

High Claimant Protection $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 TBD TBD TBD

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

In – Summary Risk Sharing Favorable Year

21

In Summary - Risk Sharing Unfavorable Year

22

Alternative Funding – Cost Projections

23

Who pays if the estimate is low?

YOU DO!

Self-Funding – Cost Projections

24

Alternative Funding - False Promise

• Some first year alternative funding proposals are immature and do not include an

estimate for claim lag

• This means that the cost of a first year self-funded plan is understated by 10% to 20%

and allows a broker who is trying to obtain your business to pitch it as a guaranteed

first year savings

• They are correct. There will be first year savings, but these savings do not repeat, so

you have to be ready for year two

• Protect yourself by asking to see mature and immature first year costs

25

Alternative Funding - False Promise

Many brokers determine your expected costs using the “best” (most aggressive) reinsurance

proposal. This approach can lead you holding the bag on an understated budget

Let’s assume your true expected claims are $500 per employee per

month and you request maximum liability set at 125% of expected

26

NFP’s Claim Estimate

Reinsurance wants your business

Self-Funding – Cost Projections

• NFP’s Methodology

• We believe it is prudent to develop cost projections via an independent

process

• NFP uses multiple methods to determine your expected claims and your

case trend

• We will share our methodology with you

• NFP uses actuarial tools to compare your claims experience with

demographic norms

• NFP underwrites your plan separately from your TPA and/or reinsurance

provider

• We tell you, our client, if we think the reinsurance company has

understated or overstated your claims

• You make an informed decision and budget properly

27

Know Where Your Claims are Unpredictable

While year to year trend for claimants under $50,000 ranges

from -4% to +9%, average trend for claimants under $50,000

during the 6 years study period is only is +2%. Claims in this

range are relatively stable.

28

Protect Yourself – Understand the Nuances

29

Protect Yourself – Understand the Nuances

30

Interest

Charges

Fixed

Monthly

Cost

Fixed

Monthly Cost

with True Up

Year End

True Up

Understand the Nuances

• What are some cash flow models?

• Do I pay as claims are incurred?

• Do I pay a flat monthly rate with a true-up?

• How long does it take for a true-up to occur?

• What if my monthly claims are under budget?

• What if my monthly claims are over budget?

• Are projected costs immature or mature?

• Do I have to fund high claims and wait for a refund?

• Who holds the reserves? How are they developed? What if run-out claims

are above or below the reserves?

• What happens if I terminate in a deficit position?

• What is the corridor between expected and maximum costs?

• What is in place to stabilize my claims experience?

31

Reinsurance Considerations

• First year only looks at claims incurred in first 12 months

• Paid in those 12 months

• Paid in 15 months – those 12 and next 3

• Paid in 18 months – those 12 and next 6

• Second year can look at

• Claims incurred in that 12 months and paid in next 15 or 18

• Claims incurred in that 12 months and prior 3 or 6, but paid

in that 12 months

• Claims paid in that 12 months no matter when incurred

32

January

xxx1

February

xxx1

March

xxx1

April

xxx1

May

xxx1

June

xxx1

July

xxx1

August

xxx1

September

xxx1

October

xxx1

November

xxx1

December

xxx1

January

xxx2

February

xxx2

March

xxx2

Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956

Reinsurance Considerations

Reviewing a Lag Report can help you select the type of protection you need

33

Recorded Incurred Month

Month Dec-10 Nov-10 Oct-10 Sep-10 Aug-10 Jul-10 Jun-10 May-10 Apr-10 Mar-10 Feb-10 Jan-10

Dec-10 29,311 35,600 71,101 1,115 0 3,640 632 13,210 0 0 0 0

Nov-10 0 19,611 49,799 5,837 361 483 607 60 16 0 182 182

Oct-10 0 0 16,335 81,075 35,018 -100 -7,037 22 605 472 790 656

Sep-10 0 0 0 24,859 73,949 44,876 3,740 123 44,179 0 3,959 28

Aug-10 0 0 0 0 22,030 84,250 17,482 4,148 10,841 284 -204 0

Jul-10 0 0 0 0 0 25,626 110,004 48,267 1,835 -1,001 1,351 -121

Jun-10 0 0 0 0 0 0 31,998 105,534 6,825 1,119 1,648 271

May-10 0 0 0 0 0 0 0 30,575 79,086 17,442 1,684 5,700

Apr-10 0 0 0 0 0 0 0 0 27,434 57,089 3,176 1,416

Mar-10 0 0 0 0 0 0 0 0 0 39,149 86,943 78,809

Feb-10 0 0 0 0 0 0 0 0 0 0 16,527 68,932

Jan-10 0 0 0 0 0 0 0 0 0 0 0 0

Totals 29,311 55,211 137,235 112,886 131,358 158,775 157,426 201,939 170,821 114,554 116,056 155,873

Bottom Line - Running the Numbers

34

The Parts are the Same

35

Item Fully Insured Alternative Funding

Claims Claims Claims

Protection vs.

High ClaimantsPooling charge Specific reinsurance

Fee to Cover Claims

AdjudicationIn fixed costs Administration fee

Fee to Develop and

Maintain NetworkIn fixed costs

Network access/rental fee in claims

or administration fee

Protection vs.

Bad Year

In fixed costs

(Risk charge/margin)Aggregate reinsurance

Disease Management In fixed costsCan be purchased separately or “a la

carte” or in administration fee

Commissions In fixed costs In reinsurance and administration fee

Plan Expenses

36

• If the same claims payer, using the same

plan design, the same network discounts

and the same cost management programs

processed your claims, the only

guaranteed cost differences between

funding alternatives is state premium

and federal ACA taxes.

• Over time, typically a five year period, a

well negotiated fully insured plan should

cost a little bit more than an identical self-

funded plan. The difference being taxes.

• Your advisor should be able to provide you

a clear retrospective analysis of your plan

using your claims to help you understand

where you stand.

Plan Expenses

Over 4 year period, the cost of being fully insured is $505,078 or 1.8%. This equates to taxes.

Year 1 Year 2 Year 3 Year 4 4 Year Total

Current Insured Plan $6,142,970 $6,332,678 $6,997,284 $7,127,640 $26,600,572

Self-Funded Plan $6,121,883 $7,171,193 $6,274,420 $6,527,998 $26,095,494

$21,087 ($838,515) $722,864 $599,642 $505,078

37

Why Assume Additional Risk

38

Employers typically

want more risk if

Group is young & healthy

Insurance companies are over-charging

Accessibility of detailed claims data

Positiveimpact to cash flow

Control of own destiny

Simplify plan design -

Fewer state laws

Achieve cost transparency

Interesting Models

39

Reinsurance Captive

• First question is, “Do I want to

be self-funded”

• Second question is, “If yes,

should I share high claimant risk

with other employers to stabilize

fixed costs?”

• Goal:

• Reduce fixed costs by

purchasing a higher individual

stop-loss level than is practical of

purchasing alone

• Share the risk of middle cost

claimants with other employers

• Stabilize costs (rate of increase)

over time

40

Reinsurance Captive

• Captive Reinsurance – Group purchasing model

• Each employer is responsible for high claimants up to a defined amount – typically $35,000 to

$75,000

• Each employer pays a fixed monthly amount into a pool designed to fund claims between their

defined amount and the reinsurance

• Employers collectively purchase reinsurance for claimants over a high amount, often $250,000

• Risks and Rewards

• Some members in the group will have a good year, while others have a bad year rather than

each member’s reinsurance being rated on it’s own merits

• This approach allows for cost stability while not paying a large fixed premium to a reinsurance

company

• If the fixed cost for the monthly pool is too low, employers may be assessed additional,

unexpected payments

• Total costs are typically 1% to 3% higher than being self-funded alone due to administrative

costs of the captive

41

Follow the Money – Captive Reinsurance

42

Claims over $250,000

Claims $50,001 to $250,000

Claims under $50,000

Claims paid by reinsurance

company. You pay monthly

premium

Claims paid by you

Claims paid by captive

members. Each employer pays

a monthly allotment into the

pool. Any funds remaining at

year end are returned or rolled-

over. Shortfalls are assessed as

they occur

Innovative Self-Funding Models

• Collaborative Purchasing – One Example is Veris/Benecon

• Average client size is 97 employees, though they do have clients with

several hundred employees

• Each employer funds actual claims up to a defined threshold

• Renewals and thresholds are developed by Veris using an the employer’s

actual claims experience and demographics blended with the Veris’ book of

business data

• Stop-loss is group purchased and the corridor of risk ranges from 10% to

20% of expected claims (instead of the normal 25%)

• Employers fund claims up to those thresholds with annual maximum

funding guaranteed over 150 employees and monthly funding guaranteed

under 50 employees

• Client retains 100% (never spends) surplus and no deficit carry forward

• Network options include Cigna or Blue Cross networks

43

Innovative Self-Funding Models

• Reference Based Pricing – Self Funding Only

• Procedure focused

• Includes non-urgent procedures with wide price variations

• Some common bloodwork

• Imaging such as CT Scans an MRI’s

• Outpatient procedures such as colonoscopy

• Non-urgent surgeries like hip and knee replacements

• Often via a carrier TPA

• Facility focused

• Uses a provider network; eliminates facility network

• Sets reference reimbursement at 1x% of Medicare (usually 70th to 80th

UCR) and plan excludes charges above that

• Engages a third party to negotiate the balance bill to $0

• Adds a reimbursement plan to make employee whole if negotiations fail

44

NFP Team

Amy Coyle

45

John Casey

and me, Elizabeth Patterson

Thank you.