ABC Company 2023 Employee Benefits Renewal February 17, 2023
I. Claims Experience – see financial monitoring report – Tab III
Avg. Covered Employees: Avg. Covered Members: +/Fixed Costs: Administration: PEPM: +/-: Stop Loss Insurance: PEPM: +/-: A) Total Fixed Costs: PEPM: +/-: Medical Claims: PEPM: +/-: Rx Claims: PEPM: +/Claimants > $100K: Avg. Per Claimant: Less Stop Loss: B) Total Net Claims: PEPM: +/Actual Plan Cost: PEPM: +/Budget: PEPM: Surplus / Deficit Employee Contributions: PEPM: Contributions as % of Budget: Company Cost: PEPM:
PY 2020
PY 2021
PY 2022
Total 745 1,553
Total 691 1,430 -8%
Total 700 1,375 -4%
$38,352 $4.29
($39,050) ($75,641) ($5) ($13) -210% 184% $973,655 $1,038,200 $824,807 $108.91 $125 $148 15% 18% $1,012,007 $999,150 $749,166 $113.20 $121 $134 6% 11% $9,213,228 $8,314,271 $6,286,352 $1,031 $1,003 $1,123 -3% 12% $3,290,761 $2,872,169 $2,258,092 $368 $346 $403 -6% 16% 13 3 4 $267,922 $792,487 $594,365 ($1,206,657) ($607,166) ($285,652) $11,297,332 $10,579,274 $8,258,792 $1,264 $1,276 $1,475 1% 16% $12,109,339 $11,580,165 $9,009,699 $1,355 $1,397 $1,609 3% 15% $10,874,842 $11,137,904 $8,201,064 $1,216 $1,343 $1,464 ($1,434,497) ($442,261) ($808,635) $4,630,256 $4,734,393 $3,388,791 $518 $753 $539 43% 43% 41% $7,479,083 $6,845,772 $5,620,908 $841 $816 $1,005
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Reduction in membership; but not the severity of claimants
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11 claimants over $100K - One is no longer covered; Two on COBRA; Six of 11 claimants are for Neoplasms
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The first eight months of the plan year continued to see several high-cost claimants hitting during this timeframe. Net claims were running at $1,495 PEPM or +9% over expected.