Darlington RFP Response

Sterling Seacrest Pritchard

REQUEST FOR PROPOSAL RESPONSE for

Presented by Mike Mewbourne | Partner Employee Benefits Practice

sspins.com

6 April 2022

TABLE OF

CONTENTS Introduction

3

General information & service team

4-7

Services

7-10

Marketing, negotiations & management 10-12 Data analysis & reporting

12-15

Legal & compliance

16-17

Compensation

17

INTRODUCTION Thank you for allowing Sterling Seacrest Pritchard (SSP) the opportunity to participate in the RFP for Darlington School. We look forward to demonstrating our experience and capabilities to match your needs. Throughout this RFP response, we will discuss our experience with working with private schools, our service philosophy, our company culture and the strengths and resources that differentiate us from the others.

This proposal does not encompass all services offered by SSP. In order to streamline the proposal, we edited some programs that you may find beneficial in the future. In addition, instead of long descriptions of services offered, we often show samples of the services in graphs and pictures. When a verbal presentation is awarded, we will fill in the detail and demonstrate the resources.

We would be honored to be chosen to serve Darlington School.

Through our experience, our strategic relationships, leverage in the marketplace and our care and concern for those we serve, we are confident that we can have a positive impact within the benefits offered to Darlington School employees and their families.

We are confident that SSP can bring new programs and services to strengthen the administration and benefit management profile of Darlington School, while making the broker transition nondisruptive with your employees and current insurance carrier partners.

Thank you again for the opportunity.

Mike Mewbourne Partner | Sterling Seacrest Pritchard

Jim Bailey CEO | Sterling Seacrest Pritchard 3

1.1 Detail the number of employee benefits clients currently served and the average demographics of your client base.

Currently, your SSP team has 39 clients they are serving. There are 4 dedicated consulting and service team members and 8 additional service, legal, actuarial, analytics and claims professionals that work with each team. Our clients range in demographics from manufacturers to law firms. We have a specialty practice with private schools and nonprofit organizations.

1.2 What distinguishes your firm from other broker/consulting firms?

Strong emphasis on education, mental health, analytics, cost control and compliance • Education – SSP provides direct educational content to our clients’ employees. With our communications platform, we are able to target specific employee populations with meaningful communications and reminders via mobile, online, mail and/or in-person. Our live and recorded workshops will enhance healthcare literacy and consumerism of your staff which saves money for each member and the school.

• Mental Health – SSP focuses on providing direct mental wellbeing support to your staff by aligning with the vendors that have proven solutions for private schools.

• Analytics & Cost Control – Data can be used to diagnose and provide insight to cost drivers. SSP has a comprehensive analytics platform for self-insured employers which we use to identify unnecessary expenses that can be avoided and to deliver strategic initiatives to control costs.

• Compliance – Annual compliance audits are integrated into our service plan for each client. We have a legal department, an automated health plan compliance calendar and perform manual audits each year with every client to ensure unnecessary penalties don’t occur.

Access to unique solutions for private schools – SSP is a leader in serving private schools and nonprofits and has a dedicated practice for those industries staffed with professionals that have served the private school and nonprofit sector for 30 years.

Community and nonprofit support – Giving back to the community and supporting our nonprofit clients so they may help their communities is a commitment SSP has had for decades. You will see we have a dedicated community section on our website which showcases some of the volunteering we do on a regular basis.

Employee-owned – Perpetuation helps keep us on our toes and competitive. We get to decide the direction of the company on an employee-level. This allows us to continue to adapt to our clients’ needs and remain focused on providing the best services to each client.

Market leverage – SSP is the largest employee-owned insurance broker in the southeast. This gives us the market clout and leverage that appeals to progressive-minded carriers and vendors that want to partner with us to deliver modern solutions to the increasing cost of healthcare.

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1.3 Describe the proposed team that would work with Darlington School and provide information about the qualification and expertise of each team member.

Mike Mewbourne

Partner | Consultant mmewbourne@sspins.com | 404.643.9119 • • • •

Lead Consultant PPACA Certified Advisor and Compliance Specialist Strategic Planning and Carrier Negotiations Open Enrollment and Additional Education for Employees

For 22 years, Mike has served as a benefits consultant for small to mid-sized companies. He is an PPACA Certified Advisor, compliance consultant and educator for his clients. Mike focuses on healthcare, human capital, legislative reform and wellbeing as a means to enhance employee morale and control costs. Mike has a passion for educating his clients’ employees about becoming intelligent healthcare purchasers. With a Bachelor of Science in Exercise Science from Valdosta State University, Mike has the knowhow to create awareness and engagement with physical and mental wellbeing.

Jacquie Chambers

Senior Account Manager jchambers@sspins.com | 678.538.2897 • • • • •

Primary Contact for Administration Management and Execution of Service Plan RFP/Renewal Marketing New Client Implementation and Onboarding Open Enrollment Coordination

Jacquie brings over 23 years of employee benefits expertise to her clients. She joined Sterling Seacrest Pritchard following six years of employment with Managed Healthcare Solutions as a Senior Account Manager and eight years as a Benefits Manager at Facility Design Group. She has worked with employers of all sizes. She has also had extensive experience with all ancillary employee benefits including Life, Disability, EAPs, HRAs, FSAs, COBRA and more.

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1.3 Describe the proposed team that would work with Darlington School and provide information about the qualification and expertise of each team member.

Charlotte Conner

Associate Account Manager cconner@sspins.com | 404.832.8642 • • • • •

Direct Employee Contact for Customer Service Claims Advocacy and Resolution Billing and Audit Specialist Open Enrollment Assistance Communications Developer

Charlotte graduated from Albany State University with my Bachelor’s Degree in Political Science. After graduation, she attended law school in Michigan and worked at a law office, helping process legal claims.

When she moved back to Georgia and taught for four years, she then decided to get back into corporate America. She’s been with SSP for 4 years as an Account Manager.

Nnamdi Anene

Client Service Advocate nanene@sspins.com | 404.832.8642 • • • • •

Direct Employee Contact for Customer Service Claims Advocacy and Resolution Billing and Audit Support Open Enrollment Assistance Communications Support

Nnamdi graduated from the Terry College of Business at the University of Georgia with a B.B.A. in Risk Management & Insurance in May of 2021. They have the #1 Risk and Insurance program in the country!

While in school, he interned for us and proved to be quite the asset for our department. He assisted with enrollments, renewals, variance reports, and more all in a timely fashion with excellent documentation accuracy and received consistent top-tier rating and increases in responsibilities.

In addition to these 4 dedicated team members, SSP provides 8 additional specialists that each SSP team has access to. These team members specialize in technology, human resources consulting, legal, actuarial & underwriting support, analytics, benchmarking and complex claims resolution.

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1.4 Please discuss any recent innovative developments by your firm.

Sterling Seacrest Partners and Pritchard & Jerden merged to form SSP in April of 2021. We became the largest employee-owned insurance agency in the southeast. This improved our market leverage and brought more resources to our clients. Our moto is “Stronger Together” because we believe the partnership of two top-tier agencies provide our clients with more support and expanded access to quality benefits that we did not have before.

We’ve been recognized as Best Places to Work for 11 years running from both the Atlanta Business Chronical and Business Insurance Magazine. These awards are awarded based on our employee survey responses each year.

2.1 Describe the steps you will take in reviewing Darlington School’s current employee benefit plans and designing changes to the program (as needed).

Step 1: Analytics specialist will review all healthcare, dental, vision and disability claims data back to inception of the UMR plan and back 2 years for ancillary benefits (Rx, large claimants, care gaps, COBRA, Medicare and provider discounts, access and quality).

Step 2: SSP benefits survey developed and sent to Darlington School staff to determine areas that the staff would like addressed to better suite their needs.

Step 3: Private school benchmarking report developed to ensure the program is competitive.

Step 4: Proposal develop incorporating integrated cost containment programs that address cost drivers that can be controlled and help employees with better healthcare outcomes.

Step 5: Execute plan which includes pre/during/post open enrollment education for employees.

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2.2 In your opinion, what are the three major challenges organizations our size face, and how will your firm help meet these challenges?

Schools are challenged with high turnover and the current competitive labor market. Below are three challenges that contribute to attraction and retention of valuable staff members.

1. Escalating healthcare insurance expense: Identifying cost drivers and developing programs to mitigate risks are the pillars of SSP’s T.R.I.P. (Targeted Risk Intervention Program). This program is a multi-year strategy that deploys SSP’s service model including proactive mental, physical and financial wellbeing initiatives, employee education, claims analytics and actionable interventions in order to control rising healthcare and insurance costs long-term.

2. Employee education and guidance: 36 percent of adults in the U.S. have low health literacy. Individuals with low health literacy experience greater health care use and costs compared to those with proficient health literacy. SSP’s healthcare consumerism workshops provide monetary incentives to employees for engaging in learning environments in order to increase health literacy, optimize health plan usage and save money. We also provide an advocacy service which provides experts who are trained in the healthcare industry to personally guide people and help them navigate “the system”. In addition to price transparency, an Advocate can review and negotiate medical bills, locate in-network providers, review prescriptions for lower-cost options, and provide guidance to understand and use their benefits more efficiently.

3. Mental health support for staff: Mental and Behavioral (M&B) health benefits are currently the most desired employee benefit. M&B health benefits can help employees improve their stress and coping mechanisms while decreasing their risk of physical illness. More content employees also better communicate with their managers, their team and other departments as well as maintain a higher level of productivity. SSP tailors these programs to schools.

2.3 Detail your benchmarking capability and access to survey data.

SSP provides benchmarking analytics from the WakelyBCS Benchmarking Dashboard. The dashboard boasts 9,597 employer groups and 21,959 health plans spanning 47 states in the country. The dashboard provides you with more than one benchmarking data set by also offering relevant public benchmarking data from the annual Kaiser Family Foundation Employer Health Benefits Survey.

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2.4 Are there new coverage options that we should consider in seeking proposals for health insurance services?

Most private schools in GA are focused on providing expanded mental & behavioral health services that extend beyond Employee Assistance Programs (EAPs).

We are also seeing an uptick with concierge services that provide advocacy for employees when they are in need of specialized care or when they need assistance shopping for the highest quality and lowest cost care and prescription drugs.

Long term disability (LTD) has always been undervalued; however, it’s now more common for employers with more than 50 employees to provide it at the employer’s expense. Darlington School only has around 35% participation in the LTD program currently, and this coverage can mean the difference between maintaining quality of life and bankruptcy for some people if they have a disability.

Lastly, a centralized mobile-enabled platform (app) that provides an experience where all benefits are housed that includes an advocacy service is trending, especially for self-insured companies.

Our app provides employees one place to view all benefits, ID cards, provide telemedicine, connect with a billing specialist to negotiate bills, find high quality providers, make appointments for members and help shop for lower-cost, higher-quality healthcare and medications.

2.5 Describe your underwriting and actuarial resources.

SSP provides both in-house and external actuarial services. We provide everything from IBNR, IBNP, predictive modeling, budgeting factor calculations, pricing models, self-insurance feasibility studies, renewal projections and more.

2.6 Describe how your firm will provide value with Rx and Pharmacy Benefit Management (PBM) analysis and REAL transparency into costs and rebates.

Our in-house PBM consultant analyzes and writes PBM contracts. We will review and compare PBM contracts and identify language that: 1.

2.

3.

4.

Increases risk and liabilities for the school and members Redirects savings and rebates to the PBM and/or TPA Limits members’ ability to access life-savings and specialty medications Makes it difficult for members to get preauthorization approval for necessary medications

SSP will ensure full transparency of revenue sources from the PBM and write suggested modifications to the contract to ensure patient protections are in place to allow access and cost control for enrolled members.

SSP also provides medical and Rx utilization analytics that identify conditions and medications that we may help with getting preauthorization for and provide member outreach to help.

9

2.7 Describe any additional service options that may be of interest to Darlington School.

Below is a short list of additional, more advanced solutions that private schools are targeting.

Private school healthcare insurance consortium: https://vimeo.com/420369597 Medicare and COBRA enrollment support Fertility benefits Oncology management program Outpatient surgical and major diagnostics program: https://getkisx.com/ Rx Consortium Specialty Rx carve out and member support: https://www.sharxplan.com/employers/

3.1 Outline your approach to negotiations and renewals with insurance carriers on your client’s behalf and provide a sample timeline.

The most important strategy to take to attain and maintain a high quality and competitively priced program is to: 1.

2.

3.

4.

5.

Ensure you are provided with the right data on your controllable cost drivers Identify strategic point solutions to implement and control costs while still maintaining quality Execute those solutions with member support Report on successes with cost reductions and avoidance Share your successful efforts to reduce/avoid costs and to maintain programs that control future costs with underwriters

If you do 1-4 above but leave out 5, you will not get favorable terms from the market or on your reinsurance contract renewal which could include lasers. Payers (schools and stop loss carriers) want effective cost containment programs that are tailored and practical for each school.

Underwriters are more willing to provide favorable terms in their contracts if they know you are making efforts to keep costs down.

The SSP + Darlington Annual Service Plan is strictly adhered to and always initiated by your SSP team. For a self-insured group with 100-200 enrolled subscribers, we start the renewal process 6 months before your renewal. Please refer to the SSP + Darlington Annual Service Plan or see next page.

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3.2 What market leverage does your company have with vendors and how have you used this leverage to your client’s advantage?

Sterling Seacrest Pritchard is the largest independently-owned insurance agency in the southeastern United States with 300 employees and $80M in revenue. With our Assurex Global membership, we currently produce $30B in annual insurance premiums across the globe. We have preferred broker status with over 400 insurance carriers. Please refer to: Market Leverage.

Because of this, we are provided access to unique programs that cater to specific industries such as the Independent School Benefits Consortium (ISBC) for private schools. There is no better program for schools that have 50 -250 employees. The long-term performance of the program speaks for itself. Click here for details: https://vimeo.com/420369597. Year-over-year results of the ISBC program will be shared during the in-person meeting.

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3.3 Describe your approach to monitoring the performance of insurance carriers, and other vendors.

As part of SSP’s Annual Service Plan, we conduct annual carrier and broker satisfaction reviews with all clients. The results from all teams are combined to determine common performance issues. Our management team will schedule in-person meetings with carriers to discuss what needs to be improved and share the feedback with our clients. If we do not see improvement, we will suggest a move away from the carrier to one that is inline with our performance standards, pricing, administrative support and benefit quality.

3.4 Describe your experience managing employee claims escalation, your experience assisting clients with complicated administrative issues, and fostering positive resolution.

All 4 dedicated team members have experience with resolving claims and assisting with appeals.

Furthermore, we have 2 additional claims advocates that do nothing but complex claims resolution. They both have extensive backgrounds from insurance carriers’ claims departments and understand the carrier approval process.

We encourage collaboration when handling complicated administrative issues. We are a close team and always help one another out when there’s a need. In our weekly team meetings, we discuss claims and administrative issues and develop a plan for resolution, many times involving multiple team members’ input and efforts.

4.1 What resources do you use to analyze medical and pharmacy claims?

SSP uses the analytics platform called Self-Insured Reporting (SIR). The platform has 100s of integrations that produce reports including aggregate reporting, stop loss specific deductible reports, large claimant data, gaps in care, pharmacy, budget tracking, renewal projections, predictive modeling, plan design modeling, employee/employer contribution modeling, IBNR, IBNP, funding summary, claim lag study, COBRA claims, Medicare opportunities, case management and more. See video explanation here: https://www.youtube.com/watch?v=Ci7LnsZjk2g

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4.2 What types of plan and benefit reports do you provide and how frequently do you provide them? Provide examples.

You have access to any of the reports mentioned above. SIR allows for automated reports to be generated at your desired frequency and sent to designated staff. You may choose the reports that are most important for each staff member. SSP will guide you on what reports are best for you and provide those reports with insights on a monthly basis. Examples are below and on the next page.

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IBNP Report - Example (SCHOOL NAME) MED & RX RESERVE SUMMARY EXHIBIT Date

Completion Factor Members

Incurred Loss

Ultimate Loss

Reserve

Incurred PMPM

Ultimate PMPM Reserve PMPM

Apr-19

100.000000%

1,366

$576,152.02

$576,152.02

$0.00

$421.78

$421.78

$0.00

May-19

100.000000%

1,375

$831,369.95

$831,369.95

$0.00

$604.63

$604.63

$0.00

Jun-19

100.000000%

1,362

$587,929.94

$587,929.94

$0.00

$431.67

$431.67

$0.00

Jul-19

100.000000%

1,338

$916,833.49

$916,833.49

$0.00

$685.23

$685.23

$0.00

Aug-19

100.000000%

1,327

$906,544.60

$906,544.60

$0.00

$683.15

$683.15

$0.00

Sep-19

100.000000%

1,324

$680,047.56

$680,047.56

$0.00

$513.63

$513.63

$0.00

Oct-19

100.000000%

1,288

$865,043.96

$865,043.96

$0.00

$671.62

$671.62

$0.00

Nov-19

100.000000%

1,278

$702,612.38

$702,612.38

$0.00

$549.77

$549.77

$0.00

Dec-19

100.000000%

1,266

$869,597.30

$869,597.30

$0.00

$686.89

$686.89

$0.00

Jan-20

100.000000%

1,276

$321,776.59

$321,776.59

$0.00

$252.18

$252.18

$0.00

Feb-20

100.000000%

1,244

$908,003.39

$908,003.39

$0.00

$729.91

$729.91

$0.00

Mar-20

100.000000%

1,207

$475,618.83

$475,618.83

$0.00

$394.05

$394.05

$0.00

Apr-20

100.000000%

1,189

$630,172.99

$630,172.99

$0.00

$530.00

$530.00

$0.00

May-20

100.000000%

1,181

$556,814.95

$556,814.95

$0.00

$471.48

$471.48

$0.00

Jun-20

100.000000%

1,144

$525,388.34

$525,388.34

$0.00

$459.26

$459.26

$0.00

Jul-20

100.000000%

1,103

$442,113.15

$442,113.15

$0.00

$400.83

$400.83

$0.00

Aug-20

100.000000%

1,106

$681,108.68

$681,108.68

$0.00

$615.83

$615.83

$0.00

Sep-20

100.000000%

1,090

$623,914.42

$623,914.42

$0.00

$572.40

$572.40

$0.00

Oct-20

100.000000%

1,074

$530,938.70

$530,938.70

$0.00

$494.36

$494.36

$0.00

Nov-20

100.000000%

1,081

$743,273.63

$743,273.63

$0.00

$687.58

$687.58

$0.00

Dec-20

100.000000%

1,085

$558,155.62

$558,155.62

$0.00

$514.43

$514.43

$0.00

Jan-21

100.000000%

1,080

$298,224.91

$298,224.91

$0.00

$276.13

$276.13

$0.00

Feb-21

100.000000%

1,131

$371,345.93

$371,345.93

$0.00

$328.33

$328.33

$0.00

Mar-21

99.949695%

1,124

$394,720.74

$394,919.40

$198.66

$351.18

$351.35

$0.18

Apr-21

99.867434%

1,125

$661,435.26

$662,313.26

$878.00

$587.94

$588.72

$0.78

May-21

99.809205%

1,122

$325,263.59

$325,885.36

$621.77

$289.90

$290.45

$0.55

Jun-21

99.319431%

1,140

$693,317.66

$698,068.50

$4,750.84

$608.17

$612.34

$4.17

Jul-21

98.193008%

1,164

$749,794.84

$763,592.91

$13,798.07

$644.15

$656.01

$11.85

Aug-21

98.038559%

1,152

$614,884.67

$627,186.57

$12,301.90

$533.75

$544.43

$10.68

Sep-21

97.449685%

1,137

$1,041,581.36

$1,068,840.15

$27,258.79

$916.08

$940.05

$23.97

Oct-21

96.290798%

1,104

$937,988.92

$974,121.04

$36,132.12

$849.63

$882.36

$32.73

Nov-21

94.973668%

1,097

$959,835.98

$1,010,633.79

$50,797.81

$874.96

$921.27

$46.31

Dec-21

89.740756%

1,151

$484,555.51

$539,950.33

$55,394.82

$420.99

$469.11

$48.13 $51.40

Jan-22

84.369169%

1,166

$323,501.55

$383,435.74

$59,934.19

$277.45

$328.85

Feb-22

71.532023%

1,159

$252,540.75

$353,045.72

$100,504.97

$217.90

$304.61

$86.72

Mar-22

27.154150%

1,154

$93,249.56

$343,408.13

$250,158.57

$80.81

$297.58

$216.78

March IBNR

$612,730.52

"Floor"

*MH Pended Claims

$442,465.30

"In the Hopper"

(Pended Over Stop Loss)

$1,867.00

Net Out of Pended

(Est. Cigna Discount)

($233,274.46)

"45%-50% Disc"

Estimated "Hybrid" IBNP

$823,788.36

*Pended claims are raw claims that have been submitted, but not processed with any discounts, audits, or other coordination of benefits. *Pended Claims for members who have satisfied the $250K

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Specific Deductible are removed.

4.3 How do you use data to manage costs? Provide examples.

One example of using data to manage costs is identifying employees on high-cost specialty medications that are able to source it elsewhere at a fraction of the cost. Once we are able to determine eligibility for the alternative funding for the medications in question, we provide outreach to those members to educate them on how they can enroll in a program to get the same drug at no cost or a fraction of what they are paying currently. Specialty medications have a major impact on the price of healthcare insurance. Providing members with this option will not only reduce or eliminate their drug expense, it will also drastically reduce the school’s.

4.4 How do you objectively and independently verify the value of network discounts?

1. SSP gathers 12 months of claims data, based on how covered lives actually used health care services. This data will show how they actually used care, including what types of care were used and which doctors, hospitals, health systems provided that care.

2. The claims are sorted by each in-network provider based on each provider’s tax identification number.

3. Each network provides a database of six months of actual claims, which are also sorted by each in-network provider based on each provider’s tax identification number. These claims show the actual savings produced by the discounts included in contracts for health care services.

4. The data is analyzed based on the network’s aggregated savings. This will project what savings can be expected based on covered lives’ actual use of services.

5. The combined results reveal the value of each network’s agreements with providers. The results should show both the overall discount achieved by the network and the dollars that the school can expect to save, based on the submitted claims.

4.5 Does your firm employ data mining tools to reduce healthcare costs? Explain your process.

Yes, this is a capability included with the SIR platform. Examples include mining data to identifying noncompliance with Rx and medical conditions and gaps in care. Please refer to questions 4.1, 4.2 and 4.3 for more details.

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5.1 How do you provide legal research, compliance, and legal consultation and information on the benefit plans?

We have 2 approaches we use together: 1. Humana approach: SSP provides monthly compliance webinars, relevant regulatory updates and whitepapers and a team of legal and HR staff. Below are SSP’s legal resources.

• In-house counsel • ERISA law firm • SPHR certified HR consults 2. Automated approach: • Automated health plan compliance calendar developed each year Below is an example of our monthly compliance webinar invitations. They are recorded and sent to all that register, even if they do not attend.

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5.2 How do you keep your clients up-to-date? Provide samples.

In addition to our monthly compliance webinars, automated health plan compliance calendar and relevant market updates, we adhere to our SSP Annual Service Plan (see page 11).

5.3 Do you prepare your clients Form 5500 filings on their behalf and at what cost?

Yes, at no cost to our clients.

6.1 Describe your protocol for disclosure of compensation and philosophy on compensation transparency.

We believe in 100% transparency. SSP provides broker compensation disclosures on every product represented. We also file your 5500 which includes full compensation on each product.

6.2 Describe our right to terminate a contract with you. Is there a minimum contract period?

We have no required contract length. You may terminate the contract with SSP at any time with no penalty.

6.3 Please provide a sample fee agreement.

Click here or use this address to view: https://issuu.com/pjmarcomm/docs/ssp_fee_agreement?fr=sNzE1YjQ3MjE4NjQ

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THE INSURANCE BROKERAGE YOU N E V E R E X P E C T 18 E D.