First Name*

Last Name*

E-Mail Address*

Company Name

State Company is Domiciled in

How many Employees are enrolled in your Health Plan?

What is the plans funding mechanism What is the plans funding mechanism Fully Insured Fully Insured Level Funded Self Insured Self Insured Level Funded

What has your average renewal rate increase been for the past 3 years? (aka trend)

What month does your plan renew?

Do you currently have a 2-3 year health plan strategy? Do you currently have a 2-3 year health plan strategy? Yes No

Do you currently have unrestricted access to full claims data (not just reports)? Do you currently have unrestricted access to full claims data (not just reports)? Yes No

How does your health plan incentivize members to seek lower-cost and/or higher-quality care? (Select all that apply) How does your health plan incentivize members to seek lower-cost and/or higher-quality care? (Select all that apply) Reduced/no cost share when independent primary care refers care Waive deductible/co-insurance for specific care Waive deductible/coinsurance at specific providers Time off for screening and preventative care Reduced/no cost share if work with advocate/concierge/navigator Optimizing copays by service type Premium reductions for Wellness program participation Reduced/no cost share for specific medications Reduced/no cost share at specific pharmacies Other None

What types of human support do members have access to through the plan? (Select all that apply) What types of human support do members have access to through the plan? (Select all that apply) Health Literacy/Education programs Health coach Member champion at advisor firm Care/clinical concierge/advocate/navigator Benefits concierge/advocate/navigator Plan Sponsor's HR Team Designated member champion at plan sponsor (not just HR team) Advisor firm account team PBM customer service Plan administrator customer service Other None

Does your current Broker/Advisor completely disclose all direct and indirect compensation in a timely manner? Does your current Broker/Advisor completely disclose all direct and indirect compensation in a timely manner? Yes No

Does the health plans Insurer or Third-Party Administrator (TPA) allow the Plan Sponsor to select its Pharmacy Benefits Manager (PBM)? Does the health plans Insurer or Third-Party Administrator (TPA) allow the Plan Sponsor to select its Pharmacy Benefits Manager (PBM)? Yes No Not applicable

Which major specialty area(s) does the plan have specific strategies and programs for? (Select all that apply) Which major specialty area(s) does the plan have specific strategies and programs for? (Select all that apply) ER visits Transplant Other elective hospitalizations Other disease-specific conditions Tobacco use Substance abuse Mental/Behavioral health Specialty drugs Dialysis Cancer MSK/Orthopedic Maternity Non-specialty drugs Elective surgeries/procedures Cardiometabolic/Diabetes Other None Don't Know

What types of add-in pharmacy programs and strategies does the plan leverage? (Select all that apply) What types of add-in pharmacy programs and strategies does the plan leverage? (Select all that apply) Dispensing through Advanced Primary Care clinic Co-pay assistance International sourcing Manufacturer assistance programs Specialty drug carve outs Steerage to therapeutic equivalents None Unsure Not Applicable

What Value Based Primary Care strategies does the plan employ? (Select all that apply) What Value Based Primary Care strategies does the plan employ? (Select all that apply) Virtual primary care (not just telehealth) Direct agreements w/ Independent primary care practices Onsite clinic Nearsite clinic Direct Primary Care Other None

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