agenda - friday, july 15, 2016 - kane county,...

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KANE COUNTY LENERT, Martin, Barreiro, Dahl, Davoust, Gillam, Scheflow HUMAN SERVICES COMMITTEE FRIDAY, JULY 15, 2016 County Board Room Agenda 9:00 AM Kane County Government Center, 719 S. Batavia Ave., Bldg. A, Geneva, IL 60134 Kane County Page 1 1. Call to Order 2. Approval of Minutes: June 17, 2016 3. Public Comment 4. Monthly Financial Reports A. Monthly Reports (attached) 5. Veteran's Assistance Commission A. Monthly Reports (attached) 6. Department of Human Resource Management A. Monthly EEO Reports (attached) B. Monthly Insurance (attached) C. IPBC Benchmarking Report for Kane County (attached) D. ATM Summary Report (attached) E. Year to Date Workers Compensation and Liability Reports (attached) F. Compliance Update 7. Old Business A. RFP Scope of Work for Claims Management Services 8. New Business A. 2017 Budget Request for Veterans' Assistance Commission B. 2017 Budget Request for Human Resources Department C. Resolution: AUTHORIZING PLACEMENT OF AUTOMATED TELLER MACHINE AT 530 S. RANDALL ROAD BRANCH COURT LOCATION D. Resolution: AMENDING PERSONNEL POLICY HANDBOOK (AMERICANS WITH DISABILITIES ACT REASONABLE ACCOMMODATION POLICY) 9. Reports Placed On File 10. Executive Session (if needed) 11. Adjournment

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KANE COUNTY LENERT, Martin, Barreiro, Dahl, Davoust, Gillam, Scheflow

HUMAN SERVICES COMMITTEE

FRIDAY, JULY 15, 2016

County Board Room Agenda 9:00 AM

Kane County Government Center, 719 S. Batavia Ave., Bldg. A, Geneva, IL 60134

Kane County Page 1

1. Call to Order

2. Approval of Minutes: June 17, 2016

3. Public Comment

4. Monthly Financial Reports

A. Monthly Reports (attached)

5. Veteran's Assistance Commission

A. Monthly Reports (attached)

6. Department of Human Resource Management

A. Monthly EEO Reports (attached)

B. Monthly Insurance (attached)

C. IPBC Benchmarking Report for Kane County (attached)

D. ATM Summary Report (attached)

E. Year to Date Workers Compensation and Liability Reports (attached)

F. Compliance Update

7. Old Business

A. RFP Scope of Work for Claims Management Services

8. New Business

A. 2017 Budget Request for Veterans' Assistance Commission

B. 2017 Budget Request for Human Resources Department

C. Resolution: AUTHORIZING PLACEMENT OF AUTOMATED TELLER MACHINE AT 530 S. RANDALL ROAD BRANCH COURT LOCATION

D. Resolution: AMENDING PERSONNEL POLICY HANDBOOK (AMERICANS WITH DISABILITIES ACT REASONABLE ACCOMMODATION POLICY)

9. Reports Placed On File

10. Executive Session (if needed)

11. Adjournment

Current Month

Transactions

Total

Amended

Budget

YTD Actual

Transactions

Total %

Received

660 Veterans' Commission 132,634 331,071 157,070 47.44%

380 Veterans' Commission 132,634 331,071 157,070 47.44%

Grand Total 132,634 331,071 157,070 47.44%

Human Services Committee Revenue Report - Summary

Through June 30, 2016 (58.3% YTD)

Packet Pg. 2

Current Month

Transactions

Total

Amended

Budget

YTD Actual

Transactions

YTD

Encumbrances

Total %

Used

120 Human Resource Management 213,465 2,370,444 1,469,296 19,464 62.81%

001 General Fund 26,953 403,554 199,226 73 49.39%

010 Insurance Liability 186,512 1,966,890 1,270,070 19,391 65.56%

660 Veterans' Commission 24,153 331,071 168,531 0 50.90%

380 Veterans' Commission 24,153 331,071 168,531 0 50.90%

Grand Total 237,619 2,701,515 1,637,827 19,464 61.35%

Human Services Committee Expenditure Report - Summary

Through June 30, 2016 (58.3% YTD, 57.69% Payroll)

Packet Pg. 3

Current

Month

Transactions

Total Amended

Budget

Current

Month

Transactions

YTD

Encumbrances

Total %

Used

120 Human Resource Management 213,465 2,370,444 1,469,296 19,464 62.81%

001 General Fund 26,953 403,554 199,226 73 49.39%

Personnel Services- Salaries & Wages 20,607 310,973 157,343 0 50.60%

Personnel Services- Employee Benefits 4,711 71,285 32,928 0 46.19%

Commodities 151 4,896 1,886 73 40.00%

Contractual Services 1,483 16,400 7,069 0 43.10%

010 Insurance Liability 186,512 1,966,890 1,270,070 19,391 65.56%

Personnel Services- Salaries & Wages 11,041 144,411 82,809 0 57.34%

Personnel Services- Employee Benefits 3,197 42,095 22,876 0 54.34%

Contractual Services 172,273 1,780,384 1,164,385 19,391 66.49%

Capital 0 0 0 0 0.00%

660 Veterans' Commission 24,153 331,071 168,531 0 50.90%

380 Veterans' Commission 24,153 331,071 168,531 0 50.90%

Personnel Services- Salaries & Wages 14,107 180,748 102,905 0 56.93%

Personnel Services- Employee Benefits 7,055 83,318 47,105 0 56.54%

Commodities 71 6,587 653 0 9.92%

Contractual Services 2,920 60,418 17,868 0 29.57%

Grand Total 237,619 2,701,515 1,637,827 19,464 61.35%

Human Services Committee Expenditure Report - Detail

Through June 30, 2016 (58.3% YTD, 57.69% Payroll)

Packet Pg. 4

Vendor Invoice No. Invoice Description Status Held Reason Invoice Date Due Date G/L Date Received Date Payment Date Invoice AmountFund 001 - General Fund

Department 120 - Human Resource ManagementSub-Department 120 - Human Resource Management

Account 53100 - Conferences and Meetings9235 - Susan Brown 052716 PEV Paid by Check

# 35155706/02/2016 06/02/2016 06/02/2016 06/13/2016 196.50

8246 - Barbara L. Jacklow 052616 PEV Paid by EFT # 34850

06/02/2016 06/02/2016 06/02/2016 06/13/2016 418.00

Account 53100 - Conferences and Meetings Totals Invoice Transactions 2 $614.50Account 53110 - Employee Training

7562 - Equal Employment Opportunity Comm.Training Ins.

EEOC #16SCHI13

EEOC Job Number 16SCHI13

Paid by Check # 351615

05/31/2016 05/31/2016 05/31/2016 06/13/2016 1,846.00

Account 53110 - Employee Training Totals Invoice Transactions 1 $1,846.00Account 53120 - Employee Mileage Expense

8246 - Barbara L. Jacklow 052616 PEV Paid by EFT # 34850

06/02/2016 06/02/2016 06/02/2016 06/13/2016 18.58

Account 53120 - Employee Mileage Expense Totals Invoice Transactions 1 $18.58Account 55000 - Miscellaneous Contractual Exp

1299 - Kane County Regional Office of Education

0000009267 Fingerprinting - May 2016

Paid by EFT # 35077

05/31/2016 06/17/2016 06/17/2016 06/27/2016 400.00

Account 55000 - Miscellaneous Contractual Exp Totals Invoice Transactions 1 $400.00Account 60080 - Employee Recognition Supplies

9235 - Susan Brown 052716 PEV Paid by Check # 351557

06/02/2016 06/02/2016 06/02/2016 06/13/2016 93.45

Account 60080 - Employee Recognition Supplies Totals Invoice Transactions 1 $93.45Sub-Department 120 - Human Resource Management Totals Invoice Transactions 6 $2,972.53

Department 120 - Human Resource Management Totals Invoice Transactions 6 $2,972.53Fund 001 - General Fund Totals Invoice Transactions 6 $2,972.53

Fund 010 - Insurance LiabilityDepartment 120 - Human Resource Management

Sub-Department 130 - Insurance Liability- HRMAccount 50000 - Project Administration Services

8258 - CCMSI 0098882-IN claims & admin fee - May 2016

Paid by Check # 351776

05/31/2016 06/17/2016 06/17/2016 06/27/2016 6,300.83

Account 50000 - Project Administration Services Totals Invoice Transactions 1 $6,300.83Account 50150 - Contractual/Consulting Services

1026 - Laner Muchin Dombrow Becker Levin & Tominberg Ltd

491866 May, 2016 Retainer and Professional Services

Paid by EFT # 34861

05/01/2016 05/01/2016 05/01/2016 06/13/2016 12,090.60

1248 - Kinnally Flaherty Krentz Loran Hodge & Masur PC

5301-04/2 (PMK) Transfer Station Paid by Check # 351850

05/31/2016 06/16/2016 06/16/2016 06/27/2016 437.50

1248 - Kinnally Flaherty Krentz Loran Hodge & Masur PC

5301-00/37 (PMK) Special Asst State's Attorney

Paid by Check # 351850

05/31/2016 06/16/2016 06/16/2016 06/27/2016 2,213.50

Account 50150 - Contractual/Consulting Services Totals Invoice Transactions 3 $14,741.60

Run by Finance Reports on 07/08/2016 11:07:24 AM Page 1 of 3

Human Services Accounts Payable by GL Distribution

Payment Date Range 06/01/16 - 06/30/16

Packet Pg. 5

Vendor Invoice No. Invoice Description Status Held Reason Invoice Date Due Date G/L Date Received Date Payment Date Invoice AmountFund 010 - Insurance Liability

Department 120 - Human Resource ManagementSub-Department 130 - Insurance Liability- HRM

Account 53000 - Liability Insurance8258 - CCMSI 2016-00001014 WC & Liability Claims

ReimbursementPaid by EFT # 35429

06/03/2016 06/03/2016 06/03/2016 06/03/2016 20,697.98

1016 - Wine Sergi Insurance (Acrisure, LLC)

109613 Notary Bond - Jessica Vargas

Paid by EFT # 34953

05/25/2016 05/31/2016 05/31/2016 06/13/2016 25.00

1016 - Wine Sergi Insurance (Acrisure, LLC)

109609 Notary Bond - Janet Lusk

Paid by EFT # 34953

05/25/2016 05/31/2016 05/31/2016 06/13/2016 25.00

1016 - Wine Sergi Insurance (Acrisure, LLC)

109611 Notary Bond - Melissa Gonzalez

Paid by EFT # 34953

05/25/2016 05/31/2016 05/31/2016 06/13/2016 25.00

1016 - Wine Sergi Insurance (Acrisure, LLC)

109612 Notary Bond - Elizabeth Maldonado

Paid by EFT # 34953

05/25/2016 05/31/2016 05/31/2016 06/13/2016 25.00

8258 - CCMSI 2016-00001016 Liability Prison Legal News

Paid by EFT # 35430

06/19/2016 06/19/2016 06/19/2016 06/19/2016 75,000.00

8728 - State Street Collision, Inc. 3581 Auto Repair -Squad 20 Paid by EFT # 35153

06/06/2016 06/17/2016 06/17/2016 06/27/2016 3,794.63

3171 - Strypes Plus More, Inc. 13415 Decal Striping and Lettering- Squad 20

Paid by EFT # 35157

06/09/2016 06/17/2016 06/17/2016 06/27/2016 200.00

1016 - Wine Sergi Insurance (Acrisure, LLC)

109809 Notary Bond - Kimberly Mavigliano

Paid by EFT # 35189

06/13/2016 06/17/2016 06/17/2016 06/27/2016 25.00

1016 - Wine Sergi Insurance (Acrisure, LLC)

109810 Notary Bond - Leonard Cajic

Paid by EFT # 35189

06/13/2016 06/17/2016 06/17/2016 06/27/2016 25.00

Account 53000 - Liability Insurance Totals Invoice Transactions 10 $99,842.61Account 53010 - Workers Compensation

8258 - CCMSI 2016-00001014 WC & Liability Claims Reimbursement

Paid by EFT # 35429

06/03/2016 06/03/2016 06/03/2016 06/03/2016 56,476.17

Account 53010 - Workers Compensation Totals Invoice Transactions 1 $56,476.17Account 53110 - Employee Training

7562 - Equal Employment Opportunity Comm.Training Ins.

EEOC #16SCHI13

EEOC Job Number 16SCHI13

Paid by Check # 351615

05/31/2016 05/31/2016 05/31/2016 06/13/2016 3,084.00

Account 53110 - Employee Training Totals Invoice Transactions 1 $3,084.00Sub-Department 130 - Insurance Liability- HRM Totals Invoice Transactions 16 $180,445.21

Department 120 - Human Resource Management Totals Invoice Transactions 16 $180,445.21Fund 010 - Insurance Liability Totals Invoice Transactions 16 $180,445.21

Fund 380 - Veterans' CommissionDepartment 660 - Veterans' Commission

Sub-Department 660 - Veterans' CommissionAccount 52140 - Repairs and Maint- Copiers

8930 - Impact Networking, LLC 662804 Copier Overage for May Paid by EFT # 34847

05/26/2016 06/25/2016 05/31/2016 05/31/2016 06/13/2016 23.96

Account 52140 - Repairs and Maint- Copiers Totals Invoice Transactions 1 $23.96

Run by Finance Reports on 07/08/2016 11:07:24 AM Page 2 of 3

Human Services Accounts Payable by GL Distribution

Payment Date Range 06/01/16 - 06/30/16

Packet Pg. 6

Vendor Invoice No. Invoice Description Status Held Reason Invoice Date Due Date G/L Date Received Date Payment Date Invoice AmountFund 380 - Veterans' Commission

Department 660 - Veterans' CommissionSub-Department 660 - Veterans' Commission

Account 53100 - Conferences and Meetings9019 - Jacob Zimmerman 061616 Mileage to VA eBenefits

Seminar in AuroraPaid by Check # 351934

06/16/2016 07/16/2016 06/17/2016 06/16/2016 06/27/2016 9.72

Account 53100 - Conferences and Meetings Totals Invoice Transactions 1 $9.72Account 53110 - Employee Training

4750 - Thomas G. Benson 052416 Lodging and Per Diem for NACVSO Training Conference

Paid by EFT # 34787

05/24/2016 05/31/2016 05/31/2016 06/13/2016 1,346.00

10531 - Nathaniel Johnson 053116 Per Diem for NACVSO Training Conference

Paid by Check # 351649

05/31/2016 05/31/2016 05/31/2016 06/13/2016 283.00

4749 - Steven L. Wells 052316 Per Diem for NACVSO Training Conference

Paid by EFT # 34952

05/23/2016 05/31/2016 05/31/2016 05/23/2016 06/13/2016 331.00

9019 - Jacob Zimmerman 053116 Per Diem for NACVSO Training Conference

Paid by Check # 351738

05/31/2016 05/31/2016 05/31/2016 05/31/2016 06/13/2016 331.00

4526 - Fifth Third Bank 8705-JZ-05/16 NACVSO Conference P-Card Charges

Paid by EFT # 35031

06/06/2016 06/13/2016 06/13/2016 06/13/2016 06/27/2016 2,910.22

Account 53110 - Employee Training Totals Invoice Transactions 5 $5,201.22Account 60000 - Office Supplies

1024 - Ready Refresh by Nestle (Ice Mountain)

06E8106647400 Water Service for May Paid by EFT # 34897

06/02/2016 06/22/2016 06/06/2016 06/06/2016 06/13/2016 5.78

Account 60000 - Office Supplies Totals Invoice Transactions 1 $5.78Sub-Department 660 - Veterans' Commission Totals Invoice Transactions 8 $5,240.68

Department 660 - Veterans' Commission Totals Invoice Transactions 8 $5,240.68Fund 380 - Veterans' Commission Totals Invoice Transactions 8 $5,240.68

Grand Totals Invoice Transactions 30 $188,658.42

Run by Finance Reports on 07/08/2016 11:07:24 AM Page 3 of 3

Human Services Accounts Payable by GL Distribution

Payment Date Range 06/01/16 - 06/30/16

Packet Pg. 7

Kane County Purchasing Card Information

Human Services Committee

June 2016 Statement

660 VETERANS ASSISTANCE COMMISSION

Transaction Date Merchant Name Additional Information Transaction Amount

05/21/2016 EMBASSY SUITES MYRTLE BEACH -48.84

06/14/2016 EMBASSY SUITES MYRTLE BEACH -31.06

06/16/2016 HAVLICEK ACE HARDWARE GENEVA 6.99

Department Total -72.91

Committee Total -72.91

Page 1 of 17/5/2016 Packet Pg. 8

Vendor Invoice No. Invoice Description Status Held Reason Invoice Date Due Date G/L Date Received Date Payment Date Invoice AmountFund 120 - Grand Victoria Casino Elgin

Department 010 - County BoardSub-Department 020 - Riverboat

Account 45420 - Tuition Reimbursement6265 - Willie Mayes 1520-01 Marketing Management

MBA-6020-F1-01Paid by Check # 348844

11/19/2015 12/07/2015 12/08/2015 12/14/2015 2,025.00

10322 - Jaymie Rowe 1522-01 CEIS100 Intro Eng Tech Info Sys & ENG227 Pro Writing

Paid by Check # 348894

11/18/2015 12/07/2015 12/08/2015 12/14/2015 2,400.00

9457 - Ellen Schmid 1521-01 Leaders in Info Tech Forum

Paid by Check # 348899

11/18/2015 12/07/2015 12/08/2015 12/14/2015 390.00

9883 - Jessica Flynn 1517-01 MLS648 Social Consequences New Media

Paid by Check # 349023

12/09/2015 12/18/2015 11/30/2015 12/28/2015 2,220.00

9484 - Cecilia Govrik 1502-01 LEED Green Associate Exam Prep Course

Paid by EFT # 31996

11/25/2015 12/18/2015 11/30/2015 12/28/2015 299.00

6021 - Richard A. Grenda 1512-02 EDU6586 Intro Teacher Leadership Practicum

Paid by Check # 349029

12/08/2015 12/18/2015 11/30/2015 12/28/2015 990.00

9200 - Faviola Guzman 1525-01 PSY 334 Adolescent Psychology

Paid by Check # 349031

12/08/2015 12/18/2015 11/30/2015 12/28/2015 2,400.00

8634 - CRAIG K CAMPBELL 1506-04 MGMT 591/691 Lecture Series

Paid by EFT # 32609

01/12/2016 01/29/2016 11/30/2015 02/08/2016 560.00

9020 - Christopher Janovsky 1509-02 CAHC525 Counseling Skills & Strategies

Paid by Check # 349640

01/12/2016 01/29/2016 11/30/2015 02/08/2016 1,352.46

4375 - Carlos Mata 1503-02 ECN201 Principles of Microeconomics

Paid by EFT # 32709

01/12/2016 01/29/2016 11/30/2015 02/08/2016 354.00

7194 - THOMAS F ROSEBUSH 1413-06 PSF5373 Juvenile Justice

Paid by Check # 349694

01/12/2016 01/29/2016 11/30/2015 02/08/2016 2,016.00

10384 - Guadalupe Vargas 1524-01 HUMS105-Intro Hum Svc & HUMS250 Working with Indiv

Paid by Check # 349728

01/12/2016 01/29/2016 11/30/2015 02/08/2016 1,650.00

10454 - Joshua Axelsen 1516-01 EDU6515 Tech School Leaders & EDU6535 School & Community Relatio

Paid by Check # 350198

02/22/2016 03/22/2016 03/21/2016 03/21/2016 2,400.00

8634 - CRAIG K CAMPBELL 1421-07 MGMT 533 Org Design & MGMT 557 Org Culture

Paid by EFT # 33799

04/05/2016 04/07/2016 04/18/2016 04/18/2016 1,180.00

6265 - Willie Mayes 1606-01 MBA6050 Financial Management

Paid by Check # 350775

04/05/2016 04/07/2016 04/18/2016 04/18/2016 2,025.00

5053 - Salvador Rodriguez 1507-01 MBA6075 S2-02 Operations Management

Paid by Check # 350813

04/06/2016 04/07/2016 04/18/2016 04/18/2016 1,695.00

7194 - THOMAS F ROSEBUSH 1413-07 PSF5991 Integrative Project for Public Safety

Paid by Check # 350814

04/05/2016 04/07/2016 04/18/2016 04/18/2016 1,908.00

Run by Finance Reports on 07/08/2016 11:08:48 AM Page 1 of 2

Tuition Reimbursement YTD - FY2016Payment Date Range 12/01/15 - 06/30/16

Packet Pg. 9

Vendor Invoice No. Invoice Description Status Held Reason Invoice Date Due Date G/L Date Received Date Payment Date Invoice AmountFund 120 - Grand Victoria Casino Elgin

Department 010 - County BoardSub-Department 020 - Riverboat

Account 45420 - Tuition Reimbursement7194 - THOMAS F ROSEBUSH 1514-03 PSF5991 Integrative

Project for Public Safety

Paid by Check # 350814

04/05/2016 04/07/2016 04/18/2016 04/18/2016 32.00

5053 - Salvador Rodriguez 1411-05 MBA6610-Si-02 Leading Org. Development

Paid by Check # 351049

04/12/2016 04/20/2016 04/22/2016 05/02/2016 1,695.00

10041 - Lisa Bloom 1602-01 NURS308 Alt Bio Sys, NURS488 Ethics & Law, NURS425 Informatics

Paid by Check # 351549

06/01/2016 06/01/2016 06/03/2016 06/13/2016 2,400.00

4463 - Julie Wiegel 1608-01 MPH 607 Community Health Analysis

Paid by Check # 351734

06/01/2016 06/01/2016 06/03/2016 06/13/2016 2,400.00

10617 - Rebecca Aguilar 1601-01 English 102 Paid by Check # 351750

06/07/2016 06/17/2016 06/17/2016 06/27/2016 330.00

8634 - CRAIG K CAMPBELL 1611-01 MGMT 557 Organizational Culture

Paid by EFT # 34989

06/17/2016 06/17/2016 06/17/2016 06/27/2016 1,220.00

10618 - Melissa Castrovillo 1609-01 FO625-Substance Abuse Eval & Treatment

Paid by Check # 351774

06/17/2016 06/17/2016 06/17/2016 06/27/2016 1,704.00

9020 - Christopher Janovsky 1604-01 CAHC 501 Diagnosis of Mental Health Issues in Counseling

Paid by Check # 351845

06/03/2016 06/17/2016 06/17/2016 06/27/2016 1,047.52

5051 - Alice Jones 1605-01 PPPA 8137 Nature of Crime Forensic Criminology

Paid by Check # 351847

06/08/2016 06/17/2016 06/17/2016 06/27/2016 2,369.00

Account 45420 - Tuition Reimbursement Totals Invoice Transactions 26 $39,061.98Sub-Department 020 - Riverboat Totals Invoice Transactions 26 $39,061.98Department 010 - County Board Totals Invoice Transactions 26 $39,061.98

Fund 120 - Grand Victoria Casino Elgin Totals Invoice Transactions 26 $39,061.98Grand Totals Invoice Transactions 26 $39,061.98

Run by Finance Reports on 07/08/2016 11:08:48 AM Page 2 of 2

Tuition Reimbursement YTD - FY2016Payment Date Range 12/01/15 - 06/30/16

Packet Pg. 10

Organized under Chapter 330, Section 45 of the Illinois Compiled Statutes,

a statutory body comprised of the veterans organizations in Kane County, Illinois.

COUNTY OF KANE VETERANS ASSISTANCE COMMISSION

Monthly Report on Commission Activities

155.6151.6

147.1 145.3

142.9

145.2 143.7

103.6

106.3 107.1 111 115.2 113.4112.5

0

20

40

60

80

100

120

140

160

180

Average Days Pending for Claims Fiscal YTD

VA

VAC

VA's Goal

7,060 7,1146,614

6,231 6,2246,635 6,758

102 102 102 94 94 104 114

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Total Claims Pending

VA

VAC

JACOB A. ZIMMERMAN

Superintendent

COUNTY GOVERNMENT CENTER

719 South Batavia Avenue, Building A

Geneva, Illinois 60134-3077

Phone: (630) 232-3550

Fax: (630) 232-5403

www.countyofkane.org/pages/veterans.aspx

Packet Pg. 11

Organized under Chapter 330, Section 45 of the Illinois Compiled Statutes,

a statutory body comprised of the veterans organizations in Kane County, Illinois.

0

20

40

60

80

100

120

82

216

1732

29

4 1 35

Claims Applications Filed

June

ThroughMay

1,134

240

0

200

400

600

800

1,000

1,200

1,400

1,600

Forms

Forms Completed

June

ThroughMay

$2,042,133.39

$179,167.02

New VA Payments to Claimants Fiscal YTD

ThroughMay

June

Financial Assistance Expenditures

Shelter Gas Electric

Water Sewer Garbage

Food Personal Burial

Packet Pg. 12

VETERANS ASSISTANCE COMMISSION CLAIM REPORT

Category December January February March April May June July August September October November FY 2015 Total

Service-Connected Disability Claims 16 11 12 14 12 17 29 111

Non-Service Connected Pension Claims 3 4 5 5 3 1 4 25

Dependent's Compensation Claims 0 0 1 1 0 4 1 7

Survivor's Pension Claims 2 1 4 6 4 3 3 23

Intent-to-File 20 20 26 19 42 29 27 183

VCAA Response / Claims Follow up 28 10 7 10 14 8 11 88

Total Forms Completed 174 161 195 209 197 198 240 1,374

Claims Decision Reviews 10 14 16 14 18 14 18 104

Total Claims Pending 102 102 102 94 94 104 114

Intent-to-File Pending 134 130 139 142 174 174 166

New VA Monetary Awards 575,742.60$ $177,569.88 219,550.50$ 438,476.91$ 329,857.73$ 300,935.77$ 179,167.02$ 2,221,300.41$

Appeals Filed 2 2 0 2 3 0 2 11

VA Health Care Applications 5 5 5 3 8 6 5 37

Federal Ancillary Benefit Applications 3 4 4 2 1 1 1 16

Burial Benefits Applications 5 2 1 1 0 3 0 12

eBenefits Registration 7 4 5 6 42 31 13 108

DD-214 / Military Records Requests 15 16 14 11 21 18 4 99

Corrections / Upgrade Military Records 0 3 0 0 0 2 5 10

Dependent's Ancillary Applications 0 2 2 2 2 1 2 11

State Ancillary Benefit Applications 11 4 14 12 39 25 29 134

VAC Outreach (Man Hours) 34 28 19 18 23 17 34 173

Training (Man Hours) 1 12 26 11 0 145 13 208

Packet Pg. 13

VETERANS ASSISTANCE COMMISSION FAP REPORT

Category December January February March April May June July August September October November Year Totals

Shelter 418.00$ -$ -$ -$ 400.00$ -$ -$ $818.00

Gas Utility -$ -$ -$ -$ -$ -$ -$ $0.00

Electrical Utility 28.09$ 110.89$ -$ -$ -$ -$ -$ $138.98

Water/Waste Water/Garbage -$ 319.54$ -$ -$ -$ -$ -$ $319.54

Heat -$ -$ -$ -$ -$ -$ -$ $0.00

Food -$ -$ -$ -$ -$ -$ -$ $0.00

Personal Needs 50.00$ 25.00$ 25.00$ -$ -$ -$ -$ $100.00

Telephone -$ -$ -$ -$ -$ -$ -$ $0.00

Medical -$ -$ -$ -$ -$ -$ -$ $0.00

Burial -$ -$ -$ -$ -$ -$ -$ $0.00

FAP Applications Issued 1 2 2 1 1 2 0 9

FAP Applications Received 2 3 1 0 1 5 1 13

FAP Approved 1 1 0 0 1 0 0 3

FAP Renewed (Assessments) 2 1 1 0 0 0 0 4

FAP Denied 3 7 4 4 0 3 1 22

Dependents Assisted 0 4 0 0 0 0 0 4

Referrals to Other Agencies 20 21 17 12 11 7 6 94

VAC Correspondence 19 109 12 22 7 7 18 194

Veterans Transported 0 0 0 0 0 0 0 0

Monthly Mileage 29 0 0 0 0 0 0 29

Packet Pg. 14

JULY 2016 - Number of Job Applicants by Position

Department Position Date Position Posted

No. of

Applicants

During Report

Month

Total No. of

Applicants to

Date** Position Filled Date FilledAnimal Control Kennel Assistant Full time 5/17/16 4 3 Filled 6/21/16

Animal Control Kennel Assistant Part Time Weekends (2- Positions) 5/24/16 4 2 Filled 6/16/16

Building Management Building Maintenance Worker 3/18/16 0 7 Filled 6/27/16

Building Management Jail Maintenance Worker 6/1/16 7 7 Open Open

Court Services Specialized Probation Services (SPS) Officer 4/12/16 0 45 Filled 6/27/16Court Services Supervisor (2 Positions) 4/22/16 0 9 Closed Reviewing ApplicationsCourt Services Homebound Detention Officer 4/29/16 0 58 Filled 7/11/16Court Services Drug Rehabilitation Court Probation Officer 6/15/16 54 54 Closed Reviewing ApplicationsCourt Services Juvenile Probation Officer 6/29/16 5 5 Open OpenCourt Services Pre-Trial Officer 6/21/16 45 45 Closed Reviewing ApplicationsCourt Services/Judiciary Drug Rehabilitation Court Coordinator 5/23/16 0 15 Closed Reviewing ApplicationsCourt Services Juvenile Justice Center Psychologist 6/15/16 revised 6/30/16 2 2 Open OpenDevelopment & Community Services Administrative Officer Code Enforcement 5/3/16 0 21 Filled 6/20/16Development & Community Services Plan Examiner 5/18/16 1 1 Filled 6/6/16Division of Transportation Permit Engineer 5/31/16 4 0 Open Open

Health Department CHS II Community Health Practitioner Internal Only Post 5/2/16 0 0 Removed On Hold

Health Department Intern West Nile Virus Program (2 Positions) 3/11/16 1 10 Filled 5/19/16 Closed only going to fill one

Health Department Clinical Nursing Supervisor 6/1/16 2 2 Open Open

Human Resource Management Payroll Administrative Clerk 6/2/16 20 20 Open Open

Judiciary-Circuit Court of the Sixteenth Judicial

Circuit Junior Staff Attorney 5/19/16 3 3 Closed Reviewing Applications

O.C.R. Program Manager Part Time Regular 4/22/16 0 6 Removed Revised Removed Revised

O.C.R. Project Manager Full Time 5/27/16 8 8 Open Open

O.C.R. Workforce Development Business Service Representative 2- Openings 11/10/15 0 98 Closed One filled 5/9/16 & One still open

Sheriff's Department Court Security 5/17/16 40 55 Closed Reviewing Applications

Sheriff's Department Information Data Processor 5/16/16 5 14 Closed Interviewing

State's Attorney Office Biligual Deferred Prosecution Administrative Assistant 5/18/16 0 2 Closed Reviewing Applications

NA * General Application NA* NA* 9 3 NA NA

* NA - No Position posted

* State's Attorney - posting apply direct with

department

Packet Pg. 15

214

Gender

Total

65Males

149Females

8

214

Pacific Islander/Hawaiian

MultiRacial 0

No Race Entered 20

Total

0

White

Race

Black 13133

40Other

Hispanic

American Indian/Alaskan Native 0

Special DisabledVet

Disabled Veteran

0

1

0

0

Handicapped 1

Vietnam Veteran

Veteran

06/30/2016-

Job Seekers Submitting County Job Applications

EEO Report for June 30, 201606/01/2016

Packet Pg. 16

Kane County New Hire Report

5/22/2016 - 6/18/2016

Department Employee Name HireDateStatusJobTitle

SORENSON, SAMANTHA AAnimal Control 05/28/2016ACTIVEKennel Assistant

PACATTE, BLAIR ACourt Services/Juvenile Justice Center 06/13/2016ACTIVEYouth Counselor JJC

SIMPSON, DENISE HCourt Services/Juvenile Justice Center 06/13/2016ACTIVEYouth Counselor JJC

CHA, JAEYUNDevelopment/County Development 06/06/2016ACTIVEPlan Examiner

TAYLOR, AUSTIN SInformation Technologies 05/23/2016ACTIVEGIS Intern

KRAMER, AMANDA ESheriff/Sheriff 05/31/2016ACTIVEInformation Specialist

GALLO ROLON, SOFIA BState's Attorney 06/13/2016ACTIVEAdministrative Assistant

HUI, MAN FUNGTransportation 06/01/2016ACTIVEEngineering Co-op Intern

8 New Hire Employees

Page 1 of 17/7/2016

Packet Pg. 17

Kane County New Hires EEO Report5/22/2016 - 6/18/2016

4Administrative Support

2Professionals

1Service/Maintenance

1Technicians

Administrative Support 50.0%4Professionals 25.0%2Service/Maintenance 12.5%1Technicians 12.5%1

Total: 100.0%8

EEOC Category

5Female

3Male

Female 62.5%5

Male 37.5%3

Total: 100.0%8

Gender

1Asian

1Black

1Hispanic or Latino

5White

Asian 12.5%1Black 12.5%1Hispanic or Latino 12.5%1White 62.5%5

Total: 100.0%8

Race

Page 1 of 2

Packet Pg. 18

Kane County New Hires EEO Report5/22/2016 - 6/18/2016

1Animal Control

2

CourtServices/Juvenile

Justice Center

1

Development/CountyDevelopment

1

InformationTechnologies

1Sheriff/Sheriff

1State's Attorney

1Transportation

Animal Control 12.5%1Court Services/Juvenile Justice Center 25.0%2Development/County Development 12.5%1Information Technologies 12.5%1Sheriff/Sheriff 12.5%1State's Attorney 12.5%1Transportation 12.5%1

Total: 100.0%8

Department

Page 2 of 2

Packet Pg. 19

Kane County Termination Report

5/22/2016 - 6/18/2016

Department Employee Name Termination Date

LEWIS, JESSICA LAnimal Control 5/22/2016

BAIRD, JOSEPH CBuilding Management 5/26/2016

FRYE, RANDY SCircuit Clerk 6/15/2016

THOMAS, CARRIE ACourt Services/Adult Drug Court 6/1/2016

ROTTY, MATTHEW KCourt Services/Diagnostic Center 6/15/2016

SODERQUIST, DAVID KDevelopment/County Development 6/1/2016

AMOO, DINA AHealth 5/25/2016

SIENKIEWICZ, ELLEN LInformation Technologies 5/31/2016

MAHONEY, NEIL TJudiciary and Courts 5/31/2016

JOHNSON, AMBER LRegional Office of Education 5/25/2016

LAVALLE, JOSEPH ASheriff/Adult Corrections 6/15/2016

RIEDL, GEORGESheriff/Adult Corrections 6/1/2016

SWANSON, DANIEL PSheriff/Adult Corrections 6/1/2016

GODINHO, PAULO D JrSheriff/Court Security 6/15/2016

BALOUN, ROBERT ASheriff/Sheriff 6/1/2016

PARKER, DEBORAH ASheriff/Sheriff 6/3/2016

BOSTROM, SARAH JState's Attorney 6/10/2016

LLOYD, JOSHUA DState's Attorney 6/17/2016

KLINICKI, ARTHUR CTransportation 5/31/2016

BECKSTROM, MARK SWorkforce Development 6/3/2016

20 Terminated Employees

Page 1 of 17/7/2016

Packet Pg. 20

Kane County Terminations EEO Report5/22/2016 - 6/18/2016

18Full Time

2Part Time

Full Time 90.0%18

Part Time 10.0%2

Total: 100.0%20

EEOC Category

7Female

13Male

Female 35.0%7

Male 65.0%13

Total: 100.0%20

Gender

2Black

1Hispanic or Latino

17White

Black 10.0%2

Hispanic or Latino 5.0%1White 85.0%17

Total: 100.0%20

Race

Page 1 of 2

Packet Pg. 21

Kane County Terminations EEO Report5/22/2016 - 6/18/2016

1Animal Control

1

BuildingManagement

1Circuit Clerk

3

Sheriff/AdultCorrections

1

Sheriff/CourtSecurity

2Sheriff/Sheriff

2State's Attorney

Animal Control 5.0%1Building Management 5.0%1Circuit Clerk 5.0%1Court Services/Adult Drug Court 5.0%1Court Services/Diagnostic Center 5.0%1Development/County Development 5.0%1Health 5.0%1Information Technologies 5.0%1Judiciary and Courts 5.0%1Regional Office of Education 5.0%1Sheriff/Adult Corrections 15.0%3Sheriff/Court Security 5.0%1Sheriff/Sheriff 10.0%2State's Attorney 10.0%2Transportation 5.0%1Workforce Development 5.0%1

Total: 100.0%20

Department

Page 2 of 2

Packet Pg. 22

Kane County

Coverage July-September 2016

Life Insurance RateVolume/Covered

Lives Amount Payable

Life/$1,000 $0.0870 21,590,000 $1,878.33

AD & D/$1,000 $0.0200 21,590,000 $431.80

Life/AD & D Only Fees

Family Life per Unit

Life Ins. Total $2,596.44

Medical Waivers

Fees $2.59 100 $259.00

Waiver Total $259.00

HMO

HMOI - Non Union - H00596 RateVolume/Covered

Lives Amount Payable New Hire

QE

Additions Terms Retirees Amount COBRA AMOUNT

Single $597.84 5 $2,989.20

Single + 1 0

Single + Sp. $1,187.66 0 $0.00

Single + Ch. $1,187.66 1 $1,187.66

Family $1,737.10 8 $13,896.80

Single Retiree < 65 $597.84 0 $0.00

Retiree < 65 + 1 < 65 0

Retiree < 65 + Sp. < 65 $1,187.66 0 $0.00

Retiree < 65 + Ch. < 65 $1,187.66 0 $0.00

Retiree < 65 + Family $1,737.10 0 $0.00

Medicare Single $542.40 0 $0.00

Medicare Single + 1 Dep. Medicare $1,084.80 0 $0.00

HMOI - Union - H00456 RateVolume/Covered

Lives Amount Payable New Hire

QE

Additions Terms Retirees Amount COBRA AMOUNT

Single $610.04 13 $7,930.52

Single + 1 0

Single + Sp. $1,211.89 2 $2,423.78

Single + Ch. $1,211.89 2 $2,423.78

Family $1,772.55 7 $12,407.85

Single Retiree < 65 $610.04 0 $0.00

Retiree < 65 + 1 < 65 0

Retiree < 65 + Sp. < 65 $1,211.89 1 $1,211.89

Retiree < 65 + Ch. < 65 $1,211.89 0 $0.00

Retiree < 65 + Family $1,772.55 0 $0.00

Medicare Single $553.47 0 $0.00

Medicare Single + 1 Dep. Medicare $1,106.94 0 $0.00

HMOBA - Non Union - B04108 RateVolume/Covered

Lives Amount Payable New Hire

QE

Additions Terms Retirees Amount COBRA AMOUNT

Single $556.72 104 $57,898.88 2 3

Single + 1 0

Single + Sp. $1,105.24 45 $49,735.80

Single + Ch. $1,105.24 17 $18,789.08

Family $1,616.21 117 $189,096.57 1

Single Retiree < 65 $556.72 0 $0.00

Retiree < 65 + 1 < 65 0

Retiree < 65 + Sp. < 65 $1,105.24 0 $0.00

Retiree < 65 + Ch. < 65 $1,105.24 0 $0.00

Retiree < 65 + Family $1,616.21 0 $0.00

Medicare Single $506.32 0 $0.00

Medicare Single + 1 Dep. Medicare $1,013.80 0 $0.00

HMOBA - Union - B04479 RateVolume/Covered

Lives Amount Payable New Hire

QE

Additions Terms Retirees Amount COBRA AMOUNT

Single $568.08 119 $67,601.52 1 1

Single + 1 0

Single + Sp. $1,127.79 39 $43,983.81

Single + Ch. $1,127.79 26 $29,322.54 1

Family $1,649.19 144 $237,483.36 3

Single Retiree < 65 $568.08 9 $5,112.72 1 $568.08

Retiree < 65 + 1 < 65 0

Retiree < 65 + Sp. < 65 $1,127.79 5 $5,638.95

Retiree < 65 + Ch. < 65 $1,127.79 0 $0.00

Retiree < 65 + Family $1,649.19 0 $0.00 1 $1,649.19

Medicare Single $516.65 0 $0.00

INTERGOVERNMENTAL PERSONNEL BENEFIT COOPERATIVE

Illustrative Premium Equivalent Rates

Rate Tier RateVolume/

Covered Lives

Amount

Payable

Packet Pg. 23

Medicare Single + 1 Dep. Medicare $1,034.49 0 $0.00

HMO Total 664 $749,134.71

PPO

PPO - Non-Union - PC1132 (was listed as PC0347) RateVolume/Covered

Lives Amount Payable New Hire

QE

Additions Terms Retirees Amount COBRA AMOUNT

Single $741.74 77 $57,113.98

Single + 1 0

Single + Sp. $1,475.94 59 $87,080.46

Single + Ch. $1,475.94 10 $14,759.40

Family $2,160.50 67 $144,753.50

Single Retiree < 65 $741.74 0 $0.00

Retiree < 65 + 1 < 65 0

Retiree < 65 + Sp. < 65 $1,475.94 0 $0.00

Retiree < 65 + Ch. < 65 $1,475.94 0 $0.00

Retiree < 65 + Family $2,160.50 0 $0.00

Medicare Single $369.54 0 $0.00

Medicare Single + 1 Dep. Medicare $689.37 0 $0.00

PPO - Union - PC0346 RateVolume/Covered

Lives Amount Payable New Hire

QE

Additions Terms Retirees Amount COBRA AMOUNT

Single $756.88 67 $50,710.96 4

Single + 1 0

Single + Sp. $1,506.06 26 $39,157.56

Single + Ch. $1,506.06 5 $7,530.30

Family $2,204.59 51 $112,434.091 1

Single Retiree < 65 $756.88 17 $12,866.96

Retiree < 65 + 1 < 65 0

Retiree < 65 + Sp. < 65 $1,506.06 10 $15,060.60

Retiree < 65 + Ch. < 65 $1,506.06 0 $0.00

Retiree < 65 + Family $2,204.59 0 $0.00

Medicare Single $377.09 6 $2,262.54

Medicare Single + 1 Dep. Medicare $703.44 3 $2,110.32

Benefit Fund Distribution

Credit/Debit

Total $0.00

Terminal Reserve Activity

Credit/Debit $0.00

Total $0.00

Total $1,297,830.82

Packet Pg. 24

Individual In-Network Individual Out-of-Network Family In-Network*** Family Out-of-Network***

$500 $1,000 $1,200 $2,400

$500 $750 $1,000 $1,700

$1,500 $2,000 $3,000 $5,000

$1,500 $2,000 $3,000 $4,500

$570 $927 $1,485 $2,473

$750 $1,500 $2,250 $4,500

$750 $1,500 $2,250 $4,500

PPO 1 - Union $750 $1,500 $2,250 $4,500

PPO 2 (Medicare Actives Only) Union $750 $1,500 $2,250 $4,500

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Based on PPO plans with deductibles that are a fixed amount.

***Based on plans with a predetermined family deductible amount

PPO 2 (Medicare Actives Only) Non-Union

Midwest

Government

Small Employers (<500)

All Employers

PPO 1 - Non-Union

IPBC

Kane CountyPPO Plan Benchmarking

Deductible Amounts

Median Deductible Amounts**

Category

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

Individual In-Network Individual Out-of-Network Family In-Network*** Family Out-of-Network***

Median Deductibles

Midwest

Government

Small Employers (<500)

All Employers

IPBC

PPO 1 - Non-Union

PPO 2 (Medicare ActivesOnly) Non-Union

*2014 Mercer National Survey of Employer-Sponsored Plans.**Based on PPO plans with deductibles that are a fixed amount.***Based on plans with a predetermined family deductible amount

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 25

In-Network Out-of-Network

Midwest $2,500 $4,975

Government $2,500 $3,750

Small Employers (<500) $3,500 $6,000

All Employers $3,500 $6,000

IPBC $1,676 $4,205

PPO 1 - Non-Union $3,000 $6,000

PPO 2 (Medicare Actives Only) Non-Union $3,000 $6,000

PPO 1 - Union $2,750 $5,500

PPO 2 (Medicare Actives Only) Union $2,750 $5,500

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Based on PPOs with out-of-pocket maximums that are a fixed amount

Kane CountyPPO Plan Benchmarking

Individual Out-of-Pocket Maximums

Median Out-of-Pocket Maximum**

Category

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

In-Network Out-of-Network

Median Out-of-Pocket Maximums

Midwest Government Small Employers (<500)

All Employers IPBC PPO 1 - Non-Union

PPO 2 (Medicare Actives Only) Non-Union PPO 1 - Union PPO 2 (Medicare Actives Only) Union

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 26

In-Network Copay ($)Physician In-Network

Coinsurance

Physician Out-of-Network

Coinsurance

Hospital In-Network

Coinsurance

Hospital Out-of-Network

Coinsurance

Midwest $20 20% 40% 20% 40%

Government $20 20% 30% 20% 40%

Small Employers (<500) $25 20% 40% 20% 40%

All Employers $25 20% 40% 20% 40%

IPBC $20 20% 30% 20% 30%

PPO 1 - Non-Union $30 20% 40% 20% 40%

PPO 2 (Medicare Actives Only) Non-Union $30 20% 40% 20% 40%

PPO 1 - Union $30 20% 40% 20% 40%

PPO 2 (Medicare Actives Only) Union $30 20% 40% 20% 40%

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Among employers requiring copay/coinsurance

***Among employers requiring coinsurance

Median Copay/Coinsurance Amount For Physician Office Visits**Median Coinsurance Amounts For Inpatient Hospital

Services***

Kane CountyPPO Plan BenchmarkingCost Sharing Requirements

Category

$0

$5

$10

$15

$20

$25

$30

Median In-Network Office Visit Copay

Midwest Government Small Employers (<500)

All Employers IPBC PPO 1 - Non-Union

PPO 2 (Medicare Actives Only) Non-Union PPO 1 - Union PPO 2 (Medicare Actives Only) Union

0%

5%

10%

15%

20%

25%

30%

35%

40%

Physician In-Network

Coinsurance

Physician Out-of-NetworkCoinsurance

Hospital In-Network

Coinsurance

Hospital Out-of-Network

Coinsurance

Median Coinsurance Amounts for Inpatient Hospital Services

Midwest

Government

Small Employers(<500)

All Employers

IPBC

PPO 1 - Non-Union

PPO 2 (MedicareActives Only) Non-UnionPPO 1 - Union

PPO 2 (MedicareActives Only) Union

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 27

Physician Office Visit Copayments

Median Physician Office Visit

Copay**

Percentage of Employers with

Higher Copay for Specialist

Visit

Median Specialist Office Visit

Copay**

Midwest $20 41% $40

Government $20 55% $40

Small Employers (<500) $25 52% $50

All Employers $25 52% $50

IPBC $14 n/a $19

PPO 1 & 2 Non-Union $30 $50

PPO 1 & 2 Union $30 $50

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Among employers requiring an office visit copay

Kane CountyPPO Plan BenchmarkingCost Sharing Requirements

Category

Specialist Office Visit Copayments

$0

$5

$10

$15

$20

$25

$30

Median Physician Office Visit Copay

Midwest Government

Small Employers (<500) All Employers

IPBC PPO 1 & 2 Non-Union

PPO 1 & 2 Union

$0

$5

$10

$15

$20

$25

$30

$35

$40

$45

$50

Median Specialist Office Visit Copay

Midwest Government Small Employers (<500) All Employers

IPBC PPO 1 & 2 Non-Union PPO 1 & 2 Union

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 28

Percentage of Employers

Requiring an Emergency

Room Copay

Median Emergency Room

Copay***

Midwest 69% $125

Government 80% $100

Small Employers (<500) 76% $150

All Employers 76% $150

IPBC n/a $100

PPO 1 & 2 Non-Union $500

PPO 1 & 2 Union $250

*2014 Mercer National Survey of Employer-Sponsored Plans.

***Among employers requiring an emergency room copay

Kane CountyPPO Plan Benchmarking

Emergency Room Cost Sharing Requirements

Category

Emergency Room

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

Median Emergency Room Copay***

Midwest

Government

Small Employers (<500)

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 29

Percentage of Employers

Requiring a Physician Office

Visit Copay

Median Physician Office Visit

Copay**

Percentage of Employers with

Higher Copay for Specialist

Visit

Median Specialist Office Visit

Copay**

Midwest 99% $20 56% $40

Government 91% $20 56% $30

Small Employers (<500) 90% $25 63% $25

All Employers 91% $25 63% $30

IPBC 91% $22 77% $27

HMO & BA HMO (Non-Union) $30 $50

HMO & BA HMO (Union) $30 $50

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Among employers requiring an office visit copay

Specialist Office Visit Copayments

Kane CountyHMO Plan BenchmarkingCost Sharing Requirements

Category

Physician Office Visit Copayments

$0

$5

$10

$15

$20

$25

$30

Median Physician Office Visit Copay

Midwest Government Small Employers (<500)

All Employers IPBC HMO & BA HMO (Non-Union)

HMO & BA HMO (Union)

$0

$5

$10

$15

$20

$25

$30

$35

$40

$45

$50

Median Specialist Office Visit Copay

Midwest Government Small Employers (<500)

All Employers IPBC HMO & BA HMO (Non-Union)

HMO & BA HMO (Union)

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 30

Percentage of Employers

Requiring a Hospital

Deductible

Median Hospital Deductible**

Percentage of Employers

Requiring an Emergency

Room Copay

Median Emergency Room

Copay***

Midwest 43% $250 86% $100

Government 53% $250 96% $100

Small Employers (<500) 51% $250 86% $100

All Employers 52% $250 86% $100

IPBC n/a n/a n/a $104

HMO & HMO BA (Non-Union) $250 $500

HMO & HMO BA (Union) $250 $250

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Among those offering an HMO that requires a hospital deductible

***Among those offering an HMO that requires an emergency room copay

Kane CountyHMO Plan Benchmarking

Hospital and Emergency Room Cost Sharing Requirements

Category

Inpatient Hospital Emergency Room

$0

$50

$100

$150

$200

$250

Median Hospital Deductible**

Midwest Government Small Employers (<500)

All Employers IPBC HMO & HMO BA (Non-Union)

HMO & HMO BA (Union)

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

Median Emergency Room Copay***

Midwest Government Small Employers (<500)

All Employers IPBC HMO & HMO BA (Non-Union)

HMO & HMO BA (Union)

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 31

PPO/POS HMO Plan HSA-Eligible CDHP HRA-Based CDHP Either Type of CDHP

Midwest 90% 23% 47% 11% 54%

Government 85% 33% 28% 10% 33%

Small Employers (<500) 71% 30% 22% 5% 26%

All Employers 72% 30% 23% 5% 27%

IPBC 93% 82% 10% 1% 11%

Kane County X X

*2014 Mercer National Survey of Employer-Sponsored Plans.

Percentage of Employers Offering:

Kane CountyHealth Plan Benchmarking

Plans Offered

Category

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Traditional IndemnityPlan Only

PPO/POS HMO Plan HSA-Eligible CDHP HRA-Based CDHP Either Type of CDHP

Percentage of Employers Offering:

Midwest

Government

Small Employers(<500)

All Employers

IPBC

Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 32

Of Those Offering Specific Program, Percentage of Employers Providing Incentives

to Encourage Participation in or Completion Of:

Health assessment Lifestyle managementValidated Biometric

screening

Midwest 68% 61% 40% 49%

Government 60% 51% 39% 40%

Small Employers (<500) 21% Insufficient Data Insufficient Data Insufficient Data

All Employers 23% Insufficient Data Insufficient Data Insufficient Data

IPBC 25% 17% 4% 3%

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Includes penalties

Kane CountyHealth Plan BenchmarkingHealth Management Program

Category

Percentage of Employers

Providing Health

Management Incentives**

0%

10%

20%

30%

40%

50%

60%

70%

Percentage of Employers Providing Incentives to Participate in One or More Health Management Programs

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 33

Percentage of Employers Offering an HRA-Eligible CDHP in:

2014 2013 2012

Midwest 11% 10% 13% 35%

Government 10% 8% 12% 21%

Small Employers (<500) 5% 6% 4% 66%

All Employers 5% 6% 4% 63%

IPBC 3% 2% 2% 1%

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

Kane CountyHealth Plan Benchmarking

Heath Reimbursement Accounts

Category

Percentage of HRA

Sponsors Offering the

HRA as the Only Plan:

0%

2%

4%

6%

8%

10%

12%

14%

2014 2013 2012

Percentage of Employers Offering an HRA in:Midwest

Government

Small Employers(<500)

All Employers

IPBC

Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 34

Percentage of Employers Offering an HSA-Based CDHP in:

2014 2013 2012

Midwest 47% 38% 36%

Government 28% 18% 20%

Small Employers (<500) 22% 17% 18%

All Employers 23% 18% 18%

IPBC 12% 11% 10%

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

Category

Health Plan Benchmarking

Kane County

Heath Savings Accounts

0%

10%

20%

30%

40%

50%

2014 2013 2012

Percentage of Employers Offering an HSA in:

Midwest

Government

Small Employers(<500)

All Employers

IPBC

Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 35

Employee-Only

CoverageFamily Coverage

Employee-Only

CoverageFamily Coverage

Employee-Only

CoverageFamily Coverage

Midwest $500 $1,000 $2,000 $3,700 $3,000 $6,000

Government $500 $1,200 $1,500 $3,000 $3,000 $6,000

Small Employers (<500) $1,000 $1,500 $2,500 $5,000 $4,000 $8,000

All Employers $1,000 $1,400 $2,500 $5,000 $4,000 $8,000

IPBC $1,186 $2,372 $2,108 $4,215 $2,444 $4,408

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Based on employers that contribute to employee accounts.

Kane CountyHealth Plan Benchmarking

Heath Savings Accounts

Category

Median Employer Account Contribution**

For:Median In-Network Deductible For: Median Out-Of-Pocket Maximum For:

$0

$500

$1,000

$1,500

$2,000

$2,500

Employee-Only Coverage Family Coverage

Median Employer Account Contribution**

Midwest Government Small Employers (<500) All Employers IPBC Kane County

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

Employee-Only Coverage Family Coverage

Median In-Network Deductible

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 36

Employee-Only

CoverageFamily Coverage

Employee-Only

CoverageFamily Coverage

Employee-Only

CoverageFamily Coverage

Midwest $750 $1,600 $1,750 $3,500 $3,800 $8,000

Government Insufficient Data Insufficient Data Insufficient Data Insufficient Data $3,000 $6,000

Small Employers (<500) Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data

All Employers Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data

IPBC $500 $1,500 $1,500 $4,500 $2,000 $4,000

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Based on employers that contribute to employee accounts.

Kane CountyHealth Plan BenchmarkingHeath Reimbursement Accounts

Category

Median Employer Account Contribution**

For:Median In-Network Deductible For: Median Out-Of-Pocket Maximum For:

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

Employee-Only Coverage Family Coverage

Median Employer Account Contribution**

Midwest Government Small Employers (<500) All Employers IPBC Kane County

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

Employee-Only Coverage Family Coverage

Median In-Network Deductible

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 37

Will Not Cover SpouseRequire Spousal

SurchargeCash Benefit Credits

Midwest 14% 13% 13% 1% $1,861 16%

Government 3% 5% 22% 3% $2,478 9%

Small Employers (<500) 6% <1% 8% 1% $2,827 22%

All Employers 6% 1% 8% 1% $2,761 22%

IPBC 0% 1% Insufficient Data Insufficient Data Insufficient Data Insufficient Data

Kane County Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data

*2014 Mercer National Survey of Employer-Sponsored Plans.

Kane CountyHealth Plan Benchmarking

Spousal Surcharge/Opt-Out

Category

Percentage of Employers That:Percentage of Employers Offering Cash or

Credit to Employees Who Waive Coverage: Average Percentage of

Employees Waiving

Coverage

Among Those Offering

Cash, Average Amount

0%

2%

4%

6%

8%

10%

12%

14%

Will Not Cover Spouse Require Spousal Surcharge

Percentage of Employers That:

Midwest Government Small Employers (<500) All Employers IPBC Kane County

0%

5%

10%

15%

20%

25%

Average Percentage of Employees Waiving Coverage

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143

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Average Percentage of Eligible

Employees Participating

Average Annual Contribution

Amount

Average Percentage of Eligible

Employees Participating

Average Annual Contribution

Amount

Midwest 23% $1,330 6% $3,116

Government 24% $1,289 4% $2,820

Small Employers (<500) 34% $1,461 14% $3,402

All Employers 33% $1,448 13% $3,385

IPBC 31% $1,462 6% $3,711

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

** Based on employers offering health care spending account plan

***Based on employers offering dependent care spending account plan

Dependent Care Spending Account:***

Kane CountyHealth Plan BenchmarkingHealth Care Spending Accounts

Category

Health Care Spending Account:**

$1,200

$1,250

$1,300

$1,350

$1,400

$1,450

$1,500

Average Annual Health Care Spending Account Contribution

Midwest Government Small Employers (<500) All Employers IPBC Kane County

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

Average Annual Dependent Care Spending Account Contribution

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 39

New Hires Are EligibleNew Hires Are Not Eligible

(Closed Group)New Hires Are Eligible

New Hires Are Not Eligible

(Closed Group)

Midwest 29% 15% 21% 11%

Government 71% 16% 50% 11%

Small Employers (<500) 8% 2% 7% 1%

All Employers 8% 2% 7% 1%

IPBC 100% N/A 95% N/A

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

Kane CountyHealth Plan Benchmarking

Retiree Health Care

Category

Percentage of Employers Offering Coverage to Pre-

Medicare-Eligible Retirees:

Percentage of Employers Offering Coverage to

Medicare-Eligible Retirees:

0%

20%

40%

60%

80%

100%

New Hires Are Eligible New Hires Are NotEligible (Closed

Group)

Percentage of Employers Offering Coverage to Pre-Medicare-Eligible

Retirees:Midwest

Government

Small Employers(<500)

All Employers

IPBC

Kane County0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

New Hires Are Eligible New Hires Are Not Eligible(Closed Group)

Percentage of Employers Offering Coverage to Medicare-Eligible Retirees:

Midwest

Government

Small Employers(<500)

All Employers

IPBC

Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 40

For Pre-Medicare-Eligible Retirees, Percentage of Plans in Which:

Employer Pays All Cost is Shared Retiree Pays All

Midwest 11% 55% 34% 39%

Government 13% 51% 36% 26%

Small Employers (<500) Insufficient Data Insufficient Data Insufficient Data Insufficient Data

All Employers Insufficient Data Insufficient Data Insufficient Data Insufficient Data

IPBC 2% 22% 76% 65%

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

**When cost is shared

Category

Kane CountyHealth Plan Benchmarking

Pre-Medicare-Eligible Retiree Health Care

Average Contribution** as a % of

Premium

0%

10%

20%

30%

40%

50%

60%

70%

80%

Employer Pays All Cost is Shared Retiree Pays All

For Pre-Medicare-Eligible Retirees, Percentage of Plans in Which:

Midwest Government Small Employers (<500) All Employers IPBC Kane County

0%

10%

20%

30%

40%

50%

60%

70%

Average Contribution** as a % of Premium

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 41

For Medicare-Eligible Retirees, Percentage of Plans in Which:

Employer Pays All Cost is Shared Retiree Pays All

Midwest 19% 50% 31% 42%

Government 23% 30% 47% 31%

Small Employers (<500) Insufficient Data Insufficient Data Insufficient Data Insufficient Data

All Employers Insufficient Data Insufficient Data Insufficient Data Insufficient Data

IPBC 2% 22% 76% N/A

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

**When cost is shared

Category

Kane CountyHealth Plan Benchmarking

Medicare Eligible Retiree Health Care

Average Contribution** as a %

of Premium

0%

10%

20%

30%

40%

50%

60%

70%

80%

Employer Pays All Cost is Shared Retiree Pays All

For Medicare-Eligible Retirees, Percentage of Plans in Which:

Midwest Government Small Employers (<500) All Employers IPBC Kane County

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Average Contribution** as a % of Premium

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 42

Generic Formulary Brand Non-Formulary Brand Generic Formulary Brand Non-Formulary Brand

Midwest $10 $30 $50 $20 $60 $100

Government $10 $25 $45 $15 $50 $90

Small Employers (<500) $10 $30 $50 $25 $70 $120

All Employers $10 $30 $50 $24 $70 $120

IPBC HMO $10 $25 $43 $16 $41 $64

IPBC PPO $11 $26 $43 $18 $46 $76

PPO 1 (Non-Union/Union) $10 $40 $60 $20 $80 $120

HMO & BA HMO (Non-Union/Union) $10 $40 $60 $20 $80 $120

*2014 Mercer National Survey of Employer-Sponsored Plans.

Kane CountyPrescription Drug Benchmarking

Copay Requirements

Category

Median Retail Copays Median Mail Order Copays

$0

$10

$20

$30

$40

$50

$60

Generic Formulary Brand Non-Formulary Brand

Median Retail Copays

Midwest Government

Small Employers (<500) All Employers

IPBC HMO IPBC PPO

PPO 1 (Non-Union/Union) HMO & BA HMO (Non-Union/Union)

$0

$20

$40

$60

$80

$100

$120

Generic Formulary Brand Non-Formulary Brand

Median Mail Order Copays

Midwest Government

Small Employers (<500) All Employers

IPBC HMO IPBC PPO

PPO 1 (Non-Union/Union) HMO & BA HMO (Non-Union/Union)

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 43

One Level

for All Drugs Two Levels Three Levels

Four or Five

LevelsOther

Midwest 6% 6% 58% 28% 2%

Government 3% 6% 70% 21% 1%

Small Employers (<500) 6% 15% 55% 20% 4%

All Employers 6% 14% 56% 20% 4%

IPBC HMO 0% 1% 97% 2% 0%

IPBC PPO 0% 1% 97% 2% 0%

Kane County X

*2014 Mercer National Survey of Employer-Sponsored Plans.

Category

Percentage of Employers Requiring:

Kane CountyPrescription Drug Benchmarking

Prescription Drug Plan Structure

0%

20%

40%

60%

80%

100%

One Level for AllDrugs

Two Levels Three Levels Four or FiveLevels

Other

Percentage of Employers who Require the Following Rx Structure:

Midwest

Government

Small Employers(<500)

All Employers

IPBC HMO

IPBC PPO

Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 44

Midwest 95% $1,500 94% $1,500

Government 94% $1,500 87% $1,500

Small Employers (<500) 85% $1,500 79% $1,200

All Employers 86% $1,500 80% $1,250

IPBC 100% $1,800 100% $1,250

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Based on dental PPO and fee-for-service plans

Kane CountyDental Plan Benchmarking

Benefit Maximums

Percentage of Employers

with an Annual Maximum

Benefit**

Median Annual Maximum

Benefit

Median Lifetime Maximum

Orthodontic BenefitCategory

Percentage of Employers

Limiting Orthodontic Benefits

Payable Per Lifetime

$1,350

$1,400

$1,450

$1,500

$1,550

$1,600

$1,650

$1,700

$1,750

$1,800

Median Annual Maximum Benefit**

Midwest Government Small Employers (<500) All Employers IPBC Kane County

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

Median Lifetime Maximum Orthodontic Benefit**

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143

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Kane CountyDental Plan Benchmarking

Annual Deductibles

Midwest 81% $50

Government 72% $50

Small Employers (<500) 64% $50

All Employers 64% $50

IPBC n/a $50

Kane County

*2014 Mercer National Survey of Employer-Sponsored Plans.

**Based on dental PPO and fee-for-service plans

CategoryPercentage of Employers Whose Dental Plan

Requires an Annual Deductible**Median Deductible

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Percentage of Employers Requiring Annual Deductible**

Midwest Government Small Employers (<500) All Employers IPBC Kane County

$0

$10

$20

$30

$40

$50

Median Deductible**

Midwest Government Small Employers (<500) All Employers IPBC Kane County

Prepared by: Gallagher Benefit Services, Inc., Two Pierce Place, Itasca, Illinois 60143Packet Pg. 46

Surcharge Count Approved W/D Other Count Denied Count Total Count Dispensed Surcharge

May, 2016 32 56 9 7 72 $5,450 $82.50

April, 2016 27 41 12 9 62 $4,160 $70.00

March, 2016 43 57 8 2 67 $4,670 $110.00

February, 2016 21 36 7 4 47 $4,530 $53.00

January, 2016 28 42 8 3 53 $3,760 $72.80

December, 2015 33 46 5 5 56 $4,510 $82.50

November, 2015 34 46 0 5 51 $5,190 $88.00

October, 2015 32 43 17 5 65 $4,090 $82.50

September, 2015 19 29 9 3 41 $2,270 $47.50

August, 2015 0 0 0 0 0 $0 $0.00

July, 2015 0 0 0 0 0 $0 $0.00

June, 2015 0 0 0 0 0 $0 $0.00

269 396 75 43 514 $38,630 $688.80

Surcharge Count Approved W/D Other Count Denied Count Total Count Dispensed Surcharge

May, 2016 43 51 25 14 90 $6,430 $107.50

April, 2016 55 60 11 9 80 $7,630 $137.50

March, 2016 43 50 11 8 69 $7,520 $107.50

February, 2016 0 0 0 0 0 $0 $0.00

January, 2016 0 0 0 0 0 $0 $0.00

December, 2015 0 0 0 0 0 $0 $0.00

November, 2015 0 0 0 0 0 $0 $0.00

October, 2015 0 0 0 0 0 $0 $0.00

September, 2015 0 0 0 0 0 $0 $0.00

August, 2015 0 0 0 0 0 $0 $0.00

July, 2015 0 0 0 0 0 $0 $0.00

June, 2015 0 0 0 0 0 $0 $0.00

141 161 47 31 239 $21,580 $352.50

Surcharge Count Approved W/D Other Count Denied Count Total Count Dispensed Surcharge

May, 2016 37 43 23 26 92 $4,880 $92.50

April, 2016 38 43 29 23 95 $5,610 $95.00

March, 2016 18 22 17 4 43 $2,940 $45.00

February, 2016 0 0 0 0 0 $0 $0.00

January, 2016 0 0 0 0 0 $0 $0.00

December, 2015 0 0 0 0 0 $0 $0.00

November, 2015 0 0 0 0 0 $0 $0.00

October, 2015 0 0 0 0 0 $0 $0.00

September, 2015 0 0 0 0 0 $0 $0.00

August, 2015 0 0 0 0 0 $0 $0.00

July, 2015 0 0 0 0 0 $0 $0.00

June, 2015 0 0 0 0 0 $0 $0.00

93 108 69 53 230 $13,430 $232.50

Terminal ID: M296712 - KANE COUNTY CU- JUDICIAL CENTER

Terminal ID: M296714 - KANE COUTY CU- SHERIFFS OFFICE

Twelve Month Summary Report

Terminal ID: M281999 - KANE COUNTY GOVERMENT CENTER

5/31/2016 12:18:22 PM Page #: 1 of 1

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STATEMENT OF WORK For

HEALTH INSURANCE CLAIMS MANAGEMENT SERVICES

OVERVIEW The County of Kane is seeking to retain the services of a qualified and experienced agency to recommend a cost containment program and to implement and provide claims administration services. Cost containment measures may include an employee or working spouse opt-out program or a spousal surcharge program. Section A. BACKGROUND Kane County employs over 1,300 individuals, union and non-union, that enjoy a wide variety of competitive fringe benefits including: comprehensive medical coverage (PPO and HMO), dental and vision coverage and both healthcare and dependent care flexible spending accounts. Kane County’s benefits plan year starts on January 1. Health insurance is provided through Blue Cross Blue Shield of Illinois. Employees may choose to enroll in a PPO, or an HMO product (HMO-Illinois or HMO-Blue Advantage). Dental insurance is through Guardian Life Insurance Company of America. Employees may choose to enroll in a dental PPO or dental HMO product. Vision insurance is through Vision Service Plan. Kane County’s active employee population is approximately 1,320, with 50/50 union/non-union and fifteen (15) collective bargaining agreements. Approximately 90% of eligible employees enroll in health insurance; approximately 50% in the PPO plan and 50% in the two HMO plans. In the aggregate, the County pays approximately 83% of the premium cost; employees pay 17%. Employee costs are determined by an employee’s participation in the employee wellness program consisting of a biometric screening and written health risk assessment. Approximately 90% of eligible employees enroll in dental insurance. Premium costs are allocated approximately 62% employer paid and 38% employee paid. Kane County also provides voluntary life insurance (up to $50,000) and accidental death and dismemberment insurance to non-union employees who participate in any of the County’s Blue Cross Blue Shield health plans.

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In addition, as a participating employer in the Illinois Municipal Retirement Fund (IMRF), Kane County is required to provide continuation coverage for retirees. Kane County self-administers its retiree insurance program. An employee must have participated in IMRF (regular IMRF or SLEP) and the County’s health insurance program in order to participate in the retiree health program. Retiree coverage may continue until an employee becomes eligible for Medicare as long as required contributions are paid. Contributions are determined annually by the County. For those retirees employed by the County for 15 or more consecutive years, the County pays 10% of the cost of medical and dental benefits but 100% of vision benefits under the same terms and coverage as the employee received for the 12 months preceding retirement. This 10% premium reduction continues until the participant reaches Medicare eligibility, at which point the premium subsidy ceases. Upon a retiree reaching Medicare eligibility, dental and vision coverage ends but medical coverage may continue if converted to a Medicare PPO supplement health care plan. Currently, there are approximately 70 active retirees who participate in the retiree program (health, dental, vision). Kane County joined the Intergovernmental Personnel Benefit Cooperative (IPBC) in January 1, 2016. As a member of the IPBC, Kane County PPO claims are subject to three (3) tiers of stop-loss coverage: 1) individual claims under $35,000 are the responsibility of the member; 2) individual claims over $35,000 up to the stop loss amount of $125,000 are shared equally among IPBC members; 3) individual claims in excess of $125,000 are reimbursed by stop loss carrier. Aggregate stop loss protection also provides a layer of protection over all of the paid claims up to a maximum amount.

Section B. SCOPE OF WORK The successful vendor shall provide the following services:

Provide educational and marketing materials to employees and spouses highlighting the benefits of program participation;

Identify active employees with spouses who are good candidates to waive Kane County health insurance coverage;

Identify working spouses with employer-provided health insurance;

Verify alternative insurance coverage;

Create, print and stock all necessary forms to carry out program operations, including program enrollment forms;

Administer the program in a fiscally responsible manner;

Maintain all participant information including all necessary data elements for proper plan administration;

Provide claims procedure information to enrolled program participants;

Promptly reimburse enrolled program participants and update account balances within 72 hours of receiving receipts;

Process reimbursements in accordance with applicable IRS rules;

Prepare and provide on-demand reports to participants and to Kane County in a format acceptable to Kane County;

Maintain records of all transactions processed through the program in compliance with applicable local, state or federal rules and regulations;

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Handle all facets of the program including customer service and complaints without assistance from Kane County staff;

Create an adequate audit trail of reimbursements to program participants;

Perform non-discrimination testing to ensure that program does not discriminate in favor of highly compensated employees in violation of IRS regulations;

Section C. SPECIAL PROVISIONS

1. Describe real-world examples in which you have successfully assisted employers in implementing leading edge cost containment strategies, particularly in a unionized environment.

2. Specify the compensation you expect to be paid for providing your services. Include a detailed summary of all expenses.

3. Provide the formula for how “savings” to Kane County will be determined; 4. Identify all instances in which the assistance of Kane County staff will be

necessary for initial set-up of the program and for ongoing support. 5. Provide a sample of your participant statement of account. Identify the

circumstances under which employees may re-enroll in any of Kane County’s health plans.

6. Identify any legal or financial risks to Kane County for offering an employee or spousal opt out program .

7. Describe the measures your agency will take to ensure compliance with HIPAA Privacy and Security requirements.

8. Provide a sample implementation schedule identifying key tasks and dates. Section D. QUESTIONNAIRE

The vendors shall include this questionnaire in their proposal when submitted. • Name of Firm:

Business Address: Date Established: Phone Number: Fax Number: E-Mail Address: Size of Firm: Office Location Serving Kane County:

• Principal Account Staff: Names of Principles, professional qualifications,

professional certifications and educational background.

Support Staff: Names of staff that will support the principle account managers, including education and professional certifications.

• General Knowledge: Describe your experience in crafting effective strategies to

assist your clients to reduce or contain insurance costs.

Describe your experience in utilizing all aspects of an insurer’s plan to maximize your clients return on investment.

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References: Please list by name, four clients similar in size and scope to Kane County for whom an employee or spousal opt out program was implemented.

Past Clients: Provide the names, address and phone numbers of at least three clients that have recently left your organization.

Attach a financial statement (CAFR) and financial references that is signed, titled, and dated.

E. SUBMISSION REQUIREMENTS

RFP OFFER FORMAT Please number your responses accordingly.

a. Cover Letter b. Questionnaire

I. Firm Data and Experience II. Account Managers and Professional Licenses III. Support Staff Experience IV. General Knowledge V. References VI. Past Clients VII. Financial Statement VIII. Special Provisions

c. Concluding remarks Section F. RFP EVALUATION AND SELECTION Submitted proposals are evaluated by the Human Services Committee. Qualified vendors will be notified of the schedule to make oral presentations. Selection of a qualified vendor will be made on the basis of:

1. Innovative programs and cost containment strategies - (25 pts) 2. Savings to the Employer client - (30 pts) 3. Employee satisfaction with claims handling and reimbursement- (25 pts) 4. References from current clients similar to size and complexity to

Kane County - (20 pts) Section G. Anticipated Time Line

August 8, 2016 – Proposals Due August 9-26, Review and evaluation of proposals (shortlist of qualified bidders) September 16, 2016 – Finalists give presentations to Human Services Committee and approval of resolution September 28, 2016 Finance Committee Approval October 5, 2016 – Executive Board Approval October 11, 2016 – County Board Approval

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Section H. Contract Term The initial length of this contract shall be for two (2) years. Kane County reserves the right to renew this contract for two (2) additional 1-year periods. A price proposal is required for each additional one (1) year period. For any year beyond the initial year, this contract is contingent on the appropriation of sufficient funds by the Kane County Board. No charges shall be assessed for failure of the County Board to appropriate funds in future contract years.

Section I. Response Instructions An original, marked as “original”, and ten (10) complete paper copies, and one (1) CD of your proposal in PDF format is required to be returned in a sealed package bearing the name and address of the respondent and be labeled. Your proposal may be mailed or hand delivered as follows: Purchasing Department County of Kane 719 South Batavia Avenue

Building A, Room 210 Geneva, IL 60134 The County shall not be responsible for late delivery of your Proposal by a third party courier. J. Proposers’ Questions All questions pertaining to this Request for Proposals requiring clarification or interpretation of the specifications must be submitted in writing to the Purchasing Department no later than 2 p.m. on Monday, August 1, 2016. For the quickest response to all questions please send via e-mail to:

FAX to (630) 208-5107 or E-mail [email protected] PROPOSAL MAY NOT BE SUBMITTED ELECTRONICALLY.

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RESOLUTION/ORDINANCE EXECUTIVE SUMMARY

Resolution No.

AUTHORIZING PLACEMENT OF AUTOMATED TELLER MACHINE AT 530 S. RANDALL ROAD BRANCH COURT LOCATION

Committee Flow: Human Services Committee, Finance and Budget Committee, Executive Committee, County Board Contact: Sheila McCraven, 630.232.5932

Budget Information:

Was this item budgeted? NA Appropriation Amount: NA

If not budgeted, explain funding source:

Summary:

This resolution approves the placement of a KCT Credit Union automated teller machine at the 530 S. Randall Road branch court location to serve employees and customers of the Circuit Clerk’s Office. The County Board previously approved the placement of KCT Credit Union ATMs at the Government Center campus, the Judicial Center and the Sheriff’s Office.

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STATE OF ILLINOIS

COUNTY OF KANE

RESOLUTION NO.

AUTHORIZING PLACEMENT OF AUTOMATED TELLER MACHINE AT 530 S. RANDALL ROAD BRANCH COURT LOCATION

WHEREAS, the Kane County Board has the authority to hold and lease real and personal property for the benefit of taxpayers; and

WHEREAS, Kane County Government became partners with the KCT Credit Union in 1991;

and WHEREAS, Kane County employees are both employees and taxpayers; and WHEREAS, the Circuit Clerk desire to have a KCT Credit Union automated teller machine

placed in the vestibule at the 530 S. Randall Road branch court location to provide convenient access for both employees and residents doing business with the Circuit Clerk’s Office; and

WHEREAS, the KCT Credit Union will pay all costs associated with the placement of an

ATM at 530 S. Randall Road location for the 1st year of placement and to conduct a cost/usage study for year 2 and beyond; and

NOW, THEREFORE, BE IT RESOLVED that the Kane County Board approves placement

of an automated teller machine at the 530 S. Randall Road branch court location and authorizes the County Board Chairman to enter into such contacts as necessary to satisfy this resolution.

Passed by the Kane County Board on August 9, 2016.

________________________________ _____________________________ John A. Cunningham Christopher J. Lauzen Clerk, County Board Chairman, County Board Kane County, Illinois Kane County, Illinois

Vote:

ATM Placement

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RESOLUTION/ORDINANCE EXECUTIVE SUMMARY

Resolution No.

AMENDING PERSONNEL POLICY HANDBOOK (AMERICANS WITH DISABILITIES ACT REASONABLE ACCOMMODATION POLICY)

Committee Flow: Human Services Committee, Executive Committee, County Board Contact: Sheila McCraven, 630.232.5932

Budget Information:

Was this item budgeted? NA Appropriation Amount: NA

If not budgeted, explain funding source: NA

Summary:

This resolution amended the Kane County Personnel Policy Handbook to create a policy on the

Americans with Disabilities Act (ADA) and provides a mechanism for applicants and employees

to request a reasonable accommodation.

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STATE OF ILLINOIS

COUNTY OF KANE

RESOLUTION NO.

AMENDING PERSONNEL POLICY HANDBOOK (AMERICANS WITH DISABILITIES ACT REASONABLE ACCOMMODATION POLICY)

WHEREAS, from time to time the Human Services Committees finds it desirable to amend certain policies contained in the Kane County Personnel Policy Handbook and to adopt new policies; and

WHEREAS, the Human Services Committee desires to adopt a policy and procedure for

qualified applicants and employees to request an accommodation under the Americans with Disabilities Act; and

NOW, THEREFORE, BE IT RESOLVED THEREFORE, BE IT RESOLVED by the Kane

County Board the Personnel Policy Handbook is amended to add the Americans with Disabilities Act (ADA) Reasonable Accommodation policy as set forth in the attached document.

Passed by the Kane County Board on August 9, 2016.

________________________________ _____________________________ John A. Cunningham Christopher J. Lauzen Clerk, County Board Chairman, County Board Kane County, Illinois Kane County, Illinois

Vote:

ADA Policy

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AMERICANS WITH DISABILITIES ACT (ADA) REASONABLE ACCOMMODATION Kane County is committed to the fair and equal employment of individuals with disabilities under the Americans with Disabilities Act (ADA). It is Kane County's policy to provide reasonable accommodation to individuals with disabilities who are qualified for the job in question unless the accommodation would impose an undue hardship on the organization. Kane County prohibits any harassment of, or discriminatory treatment of, employees on the basis of a disability or because an employee has requested a reasonable accommodation.

In accordance with the ADA as amended, reasonable accommodations will be provided to qualified individuals with disabilities to enable them to perform the essential functions of their jobs or to enjoy the equal benefits and privileges of employment. This policy applies to all applicants for employment and all employees. Disability

“Disability” refers to a physical or mental impairment that substantially limits one or more of the major life activities of an individual. A “qualified person with a disability” means an individual with a disability who has the requisite skills, experience, and education for the job in question and who can perform the essential functions of the job with or without reasonable accommodation.

Reasonable Accommodation

Kane County will seek to provide reasonable accommodation for a known disability or at the request of an individual with a disability. Many individuals with disabilities can apply for jobs and perform the essential functions of their jobs without any reasonable accommodations. However, there are situations in which a workplace barrier may interfere. A “reasonable accommodation” is any change or adjustment to the job application process, work environment, or work processes that would make it possible for the individual with a disability to perform the essential functions of the job.

There are three types of reasonable accommodation that may be considered:

• Changes to the job application process so that a qualified applicant with a disability will receive equal consideration for the job opportunity; • Modifications to the work environment so that the qualified individual with a disability can perform the essential functions of the job; or • Adjustments that will allow a qualified individual with a disability to enjoy the same benefits and privileges of employment as other similarly situated employees without disabilities. Essential Job Functions

For each position, the job description typically will identify essential job functions. The employing department generally will review job descriptions on a periodic basis to evaluate job functions designated as essential. An employee’s questions about a job’s requirements should be directed to the employee’s supervisor or manager, or to the Human Resources Department. Requesting a Reasonable Accommodation

An employee with a disability is responsible for requesting an accommodation from the Human Resources Department, or his or her supervisor, and engaging in an informal process to clarify what the employee needs and to identify possible accommodations. If requested, the employee is responsible for providing medical documentation regarding the disability.

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The employee should describe the problem created by a workplace barrier so that an appropriate accommodation may be considered. Typically, the employing department will work with the employee to identify possible reasonable accommodations and to assess the effectiveness of each in allowing the employee to perform the essential functions of the job. Either the employing department or the employee may request the assistance of the Executive Director of Human Resources in identifying possible reasonable accommodations.

Based on this interactive process, a reasonable accommodation will be selected that is

appropriate for both the employing department and the individual employee. While an individual’s preference will be considered, the employing department is free to choose between equally effective accommodations with consideration toward expense and impact on the rest of the organization.

A request for reasonable accommodation may be denied if it would create an undue

hardship for the employing department. Factors to be considered when determining whether an undue hardship exists include the cost of the accommodation, the organization’s overall financial resources, the financial resources of the particular facility at which the accommodation is to be made, the number of employees at the facility, the total number of employees of the organization, and the type of operation. Safety

All employees are expected to comply with all safety procedures. Kane County will not place qualified individuals with disabilities in positions in which they will pose a direct threat to the health or safety of others or themselves. A “direct threat” means a significant risk to the health or safety of one’s self or others that cannot be eliminated by reasonable accommodation. The determination that an individual with a disability poses a direct threat typically will be made by the employing department and will be based on factual, objective evidence. A written copy of the determination will be given to the employee so that he or she may submit additional information and/or challenge the determination that he or she poses a direct threat. An individual may appeal the determination to the Executive Director of Human Resources, the ADA Coordinator for Kane County. Confidentiality

All information obtained concerning the medical condition or history of an applicant or employee will be treated as confidential information, maintained in separate medical files, and disclosed only as permitted by law. Complaint Procedure

It is the policy of Kane County to prohibit any harassment of, or discriminatory treatment of, employees on the basis of a disability or because an employee has requested a reasonable accommodation. If an employee feels he or she has been subject to such treatment or has witnessed such treatment or feels he or she has been retaliated against, the situation should be reported using Kane County’s ADA Grievance Procedure and Complaint Form. Kane County's policy prohibits retaliation against an employee for exercising his or her rights under the ADA or the Illinois Human Rights Act. Any employee found to have engaged in retaliation against an employee for exercising his or her rights or for making a request for reasonable accommodation under this policy will be subject to disciplinary action up to and including discharge.

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REQUEST FOR REASONABLE ACCOMMODATION Return completed form to employing department

Date of Request: __________________

_________________________________ _________________________________ Employee’s Name Employee’s Work Phone _________________________________ _________________________________ Job Title Department

What is the accommodation you are requesting? Please be as specific as possible. Is your request time sensitive? Yes No

What limitation or condition is interfering with your ability to perform your job? What job function or task are you having difficulty performing? What employment benefit or privilege are you having difficulty accessing (if any)?

How will the requested accommodation assist you?

Please provide any other information you think would be useful in evaluating your request.

I understand that all information obtained by my employer during this process will be maintained and used in compliance with ADA confidentiality requirements. I also understand that I may be required to provide my employer with medical documentation about my condition, its functional limitations, and appropriate accommodations. _________________________________ Employee’s Signature

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AMERICANS WITH DISABILITIES ACT (ADA) REASONABLE ACCOMMODATION Kane County is committed to the fair and equal employment of individuals with disabilities under the Americans with Disabilities Act (ADA). It is Kane County's policy to provide reasonable accommodation to individuals with disabilities who are qualified for the job in question unless the accommodation would impose an undue hardship on the organization. Kane County prohibits any harassment of, or discriminatory treatment of, employees on the basis of a disability or because an employee has requested a reasonable accommodation.

In accordance with the ADA as amended, reasonable accommodations will be provided to qualified individuals with disabilities to enable them to perform the essential functions of their jobs or to enjoy the equal benefits and privileges of employment. This policy applies to all applicants for employment and all employees. Disability

“Disability” refers to a physical or mental impairment that substantially limits one or more of the major life activities of an individual. A “qualified person with a disability” means an individual with a disability who has the requisite skills, experience, and education for the job in question and who can perform the essential functions of the job with or without reasonable accommodation.

Reasonable Accommodation

Kane County will seek to provide reasonable accommodation for a known disability or at the request of an individual with a disability. Many individuals with disabilities can apply for jobs and perform the essential functions of their jobs without any reasonable accommodations. However, there are situations in which a workplace barrier may interfere. A “reasonable accommodation” is any change or adjustment to the job application process, work environment, or work processes that would make it possible for the individual with a disability to perform the essential functions of the job.

There are three types of reasonable accommodation that may be considered:

• Changes to the job application process so that a qualified applicant with a disability will receive equal consideration for the job opportunity; • Modifications to the work environment so that the qualified individual with a disability can perform the essential functions of the job; or • Adjustments that will allow a qualified individual with a disability to enjoy the same benefits and privileges of employment as other similarly situated employees without disabilities. Essential Job Functions

For each position, the job description typically will identify essential job functions. The employing department generally will review job descriptions on a periodic basis to evaluate job functions designated as essential. An employee’s questions about a job’s requirements should be directed to the employee’s supervisor or manager, or to the Human Resources Department. Requesting a Reasonable Accommodation

An employee with a disability is responsible for requesting an accommodation from the Human Resources Department, or his or her supervisor, and engaging in an informal process to clarify what the employee needs and to identify possible accommodations. If requested, the employee is responsible for providing medical documentation regarding the disability.

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The employee should describe the problem created by a workplace barrier so that an appropriate accommodation may be considered. Typically, the employing department will work with the employee to identify possible reasonable accommodations and to assess the effectiveness of each in allowing the employee to perform the essential functions of the job. Either the employing department or the employee may request the assistance of the Executive Director of Human Resources in identifying possible reasonable accommodations.

Based on this interactive process, a reasonable accommodation will be selected that is

appropriate for both the employing department and the individual employee. While an individual’s preference will be considered, the employing department is free to choose between equally effective accommodations with consideration toward expense and impact on the rest of the organization.

A request for reasonable accommodation may be denied if it would create an undue

hardship for the employing department. Factors to be considered when determining whether an undue hardship exists include the cost of the accommodation, the organization’s overall financial resources, the financial resources of the particular facility at which the accommodation is to be made, the number of employees at the facility, the total number of employees of the organization, and the type of operation. Safety

All employees are expected to comply with all safety procedures. Kane County will not place qualified individuals with disabilities in positions in which they will pose a direct threat to the health or safety of others or themselves. A “direct threat” means a significant risk to the health or safety of one’s self or others that cannot be eliminated by reasonable accommodation. The determination that an individual with a disability poses a direct threat typically will be made by the employing department and will be based on factual, objective evidence. A written copy of the determination will be given to the employee so that he or she may submit additional information and/or challenge the determination that he or she poses a direct threat. An individual may appeal the determination to the Executive Director of Human Resources, the ADA Coordinator for Kane County. Confidentiality

All information obtained concerning the medical condition or history of an applicant or employee will be treated as confidential information, maintained in separate medical files, and disclosed only as permitted by law. Complaint Procedure

It is the policy of Kane County to prohibit any harassment of, or discriminatory treatment of, employees on the basis of a disability or because an employee has requested a reasonable accommodation. If an employee feels he or she has been subject to such treatment or has witnessed such treatment or feels he or she has been retaliated against, the situation should be reported using Kane County’s ADA Grievance Procedure and Complaint Form. Kane County's policy prohibits retaliation against an employee for exercising his or her rights under the ADA or the Illinois Human Rights Act. Any employee found to have engaged in retaliation against an employee for exercising his or her rights or for making a request for reasonable accommodation under this policy will be subject to disciplinary action up to and including discharge.

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REQUEST FOR REASONABLE ACCOMMODATION Return completed form to employing department

Date of Request: __________________

_________________________________ _________________________________ Employee’s Name Employee’s Work Phone _________________________________ _________________________________ Job Title Department

What is the accommodation you are requesting? Please be as specific as possible. Is your request time sensitive? Yes No

What limitation or condition is interfering with your ability to perform your job? What job function or task are you having difficulty performing? What employment benefit or privilege are you having difficulty accessing (if any)?

How will the requested accommodation assist you?

Please provide any other information you think would be useful in evaluating your request.

I understand that all information obtained by my employer during this process will be maintained and used in compliance with ADA confidentiality requirements. I also understand that I may be required to provide my employer with medical documentation about my condition, its functional limitations, and appropriate accommodations. _________________________________ Employee’s Signature

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REQUEST FOR INFORMATION FROM MEDICAL PROVIDER

________________, who is an employee of Kane County, has requested a reasonable

accommodation under the Americans with Disabilities Act (ADA). In response to that request,

we are seeking specific information as detailed below. Please provide the requested information

only – please do not send copies of medical records.

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and

other entities covered by GINA Title II from requesting or requiring genetic information of

an individual or family member of the individual, except

as specifically allowed by this law. To comply with this law, we are asking that you not

provide any genetic information when responding to this request for medical information.

`Genetic information' as defined by GINA, includes an individual's family medical history,

the results of an individual's or family member's genetic tests, the fact that an individual or

an individual's family member sought or received genetic services, and genetic information

of a fetus carried by an individual

or an individual's family member or an embryo lawfully held by an individual or family

member receiving assistive reproductive services.

Note: The ADA defines disability as a physical or mental impairment that substantially limits

one or more major life activities.

1. Does the employee have a physical or mental impairment?

Yes No

2. If yes, what is the impairment?

_________________________________________________________________

3. What is the expected duration of the impairment?

Permanent

Temporary (please explain)

_____________________________________________________________________

_____________________________________________________________________

Chronic (please explain)

_____________________________________________________________________

_____________________________________________________________________

Episodic (please explain)

_____________________________________________________________________

_____________________________________________________________________

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4. Does the impairment affect a major life activity?

(Examples of major life activities include caring for oneself, performing manual tasks,

seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing,

learning, reading, concentrating, thinking, communicating, and the operation of a major

bodily function such as the immune system, normal cell growth, and digestive, bowel,

bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive

systems).

Yes No

5. Please refer to the attached description of the employee’s job that contains a list of

essential job functions. What limitation(s) interfere with the employee’s ability to

perform the essential functions? How does the limitation(s) interfere with the employee’s

ability to perform the job functions?

_________________________________________________________________

_________________________________________________________________

8. Do you have any suggestions for adjustments to the work environment that would enable

the employee to perform the essential functions? Please describe:

_________________________________________________________________

_______________________________________________________________________

9. How would your suggested adjustments enable the employee to perform the essential

functions?

_________________________________________________________________

_________________________________________________________________

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10. Additional comments or suggestions:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Signature of healthcare professional: ____________________________ Date: _______

Please return this form to: Executive Director

Kane County Human Resources

719 S. Batavia Avenue

Geneva, IL 60134

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REQUEST FOR INFORMATION FROM MEDICAL PROVIDER

________________, who is an employee of Kane County, has requested a reasonable

accommodation under the Americans with Disabilities Act (ADA). In response to that

request, we are seeking specific information as detailed below. Please provide the

requested information only – please do not send copies of medical records.

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits

employers and other entities covered by GINA Title II from requesting or requiring

genetic information of an individual or family member of the individual, except

as specifically allowed by this law. To comply with this law, we are asking that you not

provide any genetic information when responding to this request for medical

information. `Genetic information' as defined by GINA, includes an individual's

family medical history, the results of an individual's or family member's genetic

tests, the fact that an individual or an individual's family member sought or

received genetic services, and genetic information of a fetus carried by an individual

or an individual's family member or an embryo lawfully held by an individual or

family member receiving assistive reproductive services.

Note: The ADA defines disability as a physical or mental impairment that substantially

limits one or more major life activities.

1. Does the employee have a physical or mental impairment?

Yes No

2. If yes, what is the impairment?

_________________________________________________________________

3. What is the expected duration of the impairment?

Permanent

Temporary (please explain)

_______________________________________________________________

_______________________________________________________________

Chronic (please explain)

_______________________________________________________________

_______________________________________________________________

Episodic (please explain)

_______________________________________________________________

_______________________________________________________________

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4. Does the impairment affect a major life activity?

(Examples of major life activities include caring for oneself, performing manual

tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending,

speaking, breathing, learning, reading, concentrating, thinking, communicating,

and the operation of a major bodily function such as the immune system, normal

cell growth, and digestive, bowel, bladder, neurological, brain, respiratory,

circulatory, endocrine, and reproductive systems).

Yes No

5. Please refer to the attached description of the employee’s job that contains a list of

essential job functions. What limitation(s) interfere with the employee’s ability to

perform the essential functions? How does the limitation(s) interfere with the

employee’s ability to perform the job functions?

_________________________________________________________________

_________________________________________________________________

8. Do you have any suggestions for adjustments to the work environment that would

enable the employee to perform the essential functions? Please describe:

_________________________________________________________________

_________________________________________________________________

9. How would your suggested adjustments enable the employee to perform the

essential functions?

_________________________________________________________________

_________________________________________________________________

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10. Additional comments or suggestions:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Signature of healthcare professional: ____________________________ Date: _______

Please return this form to: Executive Director

Kane County Human Resources

719 S. Batavia Avenue

Geneva, IL 60134

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