Ceridian Flow Charts

Preliminary Application and Rates Horizon Blue Cross Blue Shield of New Jersey sends client demographic information, plan information and rates to Ceridian 30 days prior to the effective date. Data Entry and Verification Ceridian will enter and verify the information with the client COBRA RATE REPORT Ceridian will produce a COBRA Rate Report. COBRA Qualifying Event Notification Forms & COBRA RATE REPORT Ceridian provides the client with a COBRA Employer User Guide including the information and web access instructions for accessing their COBRA Rate Report, and schedules appointments to review procedures with clients. Ceridian will produce a Rate Report which shows all of the plans and rates provided. Rates shown will be 100% rates without the 2% administrative fee. Implementation

Monthly Invoice Next Month’s Invoice Termination Letter Max Coverage/ Conversion Letter Ceridian generates and sends invoices approximately 10 days prior to premium due date. A Welcome Letter is sent with the first bill to the existing COBRA participant outlining COBRA rights, obligations and procedures. Ceridian generates and sends next month’s invoice even if payment HAS NOT been received. Premiums for the current month will be flagged with an asterisk and additional language regarding the grace period will be shown. Termination Letters for non- payment, maximum coverage, cancel by request are generated by Ceridian. For nonpayment, Ceridian waits 6 days after the grace period ends to allow for the mail. Ninety (90) days prior to COBRA expiration, Max Coverage / Conversion Letters are sent by Ceridian directly to COBRA participants, if applicable. Participant Update Report Certificates of Creditable Coverage are sent by Ceridian at the time of termination of COBRA. HIPAA Certificate of Creditable Coverage Compliance Ceridian COBRA Review Process Ceridian will handle and address any written requests for reviews and make required determinations. Ceridian will adjudicate COBRA eligibility throughout duration of the COBRA continuation coverage Participant Update Report faxed to the client. Ceridian forwards to Horizon Blue Cross Blue Shield of New Jersey in electronic EDI 834 format. Takeover Form The client completes and submits Takeover Notices for each Existing COBRA participant. The client can complete and submit electronic form on Ceridian website; or complete and fax or mail a paper form to Ceridian COBRA; or send an electronic file in Ceridian’s file specifications to Ceridian. The client submits information about all existing COBRA participants including those who are waiting to elect. Transfer of Existing COBRA Participants

General Notice of COBRA Rights and Obligations New Employee Added to Plan, Rehired Employee Added Back on Plan or New Spouse Added to Plan Archive Proof Of Mailing The client sends information about newly covered employees and/or spouses to Ceridian within 90 days of the date coverage begins. Client can complete and submit the New Hire Notification Form on the Ceridian website; complete and mail or fax a paper form to Ceridian; or send a file in Ceridian’s file specifications. Ceridian retains proof of compliance for a minimum of seven years. This includes a copy of what was sent and proof of mailing. The client adds employee and/or spouse to plan. New Hire Notification Form Process New Hire Notification Forms Ceridian will process the data supplied by the client. Send General Notice of COBRA Rights and Obligations Ceridian will send the General Notice of COBRA Rights and Obligations to the newly covered employee and spouse (if applicable) at the last-known home address.

The client informs Ceridian of a Qualifying Event. Client can complete and submit electronic form on Ceridian website; or complete and fax or mail a paper form to Ceridian COBRA; or send an electronic file in Ceridian’s file specifications to Ceridian. COBRA Notifications and Elections Ceridian sends COBRA Notification Letter and Election Form to Qualified Beneficiary(ies) at last known home address within 14 days of receipt of complete and accurate information regarding Qualifying Event. Month Ceridian adjudicates the 60-day election period based on the later of the date of the notice and the date benefits terminate. Is election within 60-day grace period? Election is rejected. Ceridian returns election unprocessed with a letter of explanation to Qualified Beneficiary. No Qualified Beneficiary elects coverage by paper, IVR or WEB. Election is processed. First Invoice is sent with 45-day grace period. Client notifies carriers to cancel Qualified Beneficiary(ies), COBRA Notification Letter & Election Form Yes

COBRA Monthly Billing Monthly Invoice Next Month’s Invoice Termination Letter Max Coverage/ Conversion Letter Ceridian generates and sends invoices approximately 10 days prior to premium due date. Termination Letters for non- payment, maximum coverage, cancel by request are generated by Ceridian. For nonpayment, Ceridian waits 6 days after the grace period ends to allow for the mail. Ninety (90) days prior to COBRA expiration, Max Coverage / Conversion Letters are sent by Ceridian directly to COBRA participants, if applicable. Participant Update Report Certificates of Creditable Coverage are sent by Ceridian at the time of termination of COBRA. HIPAA Certificate of Creditable Coverage Compliance Ceridian Review Process Ceridian will handle and address any written requests for reviews and make required determinations. Ceridian will adjudicate COBRA eligibility throughout duration of the COBRA continuation coverage Ceridian generates and sends next month’s invoice even if payment HAS NOT been received. Premiums for the current month will be flagged with an asterisk and additional language regarding the grace period will be shown. Participant Update Report is faxed or mailed to the client. Ceridian forwards to Horizon Blue Cross Blue Shield of New Jersey in electronic EDI 834 format.

Financial Flow COBRA Premium Participant pays COBRA premium to Ceridian. Is payment timely and in full (or within safe harbor rules)? Payment is rejected and returned to participant. Payment is processed and applied to participant’s record. Participant Update Report If this is the first payment after an election, a Participant Update Report is faxed to the client. The client forwards to non-Horizon Blue Cross Blue Shield of New Jersey carriers for additions of new elections with payments and cancellations. Ceridian provides to Horizon Blue Cross Blue Shield of New Jersey on weekly basis in electronic EDI 834 format. Premiums are collected throughout the month from all participants. Premiums disbursed within 10 business days following period reported. Yes No Standard procedure is to disburse full premiums only to the client. Partial payments that meet safe harbor rules will not be disbursed until the full premium is collected. The client is reimbursed for premiums previously paid to the carriers.

Renewals Carrier prepares renewals and delivers to the client. Renewal Rates The client sends renewal rates to Ceridian 30 days prior to the effective date of the rates. Data Entry and Verification Ceridian will enter and verify the rate information provided by the client. If renewal rates are not received 30 days prior to the effective date, Ceridian will make every attempt to implement the rates in time for the renewal. However, there are no guarantees that the rates will be updated in time. Ceridian will bill participants at the existing rate and the client will be responsible for any difference in premiums due. COBRA RATE report Ceridian will produce a new COBRA Rate Report and send it to the client.

Cancellations Termination The client informs Ceridian of any plans that have terminated as part of the renewal process. Notice of Cancellation Notice of cancelled plans must be made 30 days in advance. Client must provide information on what plans replace cancelled plans so that continuants can be billed correctly. Client Processing Continuant Invoices For clients that are canceling one or more plans but not canceling services, Ceridian follows a procedure that transfers continuants from the canceled plan to a one plan in time for billing. If information about the new plans is not provided in a timely manner, participants will continue to be billed under the old plan. If information about the new plans is not provided in a timely manner, participants will continue to be billed under the old plan. Changes will be made prospectively.