exv10wxvy



 



EXHIBIT 10(v)


BUSINESS ASSOCIATE AMENDMENT



     This Amendment is made to the AARP Health Insurance Agreement
(“Agreement”) between United HealthCare Insurance Company (“United”), AARP,
AARP Services, Inc. and the Trustees of the AARP Insurance Plan, as amended and
assigned (“Agreement”), for the purpose of outlining requirements relating to
services provided by AARP Services, Inc. (“Business Associate”) on behalf of
United. This Amendment shall apply only to the extent that in the performance
of the Agreement, Business Associate, or any of its employees, Business
Associates or agents, may obtain access to Protected Health Information or
Personal Information, as defined below. The terms and conditions of this
Amendment required by HIPAA and/or GLB are effective as of the compliance date
applicable to United, or this Agreement, under HIPAA and/or GLB, respectively.



	1.	 	The Agreement is hereby amended by the addition of the following section:
	 
	 	 	Section 7.8. Protected Health and Personal Information
	 
	 	 	1. Business Associate understands and acknowledges that it may receive from or
create or receive on behalf of United Protected Health Information, as defined
under the privacy regulations issued pursuant to the Health Insurance
Portability and Accountability Act of 1996 (“HIPAA”), and/or nonpublic
personal information, as defined under the Gramm-Leach-Bliley Act and
implementing regulations (“GLB”), during the performance of its obligations
under this Agreement. The provisions of this Agreement do not apply to (i)
information provided to or created by AARP Services, Inc. and/or AARP prior to
the effective date of GLB, or (ii) information provided to or created by AARP
Services, Inc. and/or AARP before the HIPAA effective date concerning
individuals who had received the United GLB Privacy Notice but did not
exercise their rights to “opt out” from information sharing.
	 
	 	 	2. Except as otherwise specified herein, Business Associate may use or
disclosure Protected Health Information received from or created or received
on behalf of United (“PHI”) and nonpublic personal information received from
or created or received on behalf of United (“Personal Information”) to perform
functions, activities, or services for, or on behalf of, United as specified
in this Agreement and Exhibit A (or as otherwise agreed by the parties),
provided that such use or disclosure would not violate the HIPAA privacy
regulations, GLB or other federal or state privacy laws applicable to United,
if done by United.
	 
	 	 	3. With regard to its use and/or disclosure of PHI or Personal Information,
Business Associate hereby agrees and represents and warrants to United that
Business Associate shall:




	 	(a)	 	not use or further disclose any PHI or Personal Information other
than as permitted by this Agreement or required by law.
	 
	 	(b)	 	at all times maintain and use appropriate safeguards to prevent
uses or disclosures of any PHI or Personal Information other than as
permitted by this Agreement or required by law;
	 
	 	(c)	 	ensure that any subBusiness Associate or agent to whom it provides
any PHI or Personal Information agrees in writing to the same
conditions and restrictions that apply to Business Associate with
regard to the PHI or Personal Information, including, without
limitation, all of the requirements of this Section.




	 	 	4. With regard to its use and/or disclosure of PHI, Business Associate hereby
agrees and represents and warrants to United that Business Associate shall:




	 	(a)	 	report promptly to United any use or disclosure of any PHI of which
it becomes aware that is not permitted by this Agreement;
	 
	 	(b)	 	mitigate, to the extent practicable, any harmful effect that is
known to Business Associate of a use or disclosure of PHI by Business
Associate in violation of the requirements of this Agreement; in the
time and manner designated by United, make available PHI in a
Designated Record Set, to United, or as directed by United, to an
individual, in order for United to respond to individuals’ requests for
access to information about them in accordance with the HIPAA privacy
regulation;
	 
	 	(c)	 	in the time and manner designated by United, make any amendments or
corrections to the PHI in a Designated Record Set that United directs
in accordance with the HIPAA privacy regulation;
	 
	 	(d)	 	in the time and manner designated by United, document such
disclosures of PHI and information related to such disclosures as would
be required for United to respond to a request by an individual for an
accounting of disclosures of PHI in accordance with the HIPAA privacy
regulations;
	 
	 	(e)	 	in the time and manner designated by United, make available to
United, or as directed by United, to an individual, the information
documented in accordance with subsection (d) above, to permit United to
respond




BA Amendment (United is CE)



 






 







	 	 	 	to a request by an individual for an accounting of disclosures,
in accordance with the HIPAA privacy regulations;
	 
	 	(f)	 	in the time and manner designated by United or the Secretary of
HHS, make its internal practices, books and records relating to the use
and disclosure of PHI available to the United and to the Secretary of
HHS for purposes of determining United’s compliance with the HIPAA
privacy regulations.




	 	 	5. Each term and condition of this section required by HIPAA and/or GLB shall
be effective on the compliance date applicable to United, or this Agreement,
under the HIPAA privacy regulation and/or GLB, respectively.
	 
	 	 	6. Business Associate agrees that this Agreement may be terminated by United
in accordance with the written notice, breach and cure provisions in the
Agreement in the event that United determines that Business Associate has
violated any material term of this section.
	 
	 	 	7. Upon the termination of this Agreement for any reason, Business Associate
shall return to United or destroy all PHI and/or Personal Information, and
retain no copies in any form whatsoever. This provision shall apply to PHI
and/or Personal Information that is in the possession of subBusiness
Associates, vendors or agents of Business Associate.
	 
	 	 	8. Unless otherwise specified in this Agreement, all capitalized terms in this
section not otherwise defined have the meaning established for purposes of
Title 45 parts 160 and 164 of the United States Code of Federal Regulations,
as amended from time to time.
	 
	 	 	9. The Parties agree to take such action as is necessary to amend this
Agreement from time to time as is necessary for United to comply with the
requirements of HIPAA, the HIPAA privacy regulations, GLB and other federal
and state privacy and consumer rights laws and regulations applicable to
United. Business Associate agrees to cooperate with and assist United in
order for United to meet its obligations under applicable privacy laws and
regulations.
	 
	 	 	10. This section shall survive any termination of this Agreement.
	 
	 	 	11. The terms and conditions of this section required by HIPAA shall be
construed in light of any applicable interpretation of and/or guidance on the
HIPAA privacy regulation issued by HHS from time to time. Any ambiguity in
this section shall be resolved in favor of a meaning that permits United to
comply with applicable laws and regulations.
	 
	2.	 	All other provisions of the Agreement shall remain in full force and effect.




	 	 	 	 	 	 	 
	United HealthCare Insurance Company	 	AARP Services, Inc.
	 	 	 	 	 	 	 
	Signature	 	/s/ DAVID P. INGRAHAM	 	Signature	 	/s/ DAWN M. SWEENEY
	



	 	




	 	 	 	 	 	 	 
	Title	 	SVP	 	Title	 	President
	



	 	




	 	 	 	 	 	 	 
	Date	 	4/11/03	 	Date	 	4-11-03
	



	 	








BA Amendment (United is CE)



 






 



EXHIBIT A

BUSINESS ASSOCIATE AMENDMENT




	 	 	 	 	 	 	 
	Function	 	Process	 	Frequency	 	Required Data
	
	 	
	 	
	 	

	Royalty Verification	 	
Verify member
premium and
provider royalty
payments
	 	Monthly
	 	Individual member
names, demographic
contact
information,
specific product
participation,
enrollment/term
dates, premium
amounts by product,
any and all
Insurance Trust
activity related
information
	 	 	 	 	 	 	 
	Customer Service	 	
Respond to member
requests for issue
or dispute
resolution,
maintain ombudsmen
services to help
resolve claims,
disputes and other
issues with service
providers,
responding to
complaint
correspondence
regarding the
service providers
	 	Daily
	 	Individual member
names, specific
product
participation,
enrollment/term
dates, premium
amounts by product,
member age,
Medicare status,
demographic contact
information, claim
payment history and
status, reasons for
claim denial,
explanations for
benefit
authorization,
benefit amounts,
premium/EFT
billing, account
status,
prescription
purchase and
pricing
information, status
of prescription
orders,
prescription
billing
information, status
of accounts, copies
of scripts as
requested to verify
incorrect orders.
	 	 	 	 	 	 	 
	Quality Assurance	 	
Create and monitor
performance and
service standards
for HCO, monitor
providers for
compliance with
agreed upon
standards, develop
and complete ASI
member satisfaction
surveys.
Review/approve
strategic operating
and marketing
plans, review and
approve all
marketing and
website copy. Audit
and inspect
management reports,
complaints,
finances and
statistical data of
providers, perform
internal audits of
providers, review
product
development,
budgets and pricing
by the providers,
and provide general
quality control
under the
Agreement
	 	Monthly
	 	Claims inventory,
claims received,
claims processed,
claims pended, days
to complete claim
processing,
enrollment
inventory,
enrollments
received,
enrollments
processed by
product, numbers of
members transferred
to UHC for claim
issue resolution,
timeliness of
answering and
responding to these
calls and member
inquiries, numbers
of pieces of
correspondence
received, percent
of correspondence
resolved in 5
business days,
percent resolved in
10 business days,
related outstanding
issues; numbers of
underwriting
appeals, percent
resolved in 10 days
and related
outstanding issues,
all customer
satisfaction
surveys and results
from each survey,
all marketing
plans, operating
plans, marketing
copy, strategic
plans, financial
reports and
statistical data,
product
development,
budgets and pricing
information, new
product planning
and any other
related
information.



 






 



EIGHTH AMENDMENT TO THE AARP HEALTH INSURANCE AGREEMENT



     This Eighth Amendment to the AARP Health Insurance Agreement (this
“Amendment”), effective as of July 24, 2003 (the “Effective Date”), is made by
and between AARP Services, Inc., a Delaware corporation (“ASI”) and United
HealthCare Insurance Company, a Connecticut corporation (“United”). The
parties hereto shall collectively be referred to as the “Parties”.


RECITALS



     WHEREAS, the AARP, the Trustees of the AARP Insurance Plan, and United are
parties to a certain AARP Health Insurance Agreement dated as of February 26,
1997 (the “Original Agreement”).


     WHEREAS, by subsequent amendment and assignment on December 28, 1999,
AARP, AARP Trust and United agreed to the assignment to and assumption by ASI
of certain rights and obligations (the “Third Amendment”) and, further, United,
AARP and AARP Trust executed a Royalty Agreement dated December 28, 1999
granting United a license to the AARP Marks defined therein and the amended and
assigned agreement was made a part thereof.


     WHEREAS, in addition to the Third Amendment, six other amendments have
been made to the Original Agreement (collectively, the “Agreement”).


     WHEREAS, pursuant to Subsection 6.4.5, the funds in the SHIP Portfolio
have been invested in accordance with a written investment strategy (“AARP
Investment Policy”).


 






 


     WHEREAS, the Parties desire to improve SHIP Portfolio performance through
a modification in risk tolerance and the elimination of the December 31, 2007
maturity date constraint.


     WHEREAS, pursuant to Subsection 6.4.5, United has proposed revisions to
the AARP Investment Policy that have been approved by AARP Trust and
memorialized in a letter from United to ASI dated July 24, 2003.


     WHEREAS, elimination of the December 31, 2007 maturity date constraint
necessitates a modification to the Agreement to effectuate this change and
mitigate United’s resulting risk of loss at the maturity date.


                  NOW, THEREFORE, the Parties agree as follows:




	1.	 	Subsection 6.4.7 of the Agreement is amended by deleting the subsection
in its entirety and replacing it with the following:




		
	 	6.4.7. Investment Performance; Ownership. United does not guarantee the
preservation of the principal amount of the assets comprising the SHIP
Portfolio, and does not guarantee the achievement of any specific rate of
return on the assets comprising the SHIP Portfolio. United shall not impose
any investment liquidation charge in connection with the scheduled
termination of this Agreement, except as permitted under Section 10.4.3.8
hereof. The SHIP Portfolio shall not constitute an asset of AARP or AARP
Trust, nor shall AARP or AARP Trust have any interest in the income derived
therefrom.




	2.	 	Subsection 10.4.3 of the Agreement is amended by the addition of new
subparagraph 10.4.3.8, to read as follows:




		
	 	10.4.3.8. Investments Maturing Beyond Termination Date. The investment
strategy described in Subsection 6.4.5 hereof, as approved by AARP Trust,
permits the SHIP Portfolio (as defined in Subsection 6.4.1 hereof) to
include investments that may have part or all of their principal amount
outstanding after the termination date set forth in Section 10.1 of this
Agreement. In this event, if this Agreement terminates on the date set
forth in Section 10.1:



 






 



		
	 	(a) any transfers made pursuant to Subsection 10.4.3 shall be adjusted for
the Portfolio Capital Gain/Loss in the manner described in Subparagraph
10.4.3.4 (including but not limited to the provision of Subparagraph
10.4.3.4 that permits AARP to require an alternative method of transfer) and




		
	 	(b) the determination of the required RSF Balance pursuant to Subparagraph
10.4.3.7 shall be made prior to the adjustment for the Portfolio Capital
Gain/Loss, and this adjustment may serve to decrease the transferred RSF
Balance below the minimum level prescribed by Subparagraph 10.4.3.7.




	3.	 	Except as amended hereby, all other terms and conditions of the Agreement
shall remain in full force and effect.



            IN WITNESS WHEREOF, the Parties have executed this Eighth Amendment as of
the date and year first above written.



	 	 	 
	/s/ DAWN M. SWEENEY	 	/s/ DAVID P. INGRAHAM
	
	 	


	AARP Services, Inc.	 	
United HealthCare Insurance
	 	 	
Company



 






 



NINTH AMENDMENT TO THE AARP HEALTH INSURANCE AGREEMENT:

50-64 PLAN



     This Ninth Amendment to the AARP Health Insurance Agreement (“Ninth
Amendment” or “Amendment”), effective as of October 1, 2003 (the “Effective
Date”), is made by and between AARP Services, Inc., a Delaware corporation
(“ASI”) and United HealthCare Insurance Company, a Connecticut corporation
(“United”). The parties hereto shall collectively be referred to as the
“Parties”.


RECITALS



     WHEREAS, AARP, the Trustees of the AARP Insurance Plan (“Trustees”), and
United are parties to a certain AARP Health Insurance Agreement dated as of
February 26, 1997 (the “Original Agreement”).


     WHEREAS, by subsequent amendment and assignment on December 28, 1999,
AARP, AARP Trust and United agreed to the assignment to and assumption by ASI
of certain rights and obligations (the “Third Amendment”).


     WHEREAS, various other amendments have been made to the Original Agreement
(collectively, the “Agreement”).


     WHEREAS, pursuant to subsections 3.2.3 and 3.2.4 of the Agreement, the
Parties agreed to undertake product development activities with respect to
additional products and services to enhance the value of the SHIP to AARP
members and differentiate the SHIP from other insurance programs.



	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



1






 



     WHEREAS, the Parties have worked together to design a program offering
comprehensive insurance products for AARP members age 50 to 64 (“50-64 Plan”,
as defined below).


     WHEREAS, the Trustees have approved the 50-64 Plan and authorized the
Parties to implement it on a pilot basis, with a review to occur during the
Pilot Period, as defined below, to determine whether the 50-64 Plan will be
offered beyond the Pilot Period.


     WHEREAS, subsection 3.2.4 of the Agreement requires the terms and
conditions associated with the offering of any new products to be documented in
amendments or exhibits to the Agreement.


     NOW, THEREFORE, the Parties agree as follows:



	 	 	 
	     A.	 	
Article 2 of the Agreement is amended by amending sections 2.56,
2.86, 2.118 and 2.123 to read as follows:
	 	 	 
	 	 	
“2.56. Policy Year means January 1 through December 31 inclusive. For
the 50-64 Plan, the first Policy Year is calendar year 2004. Any 50-64
Plan sales effective as of the end of 2003 and their experience will be
included as part of the 2004 Policy Year.”





	 	 	 
	 	 	“2.86. SHIP Plan means any health insurance plan, including any Medicare
Select plan and any 50-64 Plan, underwritten by United pursuant to this
Agreement, including without limitation any such plan described by any
master group insurance policy issued to AARP Trust by United (or its
affiliates) and insured or reinsured by United (or its affiliates) at any
time during the term of this Agreement.”





	 	 	 
	 	 	“2.118. Network Provider means any health care provider in the United
network that has agreed to participate in (a) a Medicare Select plan made
available under the SHIP, other than a Network Pharmacy, Network
Pharmaceutical Manufacturer, or Network Pharmacy Benefit Manager or (b)
the 50-64 Plan.”




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



2






 




	 	 	 
	 	 	
“2.123. SHIP Pharmacy Plan means a Medicare Supplement, pre-standardized
Medicare Supplement or Medicare Select policy or certificate, or a 50-64
Plan, offered under the SHIP which provides an outpatient prescription
drug benefit.”





	 	 	 
	     B.	 	
Article 2 of the Agreement is further amended by the addition of
the following sections 2.129 through 2.134:
	 	 	 
	 	 	
“2.129. 50-64 Member Contributions for a Policy Year means the sum of the
monthly amounts earned for that Policy Year from each insured enrolled in
the 50-64 Plan during that Policy Year.
	 	 	 
	 	 	
2.130. 50-64 Plan means the preferred provider organization (PPO)
insurance products, initially consisting of comprehensive PPO and
catastrophic PPO products, that have been developed for AARP members age
50 to 64. These products include the use of Network Providers and
coverage for services received from out-of-network providers. These
products are further described in Exhibit 2.130, which exhibit may be
modified from time to time in writing upon mutual agreement.
	 	 	 
	 	 	
2.131. 50-64 Subfund has the meaning set forth in Section 8.2.1 hereof.
	 	 	 
	 	 	
2.132. 50-64 Target Benefit Ratio means the quotient obtained by
dividing the target Incurred Claims for the 50-64 Plan by the target
50-64 Member Contributions for a Policy Year.
	 	 	 
	 	 	
2.133. Marketing Expenses includes those expenses incurred directly for
marketing such as postage, advertising, creative development, production,
printing, agency fees, model and segmentation development, and campaign
implementation costs, exclusive of corporate overhead charges.
	 	 	 
	 	 	
2.134. Pilot Period means January 1, 2004 until June 30, 2005. The
Pilot Period may be changed upon mutual written agreement. Any 50-64
Plan sales effective as of the end of 2003 and their experience will be
included as part of the Pilot Period.”
	 	 	 
	     C.	 	
Section 3.2.2 of the Agreement is amended by the addition of new
subparagraph (j) to read as follows:
	 	 	 
	 	 	
"(j). United shall develop and make available to AARP members the 50-64
Plan in such sites and within such timeframes as agreed to by the
Parties. United shall make available a network of Network Providers and
manage the Network Provider relationships for the 50-64 Plan.




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



3






 




	 	 	 
	 	 	
Additionally, the Parties agree to the following:
	 	 	 
	 	 	
(1) Pilot Period Evaluation. The Parties shall conduct a Pilot Period
evaluation of the 50-64 Plan to be completed by June 30, 2005. The
evaluation will measure the following criteria: (a) the underwriting
acceptance rate calculated by dividing the number of accepted
applications by the total number of applications received net of
withdrawals, (b) the cumulative number of paid sales, (c) lapse rate, (d)
50-64 benefit ratio (loss ratio), (e) the marketing cost per paid
response, and (f) such other criteria that may be mutually agreed upon.
The benchmarks for conducting the evaluation of criteria (a) through (e)
above are set forth in Exhibit 3.2.2(j)(1). The Parties agree that the
results of this evaluation may necessitate changes to the program or
necessitate the discontinuance of new 50-64 Plan sales. Any changes
to the program or the decision to discontinue new 50-64 Plan sales shall
be made upon mutual written agreement, except as provided in Subparagraph
3.3.7.1 below. The Parties further agree to conduct preliminary
evaluations every six (6) months during the Pilot Period that measure the
above criteria to the extent feasible and meaningful.
	 
	 	 	
(2) Reports. United shall provide reports to ASI, at intervals and in a
format and medium to be mutually agreed to by the Parties, to monitor and
evaluate program performance. The types of reports and frequency of
distribution to ASI are set forth in Exhibit 3.2.2(j)(1).
	 	 	 
	 	 	
(3) Decisions. Except as provided in Sections 3.2.2(j)(1) and 3.3.7.1,
ASI and the Trustees shall have the decision-making authority during the
Pilot Period in recognition of the greater risk borne by the 50-64
Subfund. After the first twelve (12) months of the Pilot Period, the
Parties shall negotiate and agree on the terms relating to decision
making authority that will apply after the Pilot Period, taking into
account such factors as claims risk, brand risk, marketing risk and
other relevant risk factors identified by the Parties. Notwithstanding
the foregoing, United shall retain decision-making authority for all
activities required by law and this Agreement to be made by the insurer
and claim and service administrator, such as decisions relating to claim
adjudication (e.g., benefit payments and denials).
	 	 	 
	 	 	
(4) Pharmacy benefit. Determination of the pharmacy benefit design for
the 50-64 Plan is the responsibility of United and ASI. United shall
utilize its pharmacy management programs in the administration of the
pharmacy benefit for the 50-64 Plan for the Pilot Period, including its
Retail Pharmacy Network, Drug List (Formulary), Pharmacy and Therapeutics
Committee and Drug Utilization programs. United contracts with a
pharmacy benefit management company (“PBM”) for the purpose of
administering these management programs. However, subject to input by




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



4






 




	 	 	 
	 	 	
ASI, United retains responsibility and control of all pharmacy management
program decisions. The contracted PBM shall not have the authority to
implement clinical or benefit programs without United’s written consent.
	 	 	 
	 	 	
(5) Performance Standards. United shall meet or exceed the performance
standards and measurements set forth in Exhibit 3.2.2(j)(5) in performing
its obligations relating to administration of the 50-64 Plan. Exhibit
3.2.2(j)(5) also lists penalties, in percentage terms, that will be
applied in the event that United fails to meet a 50-64 Plan performance
standard; such penalties are a percentage of 50-64 Member Contributions
for the applicable Policy Year. In addition, United will adhere to AARP
Health Care Options’ brand guidelines and creative development process,
which includes 50-64 Plan marketing budget approval.”
	 	 	 
	 	D.	
Section 3.3 of the Agreement is amended by the addition of new
subparagraph 3.3.7.1 to read as follows:
	 	 	 
	 	 	
“3.3.7.1. The provisions of Sections 3.3.7 and 3.3.8 shall apply with
respect to the determination of 50-64 Member Contribution rates; provided
however that, during the Pilot Period, United may propose revisions to
50-64 rates at appropriate times for review and approval by the Trustees.
Either party may decide to cease new 50-64 Plan sales at any time.”
	 	 	 
	 	E.	
Section 3.7 of the Agreement is amended by the addition of new
subsection 3.7.1 to read as follows:
	 	 	 
	 	 	
“3.7.1. The provisions of Section 3.7 shall not apply to the 50-64 Plan.”
	 	 	 
	 	F.	
Section 6.1 of the Agreement is amended by the addition of new
subsection 6.1.1 to read as follows:
	 	 	 
	 	 	
“6.1.1. AARP Royalty for 50-64 Plan. AARP shall be entitled to receive
a royalty for AARP’s endorsement of the 50-64 Plan and the license to use
the AARP Marks in connection therewith. This royalty shall be *** of
50-64 Member Contributions initially and is subject to annual review and
revision.”
	 	 	 
	 	G.	
Section 6.2 of the Agreement is amended by the addition of new
subsection 6.2.6 to read as follows:
	 	 	
“6.2.6. Administration Charges for 50-64 Plan Services; Expenses.
	 	 	 
	 	 	
(a) United’s Administrative Services Fee for 50-64 Plan Services.
United’s Administrative Services Fee for Services provided for the 50-64




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



5 






 




	 	 	 
	 	 	
Plan shall be a specified percentage of 50-64 Member Contributions. This
percentage shall be *** initially and is subject to annual review and
revision upon mutual written agreement. Postage costs for activities
other than marketing shall be included as a component of the
Administrative Service Fee for the 50-64 Plan rather than included as
Pass-Through Expenses. Marketing postage costs shall be included as part
of Marketing Expenses under Subparagraph 6.2.6(c) below.
	 	 	 
	 	 	
(b) Contingency Margin. Pricing for the 50-64 Plan shall include a
contingency margin to cover higher than expected costs for benefits and
expenses as mutually agreed by the Parties (“Contingency Margin”). The
Contingency Margin shall be *** of 50-64 Member Contributions for the
Pilot Period.
	 	 	 
	 	 	
(c) Marketing Expenses. Pricing for the 50-64 Plan shall include
provision for expected Marketing Expenses. Actual Marketing Expenses
shall be charged to the 50-64 Subfund but treated like a loan and repaid
with interest on a monthly basis to the 50-64 Subfund as the 50-64 Member
Contributions are earned. During the first Policy Year, the repayment
with interest will equal *** of 50-64 Member Contributions. For
subsequent Policy Years, the provision in pricing for new Marketing
Expenses and the percentage of actual 50-64 Member Contributions that is
applied to repay the 50-64 Subfund with interest for Marketing Expenses
shall be subject to review and approval by the Trustees.
	 	 	 
	 	 	
(d) Charges for Claims and Marketing Risks. The 50-64 Subfund shall
receive *** of the 50-64 Member Contributions for claims risk and *** of
the 50-64 Member Contributions for marketing risk associated with the
50-64 Plan.
	 	 	 
	 	 	
(e) Tax-Timing Expenses, premium tax, AARP royalty, United compensation,
Contingency Margin, Marketing Expenses and investment income for the
50-64
Plan shall be paid through a retrospective experience rating charge (as
described in Section 8.3 hereof). Attached as Exhibit 6.2.6(e) is a pro
forma expense summary for the 50-64 Plan which itemizes the expected
expenses (on a present value basis) as of the Effective Date.”
	 	 	 
	 	H.	
Section 6.3 of the Agreement is amended by the addition of new
subsection 6.3.4 to read as follows:
	 	 	 
	 	 	
“6.3.4. United’s Risk and Profit Charges for 50-64 Plan. The Parties
agree that the first paragraph of Section 6.3 and Subsections 6.3.1 and
6.3.2 shall not apply to the 50-64 Plan. Instead, United’s risk and
profit compensation for assuming the risk associated with the 50-64 Plan
shall




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



6 






 




	 	 	 
	 	 	
be the sum of the following components:
	 	 	 
	 	 	
(a) Base risk and profit charge: *** of 50-64 Member
Contributions;
	 	 	 
	 	 	
(b) United charge for claims risk: *** of 50-64 Member
Contributions; and
	 	 	 
	 	 	
(c) Risk sharing of benefit losses and gains: as set forth in
Section 6.12.”
	 	 	 
	 	I.	
Article 6 of the Agreement is amended by the addition of the
following new section 6.12 to read as follows:
	 	 	 
	 	 	
“6.12. Risk Sharing of Benefit Losses and Gains for the 50-64 Plan.
	 	 	 
	 	 	
6.12.1. 50-64 Target Benefit Ratio. Initially, the 50-64 Target Benefit
Ratio shall be *** of 50-64 Member Contributions and is illustrated in
Exhibit 6.2.6(e). During the Pilot Period, United will recommend
appropriate changes to the 50-64 Target Benefit Ratio for the next Policy
Year for ASI and Trustee approval.
	 	 	 
	 	 	
6.12.2. Stop-Loss Arrangement; Loss Corridor Limit. United shall
reimburse the 50-64 Subfund for 50-64 Plan benefit costs above the Loss
Corridor Limit in any Policy Year in which the Loss Corridor Limit is
exceeded. The Loss Corridor Limit refers to actual 50-64 Plan benefit
costs above the 50-64 Target Benefit Ratio in a Policy Year, expressed as
a percentage as set forth below:
	 	 	 
	 	 	
(a) First Policy Year – The Loss Corridor Limit is actual 50-64 Plan
benefit costs that are *** above the 50-64 Target Benefit Ratio;
	 	 	 
	 	 	
(b) Second Policy Year – The Loss Corridor Limit is actual 50-64 Plan
benefit costs that are *** above the 50-64 Target Benefit Ratio; and
	 	 	 
	 	 	
(c) Third and Subsequent Policy Years – The Loss Corridor Limit is actual
50-64 Plan benefit costs that are *** above the 50-64 Target Benefit
Ratio in the applicable Policy Year.
	 	 	 
	 	 	
6.12.3. Sharing of Benefit Gains; Gains Corridor Limit. United shall
receive gain-sharing compensation from the 50-64 Subfund for 50-64 Plan
benefit costs below the Gains Corridor Limit in any Policy Year. The
Gains Corridor Limit refers to actual 50-64 Plan benefit costs below the
50-64 Target Benefit Ratio in a Policy Year, expressed as a percentage as
set forth below:
	 	 	 
	 	 	
(a) First Policy Year – The Gains Corridor Limit is actual 50-64 Plan
benefit costs that are *** below the 50-64 Target Benefit Ratio;




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



7 






 




	 	 	 
	 	 	
(b) Second Policy Year – The Gains Corridor Limit is actual 50-64 Plan
benefit costs that are *** below the 50-64 Target Benefit Ratio; and
	 	 	 
	 	 	
(c) Third and Subsequent Policy Years – The Gains Corridor Limit is
actual 50-64 Plan benefit costs that are *** below the 50-64 Target
Benefit Ratio in the applicable Policy Year.
	 	 	 
	 	 	
6.12.4. Attached as Exhibit 6.12.4 is a document that illustrates how
risk sharing of benefit losses and gains will occur as described in this
Section 6.12.”
	 	 	 
	 	J.	
Section 8.2 of the Agreement is amended by the addition of the
following new subsection 8.2.1 to read as follows:
	 	 	 
	 	 	
“8.2.1. 50-64 Subfund. As of the Effective Date of this Ninth
Amendment, the 50-64 Subfund (“50-64 Subfund” or “50-64 SF”) shall
consist of a *** initial allocation of funds in the RSF. The 50-64
Subfund shall increase or decrease over time based on the financial
performance of the 50-64 Plan.”
	 	 	 
	 	K.	
The parties shall negotiate in good faith twelve months prior to
expiration of the Pilot Period to reach agreement on new terms or a new
agreement to be effective upon completion of the Pilot Period, if the
parties decide to offer the 50-64 Plan beyond the Pilot Period.



       IN WITNESS WHEREOF, the Parties have executed this Amendment as of the
date and year first above written.



	 	 	 
	/s/ DAWN M. SWEENEY	 	/s/ DAVID P. INGRAHAM
	
	 	

	AARP Services, Inc.	 	
United HealthCare Insurance
	 	 	
Company




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



8 






 



EXHIBIT 2.130


50-64 PLAN DESCRIPTION



Background



The 50-64 Plan has been designed to bring to the market for AARP Members a
program tailored to the needs of the 50-64 population,1 specifically in the
areas of
broad coverage, innovative intervention-oriented care and disease management
and affordability relative to the level of benefit coverage.


Initially, two PPO products (one comprehensive and one catastrophic) designed
to address the diverse needs of the target population will be offered. In the
first phase, these products will be available in a select number of pilot
states, with plans to expand to additional markets.


Comprehensive PPO Product



This product provides the insured member with benefits both in and out of
network within agreed price points while maintaining an appropriate level of
cost sharing to promote responsible usage of the services. Expenses for the
insured member and the program are reduced when services are rendered through a
Network Provider. In-network benefits are richer in order to encourage the
insured member to use a Network Provider. The overall quality of care is
enhanced through United’s Care Coordination program which is available in and
out of network. In-network benefits have caps on the amount the member will
share in the cost of health care while out-of-network utilization has no caps
on the member’s out-of-pocket expenditures. The benefit design for this
product is further described below.


Catastrophic PPO Product


This product is designed to provide benefits for the high cost items that
create the biggest burden for members. It focuses on hospital and surgical
benefits as well as catastrophic illnesses. This product lowers premium costs
by eliminating benefits for lower-cost services. Therefore, unlike the
comprehensive product, this product does not provide coverage for preventive
care, physician’s office visits, behavioral health, most forms of diagnostic
testing, and other services listed below in the chart. This product provides



1 Although the 50-64 Plan is designed for the 50-64 AARP membership, spouses of
AARP members, including spouses under the age of 50, are also eligible to
participate. Additionally, state and federal laws may require coverage to be
continued for insured members once they turn 65; the 50-64 Plans will conform
to all applicable state and federal requirements.



	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



9






 



benefits for services that are potentially more catastrophic to the insured
member financially, such as inpatient hospital stays and expensive surgical
procedures. The benefit design for this product is further described below.


Value-added Services



The following services shall be provided to members who participate in the
50-64 Plan:



	•	 	AARP Nurse HealthLine – This service provides toll-free 24 hour,
365-day access to registered nurses who provide health information,
discuss treatment options, and guide individuals to an appropriate
level of care. AARP Nurse HealthLine gives individuals information
that helps them make educated decisions about their personal health
and use of medical resources.

	•	 	Web-based tools – Access to myuhc.com and online pharmacy web site.
To help members find prescription drug information, the Online
Pharmacy provides information on safe drug use, email prescription
reminders, drug cost comparisons across retail and mail order
channels, and other information. The following references on
myuhc.com shall be suppressed:

	 	 	(1) The reference to alternative medicine discounted providers shall be
suppressed by removing United Naturally from the Alternative and Complementary
medicine section of myuhc.com under health topics and tools; and

	 	 	(2) The reference to OTC shall be suppressed by removing Family meds from the
OTC/Other products section of myuhc.com under prescriptions.

	•	 	Care Management – This service provides care management services to
members at risk or affected by chronic health conditions. Care
coordination offers proactive programs to help individuals manage
their condition or disease and improve their health status. Community
partners offer services to high-risk members.

	•	 	Transplant Benefit Management and Cancer Benefit Management – This
service provides individuals with case management support to assist
with counseling, physician interaction and referrals to credentialed
transplant or cancer resources.

	•	 	Behavioral Health Management – This feature provides access to mental
health and substance abuse programs to help people live and work well.
A network of professionals is available for direct access to the most
appropriate care.




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 



10






 






50-64 Plan Design




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Comprehensive Plan
	 	Catastrophic Plan

	Core Plan Design
	 	 	 	In Network
	 	Out-of-Network
	 	In Network
	 	Out-of-Network

	Annual Deductible	 	 
	 	$	1,000	 	 	$	2,000	 	 	$	2,000	 	 	$	3,000	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Annual out-of-pocket	 	 
	 	$2,500 combined, 
then 100%	 	$2,500 combined, 
then 80%	 	$2,500 combined, 
then 100%	 	$2,500 combined, 
then 80%
	Maximum (Coinsurance	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	only)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Lifetime Maximum	 	 
	 	$5 Million	 	$5 Million
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Benefits
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Inpatient Hospital	 	 
	 	 	 	 	 	 	 	 	 	80% after	 	60% after deductible
	Outpatient Surgery	 	 
	 	 	 	 	 	 	 	 	 	deductible	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Office Visit	 	 
	 	 	 	 	 	 	 	 	 	Not Covered
	Primary or Specialist	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 
	 	80% after deductible	 	60% after deductible	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Preventive Care
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Radiology and Lab	 	 
	 	 	 	 	 	 	 	 	 	80% after	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	deductible	 	60% after deductible
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	(Outpatient surgery	 	(Outpatient surgery or
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	or Inpatient only)	 	Inpatient only)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Prescription
	Generic	 	 
	 	$10 Copay/	 	50% of Network	 	$10 Copay after	 	50% after $5K
	 	 	 	 	 
	 	(Unlimited)	 	Amount	 	$5K deductible	 	deductible
	 	 	 	 	 
	 	 	 	 	 	(Unlimited)	 	(Unlimited)	 	(Unlimited)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Brand	 	 
	 	50% Coinsurance	 	 	 	 	 	50% after $5K	 	50% after $5K
	 	 	 	 	 
	 	(Unlimited)	 	50% of Network	 	deductible	 	deductible
	 	 	 	 	 
	 	 	 	 	 	Amount	 	(Unlimited)	 	(Unlimited)
	 	 	 	 	 
	 	 	 	 	 	(Unlimited)	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Behavioral Health/
	Substance Abuse	 	 
	 	80% after deductible	 	60% after deductible	 	Not Covered
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Emergency Care	 	 
	 	80% after deductible	 	80% after deductible	 	80% after	 	Same as network
	 	 	 	 	 
	 	 	 	 	 	(in network	 	deductible	 	(in network deductible)
	 	 	 	 	 
	 	 	 	 	 	deductible)	 	 	 	 	 	 	 	 





	 	 	 	 	 	 	 
	***

	 	Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	11	 









 








	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Comprehensive Plan
	 	Catastrophic Plan

	Core Plan Design
	 	 	 	In Network
	 	Out-of-Network
	 	In Network
	 	Out-of-Network

	Skilled Nursing Facility / Inpatient Rehabilitation	 	 
	 	80% after deductible (60 days combined	 	60% after deductible (60 days combined	 	80% after deductible (60 days combined	 	60% after deductible (60 days combined
	Facility Service	 	 
	 	calendar year max)	 	calendar year max)	 	calendar year max)	 	calendar year max)
	 	 	 
	 	 	 	 	 	 	 	 	 	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Durable Medical	 	 
	 	80% after deductible	 	60% after deductible	 	80% after	 	60% after deductible
	Equipment	 	 
	 	$2,500 combined 	 	$2,500 combined	 	deductible	 	$2,500 combined
	 	 	 
	 	calendar year max	 	calendar year max	 	$2,500 combined	 	calendar year max only
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	calendar year max	 	for Covered Health
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	only for Covered	 	Services ordered at time
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	Health Services	 	of treatment in hospital
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	ordered at time of	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	treatment in	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	hospital	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Home Health	 	 
	 	80% after deductible	 	60% after deductible	 	 	 	 	 	 	 	 
	 	 	 	 	 
	 	(60 visit combined max)	 	(60 visit combined	 	Not Covered
	 	 	 	 	 
	 	 	 	 	 	max)	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	IV Therapy	 	 
	 	80% after deductible	 	60% after deductible	 	80% after	 	60% after deductible
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	deductible	 	(Covered Health
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	(Covered Health	 	Service)
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	Service)	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Ambulance –	 	 
	 	80% after deductible	 	Same as network	 	80% after deductible	 	Same as network
	Emergency Only
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Dental Services –	 	 
	 	80% after deductible	 	Same as network	 	80% after	 	Same as network
	Accident Only	 	 
	 	 	 	 	 	 	 	 	 	deductible	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Hospice	 	 
	 	80% after deductible	 	60% after deductible	 	80% after	 	60% after deductible
	 	 	 	 	 
	 	360 day max	 	 	 	 	 	deductible	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	360 day max	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Prosthetic Devices	 	 
	 	80% after deductible/5k	 	60% after	 	80% after	 	60% after deductible/5k
	 	 	 	 	 
	 	combined calendar year	 	deductible/5k	 	deductible/5k	 	combined calendar year
	 	 	 	 	 
	 	max	 	combined calendar	 	combined calendar	 	max
	 	 	 	 	 
	 	 	 	 	 	year max	 	year max	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Reconstructive	 	 
	 	80% after deductible	 	60% after deductible	 	80% after deductible	 	60% after deductible
	Procedures
	(non-cosmetic)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Rehabilitation Services	 	 
	 	80% after deductible; 20	 	60% after deductible;	 	Not Covered
	 	 	 	 	 
	 	visits of each PT, OT, ST	 	20 visits each of PT,	 	 	 	 	 	 	 	 
	 	 	 	 	 
	 	allowed Cardiac Rehab – 36	 	OT, ST allowed
Cardiac Rehab – 36	 	 	 	 	 	 	 	 
	 	 	 	 	 
	 	visits; no chiropractic	 	visits; no chiropractic	 	 	 	 	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Transplantation	 	 
	 	80% after deductible	 	Non-network not	 	80% after	 	Non-network not
	 	 	 	 	 
	 	 	 	 	 	available (unless	 	deductible	 	available (unless
	Services	 	 
	 	 	 	 	 	mandated by state)	 	 	 	 	 	mandated by state)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Urgent Care Services	 	 
	 	80% after deductible	 	60% after deductible	 	Not Covered








	 	 	 	 	 	 	 
	***

	 	Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	12	 









 








	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Comprehensive Plan
	 	Catastrophic Plan

	Core Plan Design
	 	 	 	In Network
	 	Out-of-Network
	 	In Network
	 	Out-of-Network

	Health & Well Being
	Services
	- Behavioral Health	 	 
	 	Yes	 	No
	Mgmt
	- NurseLine	 	 
	 	Yes	 	Yes
	- Care Management	 	 
	 	Yes	 	Yes
	- Transplant &	 	 
	 	Yes	 	Yes
	Cancer Benefit
	Management







	 	 	 	 	 	 	 
	***

	 	Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	13	 













 


EXHIBIT 3.2.2(j)(1)



PILOT EVALUATION BENCHMARKS




	 	 	 	 	 	 	 	 	 	 	 
	
Criteria	 	
0 – 6 Months	 	7 – 12 
Months	 	13 – 18
 Months	 	
Evaluation	 	
Comments
	
	 	
	 	
	 	
	 	
	 	

	Cumulative Sales	 	***
	 	***
	 	***
	 	Evaluate by pilot
market segment
	 	• Pilot product in
approved states
where deemed
competitive

	 	 	 	 	 	 	 	 	 	 	 
	Cost Per

Paid Response	 	
***
	 	***
	 	***
	 	Evaluate by Pilot
Market state



- Establish target
by market state



- Actual marketing
expenditures by
state

	 	• Higher cost per
paid response is
tied to lower sales



• Target varies
based on average
level of premium
collected for each
new sale. Factors
influencing this
are:


    • Plan Mix between
comprehensive and
catastrophic



    • Average duration
of business



    • Average age of
new sales

	 	 	 	 	 	 	 	 	 	 	 
	50-64
 Incurred

Benefit Ratio	 	
***
	 	***
	 	***
	 	Evaluate by:



• Pilot market
segment


• Calendar duration

	 	• 50-64 Target Benefit Ratio is
*** including
active life
reserves.



• Target will vary
by state due to
state specific
premium tax.



• Review by ratio
and time period

	 	 	 	 	 	 	 	 	 	 	 
	Lapse Rates	 	***	 	***	 	***	 	Evaluate:


• Average length of
policy



• Average policy	 	 





	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 




14






 




	 	 	 	 	 	 	 	 	 	 	 
	
Criteria	 	
0 – 6 Months	 	7 – 12 
Months	 	13 – 18
 Months	 	
Evaluation	 	
Comments
	
	 	
	 	
	 	
	 	
	 	

	 	 	
***
	 	***
	 	***
	 	   duration by issue
year, service area,
and in aggregate



• Number lapsing
prior to a rate
change



• Track terminations
monthly



• Track Free Looks



• Conduct a lapser
report at quarterly
intervals

	 	An abbreviated
lapser report will
be done at each
time interval, with
a full report after
12 months


	 	 	 	 	 	 	 	 	 	 	 
	Underwriting

(Distribution
 of

Applicants)	 	
• Level 1:
***



• Level 2: ***



• Level 3: ***



• Denied: ***
	 	Level 1:
***



Level 2:
***



Level 3:
***



Denied:
***
	 	Level 1:
***



Level 2:
***



Level 3:
***



Denied:
***
	 	Evaluate level
distributions
quarterly by:



• Age category



• Pilot market & age




Cumulatively over
the time periods




Evaluate by each
product
(comprehensive and
catastrophic) and
the total (both
products combined).
	 	• The distribution
will be impacted by
the level of “self
underwriting” by
the applicants
(i.e., if
applicants know
they will not pass
underwriting, they
will not apply).



• The key goal for
the underwriting is
to increase
accessibility while
protecting the
program

	 	 	 	 	 	 	 	 	 	 	 
	50-64
 Subfund (SF)

Impact	 	 	 	 	 	 	 	Track the following
items across each
quarter (3 month
time period):


• Beginning and
ending period SF
balances



• Member
contributions
received



• Marketing dollars
spent

	 	 




	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 
	 
	 	 	 	 	 	15	 









 




	 	 	 	 	 	 	 	 	 	 	 
	
Criteria	 	
0 – 6 Months	 	7 – 12 
Months	 	13 – 18
 Months	 	
Evaluation	 	
Comments
	
	 	
	 	
	 	
	 	
	 	

	 	 	 	 	 	 	 	 	• Repayment of
Marketing Expenses



• Claim experience



• Any risk sharing
of benefit
gains/losses



• Contingencies (***
contingency margin
was included in the
premium as a cushion
for claims and
expenses. For the
Pilot Period, this
will be paid to the
SF.)



• Claims Risk
Provision (*** of
premium that will be
paid to the SF for
taking claims risk)



• Marketing Risk
Provision (*** of
premium that will be
paid to the SF for
taking marketing
risk)



• Other expenses
(includes
administration,
premium tax,
royalty,
risk/profit,
investment income)
	 	 





Note: Except for the 50-64 Subfund Impact, information will be tracked and
reported separately for each product (comprehensive and catastrophic) and in
total (both products combined).


Report Chart




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Report	 	Monthly	 	Quarterly	 	Semiannually	 	Annually	 	End of Pilot
	
	 	
	 	
	 	
	 	
	 	

	Enrollment
&
Underwriting
Statistics
	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 
	Cumulative Sales
	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 
	Active Insureds
	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 
	Cost Per Paid Response
	 	 	 	 	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 
	Lapser Report
	 	 	 	 	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 





	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 




16






 




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Report	 	Monthly	 	Quarterly	 	Semiannually	 	Annually	 	End of Pilot
	
	 	
	 	
	 	
	 	
	 	

	Incurred Benefit Ratio
	 	 	 	 	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 
	50-64 Subfund Report
	 	 	 	 	 	 	X	 	 	 	X	 	 	 	X	 	 	 	X	 





	 	 	 	 	 	 	 
	***	 	
Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 




17










 




EXHIBIT 3.2.2(j)(5)



	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Penalty (Percent of
	 	 	50-64 Plan	 	50-64 Plan
	Functions/Services
	 	Service Standard
	 	Contributions)

	Claim Member Services Functions
	 	 	 	 	 	 	 	 
	Speed to Answer Calls
	 	 	 	 	 	 	 	 
	n within 20 seconds
	 	 	80	%	 	 	***	 
	Call Resolution
	 	 	 	 	 	 	 	 
	n within first day
	 	 	75	%	 	 	***	 
	n within 72 hours
	 	 	98	%	 	 	***	 
	Correspondence
	 	 	 	 	 	 	 	 
	n within 5 business days
	 	 	90	%	 	 	***	 
	n within 10 business days
	 	 	98	%	 	 	***	 
	Underwriting and Issue Functions
	 	 	 	 	 	 	 	 
	Appeals
	 	 	 	 	 	 	 	 
	n within 10 business days
	 	 	98	%	 	 	***	 
	Claims Processing Functions
	 	 	 	 	 	 	 	 
	Claim Turnaround Time
	 	 	 	 	 	 	 	 
	n within 10 business days
	 	 	95	%	 	 	***	 
	Payment Accuracy
	 	 	95	%	 	 	***	 
	Enrollments
	 	 	 	 	 	 	 	 
	Enrollment Turnaround Time
	 	 	 	 	 	 	 	 
	n within 10 business days
	 	 	90	%	 	 	***	 
	Enrollment Accuracy
	 	 	97.5	%	 	 	***	 
	Billing and Collections
	 	 	 	 	 	 	 	 
	Payment Application Turnaround
	 	 	 	 	 	 	 	 
	n within 3 business days
	 	 	95	%	 	 	***	 
	Payment Application Accuracy
	 	 	98	%	 	 	***	 






	***	 	Represents text deleted pursuant to a confidentiality treatment request filed with the Securities and Exchange Commission pursuant to Rule 24b-2 under the Securities Exchange Act of 1934, as amended.






18










 



Fulfillment




	 	 	 	 	 	 	 
	
Fulfillment Turnaround Time	 	 	 	 
	 	 	 	 	 	 	 
	§	 	
within 5 business days
	 	90%
	 	***



Customer Satisfaction —

First Quarter Results




	 	 	 	 	 
	Claim Service	 	
Included in larger SHIP sample
	***	 



Note: Penalties will be calculated based on 50-64 Member Contributions, and
shall be as defined and agreed in Exhibit 3.2.5 as revised effective March 31,
2003.



	***	 	 Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.




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EXHIBIT 6.2.6(e)




50-64 PLAN

PRO FORMA EXPENSE SUMMARY




	 	 	 	 	 
	 	 	Percent of Premium

	Marketing Expenses
	 	 	***	 
	Royalty
	 	 	***	 
	United Base Risk and Profit
	 	 	***	 
	Claim Administration
	***	 	 	 
	Enrollments, Underwriting and
Other Administration
	***	 	 	 
	Subtotal
	 	 	***	 
	Premium Tax
	 	 	***	 
	Tax Timing including DAC tax
	 	 	***	 
	United Charge for Claims Risk
	 	 	***	 
	50-64 SF Claims Risk Provision
	 	 	 	***
	50-64 SF Marketing Risk Provision
	 	 	***	 
	Contingencies
	 	 	***	 
	Investment Income
	 	 	***	 
	Total Expense Ratio
	 	 	***	 
	Target Benefit Ratio
	 	 	***	 






All items are shown on a present value basis as a level percent of premiums
over ten years.
Percentages for premium tax, tax timing and investment income may vary based on
actual expenses.




	 	 	 	 	 	 	 
	***

	 	Represents text deleted pursuant to a confidentiality treatment request
filed with the Securities and Exchange Commission pursuant to Rule 24b-2
under the Securities Exchange Act of 1934, as amended.
	 	 	 	 








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EXHIBIT 6.12.4




RISK-SHARING OF BENEFIT LOSSES AND GAINS:



ILLUSTRATIONS




Risk/Gain sharing is based on actual benefit costs that are higher (+) or lower
(-) than expected benefit costs. The risk/gain sharing corridor is *** first
year, *** second year and *** in the third year. By capping the 50-64 Subfund
risk to a fixed percentage of expected benefit costs each year, the risk of
catastrophic claims is shifted to United, especially during the pilot phase
when revenue is expected to be relatively low and random shock claims could
adversely impact the program. Illustrations of risk sharing of benefit losses
and sharing of benefit gains are shown below:



A. Risk Sharing of Benefit Losses





	•	 	50-64 SF share of losses capped at corridor limits






	•	 	United’s share of losses is the remainder (catastrophic risk)





Example A1 – Benefits *** Higher Than Expected




	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Year 1
	 	Year 2
	 	Year 3

	A. Expected Benefits
	 	 	*	**	 	 	*	**	 	 	*	**
	B. Actual Benefits
	 	 	*	**	 	 	*	**	 	 	*	**
	C. Total Loss = B-A
	 	 	*	**	 	 	*	**	 	 	*	**
	D. 50-64 SF Share of Loss
	 	 	*	**	 	 	*	**	 	 	*	**
	E. United Share of Loss
	 	 	*	**	 	 	*	**	 	 	*	**







Example A2 – Benefits *** Higher than Expected




	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Year 1
	 	Year 2
	 	Year 3

	A. Expected Benefits
	 	 	*	**	 	 	*	**	 	 	*	**
	B. Actual Benefits
	 	 	*	**	 	 	*	**	 	 	*	**
	C. Total Loss = B-A
	 	 	*	**	 	 	*	**	 	 	*	**
	D. 50-64 SF Share of Loss
	 	 	*	**	 	 	*	**	 	 	*	**
	E. United Share of Loss
	 	 	*	**	 	 	*	**	 	 	*	**








	***	 	Represents text deleted pursuant to a confidentially treatment request filed with the Securities and Exchange Commission pursuant to Rule 24b-2 under the Securities Exchange Act of 1934, as amended.






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	 	B.	 	Sharing of Benefit Gains






	 	•	 	50-64 SF share of gains capped at corridor limits
	 
	 	•	 	United’s share of benefit gains is the excess outside of the corridor






	 	 	 	Example B1 – Benefits *** Lower Than Expected





	 	 	 	 	 	 	 
	 	 	Year 1
	 	Year 2
	 	Year 3

	A. Expected Benefits

	 	***
	 	***
	 	***
	B. Actual Benefits

	 	***
	 	***
	 	***
	C. Total Gain = B-A

	 	***
	 	***
	 	***
	D. 50-64 SF Share of Gain

	 	***
	 	***
	 	***
	E. United Share = C-D

	 	***
	 	***
	 	***








	 	 	 	Example B2 – Benefits *** Lower Than Expected





	 	 	 	 	 	 	 
	 	 	Year 1
	 	Year 2
	 	Year 3

	A. Expected Benefits

	 	***
	 	***
	 	***
	B. Actual Benefits

	 	***
	 	***
	 	***
	C. Total Gain = B-A

	 	***
	 	***
	 	***
	D. 50-64 SF Share of Gain

	 	***
	 	***
	 	***
	E. United Share = C-D

	 	***
	 	***
	 	***






	***	 	Represents text deleted pursuant to a confidentialy treatment request filed with the Securities and Exchange Commission pursuant to Rule 24b-2 under the Securities Exchange Act of 1934, as amended.






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