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<br />Stop Loss Worksheet <br /> <br />SDecific <br />Coverage Basis <br /> <br /> <br />U"""erica <br /> <br />Bet1dey ute and ......llh <br /> <br />Benefits Covered <br /> <br />CUrrent <br />33/9 <br />Medicaf/Rx <br />$145,000 $150,000 <br />$27.91 $96.19 <br />$70.98 $91.88 <br />$265,857 $a47,987 <br />93/9 44/12 44/12 24/12 <br /> <br />24/U <br /> <br />Coverage Amount <br /> <br />Deductible <br /> <br />Single Rate <br />Family Rate <br /> <br />Estimated Specific Premium <br />~ <br /> <br />$574,26\1 <br /> <br />Coverage Basis <br /> <br />Benefits Covered <br /> <br />24/12 <br /> <br />Coverage Amount <br /> <br />Aggregate Premium <br /> <br />Single Factor <br />Family Factor <br /> <br />$3.17 <br />$437.76 <br />$1.209.84 <br /> <br />Run-In limitation <br /> <br />Estimated Aggregate Premium $15;;520 <br /> <br /> <br />Aggregate Attachment Point $4.441,513 <br /> <br />Total Estimated Premium ~ <br /> <br />$5,889,001 <br />~lO6 <br /> <br />The City's current Stop loss coverage is under a 9 month contract with a premium of $281.378. The premium of $375,171 is an annual equivalent <br />