NCE ENROLLMENT INSTRUCTIONS () Complete NCE Standard Enrollment Form () Complete NCE Health Plan Enrollment Form () NCE Enrollment Form () Premium Check & $40 Annual Administration Fee made out to: INTERNATIONAL BENEFIT ADMINISTRATORS

ALL PAPERWORK WITH PREMIUM CHECK AND ONE TIME APPLICATION FEE, MUST BE RECEIVED BY THE 20TH OF THE MONTH FOR AN EFFECTIVE DATE OF THE 1ST OF THE FOLLOWING MONTH.

MAIL ALL COMPLETED ENROLLMENTS TO : AEGIS ADMINISTRATIVE SERVICES INC. 6970 W. DIVERSEY AVENUE CHICAGO,ILLINOIS 60607

The N.C.E. Benefit Package Coverage & Administration

The N.C.E. has created a completely portable package of benefits, comparable to those found in Fortune 500 companies, which can be provided to those traditionally excluded. We offer greater value and choice so that members can choose from virtually limitless configurations of benefit to design their own package to meet their personal needs. Build a plan as rich or economical as your family needs.

MEDICAL The NCE offers a wide variety of medical insurance plans and configurations from some of the most respected carriers in the country. Unlike other associations with a single HMO option, the NCE offers the only PPO plans available to sole proprietors in the area. You or your employees will be able to select from various HMO, HAS, EPO, POS and PPO options at rates approximately one-half of rate carriers charge sole proprietors without a group,

DENTAL Your family will also have choices when it comes to dental insurance. We offer several options including a v a r i e t y o f PPO Indemnity Plans - that give the option to visit any dental office regardless of network affiliation, to several and EPO plans with reasonable co-pays for all of the most common procedures. Carriers such as Cigna, Aetna, HealthPlex and Delta Dental afford our members the greatest degree of freedom and choice in designing their overall benefit package.

VISION Let’s not forget the eyes! The N.C.E.’s Vision Service Plans are available to all of our members. Your family will be able to visit a network office once a year for a comprehensive eye exam, as well as receive a hefty discount on all frames and lenses purchased through network locations.

DISABILITY, LIFE, LONG TERM CARE AND MUCH MORE! Complete your package of benefits by adding: Life Insurance Disability Insurance, 401(k) Plan Tax Plan Mortgage Program, Pre-Paid Legal Plan, Certified Financial Planning program, Health Advocacy Program, Credit Union, Affinity Group Auto & Homeowner’s Insurance Section 419(e) Trust, Credit Repair, Section 529 College Savings Plan, Scholarship Fund, access to the Member Networking Alliance, Discounts on all manner of business and personal services, Newsletters and Professional Advice for some of the most respected, Attorneys, CPA and Government Officials in the Country.

401 (k) Retirement Plan

Having a 401(K) plan has never been easier!…or cheaper! Traditionally, a 401(k) was so expensive to establish and administer that it was not cost effective for a company under 50 employees to even consider it. The NCE Plan eliminates virtually all of the set up cost and all of the administration, while affording members access to investment vehicles traditionally limited to the largest company plans,. Our 401(K) plan is with Deutsche Asset Management & Scudder Investments, two of the largest and most respected financial institutions in the world. Each of our m e m b e r s have the choice to invest in several different investment options including “ 5 lifestyle choices” available for the convenience minded investor, and 300 different funds for the more savvy investor. In addition to the personal advantages of a 401(K) plan, your company also benefits since is responsible for paying the administrative costs of maintaining the plan. You get all of the advantages of a more comprehensive employee benefits package, without all of the costs and paperwork.

Professional Business Advice

It seems that every day new laws and regulations are implemented that, instead of helping businesses, hinder them. Compliance with is probably the most challenging area for most small-medium sized business owners. With Top Professionals charging hundreds, even thousands of dollars for simple consultations, many employers respond by simply ignoring many of these requirements and taking on unnecessary liability as a result. As part of your membership, you will receive advice from some of the best legal, financial, taxation and political professionals in the Country on topics vital to the to the successful operation of a small business. Receive the same Legal Updates, Client Alerts and informative articles as those received by Executives at Fortune 500 Companies paying hundreds of thousands of dollars to retain these professionals. Members can post specific question on our message boards and receive specific responses to their particular set of circumstances. If a member needs more extensive assistance, these professionals have all agreed to provide N.C.E. members dramatic reductions on their regular rates and charges.

The Network Advantage

In addition to improving your access to benefits and advocating for improved business legislation, the N.C.E. can help you grow your business and increase your profitability. The success of customer communities has shown that business relationships can be created and developed on the Web, Online business networking, connecting and creating opportunities on the Web, is the next logical step. Generating revenue and supporting other business processes via relationships are as compelling reasons The N.C.E. provides its members Online-Networking boards - giving members the ability to advertise, offer discounts to and communicate with fellow members and all partnering associations to generate new business leads and relationships at no cost. Exchange marketing ideas, compare vendors, share your experience and expertise.

Ease of Administration

One Bill, One Site, One Solution To provide your family a comparable package of benefits to that offered by the N.C.E. you would likely have to spend hundreds of hours researching and comparing various products and carriers. Each month you would receive a dozen different bills payable at different times and at different amounts. With the N.C.E.’s comprehensive package of benefits, we have done the research for you- sorted out the scams, inferior products and overpriced programs and narrowed the field to a comprehensive, yet manageable menu of benefits. We remove the headaches, legwork and record keeping nightmare from purchasing benefits. Simply select the plan elements you prefer, enroll, and arrange for payment – which can be as simple as a single monthly electronic fund transfer or a single paper invoice. As a member of the N.C.E., you can be assured that we will constantly monitor the marketplace and current trends to insure that our members always have the latest, most comprehensive and cost effective products available.

P olitical ActionAction Committee

Through its Political Action Committee, the N.C.E. gives the self-employed a powerful voice on state & Federal legislation affecting small business. The NCEPAC is an unaffiliated non-partisan Political Action Committee. We do not select candidates and issues to support based on party affiliation. Our Sole criteria for endorsement and support is the candidates views on issues impacting our membership Key legislative priorities include: Tax Equality for Small Business, Health Insurance Tax Credits, Association Health Plans, Social Security Reform, Retirement Security Equality in Insurance Plans, Federal Small-Business Programs.

Get a Competitive Advantage

There are several competitive advantages gained through joining the N.C.E. and gaining access to all the benefits and programs available to our members. These are some of the primary advantages your company an d your family gains from membership:

1. Price Confidence & Stability- Due to our buying power, you can feel confident that the rates you’re

paying are the most competitive available and far superior to what you can obtain buying direct. Unlike a variety of other association or “Union” plans, our programs are legitimate and carrier approved for sole proprietors. No more 30%+ increases or having to change plans on short notice.

2. Political Power – Avail yourself of the political connections of our Directors and Lobbyists – learn to use

the system to your advantage from the professionals to make their living from it.

3. Recruiting Advantages - Your company will be able to attract employees easier than your competitors when you provide a more comprehensive employment package. In addition, retaining your key employees is easier once you raise their level of expectation regarding employment benefits, since other employers may not measure up to your offering.

4. Professional Advice – As a Member you will have access to a wealth of information and educational

materials to help you run your business more effectively and efficiently. Get access to the top professionals in all fields without the six-figure retainers.

5. Grow Your Business- By using our Network connections, members receive “free-advertising” and can get their products and services in front of both our membership and the associations and chambers of commerce we have partnered with. Members are encouraged to offer their services to fellow members and can drive sales, generate new clients, find joint-venture partners or capital -- all at no- cost!

Cu stomer service

Our Beliefs

At the N.C.E., we understand that we’re in the “ business” of providing “service”. Our goal is to strengthen our Member companies through superior, “value-added” services. Our beliefs are simple...if we help your company become more successful & profitable ...if can help you to better provide for your family our goals will be achieved as a by-product. Therefore extraordinary member service is the only “Real” objective. Our commitment to your company and your family is to provide service that is second to none.

Contact the NCE What is the

Enrollment Process?

Select Plans & Benefits

Complete Enrollment

Arrange for Payment

HOW DOES IT WORK? Enjoy the Benefits of Membership

All you need to do to join and begin enjoying all of the advantages of membership is visit our website or contact one of our representatives. You can select your own package of benefits or be assisted by one of our trained representatives. After selecting your package, you will be assisted through the enrollment processes and be sent your fulfillment kit containing all the information you need to get the maximum use of your benefits and the other services we offer.

Questions

& Answers

Q: Who Is The N.C.E.? A: The N.C.E. was formed in 1996 by former politicians, public servants, attorneys and business leaders to address the needs of micro-business through political advocacy and lobbying. Eventually we realized a more proactive approach was required and we added our own package of member benefits to supplement our other efforts.

Q: Who is eligible for Membership?

A: Membership is open to anyone who agrees to adhere the N.C.E. controlling principles and by-laws. While not all benefit packages are available to all people – we offer packages for every category of individual and business, from the sole proprietor to the largest company.

Q: How Are You Different From other Associations?

A: Unlike most associations which are run by brokers and are in the business of selling insurance, the N.C.E. is a political advocacy group qualified to offer its members large group products under state law. .

Q: What Does It Cost To Join? A: The annualMembershipfee to join the N.C.E. is $40.00 per year. This fee goes to defer our administrative costs and fund our political advocacy projects. The cost of the benefit plans varies depending upon which plan members select. The savings on any one of the dozens of benefits available to our members easily exceeds the annual. Membership fee

The N. C. E. , Inc. ®

ADVOCACY, EDUCAT I ON & S E R V I C E

w w w . T h e N C E . o r g

NCE NATIONAL CONGRESS OF EMPLOYERS

HEALTH PLAN

AVAILABLE NATIONWIDE Available to all NCE members

CHOOSE YOUR NETWORK MULTIPLAN/BEECHSTREET/PHCS

SINGLE : $199.00 EMPLOYEE + 1: $355.00

FAMILY : $490.00

PLUS THE $40.00 ANNUAL ADMINISTRATION FEE

TAKE A LOOK AT THESE NCE ASSOCIATION BENEFITS:

IN NETWORK

PCP/SPECIALIST- $30.00 COPAY HOSPITAL COPAY- $250.00 PER ADMISSION

ER COPAY- $100.00

RX-$10/$20/$40 or less/ Over $40 Discounted To View Covered Prescriptions visit www.truscriptvaluplan.com

To locate providers you can log onto to the networks website at www.multiplan.com/ www.beechstreet.com/ www.phcs.com

* Copay, Prescription plan, and network utilization are an Association benefit. * Rates include all monthly administrative and association membership costs.

NCE STANDARD ENROLLMENT FORM

FULL NAME & ADDRESS TO APPEAR ON INVOICE

Company / Name: Attn:

Address:

City: State: Zip Code:

Telephone No. Fax No.

PLAN: () MultiPlan () PHCS () Beechstreet

EFFECTIVE DATE:

TO

BPhTaB

$4

NAME OF PERSON

BE COVERED

STATUS S/2 Pty/F

Admin Fee1x a year

Total Premium

Single

$40.00

Two Party

$40.00

Family

$40.00

roker Name: one Number:________________________ x ID/SS#:_____________

roker Address:__________

NATIONAL CONGRESS OF EMPLOYERS MEMBERS APPLICATION (PLEASE PRINT)

I hereby make application for membership in The National Congress Of Employers’agreeing to conform to its By-Laws and any Amendments thereof. I understand and authorize the use of my membership fees to defer administration expenses and to further the goals and interest of the NCE. Signing below constitutes an Agreement to conform to the NCE’s by laws and the terms and conditions of the set forth therein.

I understand and agree that said fees may be deducted from any monies remitted by me, whether referred to as dues, administration fees or premium.

Participating Employee

Participating Employees Signature

Social Security Number

Address

City State Zip

Employer __

Address

City State Zip

Date Employers Telephone #

PLAN DESIGN

The Carrier Pays

Medical Benefits & Emergency Room

The Carrier will pay $100 per office visit to a maximum of 5 visits per person per year. The Carrier will pay an additional $100 for one (1) Wellness visit per year.

Hospitalization Benefits & Skilled Nursing Facility

The Carrier will pay up to the benefit amount shown if you are admitted to a hospital as a patient because of a covered sickness. $1000 1st day, $1000 per day thereafter. Unlimited admissions covered up to 30 days per year.

In Patient Surgical Benefit The Carrier will pay up to benefit amount to the maximums set forth on the surgical schedule. The surgery can be performed on an outpatient or inpatient basis. No annual maximum, this is an unlimited benefit.*

Out Patient Surgical Benefit The Carrier will pay up to benefit amount to the maximums set forth on the surgical schedule. The surgery can be performed on an outpatient or inpatient basis. No annual maximum, this is an unlimited benefit. *

Lab/X-Ray/Large Scale Testing

The Carrier will pay up to $125 per incident for a maximum of 3 incidents per year.

Substance Abuse The Carrier will pay the full cost of a maximum of three (3)

visits per year. Mental Illness

The Carrier will pay the full cost of a maximum of three (3) visits per year.

Accident Rider The Carrier will pay up to $2,500 per covered accident, to two

(2) incidents or $5,000 per year. Member is responsible for $100 deductible.

EAP/Nurse Hotline Employee Assistance Program 24 hour nurse line available to each member and family

AD&D

The Carrier will pay $5,000 for primary insured.

Term Life Insurance

The Carrier will pay $5,000 per insured, $2,500 for an insured spouse and $1,250 per insured child

Payment Design

This is a Limited Benefit Plan there are no further insured medical benefits for an Illness or Injury once the maximum Plan payment limits per Covered Person, per calendar year is reached, however, members will be entitled to Network re-pricing.

* Surgical Benefit Available upon request. Please contact the NCE customer service at 516-739-1060 ext 242, for any benefit questions in reference to your plan.

NCE

SUMMARY OF BENEFITS

Primary Care Physician Visits…………….................................................................$30 co-pay per visit *

Specialty Care Visits……………………………….…………..…………………….$30 co-pay per visit *

Lab Tests- In-Office or Free Standing Lab..................................................................$30 co-pay per visit *

Routine Radiology and Diagnostic Testing.................................................................$30 co-pay per visit *

In-Patient Hospitalization ..................................................................................$250 co-pay per admission *

Out-Patient ...........................................................................................................$250 co-pay per incident *

Emergency Room........................................................................................................$100 co-pay per visit *

Skilled Nursing Facility …………………………………………………………… $500 co-pay per stay *

Substance Abuse ............................................................................................. No co-pay 3 Visits Per Year *

Mental Illness ................................................................................................. No co-pay 3 Visits Per Year *

Accident Rider........................................................................................$2,500 Cash Indemnity per incident,

2 per year $100 deductible*

Term Life ………………………………………………………………………….$5,000 for the insured * $2,500 for the insured * $1,250 per dependent *

AD&D …………………………………………………………………………….. $5,000 for primary insured*

Prescription Drugs Adminstered through TruScript Tier 1 Prescription..................................$10 or less Tier 2 Prescription..................................$20 or less Tier 3 Prescription.................................$40 or less Tier 4 Prescription.................................Discounted

Prescription plan is separate benefit not underwritten by the carrier * After Co-Pay, Network Re-Pricing, and Carrier payment - you are responsible for the balance- if any.

* Copay, Prescription plan, and network utilization are an Association benefit. Not underwritten by the carrier.

INSTRUCTIONS FOR PRESCRIPTION DRUG CARD

Through TRU-SCRIPTS

WEBSITE: WWW.TRUSCRIPTVALUPLAN.COM 1. Click on [Drug Search] 2. Go to [CLICK HERE>] to find the current pricing of preferred medications. 3. Go to STEP 1 and put your drug name in 4. Click on [SEARCH DRUGS] 5. Scroll down to check prices.

For alternatives, Click on the “Therapeutic Class” for listing of other named drugs.

See Sample attached.

| CONTACT US | SAVINGS TIPS | PRIVACY & TERMS |

Prescription Drug Search

TIER 1 UP TO $10 Drug Qty. Therapeutic Class Price No records returned.

TIER 2 UP TO $20 Drug Qty. Therapeutic Class Price

No records returned.

TIER 3 UP TO $40

Drug

Qty.

Therapeutic Class

rice

No records returned.

TIER 4 DISCOUNT

Drug Qty. Therapeutic Class Price

FOSAMAX TAB 10MG 30 ENDOCRINE ANDMETABOLIC AGENTS - MISC.

$77.99

FOSAMAX TAB 35MG 20 ENDOCRINE AND

METABOLIC AGENTS - MISC. $355.84

FOSAMAX TAB 5MG 30 ENDOCRINE AND

METABOLIC AGENTS - MISC. $77.99

FOSAMAX TAB 70MG 4 ENDOCRINE AND

METABOLIC AGENTS - MISC.

Alternative Drugs in Therapeutic Class:

$72.96

TIER 1 UP TO $10 Drug Qty Price ANTAGON INJ

0

$2.25

TIER 2 UP TO $20

Drug Qty Price GENOTROPIN INJ 0.2MG M 1 $11.95 SANDOSTATIN INJ 0.1MG 1 $19.27

TIER 3 UP TO $40

Drug Qty Price CARNITOR SOL 10% 118 $32.65 CARNITOR TAB 330MG 30 $27.76 GENOTROPIN INJ 0.4MG M 1 $21.65 GENOTROPIN INJ 0.6MG M 1 $31.35

MIACALCIN SPR 200IU 2 $36.64 ZEMPLAR INJ 5MCG/ 1 $27.95

Sample Re-Pricing/ Benefit Schedules

MULTIPLAN SAVINGS Examples of Doctor Charges: Type of Service Code Avg. Fee Average Network

Re-pricingYou Pay

Office Visit 99213 87.25 46.61 30 CopayAngioplasty 92982 4,109.13 1,534.70 As per example,

100% CoveredBiopsy (cervix) 57500 605.16 128.25 As per example,

100% CoveredCataract (laser) 66821 2,553.02 386.45 As per example,

100% CoveredHeart arterial bypass

33536 13,025.33 5,023.57 As per example, 100% Covered

Appendix 44950 3,695.42 938.69 As per example, 100% Covered

Hernia 49590 3,893.45 913.84 As per example, 100% Covered

Stress Test 93024 1,200.00 243.00 118.00 MRI 71550 1,200.00 654.00 529.00

BEECHSTREET SAVINGS Examples of Doctor Charges: Type of Service Code Avg. Fee Average Network

Re-pricingYou Pay

Office Visit 99213 87.25 63.19 30 CopayAngioplasty 92982 4,109.13 1,278.84 As per example,

100% CoveredBiopsy (cervix) 57500 605.16 98.90 As per example,

100% CoveredCataract (laser) 66821 2,553.02 298.57 As per example,

100% CoveredHeart arterial bypass

33536 13,025.33 4,341.34 As per example, 100% Covered

Appendix 44950 3,695.42 771.48 As per example, 100% Covered

Hernia 49590 3,893.45 743.08 As per example, 100% Covered

PHCS IS SIMILAR TO MULTIPLAN & BEECHSTREET REPRICING.

EXAMPLES OF HOW THE PROGRAM WORKS:

1. DR. VISIT – DOCTOR CHARGES $87.25. AFTER REPRICING IN THE MULTIPLAN

NETWORK, THIS BILL IS REDUCED TO $46.61. YOUR COPAY IS $30.00 THUS LEAVING $16.61 AS A BALANCE DUE. THIS PROGRAM (SEE BENEFIT HIGHLIGHTS) PAYS AFTER REPRICING UP TO $75.00 MAXIMUM FOR THIS TYPE OF SERVICE. THUS $16.61 WILL BE PAID IN FULL, LEAVING YOU WITH ONLY THE COPAY AS YOUR OUT POCKET EXPENSE.

2. HERNIA OPERATION (SURGEON) – DOCTOR CHARGES $3,893.45. AFTER REPRICING IN THE BEECHSTREET NETWORK, THIS BILL IS REDUCED TO $743.08. THIS PROGRAM (SEE BENEFIT HIGHTLIGHTS) PAYS AFTER REPRICING UP TO $5,750 MAXIMUM FOR SURGERY, WHICH EQUATES THAT THE BALANCE DUE OF $743.08 IS 100% TOTALLY COVERED.

THE ABOVE 2 EXAMPLES WILL GIVE YOU A BETTER UNDERSTANDING OF HOW THIS PROGRAM WORKS.

NCE Social Security # _ _ _ - _ _ - _ _ _ _ Enrollment Information Last Name: First Name: Sex: ()M ()F

Street Address: Apt: City: State: Zip:

Date Of Birth: Mo. Day Yr. Telephone: Work:

Marital Status: ()Single ()Married ()Divorced ()Widowed

Date Of Event: Mo. Day Yr. Are you covered by any other Health insurance? () NO () YES If yes indicate:

Ins. Co. Name:__________________ ____ Address: __ ___________ ____ Policy #:________ ___________ ____ Effective Date _______/________/__ ____

Is your Spouse covered by any other Health Insurance? () NO () YES If yes indicate:

Ins. Co. Name: Address: __ ___________ ____ Policy #:________ ___________ ____ Effective Date _______/________/__ ____

Provider Network:

Multiplan () Beechstreet () PHCS ()

Term Life Beneficiary/ Relationship: * If you are applying for coverage for your spouse and/or children, please list each one below- see Election of Coverage for eligibility

In Case of Emergency Please Contact: Name __ ___________ _ Relation___ ___________ ____ Telephone #

Last Name First Name Soc. Sec. Num.

Sex Relationship Birth Date Mo. Day Yr.

Check if over 19 & Disabled

Term Life Insurance Beneficiary

Spouse: ()Wife () Husband

Dependents: () Son ()Daughter

() Son () Daughter

() Son ()Daughter

()Son () Daughter

Please Indicate Additional Dependents on a Duplicate Sheet Election of Coverage and Authorization*

The applicant in consideration of membership in the association and participation in the plan hereby acknowledges that the Association, its third party administrator, their agents, owners, successors and assigns assumes no liabilities or obligations other than those specifically identified I hereby agree to indemnify the above referenced parties from and against any and all claims, damages, losses, costs or expenses (including, without limitation, attorneys fees and disbursements) for any claims that may arise by the participation of the plan or membership in the association. I understand that pre-existing conditions will not be covered during the first 12 months of the contract unless I present evidence of prior creditable coverage. All information provided above is true and complete to the best of my knowledge. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, shall be subject to civil penalty not to exceed five thousand dollars and the stated value of the claim for each violation. Disclaimer IMPORTANT! Our medical plan is a low-cost alternatives, providing medical insurance at fixed amounts, and these limited benefitsare paired with medical discounts to designated providers. My signature below indicates that the limitation of the plan have been disclosed, explained to me and that I understand and accept said plan designs. All applicants must sign below. Any false statement will be cause for immediate cancellation of coverage.

Applicant must sign here: Date:_________________________

Name of Group: Group Number:

Effective Date: Date Submitted: Approved By: Processed By: Date:

To be completed by Employer/Contract Group