56-19 Exhibit - Agreement with Meritain Health as Third Party Administrator.pdf

Optional Services Township of West Orange Per EE Per Participant Set-Up Fee Healthcare Bluebook Standard Program ("Go Green") $2.05 N/A N/A Healthcare Bluebook - SmartSelect $3.45 N/A N/A Dental Administration Fee (Including Aetna Dental Network) $2.95 N/A N/A Vision Administration Fee $0.85 N/A N/A COBRA Administration for Outside Lines of Coverage $0.75 N/A N/A COBRA Actuarial Report N/A N/A $1,500.00 Maternity Management $0.80 N/A N/A Demand Management - 24x7 Nurse Line $0.45 N/A N/A Pre-Admission and Post-Discharge Counseling $0.50 N/A N/A Teladoc (Plus $40 per Consultation, Required for HDHP Plans) $1.55 N/A N/A Teladoc State Restrictions: Idaho - Video Only, Georgia - 3 day Rx limitation. FSA Including Restricted Debit Card & AutoRollover ($75 Monthly Minimum) N/A $5.40 $525.00 Additional Banking Fees may apply Meritain Health HSA Fee - Including Debit Card, Plus one of the following: N/A $1.10 $15/Part. - Option 1 - Employer Paid N/A $2.55 See Above - Option 2 - Employee Paid from Account (Applies to Balances Under $1,000) N/A $3.90 See Above HSA Member Welcome Kits N/A Included N/A Additional Banking Fees may apply 1/3/2019