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FINANCIAL REPORTING
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Expected Accrual Assessment by Total Summary (Total Medical) 12-Month Renewal Projection JV Partners
Self Funded Medical Self Funded Medical - Status Quo Self Insured Claim Report Sample
Total Medical
TOTAL COST VS EXPECTED ACCRUAL PEPM Total Jan 2019 — December 2019
Projected Lives (Nov-19) 3,707 Tax ID Provider Claims Medical/Rx
30-0000001 JV Partner 1
Experience (Dec-18 - Nov-19) $1,576,428 Specific Stop- Stop-Loss
Total
Total
Loss
Claims
$38,309,546 Average Lagged Lives (1 Month) 3,772 30-0000002 JV Partner 2 $2,574,313 Month/Year Subscribers Members Admin Fee Premium Total Fixed Gross Medical Gross Rx Claims Reimbursable Net Paid Claims Total Net
Plan Cost
Claims ($175k)
-$454,843
ISL Adjustments
$34,969,960 $33,598,683 Total Claims $843.71 $38,184,500 30-0000003 JV Partner 3 $576,279
-$10.05
$31,838,925 Claims Net ISL Adjustments $833.66 $37,729,657 30-0000004 JV Partner 4 $489,527 Jan-19 2,405 2,384 5,471 5,423 $93,362 $226,671 $320,033 $2,254,931 $724,894 $20,317 $0 $2,979,824 $3,299,858
$92,547
$2,004,489
$703,886
$224,692
$2,688,058
$317,239
Feb-19
$3,005,297
30-0000005 JV Partner 5 $328,505 Mar-19 2,393 5,424 $92,896 $225,540 $318,437 $2,146,731 $777,111 $688 $2,923,154 $3,241,591
Annual Trend 7.0% Total $5,545,052 Apr-19 2,392 5,445 $92,857 $225,446 $318,303 $2,478,921 $855,677 $386,407 $2,948,190 $3,266,494
Trending Months 14 May-19 2,391 5,419 $92,819 $225,352 $318,170 $2,257,775 $898,619 $221,631 $2,934,763 $3,252,934
Effective Trend 7.0% Jun-19 2,384 5,406 $92,547 $224,692 $317,239 $2,216,474 $876,056 $667,899 $2,424,631 $2,741,870
Total Cost Jul-19 2,396 2,382 5,456 5,421 $93,013 $225,823 $318,836 $2,090,771 $882,345 $388,500 $2,584,616 $2,903,452
Aug-19
$316,973
$2,959,412
$469,760
$2,544,848
$884,324
$224,504
$92,469
$3,276,385
Accrual Trended Claims $892.01 $40,370,733 Sep-19 2,393 5,442 $92,896 $225,540 $318,437 $2,630,017 $870,380 $381,438 $3,118,959 $3,437,396
Claim Fluctuation Corridor 0.0% Oct-19 2,430 5,492 $94,333 $229,028 $323,360 $1,988,416 $939,423 $447,031 $2,480,808 $2,804,168
Plan Design Adjustment 1.0000 2019 domestic vs non-domestic Nov-19 2,422 5,468 $94,022 $228,274 $322,296 $1,807,660 $821,998 $84,968 $2,544,691 $2,866,986
Projected Claims $892.01 $40,370,733 Dec-19 2,419 5,460 $93,906 $227,991 $321,896 $2,610,313 $904,933 $641,403 $2,873,843 $3,195,739
$8,662,815 $9,087,711 Jan 2019-Dec 2019 YTD Totals 28,791 65,327 $1,117,667 $2,713,552 $3,831,218 $27,031,348 $10,139,645 $3,710,042 $33,460,951 $37,292,169
Administration Fees $30.07 $1,337,562 Average/Month 2,399 5,444 $93,139 $226,129 $319,268.20 $2,252,612 $844,970 $309,170 $2,788,413 $3,107,681
Stop Loss Fees $11.13 $495,269 Service type 2019 domestic 2019 non-domestic 2019 total % domestic % non-domestic Average/PEPM $38.82 $94.25 $133.07 $942.91 $353.69 $129.41 $1,167.19 $1,300.26
Estimated Rx Claims Savings $0.00 $0 Inpatient hospital $25,076,238 $30,648,735 $55,724,973 45.00% 55.00% Lagged Lives 28,668 65,051
95% 91% 95%
YTD Total PEPM (based on lagged enrollment)
Jan-20 to Mar-20 Jan-19 to Dec-19 Jan-18 to Dec-18 Projected Cost $933.22 $42,203,564 Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.00% 35.00% PEPM Comparison $1,300.26
$40,084,594
Current Accrual
$901.15
$28,075,941
$2,347,635
Professional
7.70%
92.30%
$30,423,576
% Change in Current Accrual 3.56% 2018 Total PEPM $1,249.35
Total Medical Summary Lives Total Cost Accrual Var ($) % Pharmacy $500,576 $11,254,751 $11,755,327 4.30% 95.70% 2019 vs. 2018 Change 4.1%
Jan-20 to Mar-20 11,465 $8,662,815 $9,087,711 ($424,896) 0.953245011 Actual Cost $890.12 $39,593,962 Other $10,576 $1,574,021 $1,584,597 0.70% 99.30%
Jan-19 to Dec-19 45,058 $34,969,960 $38,309,546 ($3,339,587) 0.912826255 Total all services $48,511,448 $82,633,060 $131,144,508 37.00% 63.00% 2019 Budget PEPM $1,392.08
Jan-18 to Dec-18 44,627 $31,838,925 24 $33,598,683 ($1,759,759) 0.947624182 Actual Cost vs. Current Accrual 5 -1.22% -$490,632 2019 Actual vs. Budget -6.6% 6
Sample Claims Trending
Medical and Rx Cash Flow Summary - (By Month Paid) Sample Self Funded Claim Report - Medical Self Funded Medical
Domestic vs. non-domestic utilization I. Claim Payments are Valued as of: Plan Year Ending 12/31/20 Enrollment Fixed Claims Stop-Loss Cost Share Plan Performance Total Cost vs.
Month
March 31, 2020
(Monthly) (Cumulative) Month/Year Jan-20 Feb-20 Subscribers Total 3,853 3,826 Total Members 5,820 5,775 Admin Fee $100,855 $100,148 Specific Stop- Loss Premium $42,328 $41,987 Total Fixed Costs $143,182 $142,134 Gross Medical $1,949,725 $1,958,674 Claims Gross Rx Claims $762,711 $720,325 Claims ($300k) Reimbursable $0 $0 $2,712,436 $2,679,000 Net Paid Claims Sample Net Plan $1,916,795 $1,890,509 Cost Employee Contribution $938,824 $930,626 Total Plan Cost $2,855,619 $2,821,134 Total Accrual $3,056,429 $3,029,701 Funding Balance $200,
Fixed Costs
Large Claims
Enrolled
= Fixed + Claims
2019 domestic vs non-domestic IIa. Month Paid Subscribers (ASO and Stop Loss Paid Claims Adjustments 1 Total Paid Net Total Plan Costs Expected Plan 2 Total Plan Costs Expected Plan 2 Mar-20 Apr-20 May-20 Jun-20 3,786 0 0 0 5,695 0 0 0 $99,101 $0 $0 $0 $41,525 $0 $0 $0 $140,626 $0 $0 $0 $2,014,114 $0 $0 $0 $831,323 $0 $0 $0 $0 $0 $0 $0 $2,845,437 $0 $0 $0 $2,064,527 $0 $0 $0 $921,535 $0 $0 $0 $2,986,062 $0 $0 $0 $3,001,581 $0 $0 $0 $15,519 $0 $0 $0 99.5% $740 $739
Costs
Costs
= Fixed + Claims
Claims
Premium)
Jan 2019-Dec 2019 January-19 3,788 $138,656 $2,970,669 ($82,735) $2,887,934 $3,026,590 $3,212,577 $3,026,590 $3,212,577 Jul-20 Aug-20 Sep-20 0 0 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $691 $711
Service type 2019 domestic 2019 non-domestic 2019 total % domestic % non-domestic February-19 3,812 3,802 $139,489 $2,596,009 ($9,934) $0 $2,596,009 $2,735,498 $3,231,567 $5,762,088 $6,444,144 Oct-20 Nov-20 Dec-20 0 0 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $644 $669 $676 $694 $701
$2,713,260
$8,614,560
$3,228,996
$2,852,472
$9,673,140
March-19
$2,723,194
$139,212
April-19 3,781 $138,470 $2,773,443 ($148,990) $2,624,453 $2,762,923 $3,214,841 $11,377,484 $12,887,982 YTD Totals 11,465 17,290 $300,103 $125,839 $425,942 $5,922,513 $2,314,360 $0 $8,236,873 $5,871,830 $2,790,985 $8,662,815 $9,087,711 $424,896 95.3%
Inpatient hospital $25,076,238 $30,648,735 $55,724,973 45.0% 55.0% May-19 3,814 $139,650 $3,604,519 ($32,468) $3,572,051 $3,711,701 $3,242,769 $15,089,184 $16,130,750 Average/Month 3,822 5,763 $100,034 $26.18 $41,946 $10.98 $141,981 $37.15 $1,974,171 $517.34 $771,453 $202.16 $0 $0.00 $2,745,624 $719.50 $1,957,277 $512.15 $930,328 $243.44 $2,887,605 $756.65 $3,029,237 $792.65 $141,632 $35.99
Average/PEPM
June-19 3,806 $139,358 $2,579,242 ($53,195) $2,526,047 $2,665,405 $3,233,927 $17,754,589 $19,364,677 Lagged Med Lives 11,448 17,325 T TOOTTAALL PPLLAANN CCOOSSTT VVSS.. EESSTTIIMMAATTEEDD FFUUNNDDIINNGG AACCCCRRUUAALL PEPM Comparison
Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.0% 35.0% July-19 August-19 3,731 3,724 $136,601 $2,954,615 ($204,583) $2,750,033 $2,886,634 $3,167,666 $20,641,223 $22,532,343 Sample Net Plan Cost Employee Contribution Total Accrual (based on lagged enrollment) $757 $793 95.5%
2020 YTD Actual
$136,436
($335,562)
$25,700,716
$23,805,635
$3,168,373
2020 YTD Budget
$3,363,539
$3,164,412
$3,027,976
Actual vs. Budget
September-19 3,671 $134,527 $2,730,685 ($117,571) $2,613,114 $2,747,641 $3,123,434 $26,553,276 $28,824,150 PEPM Claims
Professional $2,347,635 $28,075,941 $30,423,576 7.7% 92.3% October-19 3,672 $134,612 $3,139,786 ($67,116) $3,072,670 $3,207,283 $3,128,355 $29,760,559 $31,952,504 $3,500,000 $3,000,000 $3,056,429 $3,029,701 $3,001,581 2019 Actual 2019 Budget Actual vs. Budget $777 $850 91.4%
Pharmacy $500,576 $11,254,751 $11,755,327 4.3% 95.7% November-19 3,688 3,769 $135,258 $3,297,017 ($786,089) $2,510,928 $2,646,186 $3,146,404 $32,406,744 $35,098,908 $2,500,000 $938,824 $930,626 $921,535 2020 vs. 2019 Actual -2.6% -6.8%
$34,969,960
December-19
$38,309,546
$2,563,216
($880,936)
$3,210,638
$2,425,018
$3,305,954
$138,197
2020 vs. 2019 Budget
Other $10,576 $1,574,021 $1,584,597 0.7% 99.3% IIb. Cumulative (1/1/2019-19) 45,058 3,853 $1,650,467 $36,038,670 ($2,719,177) $0 $33,319,493 $34,969,960 $38,309,546 $34,969,960 $38,309,546 $2,000,000 $1,500,000 $1,000,000 $1,916,795 $1,890,509 $2,064,527
$2,855,619
$2,855,619
January-20
$2,712,436
$2,712,436
$143,182
$3,056,429
$3,056,429
Total all services $48,511,448 $82,633,060 $131,144,508 37.0% 63.0% February-20 3,826 $142,134 $2,679,000 $0 $2,679,000 $2,821,134 $3,029,701 $5,676,753 $6,086,130 $500,000 $0
March-20 3,786 $140,626 $2,845,437 $0 $2,845,437 $2,986,062 $3,001,581 $8,662,815 $9,087,711 $0 $0 $0 $0 $0 $0 $0 $0
April-20 $0 1/1/2020 2/1/2020 3/1/2020 4/1/2020 $0 $0 5/1/2020 $0 $0 $0 $0 6/1/2020 7/1/2020 $0 $0 8/1/2020 $0 $0 9/1/2020 $0 $0 10/1/2020 $0 $0 11/1/2020 $0 $0 12/1/2020 $0 $0 12-Month
Average
May-20
June-20 Sample Self Funded Claim Report - Medical
July-20 Prior Plan Year Ending 12/31/2019
August-20 Subscribers Total Total Members Admin Fee Specific Stop- Loss Premium Total Fixed Costs Gross Medical Claims Gross Rx Claims Stop-Loss Reimbursable Net Paid Claims Sample Net Plan Cost Employee Contribution Total Plan Cost Total Accrual Funding Balance Total Cost vs. Funding
September-20 Prior PY Totals 45,058 68,366 $1,261,498 $388,969 $1,650,467 $27,559,897 $8,478,773 Claims ($300k) -$2,719,177 $33,319,493 $23,431,939 $11,538,020 $34,969,960 $38,309,546 $3,339,587 Accrual 91.3%
October-20 Average/Month 3,755 5,697 $105,125 $32,414 $137,539 $2,296,658 $706,564 -$226,598 $2,776,624 $1,952,662 $961,502 $2,914,163 $3,192,462 $278,299 $638 $618 $667 $651 $739 $706 $608 $724 $765 $745 $726 $720
November-20 Lagged Med Lives Average/PEPM 45,011 68,288 $28.00 $8.63 $36.63 $612.29 $188.37 -$60.41 $740.25 $520.04 $256.07 $776.88 $850.23 $73.35
December-20 Total Specific Stop- Total Fixed Gross Medical Gross Rx Stop-Loss Net Paid Sample Net Plan Employee Funding Total Cost vs.
Cumulative (1/1/2020-20) 11,465 $425,942 $8,236,873 $0 $8,236,873 $8,662,815 $9,087,711 $8,662,815 $9,087,711 Month/Year Subscribers Total Members Admin Fee Loss Premium Costs Claims Claims Claims ($300k) Reimbursable Claims Cost Contribution Total Plan Cost Total Accrual Balance Funding Accrual 2Q17 3Q17 4Q17 1Q18 2Q18 3Q18 4Q18 1Q19 2Q19 3Q19 4Q19 1Q20
Nov-18 3,674 5,580
Dec-18 3,722 5,652
Jan-19 3,788 5,724 $106,053 $32,602 $138,656 $2,431,957 $538,712 -$82,735 $2,887,934 $2,062,666 $963,924 $3,026,590 $3,212,577 $185,988 94.2%
Feb-19 3,812 5,761 $106,725 $32,764 $139,489 $2,017,328 $578,681 $0 $2,596,009 $1,768,101 $967,397 $2,735,498 $3,231,567 $496,069 84.6%
Current Policy Year To Date Mar-19 3,802 5,766 $106,445 $32,767 $139,212 $1,976,180 $747,014 -$9,934 $2,713,260 $1,883,016 $969,457 $2,852,472 $3,228,996 $376,524 88.3%
III. Rolling 12 Months Actual vs Expected (Apr-19 to Mar-20) IV. (Paid Basis) V. Current Policy Year Stop Loss Summary Apr-19 May-19 Jun-19 3,781 3,814 3,806 5,734 5,779 5,767 $105,857 $106,781 $106,557 $32,613 $32,868 $32,801 $138,470 $139,650 $139,358 $2,082,218 $2,774,373 $1,934,432 $691,225 $830,145 $644,809 -$148,990 -$32,468 -$53,195 $2,624,453 $3,572,051 $2,526,047 $1,796,657 $2,737,709 $1,692,921 $966,266 $973,991 $972,484 $2,762,923 $3,711,701 $2,665,405 $3,214,841 $3,242,769 $3,233,927 $451,918 -$468,932 $568,522 85.9% 114.5% 82.4%
Rolling Twelve Actual Plan Costs $35,018,215 Actual Plan Cost $8,662,815 Ind Stop Loss (ISL) Deductible Per Claimant $300,000 Jul-19 3,731 5,649 $104,458 $32,143 $136,601 $2,277,299 $677,316 -$204,583 $2,750,033 $1,930,997 $955,637 $2,886,634 $3,167,666 $281,032 91.1%
Rolling Twelve Expected Plan Costs $37,724,117 Expected Plan Costs $9,087,711 Large Claims Adjustments $0 Aug-19 Sep-19 Oct-19 3,724 3,671 3,672 5,659 5,591 5,587 $104,262 $102,778 $102,806 $32,174 $31,749 $31,807 $136,436 $134,527 $134,612 $2,502,827 $2,055,962 $2,508,422 $860,712 $674,723 $631,364 4 -$335,562 -$117,571 -$67,116 $3,027,976 $2,613,114 $3,072,670 $2,203,139 $1,802,311 $2,262,539 $961,273 $945,330 $944,744 $3,164,412 $2,747,641 $3,207,283 $3,168,373 $3,123,434 $3,128,355 $375,793 -$78,928 $3,961 99.9% 88.0% 102.5%
Percent of Expected 0.928271288 Percent of Expected 0.953245011 Nov-19 3,688 5,619 $103,254 $32,004 $135,258 $2,397,978 $899,039 -$786,089 $2,510,928 $1,695,575 $950,611 $2,646,186 $3,146,404 $500,218 84.1%
Dec-19 3 769 5 730 $105 521 $32 676 $138 197 $2 600 921 $705 033 -$880 936 $2 425 018 $1 596 310 $966 906 $2 563 216 $3 210 638 $647 423 79 8%
Notes:
2 1. Large Claims Adjustments are recorded on a cash basis as reported by the insurance carrier.
3
Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 2. Changes in enrollment, participation mix, and various other factors/assumptions may have a significant impact on the estimated claim costs. 21
Claims Trending
Self Funded Medical
PEPM COST VS ACCRUAL
Cost Accrual
$982
$868 $813 $848 $874
$771 $805 $771
$721
$739 $722 $748 $727 $758 $738 $758 $732 $780
$690 $685 $559 $699 $695
$609
LOCKTON COMPANIES | 1
22
Upstream Rehabilitation — Lockton Total Rewards Practice overview 32 Lockton Companies
Sample reporting
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Expected Accrual Assessment by Total Summary (Total Medical) 12-Month Renewal Projection JV Partners
Self Funded Medical Self Funded Medical - Status Quo Self Insured Claim Report Sample
Total Medical
TOTAL COST VS EXPECTED ACCRUAL PEPM Total Jan 2019 — December 2019
Projected Lives (Nov-19) 3,707 Tax ID Provider Claims Medical/Rx
30-0000001 JV Partner 1
Experience (Dec-18 - Nov-19) $1,576,428 Specific Stop- Stop-Loss
Total
Total
Loss
Claims
$38,309,546 Average Lagged Lives (1 Month) 3,772 30-0000002 JV Partner 2 $2,574,313 Month/Year Subscribers Members Admin Fee Premium Total Fixed Gross Medical Gross Rx Claims Reimbursable Net Paid Claims Total Net
Plan Cost
Claims ($175k)
-$454,843
ISL Adjustments
$34,969,960 $33,598,683 Total Claims $843.71 $38,184,500 30-0000003 JV Partner 3 $576,279
-$10.05
$31,838,925 Claims Net ISL Adjustments $833.66 $37,729,657 30-0000004 JV Partner 4 $489,527 Jan-19 2,405 2,384 5,471 5,423 $93,362 $226,671 $320,033 $2,254,931 $724,894 $20,317 $0 $2,979,824 $3,299,858
$92,547
$2,004,489
$703,886
$224,692
$2,688,058
$317,239
Feb-19
$3,005,297
30-0000005 JV Partner 5 $328,505 Mar-19 2,393 5,424 $92,896 $225,540 $318,437 $2,146,731 $777,111 $688 $2,923,154 $3,241,591
Annual Trend 7.0% Total $5,545,052 Apr-19 2,392 5,445 $92,857 $225,446 $318,303 $2,478,921 $855,677 $386,407 $2,948,190 $3,266,494
Trending Months 14 May-19 2,391 5,419 $92,819 $225,352 $318,170 $2,257,775 $898,619 $221,631 $2,934,763 $3,252,934
Effective Trend 7.0% Jun-19 2,384 5,406 $92,547 $224,692 $317,239 $2,216,474 $876,056 $667,899 $2,424,631 $2,741,870
Total Cost Jul-19 2,396 2,382 5,456 5,421 $93,013 $225,823 $318,836 $2,090,771 $882,345 $388,500 $2,584,616 $2,903,452
Aug-19
$316,973
$2,959,412
$469,760
$2,544,848
$884,324
$224,504
$92,469
$3,276,385
Accrual Trended Claims $892.01 $40,370,733 Sep-19 2,393 5,442 $92,896 $225,540 $318,437 $2,630,017 $870,380 $381,438 $3,118,959 $3,437,396
Claim Fluctuation Corridor 0.0% Oct-19 2,430 5,492 $94,333 $229,028 $323,360 $1,988,416 $939,423 $447,031 $2,480,808 $2,804,168
Plan Design Adjustment 1.0000 2019 domestic vs non-domestic Nov-19 2,422 5,468 $94,022 $228,274 $322,296 $1,807,660 $821,998 $84,968 $2,544,691 $2,866,986
Projected Claims $892.01 $40,370,733 Dec-19 2,419 5,460 $93,906 $227,991 $321,896 $2,610,313 $904,933 $641,403 $2,873,843 $3,195,739
$8,662,815 $9,087,711 Jan 2019-Dec 2019 YTD Totals 28,791 65,327 $1,117,667 $2,713,552 $3,831,218 $27,031,348 $10,139,645 $3,710,042 $33,460,951 $37,292,169
Administration Fees $30.07 $1,337,562 Average/Month 2,399 5,444 $93,139 $226,129 $319,268.20 $2,252,612 $844,970 $309,170 $2,788,413 $3,107,681
Stop Loss Fees $11.13 $495,269 Service type 2019 domestic 2019 non-domestic 2019 total % domestic % non-domestic Average/PEPM $38.82 $94.25 $133.07 $942.91 $353.69 $129.41 $1,167.19 $1,300.26
Estimated Rx Claims Savings $0.00 $0 Inpatient hospital $25,076,238 $30,648,735 $55,724,973 45.00% 55.00% Lagged Lives 28,668 65,051
95% 91% 95%
YTD Total PEPM (based on lagged enrollment)
Jan-20 to Mar-20 Jan-19 to Dec-19 Jan-18 to Dec-18 Projected Cost $933.22 $42,203,564 Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.00% 35.00% PEPM Comparison $1,300.26
$40,084,594
Current Accrual
$901.15
$28,075,941
$2,347,635
Professional
7.70%
92.30%
$30,423,576
% Change in Current Accrual 3.56% 2018 Total PEPM $1,249.35
Total Medical Summary Lives Total Cost Accrual Var ($) % Pharmacy $500,576 $11,254,751 $11,755,327 4.30% 95.70% 2019 vs. 2018 Change 4.1%
Jan-20 to Mar-20 11,465 $8,662,815 $9,087,711 ($424,896) 0.953245011 Actual Cost $890.12 $39,593,962 Other $10,576 $1,574,021 $1,584,597 0.70% 99.30%
Jan-19 to Dec-19 45,058 $34,969,960 $38,309,546 ($3,339,587) 0.912826255 Total all services $48,511,448 $82,633,060 $131,144,508 37.00% 63.00% 2019 Budget PEPM $1,392.08
Jan-18 to Dec-18 44,627 $31,838,925 24 $33,598,683 ($1,759,759) 0.947624182 Actual Cost vs. Current Accrual 5 -1.22% -$490,632 2019 Actual vs. Budget -6.6% 6
Sample Claims Trending
Medical and Rx Cash Flow Summary - (By Month Paid) Sample Self Funded Claim Report - Medical Self Funded Medical
Domestic vs. non-domestic utilization I. Claim Payments are Valued as of: Plan Year Ending 12/31/20 Enrollment Fixed Claims Stop-Loss Cost Share Plan Performance Total Cost vs.
Month
March 31, 2020
(Monthly) (Cumulative) Month/Year Jan-20 Feb-20 Subscribers Total 3,853 3,826 Total Members 5,820 5,775 Admin Fee $100,855 $100,148 Specific Stop- Loss Premium $42,328 $41,987 Total Fixed Costs $143,182 $142,134 Gross Medical $1,949,725 $1,958,674 Claims Gross Rx Claims $762,711 $720,325 Claims ($300k) Reimbursable $0 $0 $2,712,436 $2,679,000 Net Paid Claims Sample Net Plan $1,916,795 $1,890,509 Cost Employee Contribution $938,824 $930,626 Total Plan Cost $2,855,619 $2,821,134 Total Accrual $3,056,429 $3,029,701 Funding Balance $200,
Fixed Costs
Large Claims
Enrolled
= Fixed + Claims
2019 domestic vs non-domestic IIa. Month Paid Subscribers (ASO and Stop Loss Paid Claims Adjustments 1 Total Paid Net Total Plan Costs Expected Plan 2 Total Plan Costs Expected Plan 2 Mar-20 Apr-20 May-20 Jun-20 3,786 0 0 0 5,695 0 0 0 $99,101 $0 $0 $0 $41,525 $0 $0 $0 $140,626 $0 $0 $0 $2,014,114 $0 $0 $0 $831,323 $0 $0 $0 $0 $0 $0 $0 $2,845,437 $0 $0 $0 $2,064,527 $0 $0 $0 $921,535 $0 $0 $0 $2,986,062 $0 $0 $0 $3,001,581 $0 $0 $0 $15,519 $0 $0 $0 99.5% $740 $739
Costs
Costs
= Fixed + Claims
Claims
Premium)
Jan 2019-Dec 2019 January-19 3,788 $138,656 $2,970,669 ($82,735) $2,887,934 $3,026,590 $3,212,577 $3,026,590 $3,212,577 Jul-20 Aug-20 Sep-20 0 0 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $691 $711
Service type 2019 domestic 2019 non-domestic 2019 total % domestic % non-domestic February-19 3,812 3,802 $139,489 $2,596,009 ($9,934) $0 $2,596,009 $2,735,498 $3,231,567 $5,762,088 $6,444,144 Oct-20 Nov-20 Dec-20 0 0 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $644 $669 $676 $694 $701
$2,713,260
$8,614,560
$3,228,996
$2,852,472
$9,673,140
March-19
$2,723,194
$139,212
April-19 3,781 $138,470 $2,773,443 ($148,990) $2,624,453 $2,762,923 $3,214,841 $11,377,484 $12,887,982 YTD Totals 11,465 17,290 $300,103 $125,839 $425,942 $5,922,513 $2,314,360 $0 $8,236,873 $5,871,830 $2,790,985 $8,662,815 $9,087,711 $424,896 95.3%
Inpatient hospital $25,076,238 $30,648,735 $55,724,973 45.0% 55.0% May-19 3,814 $139,650 $3,604,519 ($32,468) $3,572,051 $3,711,701 $3,242,769 $15,089,184 $16,130,750 Average/Month 3,822 5,763 $100,034 $26.18 $41,946 $10.98 $141,981 $37.15 $1,974,171 $517.34 $771,453 $202.16 $0 $0.00 $2,745,624 $719.50 $1,957,277 $512.15 $930,328 $243.44 $2,887,605 $756.65 $3,029,237 $792.65 $141,632 $35.99
Average/PEPM
June-19 3,806 $139,358 $2,579,242 ($53,195) $2,526,047 $2,665,405 $3,233,927 $17,754,589 $19,364,677 Lagged Med Lives 11,448 17,325 T TOOTTAALL PPLLAANN CCOOSSTT VVSS.. EESSTTIIMMAATTEEDD FFUUNNDDIINNGG AACCCCRRUUAALL PEPM Comparison
Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.0% 35.0% July-19 August-19 3,731 3,724 $136,601 $2,954,615 ($204,583) $2,750,033 $2,886,634 $3,167,666 $20,641,223 $22,532,343 Sample Net Plan Cost Employee Contribution Total Accrual (based on lagged enrollment) $757 $793 95.5%
2020 YTD Actual
$136,436
($335,562)
$25,700,716
$23,805,635
$3,168,373
2020 YTD Budget
$3,363,539
$3,164,412
$3,027,976
Actual vs. Budget
September-19 3,671 $134,527 $2,730,685 ($117,571) $2,613,114 $2,747,641 $3,123,434 $26,553,276 $28,824,150 PEPM Claims
Professional $2,347,635 $28,075,941 $30,423,576 7.7% 92.3% October-19 3,672 $134,612 $3,139,786 ($67,116) $3,072,670 $3,207,283 $3,128,355 $29,760,559 $31,952,504 $3,500,000 $3,000,000 $3,056,429 $3,029,701 $3,001,581 2019 Actual 2019 Budget Actual vs. Budget $777 $850 91.4%
Pharmacy $500,576 $11,254,751 $11,755,327 4.3% 95.7% November-19 3,688 3,769 $135,258 $3,297,017 ($786,089) $2,510,928 $2,646,186 $3,146,404 $32,406,744 $35,098,908 $2,500,000 $938,824 $930,626 $921,535 2020 vs. 2019 Actual -2.6% -6.8%
$34,969,960
December-19
$38,309,546
$2,563,216
($880,936)
$3,210,638
$2,425,018
$3,305,954
$138,197
2020 vs. 2019 Budget
Other $10,576 $1,574,021 $1,584,597 0.7% 99.3% IIb. Cumulative (1/1/2019-19) 45,058 3,853 $1,650,467 $36,038,670 ($2,719,177) $0 $33,319,493 $34,969,960 $38,309,546 $34,969,960 $38,309,546 $2,000,000 $1,500,000 $1,000,000 $1,916,795 $1,890,509 $2,064,527
$2,855,619
$2,855,619
January-20
$2,712,436
$2,712,436
$143,182
$3,056,429
$3,056,429
Total all services $48,511,448 $82,633,060 $131,144,508 37.0% 63.0% February-20 3,826 $142,134 $2,679,000 $0 $2,679,000 $2,821,134 $3,029,701 $5,676,753 $6,086,130 $500,000 $0
March-20 3,786 $140,626 $2,845,437 $0 $2,845,437 $2,986,062 $3,001,581 $8,662,815 $9,087,711 $0 $0 $0 $0 $0 $0 $0 $0
April-20 $0 1/1/2020 2/1/2020 3/1/2020 4/1/2020 $0 $0 5/1/2020 $0 $0 $0 $0 6/1/2020 7/1/2020 $0 $0 8/1/2020 $0 $0 9/1/2020 $0 $0 10/1/2020 $0 $0 11/1/2020 $0 $0 12/1/2020 $0 $0 12-Month
Average
May-20
June-20 Sample Self Funded Claim Report - Medical
July-20 Prior Plan Year Ending 12/31/2019
August-20 Subscribers Total Total Members Admin Fee Specific Stop- Loss Premium Total Fixed Costs Gross Medical Claims Gross Rx Claims Stop-Loss Reimbursable Net Paid Claims Sample Net Plan Cost Employee Contribution Total Plan Cost Total Accrual Funding Balance Total Cost vs. Funding
September-20 Prior PY Totals 45,058 68,366 $1,261,498 $388,969 $1,650,467 $27,559,897 $8,478,773 Claims ($300k) -$2,719,177 $33,319,493 $23,431,939 $11,538,020 $34,969,960 $38,309,546 $3,339,587 Accrual 91.3%
October-20 Average/Month 3,755 5,697 $105,125 $32,414 $137,539 $2,296,658 $706,564 -$226,598 $2,776,624 $1,952,662 $961,502 $2,914,163 $3,192,462 $278,299 $638 $618 $667 $651 $739 $706 $608 $724 $765 $745 $726 $720
November-20 Lagged Med Lives Average/PEPM 45,011 68,288 $28.00 $8.63 $36.63 $612.29 $188.37 -$60.41 $740.25 $520.04 $256.07 $776.88 $850.23 $73.35
December-20 Total Specific Stop- Total Fixed Gross Medical Gross Rx Stop-Loss Net Paid Sample Net Plan Employee Funding Total Cost vs.
Cumulative (1/1/2020-20) 11,465 $425,942 $8,236,873 $0 $8,236,873 $8,662,815 $9,087,711 $8,662,815 $9,087,711 Month/Year Subscribers Total Members Admin Fee Loss Premium Costs Claims Claims Claims ($300k) Reimbursable Claims Cost Contribution Total Plan Cost Total Accrual Balance Funding Accrual 2Q17 3Q17 4Q17 1Q18 2Q18 3Q18 4Q18 1Q19 2Q19 3Q19 4Q19 1Q20
Nov-18 3,674 5,580
Dec-18 3,722 5,652
Jan-19 3,788 5,724 $106,053 $32,602 $138,656 $2,431,957 $538,712 -$82,735 $2,887,934 $2,062,666 $963,924 $3,026,590 $3,212,577 $185,988 94.2%
Feb-19 3,812 5,761 $106,725 $32,764 $139,489 $2,017,328 $578,681 $0 $2,596,009 $1,768,101 $967,397 $2,735,498 $3,231,567 $496,069 84.6%
Current Policy Year To Date Mar-19 3,802 5,766 $106,445 $32,767 $139,212 $1,976,180 $747,014 -$9,934 $2,713,260 $1,883,016 $969,457 $2,852,472 $3,228,996 $376,524 88.3%
III. Rolling 12 Months Actual vs Expected (Apr-19 to Mar-20) IV. (Paid Basis) V. Current Policy Year Stop Loss Summary Apr-19 May-19 Jun-19 3,781 3,814 3,806 5,734 5,779 5,767 $105,857 $106,781 $106,557 $32,613 $32,868 $32,801 $138,470 $139,650 $139,358 $2,082,218 $2,774,373 $1,934,432 $691,225 $830,145 $644,809 -$148,990 -$32,468 -$53,195 $2,624,453 $3,572,051 $2,526,047 $1,796,657 $2,737,709 $1,692,921 $966,266 $973,991 $972,484 $2,762,923 $3,711,701 $2,665,405 $3,214,841 $3,242,769 $3,233,927 $451,918 -$468,932 $568,522 85.9% 114.5% 82.4%
Rolling Twelve Actual Plan Costs $35,018,215 Actual Plan Cost $8,662,815 Ind Stop Loss (ISL) Deductible Per Claimant $300,000 Jul-19 3,731 5,649 $104,458 $32,143 $136,601 $2,277,299 $677,316 -$204,583 $2,750,033 $1,930,997 $955,637 $2,886,634 $3,167,666 $281,032 91.1%
Rolling Twelve Expected Plan Costs $37,724,117 Expected Plan Costs $9,087,711 Large Claims Adjustments $0 Aug-19 Sep-19 Oct-19 3,724 3,671 3,672 5,659 5,591 5,587 $104,262 $102,778 $102,806 $32,174 $31,749 $31,807 $136,436 $134,527 $134,612 $2,502,827 $2,055,962 $2,508,422 $860,712 $674,723 $631,364 4 -$335,562 -$117,571 -$67,116 $3,027,976 $2,613,114 $3,072,670 $2,203,139 $1,802,311 $2,262,539 $961,273 $945,330 $944,744 $3,164,412 $2,747,641 $3,207,283 $3,168,373 $3,123,434 $3,128,355 $375,793 -$78,928 $3,961 99.9% 88.0% 102.5%
Percent of Expected 0.928271288 Percent of Expected 0.953245011 Nov-19 3,688 5,619 $103,254 $32,004 $135,258 $2,397,978 $899,039 -$786,089 $2,510,928 $1,695,575 $950,611 $2,646,186 $3,146,404 $500,218 84.1%
Dec-19 3 769 5 730 $105 521 $32 676 $138 197 $2 600 921 $705 033 -$880 936 $2 425 018 $1 596 310 $966 906 $2 563 216 $3 210 638 $647 423 79 8%
Notes:
2 1. Large Claims Adjustments are recorded on a cash basis as reported by the insurance carrier.
3
Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 2. Changes in enrollment, participation mix, and various other factors/assumptions may have a significant impact on the estimated claim costs. 21
Claims Trending
Self Funded Medical
PEPM COST VS ACCRUAL
Cost Accrual
$982
$868 $813 $848 $874
$771 $805 $771
$721
$739 $722 $748 $727 $758 $738 $758 $732 $780
$690 $685 $559 $699 $695
$609
LOCKTON COMPANIES | 1
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Upstream Rehabilitation — Lockton Total Rewards Practice overview 32 Lockton Companies
