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CityofLaPorte
<br />NetEmployerCostandBudgetExhibitMedical,Rx
<br />2017PlanYear
<br />ABCD=A+B+CEFGHI=E+F+GHJKLM=J+K+LNO=I+M+NP=I+MQR=QP
<br />1
<br />ENROLLMENTCLAIMSDATAFIXEDCOSTEMPLOYERNETCOSTBUDGETDATA
<br />23
<br />MonthPPOAHF1000AHF1500TotalPPOAHF1000AHF1500StopLossAHFFundTotalAdminStopLossRxRebatesTotalEEContribsNetCostTotalCostBudgetSurplus
<br />20170119915251 402$326,572$127,724$21,013$0$20,574$495,884$14,399$30,768$0$45,167($45,083)$495,967$541,051$615,380$74,329
<br />20170219815252 402$321,747$122,737$17,919$0$30,565$492,969$14,400$30,878$0$45,278($45,273)$492,974$538,247$616,863$78,616
<br />201703
<br />201704
<br />201705
<br />201706
<br />201707
<br />201708
<br />201709
<br />201710
<br />201711
<br />201712
<br />Total397304103804$648,318$250,462$38,933$0$51,140$988,853$28,799$61,646$0$90,445($90,356)$988,941$1,079,297$1,232,243$152,945
<br />Avg/PEPM 19915252 402$1,633.04$823.89$377.99$0.00$125.65$1,229.92$35.82$76.67$0.00$112.49($112.38)$1,230.03$1,342.41$1,532.64$190.23
<br />BUDGETANDCONTRIBUTIONDATAYeartoDateSummaryTotalPEPM
<br />PPOPlan EEEESpEEChFam TotalNetPaidClaims$988,853$1,229.92
<br />2017MaximumClaims$809.30$1,982.78$1,982.78$1,982.78TotalFixedCosts$90,445$112.49
<br />EmployeeContributions$55.22$165.75$155.16$185.32 SubtotalTotalCosts$1,079,297$1,342.41
<br />EmployerContributions$850.83$1,827.55$1,475.72$2,442.22 TotalCostas%ofBudget88%
<br />PremiumEquivalents$906.05$1,993.30$1,630.88$2,627.54EmployeeContributions($90,356)($112.38)
<br />FixedCostsAdmin$34.38$34.38$34.38$34.38 TotalNetEmployerCosts$988,941$1,230.03
<br />FixedCostsStopLoss$41.29$96.21$96.21$96.21
<br />AHF1000Plan EEEESpEEChFam
<br />AHF1500
<br />Med,71%Rx,29%
<br />2017MaximumClaims$809.30$1,982.78$1,982.78$1,982.78
<br />EmployeeContributions$22.71$130.35$120.08$155.61
<br />EmployerContributions$628.20$1,301.66$1,051.57$1,732.03
<br />AHF1000
<br />Med,73%Rx,27%
<br />PremiumEquivalents$650.91$1,432.01$1,171.65$1,887.64
<br />FixedCostsAdmin$35.34$35.34$35.34$35.34
<br />PPO
<br />Med,72%Rx,28%
<br />FixedCostsStopLoss$41.29$96.21$96.21$96.21
<br />AHF1500Plan EEEESpEEChFam
<br />0%10%20%30%40%50%60%70%80%90%100%
<br />2017MaximumClaims$809.30$1,982.78$1,982.78$1,982.78
<br />EmployeeContributions$14.65$105.00$95.25$120.68 ASOandStopLossDetail
<br />EmployerContributions$616.62$1,283.80$1,041.04$1,710.01 Administration
<br />PremiumEquivalents$631.27$1,388.80$1,136.29$1,830.69AdministratorAetna
<br />FixedCostsAdmin$35.34$35.34$35.34$35.34NetworkAetna
<br />FixedCostsStopLoss$41.29$96.21$96.21$96.21 StopLoss
<br />CarrierSABenefits/PartnerRE
<br />SpecificStopLossDeductible$165,000
<br />Contract24/12
<br />CoverageMedical/Rx
<br />AggregateStopLossMedical/Rx
<br />1
<br />Duetocarrierenrollmentreporting,figuressuchasContributionsandBudgetmayvaryslightly.
<br />2
<br />EmployeeContributionsrepresentanestimatebasedonthemonthlyheadcountsmultipliedbythemonthlyemployeeNonTobaccocontributions,nottheactualemployeecontributionscollectedbyCityofLaPorte.
<br />3
<br />Budgetrepresentsthemonthlyheadcountsmultipliedbythe2017AHF&PPOfullyinsuredequivalentrates.
<br />1
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