Agmt22 Intercare Holdings Insurance Services, Inc.

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REV: 04-22-2022 EI EXHIBIT “A” SCOPE OF SERVICES AND FEE Consultant will provide claims administration. The claims administration fees includes the handling of 264 pending claims (16 Medical Only; 102 Future Medical and 146 Indemnity) and up to 125 new claims per year. If the number of new claims reported materially exceeds such number to warrant a change in the number of staff assigned to the program, the claims administration fee may be adjusted pursuant to a written amendment signed by the parties. The staffing model is based on an average caseload of 150 Indemnity claims per adjuster and uses a 2:1 conversion ratio of Future Medical/Medical Only to 1 Indemnity claim. In calculating the staffing model, a 150 average caseload on an as converted basis would produce 1.5 full time employee for the Claims Adjuster position. The Claims administration fee is based on 2 dedicated Claims Adjusters, 1 dedicated Assistant, and a designated Supervisor and designated Administrative Support person. The dedicated positions will handle the City’s program exclusively. In addition, an Account Manager will provide additional client support and advocacy to the program, deliver the annual stewardship report at the end of each contract year, coordinate training for the City as needed and provide Risk Management support. A designated Nurse Case Manager will be assigned to the program to assist with telephonic disability management and return to work. I. Fee Schedule for Claims Administration For the services outlined herein, Consultant shall be paid a flat annual rate per fee schedule below. Contract Year Fixed Flat Annual Fee July 1, 2022 – June 30, 2023 $ 491,941.99 July 1, 2023 – June 30, 2024 $ 498,957.25 July 1, 2024 – June 30, 2025 $ 513,907.97 ATTY/AGR.2022.099/Intercare Holdings Insurance Services, Inc. (Page 11 of 11)