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? <br />MEDICAL MUTUAL$ <br />Fully Insured Proposal <br />for <br />Mayfield Village <br />• The quoted rates assume no retirees are cAVered on this plan. <br />• The benefits must be approved by our Benefits Services department. <br />• 7he quoted rates include standard broker commissions for groups with 57-99 eligible employees. Groups with 100 or more eligible <br />employees will require a single case agreement (SCA) from the writing agent with a commission amount of 3%. <br />• The quoted rates are based on medical history questionnaires (MHQs) provided as part of the request for proposal submission. Final rates <br />are contingent upon the completion of Medical Mutual MHQs unless waived by Underwriting. <br />• Products marketed by Medical Mutual may be underwritten by one of its subsidiaries, such as Medical Health Insuring Corporation of Ohio or <br />Consumers Life Insurance Company. <br />Wellness Program Selected: <br />? Essential - inciuded in quoted rates <br />? Impact- an additional $1.00 per employee per month will be added to the enclosed rates <br />? Solutions - an additional $3.00 per employee per month will be added to the enclosed rates <br />ness Programs, please ask your sales representative. <br />For more information about Medical Mutual's suite of 7No <br />Is this group a member of an alliance? [] Yes If yes, which alliance? <br /> <br />If yes, what is the alliance mem6er/group number? <br />Quote ID: 0066524-01