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ADDENDUM <br /> FEE SCHEDULE <br /> BASE FEES PEPM RATE <br /> UNITED STATES: <br /> — In-person EAP Services-Choose session model $1.54 <br /> ❑ 1-3 session ❑ 1-6 session <br /> ❑ 1-4 session ❑ 1-8 session <br /> 0 1-5 session ❑ 1-10 session <br /> — Telephonic EAP Services <br /> X Legal Consultation&Financial Consultation Services' $0.07 <br /> Work/Life Services' <br /> Nurse Advice Line Services' <br /> New Parent Support Services'•2 <br /> Employee Concern Line' <br /> Other: <br /> INTERNATIONAL: <br /> EAP Services-Insert session model <br /> ❑ im sessions <br /> Telephonic EAP Services <br /> Work/Life Services' <br /> Legal Consultation&Financial Consultation Services' <br /> Other,Describe: <br /> SUPPLEMENTAL FEES <br /> United States $ <br /> Additional In-person Sessions 90.00 per In-person Session <br /> Additional Service Hours $230.00 per provider hour <br /> Mandatory ReferralS3 $700.00 per case <br /> CISM Cancellation Fee $250.00 per scheduled hour <br /> International <br /> Describe: <br /> Describe: <br /> Describe: <br /> Communication Materials <br /> Brochures with 2 Wallet Cards $ 0.40 per unit—Estimate <br /> Posters $ 1.60 per unit—Estimate <br /> Services may only be selected if EAP services are purchased, <br /> 2 New Parent Support Services may'only be selected if Work/Life Services are selected. <br /> 3 Charge applies only if Sponsor selects Telephonic EAP Service model and when an Employee was referred to the <br /> EAP under a"last chance"or similar agreement. <br /> 3 <br />