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<div style="direction:ltr; font-family:Tahoma; color:#000000; font-size:10pt">Dear Business Managers and Benefits Administrators:
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<div>Just a quick reminder, <font color="#ff0000">if you have not yet responded to the Bronze Plan survey below,<b> please do so today if possible.</b></font> We only need one response per entity, but many entities have not yet responded. We appreciate your
time and assistance!</div>
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<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">We are asking you to please take a few minutes and
respond to this email, answering the questions below about the Bronze Plan option. We only need one response per entity. Thank you in advance for your help.</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">You will fall into one of the following categories.
We only need you to answer the questions in the appropriate category: </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
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<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b><u>CATEGORY 1</u></b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">: Your entity </span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>elected
to offer </b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">the Bronze Plan option to your employees for the 2015-16 Plan Year who are not benefit eligible and not receiving an employer contribution, but meet the requirements
under the ACA:</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:-18pt; margin:0px 0px 0px 90pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">A)</span></font><font face="Arial,sans-serif"> </font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Will
your entity be able to avoid all of the penalties by meeting the affordability requirements? </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px 0px 0px 90pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">(mark with X) </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">__</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>Yes</b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">__</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>No</b></span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px 0px 0px 36pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:-18pt; margin:0px 0px 0px 90pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">B)</span></font><font face="Arial,sans-serif"> </font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">If
you answered Yes, how are you ensuring these requirements are met in offering the Bronze Plan option?</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:-72pt; margin:0px 0px 0px 72pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b><u>CATEGORY 2</u></b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">:</span></font><font face="Arial,sans-serif" size="2" color="#44546A"><span style="font-size:10pt"> </span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Your
entity </span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>did not elect to offer</b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> the Bronze Plan option to employees for the 2015-16 Plan
Year who are not benefit eligible, but meet the ACA requirement to offer benefits:</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:-18pt; margin:0px 0px 0px 90pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">A)</span></font><font face="Arial,sans-serif"> </font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Did
you make these employees benefit eligible? (mark with X)</span></font><font face="Arial,sans-serif" size="2" color="#44546A"><span style="font-size:10pt"> </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">___</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>Yes</b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">___</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>No</b></span></font></span></font></div>
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<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:-18pt; margin:0px 0px 0px 90pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">B)</span></font><font face="Arial,sans-serif"> </font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Did
you offer another plan option to these individuals? (mark with X) </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">___</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>Yes</b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">___</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>No</b></span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px 0px 0px 36pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:36pt; margin:0px 0px 0px 54pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">If </span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>Yes</b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">,
which Plan(s)?</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:-18pt; margin:0px 0px 0px 90pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">C)</span></font><font face="Arial,sans-serif"> </font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Did
you provide an employer contribution to these employees? (mark with X) </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">___</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>Yes</b></span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font><font face="Arial,sans-serif" size="4"><span style="font-size:14pt">___</span></font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b>No</b></span></font></span></font></div>
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<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b><br>
</b></span></font></span></font></div>
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<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"><b><br>
</b></span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font><font face="Arial,sans-serif" size="2" style="text-indent:18pt"><span style="font-size:10pt">If </span></font><font face="Arial,sans-serif" size="2" style="text-indent:18pt"><span style="font-size:10pt"><b>Yes</b></span></font><font face="Arial,sans-serif" size="2" style="text-indent:18pt"><span style="font-size:10pt">,
how much? __________________________________________</span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; text-indent:-18pt; margin:0px 0px 0px 90pt">
<font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">D)</span></font><font face="Arial,sans-serif"> </font><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">How
do you evaluate to ensure the plan offerings meet the ACA affordability requirement?</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Name of person completing questionnaire: _______________________________________ </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Title: _______________________</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Name of entity: ____________________________________</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt">Please send your response to:</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Forte" size="3"><span style="font-size:12pt">DeeDee Voigt</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="3"><span style="font-size:12pt">Senior Benefits Analyst, Oregon Educators Benefit
Board</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="3"><span style="font-size:12pt">Health Policy and Analytics</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><a href="mailto:OEBB.Benefits@oregon.gov" target="_blank"><font face="Arial,sans-serif" size="3"><span style="font-size:12pt">OEBB.Benefits@oregon.gov</span></font></a></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="3"><span style="font-size:12pt">Main: 888-469-6322</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="3"><span style="font-size:12pt">Fax: 503-378-5832</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"> </span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Gisha,sans-serif" size="2"><span style="font-size:10pt"> </span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><img alt="cid:image001.jpg@01D10D96.C6B9DCE0" style="max-width:100%; height:auto" height="75" width="199" border="0"></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"> </span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="4" color="#44546A"><span style="font-size:14pt">CONFIDENTIALITY NOTICE</span></font></span></font></div>
<div style="font-family:'Times New Roman'; font-size:16px; margin:0px"><font face="Calibri,sans-serif" size="2"><span style="font-size:11pt"><font face="Arial,sans-serif" size="4" color="#44546A"><span style="font-size:14pt">This email may contain information
that is privileged, confidential, or otherwise exempt from disclosure under applicable law. If you are not the addressee or it appears from the context or otherwise that you have received this email in error, please advise me immediately by reply email, keep
the contents confidential, and immediately delete the message and any attachments from your system.</span></font></span></font></div>
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