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Medicare Part D — Retiree Drug Subsidy S <br />Customer service for Members <br />Part D subsidy enhanced service (ESI sends reports <br />$1.12 PMPM for Medicare -qualified Members <br />to CMS on behalf of Client) <br />with a minimum annual fee of $7,500 <br />i Notice of Creditable Coverage <br />$1.35/letter+ postage <br />Part D Subsidy standard service (ESI sends reports to <br />$0.62 PMPM for Medicare -qualified Members <br />Client) <br />with a minimum annual fee of $5,000 <br />B. Home Delivery Services <br />$1.35/letter + postage <br />A. Notice of Creditable Coverage <br />Web -based client reporting — Annual Strategic Account Plan report <br />PBM Services — No Additional Fee <br />Customer service for Members <br />Electronic claims processing <br />Electronic/on-line eligibility submission <br />Plan setup <br />Standard coordination of benefits (COB) <br />reiect for primary carrier <br />Software training for access to our on-line <br />system(s) <br />• FSA eligibility feeds <br />A. Network Pharmacy Services <br />Pharmacy help desk Pharmacy reimbursement <br />Pharmacy network management Network development (upon request) <br />B. Home Delivery Services <br />Benefit education Prescription delivery — standard <br />Reporting Services <br />Web -based client reporting — Annual Strategic Account Plan report <br />Ad-hoc desktop parametric reports Billing reports <br />Claims detail extract file electronic CPDP format Inquiry access to claims processing system <br />Load 12 months claims history for clinical reports <br />and reporting <br />Website Services <br />Express-Scripts.com for Members — access to <br />benefit, drug, health and wellness information; <br />prescription ordering capability; and customer <br />service <br />Implementation Package and Member Communications <br />• New Member packets (includes two standard <br />resin ID cards) <br />• Member replacement cards printed via web (For <br />hard -copy cards, charges are passed through from the <br />PBM <br />Implementation support <br />Clinical <br />Concurrent Drug Utilization Review (DUR) <br />Overrides <br />a. Sponsor -requested overrides <br />b. Lost/stolen overrides <br />c. Vacation supplies <br />No Charge <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARN3 <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />