Page 26 - Vidant Health
P. 26
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)
$843.71
$38,184,500
Total Claims $833.66 3,772 $37,729,657
-$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
Trending Months
Accrual
assumptions take into
Effective Trend
account domestic
chargemaster increases
Trended Claims
annually and changes in
Claim Fluctuation Corridor
Plan Design Adjustment
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
Administration Fees
$1,337,562
$30.07
97%
101%
102%
Stop Loss Fees
$11.13
$495,269
Estimated Rx Claims Savings
$0.00
$0
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
Current Accrual
$901.15
$40,084,594
% Change in Current Accrual
Total Cost
Accrual
Var ($)
3.56%
Jan-19 to Nov-19
$1,500,000
$39,593,962
Actual Cost
$890.12
112,140
$44,000,000
$43,000,000
Jan-18 to Dec-18
$41,500,000
($500,000)
$42,000,000
111,429
Jan-17 to Dec-17
Actual Cost vs. Current Accrual
-$490,632
-1.22%
• 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
Inpatient hospital
$55,724,973
$25,076,238
$30,648,735
Fixed Costs
Total Plan Costs
= Fixed +
Adjustments
Premium)
$2,512,347
$2,798,615
$2,512,347
$141,756
$5,004,311
$2,491,964
$141,228
$5,585,742
$7,879,575
Professional
$140,998
$8,372,206
$28,075,941
$30,423,576
$2,875,265
$2,347,635
$10,450,871
$140,651
$11,156,468
$2,571,296
$141,010
• 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
$13,948,781
$3,329,971
$13,780,842
$2,803,103
June-18
$2,818,647
$2,960,222
$19,845
$11,755,327
$500,576
$2,785,631
July-18
$2,624,883
$738
$2,765,534
Plan Year Ending 12/31/19
$3,383,081
August-18
$2,810,564
$3,525,080
$222,319
$2,650,996
$2,803,528
September-18
$39,661
$2,509,503
$1,574,021
Other
October-18
$2,907,057
$491,274
$3,047,477
$10,576
$1,584,597
$2,414,380
Admin Fee
Specific Stop-
$2,781,392 Total Fixed
$2,761,428
Total
$40,127
November-18
Month/Year
$2,274,797
Total Sub-
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
$942,392
$0
Jan-19
$34,384,213
$33,490,389 $140,822
$82,633,060
Total all services
$33,490,389
$107,634
$33,188
$0
$33,420
$108,437
5,784
$0 Feb-19
3,834
$3,205,023 $141,856
$0
$3,228,417 $141,738
$33,471
5,790
$2,970,669
3,828
$3,205,023
$0 Mar-19
$108,267
$3,111,491
January-19
$2,737,865
February-19
$2,596,009
$6,433,440
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
$259,468
$969,866
$35,037,333 $139,772
$256.95
$37.05
Average/PEPM
Lagged Lives
Current Policy Year To Date
$4,000,000
Current Policy Year Stop Loss Summary
Rolling 12 Months Actual vs Expected (Dec-18 to Nov-19)
(based on lagged enrollment)
• 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
$3,500,000
Rolling Twelve Expected Plan Costs
Large Claims Adjustments
$3,000,000
Expected Plan Costs
Percent of Expected
Percent of Expected
2019 YTD Actual
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
• 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
Stop-Loss
Total
Total
Plan Cost
Claims
Loss
Tax ID
Provider
Premium
Claims ($175k)
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
$3,299,858
Jan-19
5,471
$2,979,824
$226,671
$724,894
$2,254,931
$93,362
$320,033
2,405
$0
Feb-19
$2,146,731
$92,896
$2,923,154
$225,540
$688
$3,241,591
$318,437
$777,111
$2,478,921
$225,446
$318,303
$2,948,190
$92,857
Apr-19
$855,677
$386,407
$3,266,494
$92,819
$2,257,775
$898,619
$318,170
$225,352
$2,934,763
$576,279
$3,252,934
JV Partner 3
May-19
$221,631
30-0000003
Jun-19
• 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
$489,527
$318,836
$2,090,771
$2,584,616
Jul-19
$388,500
$225,823
$2,903,452
$93,013
$882,345
$92,469
$469,760
$2,959,412
$3,276,385
$224,504
$884,324
$2,544,848
$316,973
JV Partner 5
30-0000005
Sep-19
$381,438
$318,437
$3,118,959
$3,437,396
$870,380
$92,896
$2,630,017
$328,505
$225,540
Oct-19
$94,333
$229,028
$323,360
$447,031
$1,988,416
$2,804,168
$2,480,808
$939,423
Total
$228,274
$821,998
$322,296
$2,544,691
$1,807,660
Nov-19
$94,022
$84,968
$2,866,986
$227,991
Dec-19
$321,896
$93,906
$2,610,313
$2,873,843
$641,403
$904,933
$3,195,739
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
$309,170
$2,252,612
$2,788,413
$3,107,681
$844,970
$93,139
$226,129
5,444
2,399
$319,268.20
$353.69
$942.91
$94.25
$38.82
$133.07
$129.41
$1,167.19
Average/PEPM
$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
4.1%
2019 vs. 2018 Change
2019 Budget PEPM
$1,392.08
loss, medical, pharmacy, dental, • Expense allocation analysis Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 3 2019 Actual vs. Budget -6.6% 6
vision) • COVID-19 projections and SAMPLE Claims Trending
Self Funded Medical
Incurred But Not Paid Health Plan Reserve as of
3/31/2020 3/31/2020 PEPM Claims by Policy Period Quarter PEPM Claims 12-Month Average
Benefit
• Global or plan level reporting reporting Medical/Rx Total $6,163,200 $900 $800 $700 $600 $650 $680 $710 $730 $780 $730 $790 $790
$308,000
Margin: 5%:
$6,471,200
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
Date (Med/Rx)
Covered Members
Estimate (Med/Rx)
Covered Employees
SAMPLE Medical/Rx Historical and Projected IBNR
7,419
May-17
• 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
7,479
Jun-17
7,366
Aug-17
7,353
Sep-17
Oct-17
7,375
7,347
Nov-17
7,484
Dec-17
7,523
Jan-18
7,498
Feb-18
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
7,506
Jun-18
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
7,453
Aug-18
7,520
Oct-18
7,428
Nov-18
7,390
Dec-18
7,484
7,612
Jan-19
Feb-19
7,669
7,657
Mar-19
May-19
7,668
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
Sep-19
$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
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
7,414
Nov-19
$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
Jan-20
7,680
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
Vidant Health — Lockton Total Rewards Practice overview 26 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)
$843.71
$38,184,500
Total Claims $833.66 3,772 $37,729,657
-$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
Trending Months
Accrual
assumptions take into
Effective Trend
account domestic
chargemaster increases
Trended Claims
annually and changes in
Claim Fluctuation Corridor
Plan Design Adjustment
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
Administration Fees
$1,337,562
$30.07
97%
101%
102%
Stop Loss Fees
$11.13
$495,269
Estimated Rx Claims Savings
$0.00
$0
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
Current Accrual
$901.15
$40,084,594
% Change in Current Accrual
Total Cost
Accrual
Var ($)
3.56%
Jan-19 to Nov-19
$1,500,000
$39,593,962
Actual Cost
$890.12
112,140
$44,000,000
$43,000,000
Jan-18 to Dec-18
$41,500,000
($500,000)
$42,000,000
111,429
Jan-17 to Dec-17
Actual Cost vs. Current Accrual
-$490,632
-1.22%
• 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
Inpatient hospital
$55,724,973
$25,076,238
$30,648,735
Fixed Costs
Total Plan Costs
= Fixed +
Adjustments
Premium)
$2,512,347
$2,798,615
$2,512,347
$141,756
$5,004,311
$2,491,964
$141,228
$5,585,742
$7,879,575
Professional
$140,998
$8,372,206
$28,075,941
$30,423,576
$2,875,265
$2,347,635
$10,450,871
$140,651
$11,156,468
$2,571,296
$141,010
• 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
$13,948,781
$3,329,971
$13,780,842
$2,803,103
June-18
$2,818,647
$2,960,222
$19,845
$11,755,327
$500,576
$2,785,631
July-18
$2,624,883
$738
$2,765,534
Plan Year Ending 12/31/19
$3,383,081
August-18
$2,810,564
$3,525,080
$222,319
$2,650,996
$2,803,528
September-18
$39,661
$2,509,503
$1,574,021
Other
October-18
$2,907,057
$491,274
$3,047,477
$10,576
$1,584,597
$2,414,380
Admin Fee
Specific Stop-
$2,781,392 Total Fixed
$2,761,428
Total
$40,127
November-18
Month/Year
$2,274,797
Total Sub-
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
$942,392
$0
Jan-19
$34,384,213
$33,490,389 $140,822
$82,633,060
Total all services
$33,490,389
$107,634
$33,188
$0
$33,420
$108,437
5,784
$0 Feb-19
3,834
$3,205,023 $141,856
$0
$3,228,417 $141,738
$33,471
5,790
$2,970,669
3,828
$3,205,023
$0 Mar-19
$108,267
$3,111,491
January-19
$2,737,865
February-19
$2,596,009
$6,433,440
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
$259,468
$969,866
$35,037,333 $139,772
$256.95
$37.05
Average/PEPM
Lagged Lives
Current Policy Year To Date
$4,000,000
Current Policy Year Stop Loss Summary
Rolling 12 Months Actual vs Expected (Dec-18 to Nov-19)
(based on lagged enrollment)
• 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
$3,500,000
Rolling Twelve Expected Plan Costs
Large Claims Adjustments
$3,000,000
Expected Plan Costs
Percent of Expected
Percent of Expected
2019 YTD Actual
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
• 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
Stop-Loss
Total
Total
Plan Cost
Claims
Loss
Tax ID
Provider
Premium
Claims ($175k)
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
$3,299,858
Jan-19
5,471
$2,979,824
$226,671
$724,894
$2,254,931
$93,362
$320,033
2,405
$0
Feb-19
$2,146,731
$92,896
$2,923,154
$225,540
$688
$3,241,591
$318,437
$777,111
$2,478,921
$225,446
$318,303
$2,948,190
$92,857
Apr-19
$855,677
$386,407
$3,266,494
$92,819
$2,257,775
$898,619
$318,170
$225,352
$2,934,763
$576,279
$3,252,934
JV Partner 3
May-19
$221,631
30-0000003
Jun-19
• 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
$489,527
$318,836
$2,090,771
$2,584,616
Jul-19
$388,500
$225,823
$2,903,452
$93,013
$882,345
$92,469
$469,760
$2,959,412
$3,276,385
$224,504
$884,324
$2,544,848
$316,973
JV Partner 5
30-0000005
Sep-19
$381,438
$318,437
$3,118,959
$3,437,396
$870,380
$92,896
$2,630,017
$328,505
$225,540
Oct-19
$94,333
$229,028
$323,360
$447,031
$1,988,416
$2,804,168
$2,480,808
$939,423
Total
$228,274
$821,998
$322,296
$2,544,691
$1,807,660
Nov-19
$94,022
$84,968
$2,866,986
$227,991
Dec-19
$321,896
$93,906
$2,610,313
$2,873,843
$641,403
$904,933
$3,195,739
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
$309,170
$2,252,612
$2,788,413
$3,107,681
$844,970
$93,139
$226,129
5,444
2,399
$319,268.20
$353.69
$942.91
$94.25
$38.82
$133.07
$129.41
$1,167.19
Average/PEPM
$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
4.1%
2019 vs. 2018 Change
2019 Budget PEPM
$1,392.08
loss, medical, pharmacy, dental, • Expense allocation analysis Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 3 2019 Actual vs. Budget -6.6% 6
vision) • COVID-19 projections and SAMPLE Claims Trending
Self Funded Medical
Incurred But Not Paid Health Plan Reserve as of
3/31/2020 3/31/2020 PEPM Claims by Policy Period Quarter PEPM Claims 12-Month Average
Benefit
• Global or plan level reporting reporting Medical/Rx Total $6,163,200 $900 $800 $700 $600 $650 $680 $710 $730 $780 $730 $790 $790
$308,000
Margin: 5%:
$6,471,200
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
Date (Med/Rx)
Covered Members
Estimate (Med/Rx)
Covered Employees
SAMPLE Medical/Rx Historical and Projected IBNR
7,419
May-17
• 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
7,479
Jun-17
7,366
Aug-17
7,353
Sep-17
Oct-17
7,375
7,347
Nov-17
7,484
Dec-17
7,523
Jan-18
7,498
Feb-18
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
7,506
Jun-18
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
7,453
Aug-18
7,520
Oct-18
7,428
Nov-18
7,390
Dec-18
7,484
7,612
Jan-19
Feb-19
7,669
7,657
Mar-19
May-19
7,668
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
Sep-19
$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
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
7,414
Nov-19
$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
Jan-20
7,680
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
Vidant Health — Lockton Total Rewards Practice overview 26 Lockton Companies
