Page 24 - Optim Orthopedics
P. 24
Financial reporting
Financial reporting Cost vs. Accrual Sample Monthly Medical/Rx Projection
12-Month Renewal Projection
Total Cost vs Expected Accrual
Self Funded Medical - Status Quo
PEPM Total Medical Total
$46,500,000 $48,000,000 Projected Lives (Nov-19) 3,707
$44,000,000 $43,000,000 $42,000,000 $41,500,000 Experience (Dec-18 - Nov-19)
Average Lagged Lives (1 Month)
$38,184,500
Total Claims $833.66 3,772 $37,729,657
$843.71
-$10.05
ISL Adjustments
-$454,843
Claims Net ISL Adjustments
Extensive and Additional reports Total Cost Annual Trend $892.01 7.0% 7.0% 0.0% 14 $40,370,733 Note: Trend
assumptions take into
Accrual
Trending Months
Effective Trend
account domestic
chargemaster increases
Trended Claims
annually and changes in
Claim Fluctuation Corridor
customizable inancial include Jan-19 to Nov-19 Jan-18 to Dec-18 Jan-17 to Dec-17 Projected Claims $892.01 1.0000 $40,370,733 domestic drug pricing
Plan Design Adjustment
Administration Fees
$1,337,562
$30.07
101%
102%
97%
$495,269
Stop Loss Fees
$11.13
Estimated Rx Claims Savings
$0
$0.00
reporting capabilities • Utilization reports Total Medical Summary Lives 103,819 $46,500,000 $48,000,000 ($1,000,000) 102% 101% 97% % 14 Projected Cost $933.22 $42,203,564 4
$901.15
Current Accrual
$40,084,594
Var ($)
3.56%
% Change in Current Accrual
Accrual
Total Cost
Jan-19 to Nov-19
$1,500,000
Actual Cost
$890.12
$39,593,962
$43,000,000
112,140
$44,000,000
Jan-18 to Dec-18
($500,000)
$41,500,000
$42,000,000
111,429
Jan-17 to Dec-17
-1.22%
-$490,632
Actual Cost vs. Current Accrual
• Cash & Accrual (C&A) reports • Domestic leakage
— Finance/HR executive • Non-domestic utilization Domestic vs. non-domestic utilization Monthly Financial Reporting Sample
Medical /Rx
2019 domestic vs non-domestic
Jan 2019-Dec 2019
dashboards Service type 2019 domestic 2019 non-domestic 2019 total % domestic 45.0% % non-domestic 55.0% Sample Client Claim Payments are Valued as of: (Monthly) (Cumulative)
Medical and Rx Cash Flow Summary - (By Month Paid)
I.
analytics Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.0% 7.7% 35.0% 92.3% IIa. January-18 February-18 March-18 April-18 May-18 Month Paid Enrolled Subscribers 3,762 3,749 3,743 3,730 3,737 (ASO and Stop Loss $2,408,184 $2,350,989 $2,734,267 $2,430,645 $3,188,961 Paid Claims Large Claims $37,593 $253 $0 $0 $0 1 Total Paid Net Claims $2,370,591 $2,350,736 $2,734,267 $2,430,645 $3,188,961 = Fixed + Claims Expected Plan Costs 2 $2,798,615 $2,787,127 $2,786,464 $2,784,263 $2,792,313 Total Plan Costs Claims Expecte
November 30, 2019
$55,724,973
$30,648,735
$25,076,238
Inpatient hospital
Total Plan Costs
Fixed Costs
= Fixed +
Adjustments
Premium)
$141,756
$2,798,615
$2,512,347
$2,512,347
$2,491,964
$5,004,311
$141,228
$5,585,742
$2,347,635
$7,879,575
Professional
$28,075,941
$8,372,206
$140,998
$30,423,576
$2,875,265
$140,651
$10,450,871
$11,156,468
$2,571,296
$141,010
$13,948,781
$13,780,842
• Domestic steerage and JV • Demographic analysis Pharmacy $48,511,448 $11,254,751 $131,144,508 37.0% 4.3% 0.7% 63.0% 95.7% 99.3% IIb. Cumulative (1/1/2018-18) 3,753 3,726 3,760 3,745 3,714 3,695 3,742 44,856 3,806 3,834 $141,575 $140,651 $141,999 $141,493 $140,420 $139,583 $141,357 $1,692,721 $140,822 $141,856 $2,838,492 $2,625,621 $3,605,400 $2,549,164 $3,398,331 $2,314,924 $3,188,907 $33,633,884 $2,970,669 $2,596,009 Sample Self Funded Claim Report - Medical $16,741,064 $19,506,597 $23,031,678 $25,682,674 $28,730,151 $31,144,531 $34,384,213 $3,111,491 $5,849,356 Gross Medic
$3,329,971
$2,960,222
$2,803,103
$2,818,647
$19,845
June-18
$500,576
$11,755,327
July-18
$2,624,883
$2,765,534
$2,785,631
Plan Year Ending 12/31/19
$738
$3,525,080
$2,810,564
$222,319
August-18
$3,383,081
$2,650,996
September-18
$39,661
$2,509,503
$2,803,528
October-18
$3,047,477
$1,574,021
$10,576
$1,584,597
Other
$491,274
$2,907,057
$2,414,380
Admin Fee
Specific Stop-
$2,761,428
$2,781,392 Total Fixed
Total
$40,127
November-18
Month/Year
Total Sub-
$2,274,797
Loss Premium
Members
scribers
Costs
Claims
$3,098,325
$90,583
December-18
($450k)
$33,490,389
$3,239,682
$2,795,963
$32,691,492
3,806
5,747
$0
$942,392
Jan-19
$33,490,389
$33,490,389 $140,822
$82,633,060
Total all services
$34,384,213
$107,634
$33,188
$3,205,023 $141,856
3,834
$33,420
$0 Feb-19
5,784
$0
$108,437
$3,111,491
5,790
January-19
$0 Mar-19
$108,267
$3,228,417 $141,738
$0
$3,205,023
$33,471
3,828
$2,970,669
$6,433,440
February-19
$2,737,865
$2,596,009
utilization March-19 April-19 May-19 June-19 July-19 August-19 September-19 October-19 November-19 December-19 3,828 3,805 3,834 3,826 3,753 3,748 3,696 3,690 3,707 $141,738 $140,848 $141,863 $141,598 $138,911 $138,830 $136,895 $136,718 $137,415 $2,723,194 $2,773,443 $3,604,519 $2,579,242 $2,954,615 $3,363,539 $2,730,685 $3,139,786 $3,297,017 $2,741 Jul-19 $440 Aug-19 $40,121 Sep-19 ($3,074) v - 19 $219,239 $0 Apr-19 $0 May-19 $0 Jun-19 $0 Oct-19 YTD Totals No Dec-19 $2,723,194 $2,773,443 $3,604,519 $2,576,501 $2
$3,211,094 $141,863
$3,231,374 $141,598
$3,225,183 $138,911
$3,161,773 $138,830
$3,164,750 $136,895
$3,120,375 $136,718
$3,118,977 $137,415
$3,138,444
• Enrollment reports III. Cumulative (1/1/2019-19) 41,528 $1,537,496 $93,126,066 $94,583,239 98% $32,732,717 IV. Actual Plan Cost Average/Month (Paid Basis) $32,473,249 $34,010,745 $35,037,333 3,775 41,563 97% 62,951 5,719 $34,010,745 $106,764 $28.30 V. $33,009 $8.72 Ind Stop Loss (ISL) Deductible Per Claimant $2,268,998 $600.55 -- $35,037,333 $706,704 $187.07 $500,000 $259,468 $23,588 $6.20 $2,952,114 $781.29 $2,122,019 $562.12 PEPM Comparison $3,091,886 $818.34 $3,185,212 $843.74 $93,326 $25.41 $825
$35,037,333 $139,772
$969,866
$259,468
Average/PEPM
$37.05
$256.95
Current Policy Year To Date
Lagged Lives
Current Policy Year Stop Loss Summary
$4,000,000
Rolling 12 Months Actual vs Expected (Dec-18 to Nov-19)
(based on lagged enrollment)
$3,500,000
• Budget vs. claim reports $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 Cautiously Optimistic Employee Contributions Sample Net Plan 2019 YTD Budget 96.4% 104.0% $856 $780 $750
Rolling Twelve Actual Plan Costs
Large Claims Adjustments
$3,000,000
Expected Plan Costs
Rolling Twelve Expected Plan Costs
2019 YTD Actual
Percent of Expected
Percent of Expected
Actual vs. Budget
Cost
2018 Actual
Total Accrual
2018 Budget
Actual vs. Budget
• Network discounts (domestic Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 2 $0 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 2019 vs. 2018 Actual 12.6% 6.5% 5
2019 vs. 2018 Budget
• Monthly IBNR analysis
and non-domestic)
• Certiied IBNR reports Joint venture (JV) partner — sample health system utilization Self Insured Claim Report Sample
• Network disruption JV Partners Medical/Rx
Stop-Loss
• Large claim reports 30-0000001 Jan 2019 — December 2019 $1,576,428 Month/Year Subscribers Members Admin Fee Specific Stop- Total Fixed Gross Medical Gross Rx Claims Reimbursable Net Paid Claims Total Net
Total
Total
Plan Cost
Claims
Loss
Claims ($175k)
Premium
Tax ID
Provider
Claims
JV Partner 1
• Plan design modeling 30- 0000002 JV Partner 2 $2,574,313 Mar-19 2,384 2,393 2,392 2,391 5,423 5,424 5,445 5,419 $92,547 $224,692 $317,239 $2,004,489 $703,886 $20,317 $2,688,058 $3,005,297
$724,894
$226,671
2,405
$2,254,931
$0
Jan-19
$2,979,824
$3,299,858
$320,033
5,471
$93,362
Feb-19
$225,540
$92,896
$2,923,154
$688
$2,146,731
$318,437
$777,111
$3,241,591
$318,303
$225,446
$2,478,921
$855,677
$3,266,494
Apr-19
$92,857
$386,407
$2,948,190
$2,934,763
$318,170
$898,619
$92,819
$2,257,775
$576,279
$221,631
$3,252,934
30-0000003
May-19
$225,352
JV Partner 3
• Year-over-year (YOY) or rolling • Contribution analysis 30-0000004 JV Partner 4 $5,545,052 Aug-19 2,384 2,396 2,382 2,393 2,430 2,422 2,419 5,406 5,456 5,421 5,442 5,492 5,468 5,460 $92,547 $224,692 $317,239 $2,216,474 $876,056 $667,899 $2,424,631 $2,741,870
Jun-19
$489,527
$388,500
$93,013
$2,090,771
$2,584,616
$882,345
$225,823
Jul-19
$318,836
$2,903,452
$469,760
$2,959,412
$2,544,848
$316,973
$92,469
$3,276,385
$884,324
$224,504
JV Partner 5
$870,380
$3,118,959
$318,437
$328,505
$381,438
Sep-19
30-0000005
$225,540
$3,437,396
$92,896
$2,630,017
Oct-19
$939,423
$447,031
$2,480,808
$229,028
$2,804,168
$1,988,416
$323,360
$94,333
Total
$1,807,660
$821,998
$94,022
$228,274
Nov-19
$2,866,986
$84,968
$2,544,691
$322,296
$904,933
$2,610,313
$227,991
$3,195,739
$641,403
$321,896
$2,873,843
Dec-19
$93,906
12 months Average/Month 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
YTD Totals
$2,788,413
$309,170
$3,107,681
$2,252,612
$844,970
$93,139
5,444
$319,268.20
$226,129
2,399
$942.91
$94.25
Average/PEPM
$133.07
$353.69
$129.41
$1,167.19
$38.82
$1,300.26
Lagged Lives
• Clinical reports (Infolock) PEPM Comparison 28,668 65,051 $1,300.26
YTD Total PEPM (based on lagged enrollment)
• Detailed expense (admin., stop- 2018 Total PEPM $1,249.35
2019 vs. 2018 Change
4.1%
$1,392.08
2019 Budget PEPM
loss, medical, pharmacy, dental, • Expense allocation analysis Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 3 2019 Actual vs. Budget -6.6% 6
vision) SAMPLE Claims Trending
Self Funded Medical
Incurred But Not Paid Health Plan Reserve as of
3/31/2020 PEPM Claims by Policy Period Quarter
Benefit 3/31/2020 $900 PEPM Claims 12-Month Average $780 $790 $790
$6,163,200
Medical/Rx
• Global or plan level reporting Margin: 5%: $308,000 $800 $700 $600 $650 $680 $710 $730 $730
$6,471,200
Total
SAMPLE
SAMPLE
Incurred But Not Reported Health Plan Reserve as of Incurred But Not Reported Health Plan Reserve as of $500 $400
3/31/2020
3/31/2020 Month Apr-17 7,478 11,581 11,350 11,419 Incurred Claims Paid to $4,569,418 $4,715,902 $4,560,988 Completion Factor 100.0% 100.0% 100.0% Total Incurred Claims $4,569,418 $4,715,902 $4,560,988 IBNR Estimate $0 $0 $0 $300
Covered Employees
Estimate (Med/Rx)
Covered Members
Date (Med/Rx)
SAMPLE Medical/Rx Historical and Projected IBNR
7,419
• Gross and net of employee $10,000,000 $9,000,000 $8,000,000 Jul-17 7,395 11,307 11,278 11,245 11,292 11,246 11,439 11,358 11,307 $4,630,174 $6,074,250 $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 $4,868,310 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% $4,630,174 $6,074,250 $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 $4,868,310 $0 $0 $0 $0 $0 $0 $0 $0 $200 $100 $0 1Q17 2Q17 3Q17 4Q17 1Q18 $65 2Q18 3Q18 4Q18 1Q19 2Q19 3Q19 4Q19
May-17
7,479
Jun-17
7,366
Aug-17
7,353
Sep-17
Oct-17
7,375
Nov-17
7,347
7,484
Dec-17
7,523
Jan-18
Feb-18
7,498
Apr-18
7,459
May-18
$7,000,000 $6,000,000 Mar-18 7,486 11,308 11,323 11,359 11,406 11,347 11,449 $5,511,525 $5,624,135 $6,007,548 $5,900,727 $5,927,124 $6,031,535 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% $5,511,525 $5,624,267 $6,008,050 $5,901,319 $5,927,899 $6,032,507 $133 $501 $592 $775 $973 $0 PEPM COST VS ACCRUAL
7,474
Jun-18
7,506
7,453
contributions $5,000,000 $4,000,000 Sep-18 7,490 11,403 11,314 11,208 11,360 11,494 11,567 11,581 $5,424,790 $5,553,954 $6,099,789 $5,264,843 $5,622,647 $5,231,368 $5,324,577 100.0% 100.0% 100.0% 100.0% 99.9% 99.9% 99.9% $5,425,876 $5,554,691 $6,101,171 $5,267,119 $5,626,413 $5,237,800 $5,330,019 $1,087 $738 $1,382 $2,276 $3,765 $6,432 $5,442 Cost Accrual
Jul-18
7,520
Aug-18
Oct-18
7,428
Nov-18
7,390
Dec-18
7,484
7,612
Jan-19
Feb-19
7,669
7,657
Mar-19
7,668
May-19
7,652
Jun-19
$3,000,000 Apr-19 7,610 11,519 11,603 11,593 $6,228,629 $5,444,632 $5,801,540 99.9% 99.8% 99.7% $6,235,891 $5,456,161 $5,820,076 $7,262 $11,529 $18,536 $1,000 $900
Jul-19 7,506 11,352 $6,681,959 99.6% $6,711,023 $29,064
$2,000,000 Aug-19 7,497 11,375 11,230 $6,007,219 $5,831,584 99.4% 99.1% $6,043,753 $5,882,077 $36,533 $50,493 $800
Sep-19
7,392
Oct-19 7,379 11,226 11,286 $6,335,851 $5,525,853 98.6% 98.2% $6,428,475 $5,625,509 $92,624 $99,657 $700
Nov-19
7,414
$1,000,000 Dec-19 7,575 11,505 11,520 $5,860,768 $5,153,306 96.8% 94.2% $6,052,870 $5,471,980 $192,102 $318,673 $600
7,680
Jan-20
Feb-20 7,686 11,590 $4,798,904 83.3% $5,758,089 $959,185
$0 Mar-20 7,680 11,560 - $1,725,983 $0 28.5% $6,049,819 $0 $4,323,836 $0 $500
-
-
Total - $194,341,036 $200,504,625 $6,163,589 $400
Estimated Outstanding Medical/Rx Liability at 03/31/20: $6,163,589 $300
Historical IBNR Projected IBNR Estimated Outstanding Medical/Rx Liability at 03/31/20 Including Margin: Margin: 5%: $308,000 $6,471,768 $200
$100
$0
LOCKTON COMPANIES | 1
8
Optim Orthopedics — Lockton Beneits Practice overview 24 Lockton Companies
Financial reporting Cost vs. Accrual Sample Monthly Medical/Rx Projection
12-Month Renewal Projection
Total Cost vs Expected Accrual
Self Funded Medical - Status Quo
PEPM Total Medical Total
$46,500,000 $48,000,000 Projected Lives (Nov-19) 3,707
$44,000,000 $43,000,000 $42,000,000 $41,500,000 Experience (Dec-18 - Nov-19)
Average Lagged Lives (1 Month)
$38,184,500
Total Claims $833.66 3,772 $37,729,657
$843.71
-$10.05
ISL Adjustments
-$454,843
Claims Net ISL Adjustments
Extensive and Additional reports Total Cost Annual Trend $892.01 7.0% 7.0% 0.0% 14 $40,370,733 Note: Trend
assumptions take into
Accrual
Trending Months
Effective Trend
account domestic
chargemaster increases
Trended Claims
annually and changes in
Claim Fluctuation Corridor
customizable inancial include Jan-19 to Nov-19 Jan-18 to Dec-18 Jan-17 to Dec-17 Projected Claims $892.01 1.0000 $40,370,733 domestic drug pricing
Plan Design Adjustment
Administration Fees
$1,337,562
$30.07
101%
102%
97%
$495,269
Stop Loss Fees
$11.13
Estimated Rx Claims Savings
$0
$0.00
reporting capabilities • Utilization reports Total Medical Summary Lives 103,819 $46,500,000 $48,000,000 ($1,000,000) 102% 101% 97% % 14 Projected Cost $933.22 $42,203,564 4
$901.15
Current Accrual
$40,084,594
Var ($)
3.56%
% Change in Current Accrual
Accrual
Total Cost
Jan-19 to Nov-19
$1,500,000
Actual Cost
$890.12
$39,593,962
$43,000,000
112,140
$44,000,000
Jan-18 to Dec-18
($500,000)
$41,500,000
$42,000,000
111,429
Jan-17 to Dec-17
-1.22%
-$490,632
Actual Cost vs. Current Accrual
• Cash & Accrual (C&A) reports • Domestic leakage
— Finance/HR executive • Non-domestic utilization Domestic vs. non-domestic utilization Monthly Financial Reporting Sample
Medical /Rx
2019 domestic vs non-domestic
Jan 2019-Dec 2019
dashboards Service type 2019 domestic 2019 non-domestic 2019 total % domestic 45.0% % non-domestic 55.0% Sample Client Claim Payments are Valued as of: (Monthly) (Cumulative)
Medical and Rx Cash Flow Summary - (By Month Paid)
I.
analytics Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.0% 7.7% 35.0% 92.3% IIa. January-18 February-18 March-18 April-18 May-18 Month Paid Enrolled Subscribers 3,762 3,749 3,743 3,730 3,737 (ASO and Stop Loss $2,408,184 $2,350,989 $2,734,267 $2,430,645 $3,188,961 Paid Claims Large Claims $37,593 $253 $0 $0 $0 1 Total Paid Net Claims $2,370,591 $2,350,736 $2,734,267 $2,430,645 $3,188,961 = Fixed + Claims Expected Plan Costs 2 $2,798,615 $2,787,127 $2,786,464 $2,784,263 $2,792,313 Total Plan Costs Claims Expecte
November 30, 2019
$55,724,973
$30,648,735
$25,076,238
Inpatient hospital
Total Plan Costs
Fixed Costs
= Fixed +
Adjustments
Premium)
$141,756
$2,798,615
$2,512,347
$2,512,347
$2,491,964
$5,004,311
$141,228
$5,585,742
$2,347,635
$7,879,575
Professional
$28,075,941
$8,372,206
$140,998
$30,423,576
$2,875,265
$140,651
$10,450,871
$11,156,468
$2,571,296
$141,010
$13,948,781
$13,780,842
• Domestic steerage and JV • Demographic analysis Pharmacy $48,511,448 $11,254,751 $131,144,508 37.0% 4.3% 0.7% 63.0% 95.7% 99.3% IIb. Cumulative (1/1/2018-18) 3,753 3,726 3,760 3,745 3,714 3,695 3,742 44,856 3,806 3,834 $141,575 $140,651 $141,999 $141,493 $140,420 $139,583 $141,357 $1,692,721 $140,822 $141,856 $2,838,492 $2,625,621 $3,605,400 $2,549,164 $3,398,331 $2,314,924 $3,188,907 $33,633,884 $2,970,669 $2,596,009 Sample Self Funded Claim Report - Medical $16,741,064 $19,506,597 $23,031,678 $25,682,674 $28,730,151 $31,144,531 $34,384,213 $3,111,491 $5,849,356 Gross Medic
$3,329,971
$2,960,222
$2,803,103
$2,818,647
$19,845
June-18
$500,576
$11,755,327
July-18
$2,624,883
$2,765,534
$2,785,631
Plan Year Ending 12/31/19
$738
$3,525,080
$2,810,564
$222,319
August-18
$3,383,081
$2,650,996
September-18
$39,661
$2,509,503
$2,803,528
October-18
$3,047,477
$1,574,021
$10,576
$1,584,597
Other
$491,274
$2,907,057
$2,414,380
Admin Fee
Specific Stop-
$2,761,428
$2,781,392 Total Fixed
Total
$40,127
November-18
Month/Year
Total Sub-
$2,274,797
Loss Premium
Members
scribers
Costs
Claims
$3,098,325
$90,583
December-18
($450k)
$33,490,389
$3,239,682
$2,795,963
$32,691,492
3,806
5,747
$0
$942,392
Jan-19
$33,490,389
$33,490,389 $140,822
$82,633,060
Total all services
$34,384,213
$107,634
$33,188
$3,205,023 $141,856
3,834
$33,420
$0 Feb-19
5,784
$0
$108,437
$3,111,491
5,790
January-19
$0 Mar-19
$108,267
$3,228,417 $141,738
$0
$3,205,023
$33,471
3,828
$2,970,669
$6,433,440
February-19
$2,737,865
$2,596,009
utilization March-19 April-19 May-19 June-19 July-19 August-19 September-19 October-19 November-19 December-19 3,828 3,805 3,834 3,826 3,753 3,748 3,696 3,690 3,707 $141,738 $140,848 $141,863 $141,598 $138,911 $138,830 $136,895 $136,718 $137,415 $2,723,194 $2,773,443 $3,604,519 $2,579,242 $2,954,615 $3,363,539 $2,730,685 $3,139,786 $3,297,017 $2,741 Jul-19 $440 Aug-19 $40,121 Sep-19 ($3,074) v - 19 $219,239 $0 Apr-19 $0 May-19 $0 Jun-19 $0 Oct-19 YTD Totals No Dec-19 $2,723,194 $2,773,443 $3,604,519 $2,576,501 $2
$3,211,094 $141,863
$3,231,374 $141,598
$3,225,183 $138,911
$3,161,773 $138,830
$3,164,750 $136,895
$3,120,375 $136,718
$3,118,977 $137,415
$3,138,444
• Enrollment reports III. Cumulative (1/1/2019-19) 41,528 $1,537,496 $93,126,066 $94,583,239 98% $32,732,717 IV. Actual Plan Cost Average/Month (Paid Basis) $32,473,249 $34,010,745 $35,037,333 3,775 41,563 97% 62,951 5,719 $34,010,745 $106,764 $28.30 V. $33,009 $8.72 Ind Stop Loss (ISL) Deductible Per Claimant $2,268,998 $600.55 -- $35,037,333 $706,704 $187.07 $500,000 $259,468 $23,588 $6.20 $2,952,114 $781.29 $2,122,019 $562.12 PEPM Comparison $3,091,886 $818.34 $3,185,212 $843.74 $93,326 $25.41 $825
$35,037,333 $139,772
$969,866
$259,468
Average/PEPM
$37.05
$256.95
Current Policy Year To Date
Lagged Lives
Current Policy Year Stop Loss Summary
$4,000,000
Rolling 12 Months Actual vs Expected (Dec-18 to Nov-19)
(based on lagged enrollment)
$3,500,000
• Budget vs. claim reports $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 Cautiously Optimistic Employee Contributions Sample Net Plan 2019 YTD Budget 96.4% 104.0% $856 $780 $750
Rolling Twelve Actual Plan Costs
Large Claims Adjustments
$3,000,000
Expected Plan Costs
Rolling Twelve Expected Plan Costs
2019 YTD Actual
Percent of Expected
Percent of Expected
Actual vs. Budget
Cost
2018 Actual
Total Accrual
2018 Budget
Actual vs. Budget
• Network discounts (domestic Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 2 $0 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 2019 vs. 2018 Actual 12.6% 6.5% 5
2019 vs. 2018 Budget
• Monthly IBNR analysis
and non-domestic)
• Certiied IBNR reports Joint venture (JV) partner — sample health system utilization Self Insured Claim Report Sample
• Network disruption JV Partners Medical/Rx
Stop-Loss
• Large claim reports 30-0000001 Jan 2019 — December 2019 $1,576,428 Month/Year Subscribers Members Admin Fee Specific Stop- Total Fixed Gross Medical Gross Rx Claims Reimbursable Net Paid Claims Total Net
Total
Total
Plan Cost
Claims
Loss
Claims ($175k)
Premium
Tax ID
Provider
Claims
JV Partner 1
• Plan design modeling 30- 0000002 JV Partner 2 $2,574,313 Mar-19 2,384 2,393 2,392 2,391 5,423 5,424 5,445 5,419 $92,547 $224,692 $317,239 $2,004,489 $703,886 $20,317 $2,688,058 $3,005,297
$724,894
$226,671
2,405
$2,254,931
$0
Jan-19
$2,979,824
$3,299,858
$320,033
5,471
$93,362
Feb-19
$225,540
$92,896
$2,923,154
$688
$2,146,731
$318,437
$777,111
$3,241,591
$318,303
$225,446
$2,478,921
$855,677
$3,266,494
Apr-19
$92,857
$386,407
$2,948,190
$2,934,763
$318,170
$898,619
$92,819
$2,257,775
$576,279
$221,631
$3,252,934
30-0000003
May-19
$225,352
JV Partner 3
• Year-over-year (YOY) or rolling • Contribution analysis 30-0000004 JV Partner 4 $5,545,052 Aug-19 2,384 2,396 2,382 2,393 2,430 2,422 2,419 5,406 5,456 5,421 5,442 5,492 5,468 5,460 $92,547 $224,692 $317,239 $2,216,474 $876,056 $667,899 $2,424,631 $2,741,870
Jun-19
$489,527
$388,500
$93,013
$2,090,771
$2,584,616
$882,345
$225,823
Jul-19
$318,836
$2,903,452
$469,760
$2,959,412
$2,544,848
$316,973
$92,469
$3,276,385
$884,324
$224,504
JV Partner 5
$870,380
$3,118,959
$318,437
$328,505
$381,438
Sep-19
30-0000005
$225,540
$3,437,396
$92,896
$2,630,017
Oct-19
$939,423
$447,031
$2,480,808
$229,028
$2,804,168
$1,988,416
$323,360
$94,333
Total
$1,807,660
$821,998
$94,022
$228,274
Nov-19
$2,866,986
$84,968
$2,544,691
$322,296
$904,933
$2,610,313
$227,991
$3,195,739
$641,403
$321,896
$2,873,843
Dec-19
$93,906
12 months Average/Month 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
YTD Totals
$2,788,413
$309,170
$3,107,681
$2,252,612
$844,970
$93,139
5,444
$319,268.20
$226,129
2,399
$942.91
$94.25
Average/PEPM
$133.07
$353.69
$129.41
$1,167.19
$38.82
$1,300.26
Lagged Lives
• Clinical reports (Infolock) PEPM Comparison 28,668 65,051 $1,300.26
YTD Total PEPM (based on lagged enrollment)
• Detailed expense (admin., stop- 2018 Total PEPM $1,249.35
2019 vs. 2018 Change
4.1%
$1,392.08
2019 Budget PEPM
loss, medical, pharmacy, dental, • Expense allocation analysis Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 3 2019 Actual vs. Budget -6.6% 6
vision) SAMPLE Claims Trending
Self Funded Medical
Incurred But Not Paid Health Plan Reserve as of
3/31/2020 PEPM Claims by Policy Period Quarter
Benefit 3/31/2020 $900 PEPM Claims 12-Month Average $780 $790 $790
$6,163,200
Medical/Rx
• Global or plan level reporting Margin: 5%: $308,000 $800 $700 $600 $650 $680 $710 $730 $730
$6,471,200
Total
SAMPLE
SAMPLE
Incurred But Not Reported Health Plan Reserve as of Incurred But Not Reported Health Plan Reserve as of $500 $400
3/31/2020
3/31/2020 Month Apr-17 7,478 11,581 11,350 11,419 Incurred Claims Paid to $4,569,418 $4,715,902 $4,560,988 Completion Factor 100.0% 100.0% 100.0% Total Incurred Claims $4,569,418 $4,715,902 $4,560,988 IBNR Estimate $0 $0 $0 $300
Covered Employees
Estimate (Med/Rx)
Covered Members
Date (Med/Rx)
SAMPLE Medical/Rx Historical and Projected IBNR
7,419
• Gross and net of employee $10,000,000 $9,000,000 $8,000,000 Jul-17 7,395 11,307 11,278 11,245 11,292 11,246 11,439 11,358 11,307 $4,630,174 $6,074,250 $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 $4,868,310 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% $4,630,174 $6,074,250 $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 $4,868,310 $0 $0 $0 $0 $0 $0 $0 $0 $200 $100 $0 1Q17 2Q17 3Q17 4Q17 1Q18 $65 2Q18 3Q18 4Q18 1Q19 2Q19 3Q19 4Q19
May-17
7,479
Jun-17
7,366
Aug-17
7,353
Sep-17
Oct-17
7,375
Nov-17
7,347
7,484
Dec-17
7,523
Jan-18
Feb-18
7,498
Apr-18
7,459
May-18
$7,000,000 $6,000,000 Mar-18 7,486 11,308 11,323 11,359 11,406 11,347 11,449 $5,511,525 $5,624,135 $6,007,548 $5,900,727 $5,927,124 $6,031,535 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% $5,511,525 $5,624,267 $6,008,050 $5,901,319 $5,927,899 $6,032,507 $133 $501 $592 $775 $973 $0 PEPM COST VS ACCRUAL
7,474
Jun-18
7,506
7,453
contributions $5,000,000 $4,000,000 Sep-18 7,490 11,403 11,314 11,208 11,360 11,494 11,567 11,581 $5,424,790 $5,553,954 $6,099,789 $5,264,843 $5,622,647 $5,231,368 $5,324,577 100.0% 100.0% 100.0% 100.0% 99.9% 99.9% 99.9% $5,425,876 $5,554,691 $6,101,171 $5,267,119 $5,626,413 $5,237,800 $5,330,019 $1,087 $738 $1,382 $2,276 $3,765 $6,432 $5,442 Cost Accrual
Jul-18
7,520
Aug-18
Oct-18
7,428
Nov-18
7,390
Dec-18
7,484
7,612
Jan-19
Feb-19
7,669
7,657
Mar-19
7,668
May-19
7,652
Jun-19
$3,000,000 Apr-19 7,610 11,519 11,603 11,593 $6,228,629 $5,444,632 $5,801,540 99.9% 99.8% 99.7% $6,235,891 $5,456,161 $5,820,076 $7,262 $11,529 $18,536 $1,000 $900
Jul-19 7,506 11,352 $6,681,959 99.6% $6,711,023 $29,064
$2,000,000 Aug-19 7,497 11,375 11,230 $6,007,219 $5,831,584 99.4% 99.1% $6,043,753 $5,882,077 $36,533 $50,493 $800
Sep-19
7,392
Oct-19 7,379 11,226 11,286 $6,335,851 $5,525,853 98.6% 98.2% $6,428,475 $5,625,509 $92,624 $99,657 $700
Nov-19
7,414
$1,000,000 Dec-19 7,575 11,505 11,520 $5,860,768 $5,153,306 96.8% 94.2% $6,052,870 $5,471,980 $192,102 $318,673 $600
7,680
Jan-20
Feb-20 7,686 11,590 $4,798,904 83.3% $5,758,089 $959,185
$0 Mar-20 7,680 11,560 - $1,725,983 $0 28.5% $6,049,819 $0 $4,323,836 $0 $500
-
-
Total - $194,341,036 $200,504,625 $6,163,589 $400
Estimated Outstanding Medical/Rx Liability at 03/31/20: $6,163,589 $300
Historical IBNR Projected IBNR Estimated Outstanding Medical/Rx Liability at 03/31/20 Including Margin: Margin: 5%: $308,000 $6,471,768 $200
$100
$0
LOCKTON COMPANIES | 1
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Optim Orthopedics — Lockton Beneits Practice overview 24 Lockton Companies
