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DocuSign Envelope ID 06CEAA47-F11 F-421A-B8CE-390F42C61208 <br /> 3. Pricing Valid July 1,2024 to June 30,2025 <br /> Workers'Com sensation Claims Administration Ci of Everett <br /> Description Pricing <br /> Life of Contract Flat Annual Fee <br /> Up to 90 Indemnity& 100 Medical Only Claims Annually $115,850.42 <br /> Per claim Fee after maximum number of claims: <br /> Medical-Only $172.65 <br /> Indemnity $1,266.12 <br /> Employer's Liability $1,266.12 <br /> Pro.ram Mana•ement <br /> Description Pricing <br /> Data Conversion-Per Data Source Waived <br /> Administration Fee- Per Annum $13,812.27 <br /> Implementation Fee-One Time Fee Waived <br /> CareMC Access-Per Annum 2 <br /> First 6 Full Access Users Included <br /> Each User over 6- Per User,Per Year $1,000.00 <br /> State Fund Oversight(OH, WA) 50%of standard fees,based on <br /> service level <br /> Archive Storage Expenses3 Pass through expense from Access <br /> 'Includes Assistance with Self-Insured Data for State Reports, State Statistical Reporting&All State Filing <br /> Requirements <br /> 2 Includes Executive Dashboard,Claim Details,Claims Summary Screen&Claims Reporting <br /> 3 In the event City of Everett takes custody of the physical files and the Access account is closed,this charge will no <br /> longer apply. <br /> Account Mana•ement and Technical Su sort <br /> Description Pricing <br /> Account Management Staff Included <br /> Electronic Data Transmission-(Per Month, Based on Frequency) <br /> Monthly File $250.00 <br /> Weekly File $600.00 <br /> Daily File $2,000.00 <br /> Training Onsite and Online Included <br /> Technical Support Included <br /> State EDI Files Included <br /> Monthly Reporting Included <br /> Ad hoc Report Programming-Per Hour $200.00 <br /> Communication Materials/Posters Pass through printing cost <br /> Annual Banking Fees One account included <br /> Additional Account(s) - Per Account $1,000.00 <br /> Carrier TPA Oversight Fees ' Bill from Carrier to Client <br /> 'Fees charged by the carrier(Oversight fees,Tail Claim transfer/takeover fees,etc.)are the responsibility of the client <br /> and will be billed directly to the client by the carrier or by CorVel should CorVel be invoiced for such fees. <br /> Intake and Immediate Intervention Services <br /> Description Pricing <br /> Claim Intake(includes one FNOL distribution)-Per Intake $34.53 <br /> Incident Only Reporting-Per Incident $34.53 <br /> Advocacy 24/7 - Per Call $99.95 <br /> I elehealth Services Fee Schedule or U&C value by CPT code <br /> City of Everett,WA—CorVel EC Amendment 3 7-25-2022 <br /> AUSTIN_WRIGHT@CORVEL.COM T: 503.501.5607 I C: 971 .227.0860 <br />