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,„N EXIS <br />R24L2 <br />Plan Document Amendment <br />$300.00 <br />r <br />go tlonat Serviet# =y Y �" <br />comttied o eft page { <br />Billing CoQe Descxrlpt�o1 r r yss r �Fe xltiitr <br />R221_5 <br />Onsite Employee Enrollment Meetings <br />$500.00 <br />Per counselor per day, plus travel expenses (if applicable) <br />R45Z5 <br />Election Confirmation Statements <br />$1.25 <br />Mailed to employee's home address. Billed per statement issued. <br />R661_7 <br />Welcome Kits <br />$3.00 <br />Employer chooses from available CONEXIS content (up to five pages). Mailed to employee's <br />home address. Billed per kit issued. <br />R45ZO <br />Welcome Kits with Election Confirmation Statements <br />$4.25 <br />Employer chosen Welcome Kit and Confirmation Statement mailed to employee's home <br />address. Billed perpackage issued. <br />T821R <br />IT Custom Programming <br />$195.00 Required <br />Per hour charge is incurred only upon client request for custom programming <br />Service Fee Guarantee Period: January 1. 2015 through December 31, 2017 <br />Client and CONEXIS have caused this Fee Schedule/Service Appendix to be executed in their names by their <br />undersigned officers or authorized representatives, the same being duly authorized to do so. <br />Authorized Bill To Signature: ���� 1�^��c._-- Date: <br />NameandTitle: �_&J`a"� V C ��$SO �e�rrhor <br />CONEXIS Signature: V _ Date: 8 <br />Eva Boucher, CCEP, Sr. VP and Chief Compliance -Officer <br />PEPM Billing -Less Than 1000 lives <br />RAS Fee Schedule/Service Appendix 2 V9.0-040111 <br />