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

Conditions of Quotation Township of West Orange Effective Date: 4/1/2019 Standard initial set-up service includes the following: Standard ID Card production and delivery to employee homes Customized ID Cards—one custom logo included at no additional charge PD, SPD, Amendment and Employee Communication materials prepared and delivered to the group electronically in PDF format Implementation of up to five plan designs One initial enrollment assistance meeting at your main location (we will also participate in one annual open enrollment meeting at your main location) Additional charges for customized set-up options are as follows: SPD, Healthy Balance Kits, Enrollment kits, Amendments and Employee Communication Material printing at cost SPDs mailed to employees homes at cost, determined on a case-by-case basis Additional enrollment meetings are provided at travel cost Summary of Benefits and Coverage (SBC). The SBC must be presented with all enrollment materials effective on or after September 23, 2012. Print SBC: — $1.65 for each color copy (min. order of 25) — $0.65 for each black and white copy (min. order of 25) — Additional cost per address if being mailed directly to employee homes. Cost determined on a case-by-case basis. Print Healthy Balance Kits: — With SBC included: $3.65 each or $4.65 each if FSA benefits are included (min. order of 25) — Without SBC: $3.00 each for $4.00 each if FSA benefits are included (min. order of 25) — Additional $3.95 per kit if being mailed directly to employee homes This presentation constitutes an entire package. Any deviation, including not purchasing any quoted line of coverage, may change the proposal and result in increased rates. Any outside vendor not listed in this proposal, including outside Rx vendors, requires prior approval and may result in additional fees. All rates are based upon the above effective date and the data submitted. We have made every effort to supply you with an accurate and comprehensive proposal, however, we will not be bound by any typographical errors or omissions contained herein. Prescription Drug Card through Meritain Health Pharmacy Management is an integral part of the program and requires inclusion. Quote assumes use of model precertification list. This list includes the precertification of

d through Meritain Health Pharmacy Management is an integral part of the program and requires inclusion. Quote assumes use of model precertification list. This list includes the precertification of certain injectables and infusions. 1/3/2019