COTTINGHAM & BUTLER HONKAMP KRUEGER & CO, P.C..

COTTINGHAM & BUTLER HONKAMP KRUEGER & CO, P.C.

Cottingham & Butler Introduction
Privately held - established in 1887 Headquarters in Dubuque, IA National provider of employee benefits and risk management solutions – clients in 48 states Over 3,500 customers 450+ employees 38th largest Insurance Broker in U.S. Recognized for excellence “Agency of the Year” National Underwriter “Agency of the Year” Rough Notes Magazine Professional services firm – focused on culture and growing organically

Office Locations A number of larger offices, with some individual sales offices 95% of businesses outside of Dubuque, IA Clients in 48 states, ranging from Florida to Alaska, Maine to California

Why We Are Different Depth and breadth of capabilities:
Property & Casualty Insurance Casualty Claims Administration (TPA) Captives & Programs Safety & Loss Control Consulting Services Employee Benefits Brokerage & Consulting Benefit Claims Administration (TPA) Medical Management Services Wellness & Condition Management Solutions Personal Insurance Services Relentless focus on outcomes and results Willing to take risks and be innovative Provide alternative financing strategies to reduce insurance costs Exceedingly focused on metrics and analytics to get behind activity and discern the real impact Constantly pushing ourselves to get better

Brokerage Expertise & Accountability
We organize our traditional brokerage sales and service into practices – Risk Management and Employee Benefits Industry Expertise: Transportation, Tribal Nations, Agribusiness, Construction, Manufacturing Claims Management Casualty TPA that handles worker’s compensation & liability claims 99+% Retention Rate Medical Claims TPA Pay claims for over 250 self-insured clients Over last 3 years, our average increase in cost per employee per year has averaged less than 3% compared to the industry average of 10% Onsite Clinical Expertise and Wellness Team Full-time Medical Director, 24 Nurses, and team of Certified Health Coaches Utilization review, case management, and condition management to over 100,000 individuals.

Brokerage Expertise & Accountability
Safety Consulting Eight full-time safety professionals Service provided to our brokerage clients as well as a la carte Captive & Program Management Developed four trucking captives, including the largest member-owned group trucking captive, and a heterogeneous captive for non-trucking clients. Each captive has retention rates in the high 90% range.

Today’s Agenda and Presenters
Pay As You Go Workers’ Compensation Matt Murray, Risk Management Account Executive P&C Overview and Risk Management Audit (RMA) Jeff Bair, Risk Management Sales Executive Benefits Consulting Services and Capabilities Brad Plummer, Jane Mueller & Nicole Pfeiffer, Employee Benefits Vice President/Sales Executives HealthCheck360° Michael Kelly, Director of HealthCheck360°

Pay As You Go Workers’ Compensation
-Matt Murray

What Is Workers’ Compensation?
Coverage for an injured worker while in the course and scope of employment. Mandatory coverage How is it priced? Each carrier has a different appetite. Pricing can be wildly different from carrier to carrier. An experience modification factor (mod) is applied to each account. In it’s simplest form a rating of an account based on “average” is average; greater than one below average; less than one above average. Carrier can apply discretionary credits/debits, dividends and other pricing tools. Each class code and state has it’s own rate.

Critical to Success in Workers’ Compensation
Licensed insurance professionals Contracts with the key carriers offering pay as you go solutions and significant volume with each carrier today Knowledge of states and negotiation As mentioned earlier, each state varies significantly on how workers’ compensation is priced. Iowa – State sets rate, carriers can deviate +/- 30% Illinois – Carriers can essentially charge whatever they want. Wisconsin – State sets rate, each carrier has the same premium. Only way to change the premium is a dividend. Minnesota – A loss cost multiplier state. Large variance in what each carrier would have for rates.

Why Pay as You Go? Growing trend in companies wanting this option
Payroll companies including ADP, Ceridian and Paychex are offering this as a bundle with the payroll services If HK is not talking to clients about bundling the services together, one of your competitors may be

Current Situation Pay as you go Solution Why Use Pay as You Go?
25% down and 9 equal payments? 10 equals? Potentially monthly if the carrier is willing to offer. Premium is based off a best “guess” on what the payroll will be for the upcoming year If the “guess” is not accurate, there is opportunity for significant additional premium or return premium Cash flow is based off your estimates and available pay plans No deposit or down payment required for the client Premium payments are based on actual payroll Less audit issues due to the premium being calculated “real time” Improved cash flow No checks to write or invoices to pay for the insured Integrates with Infinisource, once the initial set up is complete, the premium is determined when payroll is run automatically Simply put…a billing option.

What Companies Fit? All companies can fit for the pay as you go option. The following categories have the greatest take up. Under 100 employees Contractors Small businesses with cash flow issues Companies that have had historical workers’ compensation audit issues Will this work for every company? No, each company will still need to be individually reviewed by the insurance carrier to determine if the carrier will released a workers’ compensation quote. If a carrier is setup for Pay as You Go quotes…it can be done.

What Insurance Carriers Offer Coverage?
Many companies you may know… More and more carriers are beginning to offer the option

When Should C&B Get Involved?
If a client is interested in the option, C&B will engage and gather the needed information C&B will obtain competitive workers’ compensation options Provide Proposal to HK & client If they elect to go with the HK/C&B, we will immediately bind coverage and start the process of getting the client set up for the automatic payments Basic data needs to be included by HK in the data file to the pay as you go software Payroll Company ID Payroll Period Start Date Employee Number Check Date Payroll Period End Date Subject Wages Class Code Policy Effective Date Template FEIN Policy Expiration Date State

How Does the System Work?
A net rate will be determined and automatically loaded into the system. The client needs to assign a class code to each employee on initial setup. This is only needed on intake and with any new hires. Once this is complete, each payroll period will automatically generate the correct premium. An will be sent to the client, HK and C&B confirming the payment amount. A fee of $5-$9 will be charged to the client per pay period depending upon premium size.

The Workflow Payroll Data file collected with needed info
HK Payroll PayGo Software C&B Client Payroll Data file collected with needed info Software Interfaces with PayGO to automatically send payroll data Provides a class code per employee & verifies in Payroll Software Provides new hire / terminated employee info throughout year, needs to verify employees class code. Develops net rate by state & class code Automatically links rates with payroll ACH set up to withdrawal premium per pay period. Negotiates and binds quote with carriers Provides bound quote to PayGo

How Do We Get This in Front of Clients?
Ideas for Discussion Introductory mailer, showing the partnership between HK and C&B and ability to offer the payroll services and pay as you go workers’ compensation Quarterly webinars to provide knowledge and benefits of the program to HK clients Follow up by C&B or HK Payroll (to be agreed upon)

Getting Started Several of you may have a clients/prospects in mind that this option would work for C&B would run 2-3 pilot companies through the pay as you go platform Integrate systems, work kinks out, and get a working knowledge of how the process will go

Your Resource Who to contact at C&B for Pay as You Go Workers’ Comp: Matt Murray| Risk Management Account Executive |

Risk Management -Jeff Bair

Risk Management Practice Areas
Everything But Trucking and Benefits Manufacturing Construction Food Related Companies Tribal / Casinos Target $100K Premium and Higher Midwest – 2nd Tier Cities – Under the Radar of Large National Brokers Iowa, Wisconsin, Illinois, Minnesota, Indiana, Michigan, South Dakota, Nebraska, Missouri

Business Model <$100K Premium – Price Sensitive
1.) Insurance Program Design 2.) Brokerage Services >$100K Premium – Service Sensitive 1.) Risk Management Program Design 3.) Safety Services 4.) Claims Advocacy 5.) Third Party Claims Administration

Consulting Competencies
Insurance Program Design Alternative Risk Captives Large Deductibles Self Insurance Risk Management Services Safety Programming and Consulting Claims Advocacy Third Party Claims Administration Unbundled Claims Administration

Insurance Program Design Risk Management Assessment Program Design Premium and Coverage Benchmarking Objective – Move away from price and develop conversation around program design Develop consulting relationship rather than price shopping

Insurance Program Design Risk Management Assessment Program Design Premium and Coverage Benchmarking Market Perception Crazy Stuff Fruit and Vegetable Distributor’s cargo policy excluded Fruits and Vegetables Entire building schedules uninsured Egg Producer Umbrella policy excluded salmonella outbreak Every policy reviewed has had material findings Outcome Properly Designed Program Tailored to Individual Exposure More informed underwriting More Coverage / Less Premium = VALUE

Alternative Risk Captives Large Deductibles Self Insurance Significant percentage of clients participate in an alternative risk program. Shift from an annual insurance renewal to an annuity corporate finance project. Lower Total Cost of Risk Insurance becomes less expensive as they take more risk. More operational focused since they have skin in the game.

VIP - Personal Insurance
Unique Needs for VIP’s Large Property Holdings High Values Features Homeowner policy guarantees full replacement cost Sewer and Water Backup to Full limits of the policy. Auto Agreed Value with OEM replacement parts Agreed Value for Jewelry, Furs, Art and other valuables Exclusive access to top 5 affluent personal insurance markets that cater exclusively to affluent clients Pure, AIG Private Client, Chubb, Ace Complete personal assessment – appraisals Private Client Concierge Service Private Client Service Center Confidential

Who to contact at C&B for Risk Management solutions:
Your Resource Who to contact at C&B for Risk Management solutions: Jeffrey Bair| Risk Management Sales Executive | What to expect: Respect that it is your relationship Work hand in hand with you Continued communication with you during process

Benefits Consulting Services and Capabilities
-Brad Plummer, Jane Mueller, and Nicole Pfeiffer

Example of Key Account Client Service Team Assignment
Krista Sigman Director of Group & Voluntary Benefits Phone: (563) Jane Mueller Sales Executive Phone: (563) Cell: (563) Linda Perry Compliance & Human Resource Specialist Phone: (563) Nicole Pfeiffer Sales Executive Phone: (563) Cell: (563) Julie Harbaugh PPO Network Utilization Specialist Phone: (563) Christine Storlie, MBA, PHR Manager of Client Human Resources Phone: (608) Kathy Herting Plan Document Specialist Phone: (563) Craig Herbst, CPA Senior Business Analyst Phone: (563) Melanie Kintzle Benefit Services Unit Manager Phone: (563) Cell: (563) Devon Mullner Benefits Services Representative Phone: (563) Adam Jensen, JD, CEDS, FLMI Vice President and Director of Compliance Phone: (608) Taylor Orton Benefits Analyst Phone: (563)

Evaluating Benefit Plans: How Are We Different?
Funding Methods – We have expertise in all funding methods: fully insured, split- funded, minimum premium, self-funded. Most brokers specialize in one funding method. Geographic – We have benefits clients in 30+ states, and Assurex Partners in all 50 states and across the globe. Most brokers concentrate on a small geographic area or one state. Insurance Carrier Relationships – We place business for thousands of clients annually with 50+ insured medical carriers, 25+ stop loss carriers and 30+ life & disability carriers. Many brokers only have a handful of carriers they work with. Strategic Approach – Our team uses a proprietary “3 C’s” approach to evaluating benefit cost drivers and creates custom plans for each client based on company culture, recruiting/retention objectives and budgetary goals. Our team of experts provides creative solutions and outside the box ideas that our competitors don’t think of. Resources – We are truly unique, in that we can provide an integrated “one-stop shop” solution.

What We Do That is Different and Below the Surface…
Many only focus here Cost per Employee Benchmark Plan Design Dependent Eligibility Audit Metrics: Coverage Consumption Cost Sharing Health Care Reform: Implications Exchanges Penalties But what’s below the surface?

Our “3 C’s” Framework for Evaluating Benefit Plans (on a High Level)
Metric Calculation What it tells you Participation Rate The number of employees who are covered divided by the total number of eligible employees Whether you may be covering too many employees relative to benchmark averages Dependent Ratio The total number of plan participants divided by total number of covered employees Whether you may be covering too many dependents Coverage Metric Calculation What it tells you Average claims per Participant Total claims costs (eligible Medical & RX claims) before cost sharing divided by total number of participants The total amount of money spent on claims by an average participant without regard to plan design and contributions (absolute cost of benefits) Demographic Index Weighted average expected cost index based on participant age and gender (1 is average) The impact of demographics on average costs Admin Cost per Participant Total Plan admin costs divided by total number of participants The non-claims cost associated with the plan Consumption Metric Calculation What it tells you Plan Cost Sharing percentage The total amount paid by the plan divided by the total eligible claims The split between what the plan pays versus what the employee pays when medical services are purchased ER Contribution percentage (Total plan costs minus employee contributions) divided by total plan costs The percentage of total plan costs that are paid for by the employer Cost Sharing

C&B Client Trend Line versus National Average
Since 2007, Cottingham & Butler’s clients have experienced a trend of 2.8% increase in cost per employee per year versus the national average of 7.4%. C&B Confidential

6 Primary Reasons Why We Perform Differently
We focus on strategic planning for long term cost containment. Most brokers ride the renewal rollercoaster and don’t know how to effectively plan beyond the current year. We reach all over, not just locally which gives us a bigger view of the healthcare marketplace and offers alternatives that other brokers may not have access to. We excel with alternative and self-funding arrangements and believe that you should find ways to buy less insurance over time and self-fund the claims that are predictable and controllable. Most brokers focus on off-the-shelf options and have market limitations. We focus on principles and dig for the details below the surface that provide opportunities for savings. We provide wellness recommendations and deliver on our ROI estimates. We focus and deliver on compliance and HR Services making our clients more effective at managing their employees and benefit programs.

Differentiators Between C&B and Other Brokers
Dedicated Employee Benefits Marketing Team with 100+ market relationships & contracts Dedicated Analytics Team (including former BCBS Finance Manager in charge of a 6 state region) ERISA Attorney on staff HR & Compliance Consultants on staff Proprietary TPA and PPO Networks Plan Document specialist Dedicated Non-Medical market and plan specialists ACA Experts on staff 25+ Nurses and 4 Physicians on staff Wellness Consultants and proprietary programming/pricing with Healthcheck360° Transportation Industry Specific Benchmarking Exclusive HRIS/Payroll system capabilities and pricing

Client Resources You Won’t Get With Other Brokers…
3-Year Strategy Planning Guide Compliance CD & Quarterly Compliance Newsletter Health Plan Intelligence Suite (Reporting/Benchmarking Portal) MyWave HR Resources Plan Source Benefits Portal for Employees Online Benefit Enrollment Suite* Annual Compliance Manual 5500 Filing* Full HR and Compliance Audit Services* Wellness/Benefits Resources on CD Proprietary HealthCheck360° programming/pricing* Transportation Industry Specific Benchmarking Health Care Reform Tool Kit Dependent Eligibility & Spousal Coverage Audits available through SISCO* * Additional fees may apply

Risk Management for Benefits
Benefit Compliance Audit Covers H&W benefit plan policies and processes that can put an employer at risk, including the items covered in a DOL H&W plan audit HR Compliance Audit Covers HR policies and procedures that can put an employer at risk Employee Handbook Review Includes a review of the handbook with revisions to bring the handbook into compliance with applicable law and desired corporate policies HIPAA Title II Privacy and Security Consulting PHI mapping, HIPAA findings report, preparation of Privacy and Security policies and procedures, forms, training materials and presentations for staff Form 5500 Preparation/Delinquent Filer Voluntary Compliance Program Form 5500s, Schedules, and Summary Annual Report (SAR) DFVC: If your client has failed to file, would they prefer a penalty of: $10/day capped at $4,000 max per plan, or $1,100/day with no limit, going back as far as DOL wants ERISA Wrap-around SPD Preparation Includes creation of Summary Plan Description containing all the ERISA-mandated elements and required health notices Failure to provide SPDs and required notices can lead to fines and lawsuits Hint: fully-insured carriers don’t do this because it’s a Plan Sponsor duty and the certificate booklets they do provide don’t contain the required items

Best Practices Compensation Review and Benchmarking
Includes job description creation/review, marketing/benchmarking positions Compensation structure analysis and linkage to performance management Benefit Issue Research & Analysis Generic Benefit Form Preparation Includes eligibility, enrollment, plan administration, plan amendments Cafeteria Plan Preparation POP Plan, FSA, Dependent Care, Adoption Assistance COBRA Administration FMLA Administration

Vendor Partnerships Insurance Carriers: We work with numerous fully insured carriers, stop loss carriers, and voluntary benefit carriers TPAs: For our self-funded clients we work with a large number of different TPA firms and understand the strength of their customer service and claims adjudication processes PPO Networks: We have strong expertise in knowing network geographic area strengths and we can plug in regional networks for strong local discounts.

Examples of Details Mattering in the Real World
Blue Card Fees C&B engagement uncovered error in Blue Cross service delivery. Client received $550,000 retroactive credit. ACA Risk Management Review of client on-boarding procedures reveals significant gap in ability to effectively demonstrate offering coverage to 95% eligible. Exposure- Over $20 million in fines. Result: Significantly enhanced recordkeeping and on-boarding process. C&B engagement correctly calculates ACA fees saving client $109,000 versus carrier recommended method. Insurance Placement Procurement of two year stop loss contract saves client exposure on seven figure claimant. Result: Cost projections flat. Performance Based Plan Design Client implemented incentive-based plan design features to promote Wellness and Chronic Condition Medical Compliance. Care Plan Compliance Results: Asthmatics 93% Diabetics 73% Hypertensive 87% Costs are Down 7% over past five years, versus 7% compounded growth.

Eligibility Audits On average, 4 - 8% of dependent spouses and children on employer sponsored benefit plans are not eligible for the medical benefits they receive. The average cost to the employer for each dependent is $3,500 (per year in claims). A Plan with 1,000 covered employees (1,200 dependents) is likely spending between $150,000 - $200,000 per year on members who do not qualify for coverage. The simple fact is that employers can no longer afford to overlook ineligible dependents. As indicated above, 5 – 15% of covered dependents DO NOT QUALIFY for the benefits they receive! There are two primary reasons: As we discussed, over time, the intent and the enrollment procedures which safeguard the Plan have been diluted. Enrollment becomes automatic and ongoing eligibility is not monitored. Payors will not manage the census. They quietly assign this duty to the employer… The employer assigns it to the member who is unaware of their responsibility to interpret the eligibility of their dependents The exposure this creates for them employee is unacceptable, the costs assumed by the Plan are not sustainable.

Importance of Voluntary Benefits
As employers consider their health care and total rewards strategies in light of health care reform, nearly half expect voluntary benefits and services (VBS) to become more important over the next five years jumping to 48% in 2018 from the current 21%. These supplements to core benefits are designed to fill gaps in employees' security, health, wealth accumulation and address unique personal needs. The most prevalent voluntary benefit offerings currently provided by employers include life (94%), vision (84%), disability (80%), dental (80%) and accident (68%) insurance. Additionally, employers are considering adding a number of voluntary benefits over the next two years. The top offerings being considered include critical illness, identity theft and financial counseling. Towers Watson 2013 VBS Survey

Additional Broker Resources
Educational Employee Benefit Webinar and Seminar Series HR Communication Portal which includes documents for employers and employees Employee Benefits Website to share benefit plan information Benefit Booklet Content and Design Creation

Your Resources Contact Jane Mueller & Nicole Pfeiffer with employee benefit prospects: Jane Mueller | Vice President Employee Benefits | Nicole Pfeiffer | Vice President Employee Benefits |

-Michael Kelly

Subsidiary of medical management firm HealthCorp
About HealthCheck360° Created in 2007 to change focus of wellness industry to health risk management Subsidiary of medical management firm HealthCorp Natural evolution of 20+ years of experience in: Health improvement and behavior change Chronic condition management Managing over 100,000+ employee lives Proprietary & Confidential

Average group size – 300 employees Domiciled in 36 states
About Our Client Base Average group size – 300 employees Domiciled in 36 states Multiple Industries Manufacturing Professional Services Health Care Transportation/ Distribution

5 Best Practices

1. Biometric Screenings Proprietary & Confidential

2. Proprietary Objective Scoring System
Our scoring algorithm is directly correlated to present and future cost drivers Balanced across all major cost drivers Transparent to participant Designed to reward positive change across health spectrum Designed to integrate with medical management Easily understood scale Developed and reviewed by physicians Proprietary & Confidential

3. Outcome Based Incentive Models
Incentive Rate Health score of 71+ Repeat participants with <71 AND 5+ pt improvement All new participants Standard Rate Non-participants Participants who fail to meet health goals Preferred Rate Health score of 71+ Repeat participants with <71 AND 5+ pt improvement All new participants Participation Rate Participants who fail to meet health goals Standard Rate Non-participants OR…

4. Data Driven Engagement and Programming
Biometrics HRA responses Demographics Claims Stratification Ideal, Low, Moderate, High, & Very High Risk Engagement Communications Technology Health Coaching Medical Mgmt Proprietary & Confidential

5. Client Specific Reporting
Individual Report Executive & Aggregate Report Claims analysis* Health Coaching Reporting* Risk Migration Analysis Critical Value Reporting Executive Review Presentation Provides synopsis of various reports Identifies key issues Compares company data to industry cohorts * If applicable Proprietary & Confidential

Importance of Participation
18% Increase in non-participant costs HC360 Sample Population Study, N=10262, 2012 Proprietary & Confidential

Continued Positive Impact
Each dot represents at least 1,000 lives. Data integrity: 95% confidence interval that for any size population the margin of error is +/-2%

Correlation to Health Score to Claims
HC360 Sample Population Study, N=10262, 2012

HealthCheck360° Case Study
2000 EE manufacturing and distribution company – Significant correlation in high health risk levels and workers compensation expense.

Year 1 to Year 4 Migration HealthCheck360 Population Study, N=19,301, 2012.

Proposal Request Form

Your Resource Who to contact for HealthCheck360°:
Michael Kelly | Director of HealthCheck360° |

C&B Confidential

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