Page 24 - Lockton Total Rewards Practice
P. 24
Measure
Financial reporting | underwriting and Cost vs. Accrual Sample Monthly Medical/Rx Projection
12-Month Renewal Projection
Total Cost vs Expected Accrual
Self Funded Medical - Status Quo
analytics $46,500,000 $48,000,000 $44,000,000 $43,000,000 $42,000,000 $41,500,000 Projected Lives (Nov-19) $833.66 Total Medical $37,729,657
Total
PEPM
3,707
Experience (Dec-18 - Nov-19)
Average Lagged Lives (1 Month)
3,772
$38,184,500
Total Claims
$843.71
-$454,843
ISL Adjustments
-$10.05
Claims Net ISL Adjustments
Total Cost
Trending Months
Accrual Annual Trend 7.0% 7.0% 14 Note: Trend
assumptions take into
Effective Trend
account domestic
Trended Claims $892.01 $40,370,733 chargemaster increases
annually and changes in
Claim Fluctuation Corridor 0.0%
Plan Design Adjustment
Projected Claims $892.01 1.0000 $40,370,733 domestic drug pricing
$30.07
$1,337,562
Extensive and Additional reports Total Medical Summary 97% Lives Jan-18 to Dec-18 Accrual Jan-17 to Dec-17 % Administration Fees $933.22 $42,203,564
102%
101%
$495,269
Stop Loss Fees
$11.13
$0
$0.00
Estimated Rx Claims Savings
Jan-19 to Nov-19
Projected Cost
Current Accrual
$40,084,594
$901.15
Total Cost
% Change in Current Accrual
3.56%
Var ($)
$1,500,000
customizable inancial include Jan-19 to Nov-19 103,819 $46,500,000 $48,000,000 ($1,000,000) 102% 101% 97% 14 Actual Cost $890.12 $39,593,962 4
112,140
$44,000,000
Jan-18 to Dec-18
$43,000,000
$42,000,000
Jan-17 to Dec-17
111,429
($500,000)
$41,500,000
-$490,632
Actual Cost vs. Current Accrual
-1.22%
reporting capabilities • Utilization reports Domestic vs. non-domestic utilization Monthly Financial Reporting Sample
• Cash & Accrual (C&A) reports • Domestic leakage Service type 2019 domestic 2019 non-domestic 2019 total % domestic 45.0% % non-domestic 55.0% Sample Client Medical /Rx (Monthly) (Cumulative)
2019 domestic vs non-domestic
Jan 2019-Dec 2019
Medical and Rx Cash Flow Summary - (By Month Paid)
Claim Payments are Valued as of:
I.
November 30, 2019
$55,724,973
$25,076,238
Inpatient hospital
$30,648,735
Total Plan Costs
Total Paid Net
— Finance/HR executive • Non-domestic utilization Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.0% 7.7% 4.3% 35.0% 92.3% 95.7% IIa. January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 Month Paid Enrolled Subscribers 3,762 3,749 3,743 3,730 3,737 3,753 3,726 3,760 3,745 (ASO and Stop Loss $2,408,184 $2,350,989 $2,734,267 $2,430,645 $3,188,961 $2,838,492 $2,625,621 $3,605,400 $2,549,164 Paid Claims Large Claims $37,593 $253 Sample Self Funded Claim Report - Medical Total Plan Costs Claims Expected Plan Costs 2
Fixed Costs
Expected Plan
Costs 2
= Fixed +
Claims
Adjustments
1
= Fixed + Claims
Premium)
$2,798,615
$2,512,347
$2,798,615
$141,756
$2,512,347
$2,370,591
$5,585,742
$141,228
$5,004,311
$2,491,964
$2,787,127
$2,350,736
$7,879,575
$28,075,941
$2,875,265
$30,423,576
$0
Professional
$2,347,635
$2,786,464
$140,998
$8,372,206
$2,734,267
$0
$11,156,468
$2,784,263
$10,450,871
$2,430,645
$140,651
$2,571,296
$2,792,313
$3,329,971
$13,948,781
$141,010
$3,188,961
$13,780,842
$0
$19,845
$16,751,884
$2,818,647
$2,803,103
$16,741,064
$141,575
$2,960,222
$11,254,751
$11,755,327
$500,576
Pharmacy
$140,651
Plan Year Ending 12/31/19
$19,506,597
$2,785,631
$19,537,515
$2,765,534
$2,624,883
$738
$141,999
$3,383,081
$22,348,079
$3,525,080
$222,319
$23,031,678
$2,810,564
$141,493
$2,509,503
$25,682,674
$2,650,996
$25,151,607
$39,661
$2,803,528
October-18
dashboards Other Total all services $48,511,448 $82,633,060 $131,144,508 37.0% 0.7% 63.0% 99.3% IIb. Cumulative (1/1/2018-18) 3,714 3,695 3,742 44,856 3,806 3,834 3,828 $140,420 $139,583 $141,357 $1,692,721 $140,822 $141,856 $141,738 $3,398,331 $2,314,924 $3,188,907 $33,633,884 $2,970,669 $2,596,009 $2,723,194 $491,274 $40,127 $90,583 $942,392 Month/Year $0 Feb-19 $0 Mar-19 $0 Apr-19 Jan-19 $32,691,492 $2,907,057 Total Sub- $2,274,797 $3,098,325 $2,970,669 $2,596,009 $2,723,194 scribers 3,806 3,834 3,828 3,805 3,834 Members Total 5,747
$1,574,021
$10,576
$1,584,597
November-18
$2,781,392 Total Fixed
$2,761,428
Loss Premium
Claims
$2,795,963
$33,490,389
($450k)
December-18
$0
$33,490,389
$0
$3,205,023 $141,856
$3,228,417 $141,738
$0
$3,205,023
January-19
$6,433,440
analytics April-19 May-19 June-19 July-19 August-19 September-19 October-19 November-19 3,805 3,834 3,826 3,753 3,748 3,696 3,690 3,707 $140,848 $141,863 $141,598 $138,911 $138,830 $136,895 $136,718 $137,415 $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 May-19 $0 Jun-19 $0 Oct-19 No Dec-19 $2,773,443 $3,604,519 $2,576,501 $2,954,176 $3,323,418 $2,730,685 $3,142,859 $3,077,777 3,826 3,753 3,748 3,696 3,
February-19
$9,665,364
$3,231,924 $140,848
$0
March-19
$0
$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
• Budget vs. claim reports III. Cumulative (1/1/2019-19) 41,528 $1,537,496 $93,126,066 $32,732,717 IV. Actual Plan Cost Average/Month (Paid Basis) $32,473,249 $34,010,745 41,528 3,775 41,563 62,914 62,951 5,719 $1,174,401 $34,010,745 $106,764 $28.30 V. $363,095 $33,009 $8.72 Ind Stop Loss (ISL) Deductible Per Claimant $24,958,976 $2,268,998 $600.55 -- $7,773,741 $35,037,333 $706,704 $187.07 $500,000 $259,468 $23,588 $6.20 $32,473,249 $2,952,114 $781.29 $23,342,213 $2,122,019 $562.12 $10,668,531 $969,866 $256.95 $34,0
$3,138,444
December-19
YTD Totals
$1,537,496
$35,037,333 $139,772
$259,468
$37.05
Average/PEPM
Current Policy Year To Date
Lagged Lives
$4,000,000
Rolling 12 Months Actual vs Expected (Dec-18 to Nov-19)
Current Policy Year Stop Loss Summary
PEPM Comparison
• Demographic analysis Rolling Twelve Expected Plan Costs $94,583,239 98% Expected Plan Costs $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 Cautiously Optimistic $35,037,333 97% Large Claims Adjustments $259,468 Employee Contributions Sample Net Plan 2019 YTD Actual 96.4% $825 $856 $780 $750
(based on lagged enrollment)
Rolling Twelve Actual Plan Costs
$3,500,000
Percent of Expected
Percent of Expected
2019 YTD Budget
Actual vs. Budget
Cost
2018 Actual
2018 Budget
Total Accrual
• Monthly IBNR analysis Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 2 $500,000 $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 Actual vs. Budget 104.0% 12.6% 6.5% 5
2019 vs. 2018 Actual
2019 vs. 2018 Budget
• Enrollment reports
• Certiied IBNR reports
• Network discounts (domestic Joint venture (JV) partner — sample health system utilization Self Insured Claim Report Sample
Medical/Rx
• Large claim reports and non-domestic) Jan 2019 — December 2019 Month/Year Total Total Admin Fee Specific Stop- Total Fixed Gross Medical Gross Rx Claims Reimbursable Net Paid Claims Total Net
JV Partners
Stop-Loss
Loss
Claims
Provider
Tax ID
Claims
$226,671
5,471
$3,299,858
30-0000001 JV Partner 1 $1,576,428 Jan-19 Subscribers Members $93,362 Premium $320,033 $2,254,931 $724,894 Claims ($175k) $2,979,824 Plan Cost
2,405
$0
$317,239
$703,886
$3,005,297
$2,004,489
$20,317
$2,688,058
$224,692
2,384
$92,547
• Year-over-year (YOY) or rolling • Network disruption 30- 0000002 JV Partner 3 $2,574,313 Mar-19 2,393 2,392 2,391 2,384 2,396 5,424 5,445 5,419 5,406 5,456 $92,896 $225,540 $318,437 $2,146,731 $777,111 $386,407 $2,923,154 $3,241,591
5,423
Feb-19
JV Partner 2
$688
Apr-19
$318,303
$3,266,494
$2,478,921
$225,446
$855,677
$2,948,190
$92,857
$221,631
$2,934,763
$318,170
$3,252,934
May-19
$576,279
$898,619
$2,257,775
$225,352
$92,819
30-0000003
$876,056
$2,741,870
$2,216,474
Jun-19
$667,899
$224,692
$2,424,631
$92,547
$317,239
30-0000004
JV Partner 4
$489,527
$318,836
$2,584,616
$2,090,771
$388,500
$2,903,452
$882,345
$225,823
Jul-19
$93,013
12 months 30-0000005 JV Partner 5 $5,545,052 Aug-19 2,382 2,393 2,430 2,422 2,419 5,421 5,442 5,492 5,468 5,460 $92,469 $224,504 $316,973 $2,544,848 $884,324 $469,760 $2,959,412 $3,276,385
$3,437,396
$3,118,959
$328,505
$381,438
$2,630,017
$225,540
Sep-19
$318,437
$870,380
$92,896
$1,988,416
$2,480,808
Oct-19
$323,360
$447,031
$939,423
$229,028
$2,804,168
$94,333
Total
$1,807,660
$94,022
$84,968
$2,544,691
$2,866,986
$821,998
$322,296
Nov-19
$228,274
$227,991
$641,403
Dec-19
$93,906
$2,873,843
$904,933
$321,896
• Plan design modeling 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
$3,195,739
$2,610,313
YTD Totals
$3,107,681
5,444
2,399
$844,970
$2,788,413
$93,139
$2,252,612
$309,170
$226,129
$319,268.20
Average/PEPM
• Detailed expense (admin., stop- • Contribution analysis PEPM Comparison 28,668 65,051 $38.82 $94.25 $133.07 $942.91 $353.69 $129.41 $1,167.19 $1,300.26
Lagged Lives
YTD Total PEPM (based on lagged enrollment)
$1,300.26
2018 Total PEPM
$1,249.35
loss, medical, pharmacy, dental, Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 3 2019 vs. 2018 Change $1,392.08 6
4.1%
2019 Budget PEPM
-6.6%
2019 Actual vs. Budget
vision) • Clinical reports (Infolock)
Claims Trending
Self Funded Medical
SAMPLE
• Global or plan level reporting • Expense allocation analysis Benefit Incurred But Not Paid Health Plan Reserve as of 3/31/2020 PEPM Claims by Policy Period Quarter PEPM Claims 12-Month Average
3/31/2020
Medical/Rx
Margin: 5%: $6,163,200 $900 $800 $680 $710 $730 $780 $730 $790 $790
$308,000
Total $6,471,200 $700 $650
$600 $500
• Gross and net of employee SAMPLE Medical/Rx Historical and Projected IBNR Month Apr-17 7,478 11,581 11,350 Incurred Claims Paid to 3/31/2020 $4,569,418 $4,715,902 Completion Factor 100.0% 100.0% Total Incurred Claims $4,569,418 $4,715,902 IBNR Estimate $0 $0 $400 $300
SAMPLE
SAMPLE
Incurred But Not Reported Health Plan Reserve as of
Incurred But Not Reported Health Plan Reserve as of
3/31/2020
Covered Members
Covered Employees
Estimate (Med/Rx)
Date (Med/Rx)
7,419
May-17
Jun-17
$10,000,000
7,395
Jul-17
7,366
Aug-17 7,479 11,419 11,307 11,278 $4,560,988 $4,630,174 $6,074,250 100.0% 100.0% 100.0% $4,560,988 $4,630,174 $6,074,250 $0 $0 $0 $200 $65
7,375
$9,000,000 Sep-17 7,353 11,245 11,292 11,246 11,439 11,358 $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 100.0% 100.0% 100.0% 100.0% 100.0% $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 $0 $0 $0 $0 $0 $100 $0
Oct-17
Nov-17
7,347
contributions $8,000,000 $7,000,000 $6,000,000 Feb-18 7,498 11,307 11,308 11,323 11,359 11,406 11,347 11,449 $4,868,310 $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% 100.0% $4,868,310 $5,511,525 $5,624,267 $6,008,050 $5,901,319 $5,927,899 $6,032,507 $133 $501 $592 $775 $973 $0 $0 PEPM COST VS ACCRUAL 1Q17 2Q17 3Q17 4Q17 1Q18 2Q18 3Q18 4Q18 1Q19 2Q19 3Q19 4Q19
7,484
Dec-17
Jan-18
7,523
7,486
Mar-18
Apr-18
7,459
7,474
May-18
Jun-18
7,506
Jul-18
7,453
7,520
Aug-18
Oct-18
7,428
$5,000,000 Sep-18 7,490 11,403 11,314 11,208 11,360 $5,424,790 $5,553,954 $6,099,789 $5,264,843 100.0% 100.0% 100.0% 100.0% $5,425,876 $5,554,691 $6,101,171 $5,267,119 $1,087 $738 $1,382 $2,276 Cost Accrual
7,390
Nov-18
7,484
Dec-18
Jan-19 7,612 11,494 $5,622,647 99.9% $5,626,413 $3,765
Mar-19
$4,000,000 Feb-19 7,669 11,567 11,581 $5,231,368 $5,324,577 99.9% 99.9% $5,237,800 $5,330,019 $6,432 $5,442
7,657
Apr-19 7,610 11,519 $6,228,629 99.9% $6,235,891 $7,262 $1,000
7,652
Jun-19
$3,000,000 May-19 7,668 11,603 11,593 $5,444,632 $5,801,540 99.8% 99.7% $5,456,161 $5,820,076 $11,529 $18,536 $900
Jul-19 7,506 11,352 $6,681,959 99.6% $6,711,023 $29,064
Sep-19
7,392
$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
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
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
Overview — Lockton Total Rewards Practice 24 Lockton Companies
Financial reporting | underwriting and Cost vs. Accrual Sample Monthly Medical/Rx Projection
12-Month Renewal Projection
Total Cost vs Expected Accrual
Self Funded Medical - Status Quo
analytics $46,500,000 $48,000,000 $44,000,000 $43,000,000 $42,000,000 $41,500,000 Projected Lives (Nov-19) $833.66 Total Medical $37,729,657
Total
PEPM
3,707
Experience (Dec-18 - Nov-19)
Average Lagged Lives (1 Month)
3,772
$38,184,500
Total Claims
$843.71
-$454,843
ISL Adjustments
-$10.05
Claims Net ISL Adjustments
Total Cost
Trending Months
Accrual Annual Trend 7.0% 7.0% 14 Note: Trend
assumptions take into
Effective Trend
account domestic
Trended Claims $892.01 $40,370,733 chargemaster increases
annually and changes in
Claim Fluctuation Corridor 0.0%
Plan Design Adjustment
Projected Claims $892.01 1.0000 $40,370,733 domestic drug pricing
$30.07
$1,337,562
Extensive and Additional reports Total Medical Summary 97% Lives Jan-18 to Dec-18 Accrual Jan-17 to Dec-17 % Administration Fees $933.22 $42,203,564
102%
101%
$495,269
Stop Loss Fees
$11.13
$0
$0.00
Estimated Rx Claims Savings
Jan-19 to Nov-19
Projected Cost
Current Accrual
$40,084,594
$901.15
Total Cost
% Change in Current Accrual
3.56%
Var ($)
$1,500,000
customizable inancial include Jan-19 to Nov-19 103,819 $46,500,000 $48,000,000 ($1,000,000) 102% 101% 97% 14 Actual Cost $890.12 $39,593,962 4
112,140
$44,000,000
Jan-18 to Dec-18
$43,000,000
$42,000,000
Jan-17 to Dec-17
111,429
($500,000)
$41,500,000
-$490,632
Actual Cost vs. Current Accrual
-1.22%
reporting capabilities • Utilization reports Domestic vs. non-domestic utilization Monthly Financial Reporting Sample
• Cash & Accrual (C&A) reports • Domestic leakage Service type 2019 domestic 2019 non-domestic 2019 total % domestic 45.0% % non-domestic 55.0% Sample Client Medical /Rx (Monthly) (Cumulative)
2019 domestic vs non-domestic
Jan 2019-Dec 2019
Medical and Rx Cash Flow Summary - (By Month Paid)
Claim Payments are Valued as of:
I.
November 30, 2019
$55,724,973
$25,076,238
Inpatient hospital
$30,648,735
Total Plan Costs
Total Paid Net
— Finance/HR executive • Non-domestic utilization Outpatient hospital $20,576,423 $11,079,612 $31,656,035 65.0% 7.7% 4.3% 35.0% 92.3% 95.7% IIa. January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 Month Paid Enrolled Subscribers 3,762 3,749 3,743 3,730 3,737 3,753 3,726 3,760 3,745 (ASO and Stop Loss $2,408,184 $2,350,989 $2,734,267 $2,430,645 $3,188,961 $2,838,492 $2,625,621 $3,605,400 $2,549,164 Paid Claims Large Claims $37,593 $253 Sample Self Funded Claim Report - Medical Total Plan Costs Claims Expected Plan Costs 2
Fixed Costs
Expected Plan
Costs 2
= Fixed +
Claims
Adjustments
1
= Fixed + Claims
Premium)
$2,798,615
$2,512,347
$2,798,615
$141,756
$2,512,347
$2,370,591
$5,585,742
$141,228
$5,004,311
$2,491,964
$2,787,127
$2,350,736
$7,879,575
$28,075,941
$2,875,265
$30,423,576
$0
Professional
$2,347,635
$2,786,464
$140,998
$8,372,206
$2,734,267
$0
$11,156,468
$2,784,263
$10,450,871
$2,430,645
$140,651
$2,571,296
$2,792,313
$3,329,971
$13,948,781
$141,010
$3,188,961
$13,780,842
$0
$19,845
$16,751,884
$2,818,647
$2,803,103
$16,741,064
$141,575
$2,960,222
$11,254,751
$11,755,327
$500,576
Pharmacy
$140,651
Plan Year Ending 12/31/19
$19,506,597
$2,785,631
$19,537,515
$2,765,534
$2,624,883
$738
$141,999
$3,383,081
$22,348,079
$3,525,080
$222,319
$23,031,678
$2,810,564
$141,493
$2,509,503
$25,682,674
$2,650,996
$25,151,607
$39,661
$2,803,528
October-18
dashboards Other Total all services $48,511,448 $82,633,060 $131,144,508 37.0% 0.7% 63.0% 99.3% IIb. Cumulative (1/1/2018-18) 3,714 3,695 3,742 44,856 3,806 3,834 3,828 $140,420 $139,583 $141,357 $1,692,721 $140,822 $141,856 $141,738 $3,398,331 $2,314,924 $3,188,907 $33,633,884 $2,970,669 $2,596,009 $2,723,194 $491,274 $40,127 $90,583 $942,392 Month/Year $0 Feb-19 $0 Mar-19 $0 Apr-19 Jan-19 $32,691,492 $2,907,057 Total Sub- $2,274,797 $3,098,325 $2,970,669 $2,596,009 $2,723,194 scribers 3,806 3,834 3,828 3,805 3,834 Members Total 5,747
$1,574,021
$10,576
$1,584,597
November-18
$2,781,392 Total Fixed
$2,761,428
Loss Premium
Claims
$2,795,963
$33,490,389
($450k)
December-18
$0
$33,490,389
$0
$3,205,023 $141,856
$3,228,417 $141,738
$0
$3,205,023
January-19
$6,433,440
analytics April-19 May-19 June-19 July-19 August-19 September-19 October-19 November-19 3,805 3,834 3,826 3,753 3,748 3,696 3,690 3,707 $140,848 $141,863 $141,598 $138,911 $138,830 $136,895 $136,718 $137,415 $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 May-19 $0 Jun-19 $0 Oct-19 No Dec-19 $2,773,443 $3,604,519 $2,576,501 $2,954,176 $3,323,418 $2,730,685 $3,142,859 $3,077,777 3,826 3,753 3,748 3,696 3,
February-19
$9,665,364
$3,231,924 $140,848
$0
March-19
$0
$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
• Budget vs. claim reports III. Cumulative (1/1/2019-19) 41,528 $1,537,496 $93,126,066 $32,732,717 IV. Actual Plan Cost Average/Month (Paid Basis) $32,473,249 $34,010,745 41,528 3,775 41,563 62,914 62,951 5,719 $1,174,401 $34,010,745 $106,764 $28.30 V. $363,095 $33,009 $8.72 Ind Stop Loss (ISL) Deductible Per Claimant $24,958,976 $2,268,998 $600.55 -- $7,773,741 $35,037,333 $706,704 $187.07 $500,000 $259,468 $23,588 $6.20 $32,473,249 $2,952,114 $781.29 $23,342,213 $2,122,019 $562.12 $10,668,531 $969,866 $256.95 $34,0
$3,138,444
December-19
YTD Totals
$1,537,496
$35,037,333 $139,772
$259,468
$37.05
Average/PEPM
Current Policy Year To Date
Lagged Lives
$4,000,000
Rolling 12 Months Actual vs Expected (Dec-18 to Nov-19)
Current Policy Year Stop Loss Summary
PEPM Comparison
• Demographic analysis Rolling Twelve Expected Plan Costs $94,583,239 98% Expected Plan Costs $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 Cautiously Optimistic $35,037,333 97% Large Claims Adjustments $259,468 Employee Contributions Sample Net Plan 2019 YTD Actual 96.4% $825 $856 $780 $750
(based on lagged enrollment)
Rolling Twelve Actual Plan Costs
$3,500,000
Percent of Expected
Percent of Expected
2019 YTD Budget
Actual vs. Budget
Cost
2018 Actual
2018 Budget
Total Accrual
• Monthly IBNR analysis Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 2 $500,000 $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 Actual vs. Budget 104.0% 12.6% 6.5% 5
2019 vs. 2018 Actual
2019 vs. 2018 Budget
• Enrollment reports
• Certiied IBNR reports
• Network discounts (domestic Joint venture (JV) partner — sample health system utilization Self Insured Claim Report Sample
Medical/Rx
• Large claim reports and non-domestic) Jan 2019 — December 2019 Month/Year Total Total Admin Fee Specific Stop- Total Fixed Gross Medical Gross Rx Claims Reimbursable Net Paid Claims Total Net
JV Partners
Stop-Loss
Loss
Claims
Provider
Tax ID
Claims
$226,671
5,471
$3,299,858
30-0000001 JV Partner 1 $1,576,428 Jan-19 Subscribers Members $93,362 Premium $320,033 $2,254,931 $724,894 Claims ($175k) $2,979,824 Plan Cost
2,405
$0
$317,239
$703,886
$3,005,297
$2,004,489
$20,317
$2,688,058
$224,692
2,384
$92,547
• Year-over-year (YOY) or rolling • Network disruption 30- 0000002 JV Partner 3 $2,574,313 Mar-19 2,393 2,392 2,391 2,384 2,396 5,424 5,445 5,419 5,406 5,456 $92,896 $225,540 $318,437 $2,146,731 $777,111 $386,407 $2,923,154 $3,241,591
5,423
Feb-19
JV Partner 2
$688
Apr-19
$318,303
$3,266,494
$2,478,921
$225,446
$855,677
$2,948,190
$92,857
$221,631
$2,934,763
$318,170
$3,252,934
May-19
$576,279
$898,619
$2,257,775
$225,352
$92,819
30-0000003
$876,056
$2,741,870
$2,216,474
Jun-19
$667,899
$224,692
$2,424,631
$92,547
$317,239
30-0000004
JV Partner 4
$489,527
$318,836
$2,584,616
$2,090,771
$388,500
$2,903,452
$882,345
$225,823
Jul-19
$93,013
12 months 30-0000005 JV Partner 5 $5,545,052 Aug-19 2,382 2,393 2,430 2,422 2,419 5,421 5,442 5,492 5,468 5,460 $92,469 $224,504 $316,973 $2,544,848 $884,324 $469,760 $2,959,412 $3,276,385
$3,437,396
$3,118,959
$328,505
$381,438
$2,630,017
$225,540
Sep-19
$318,437
$870,380
$92,896
$1,988,416
$2,480,808
Oct-19
$323,360
$447,031
$939,423
$229,028
$2,804,168
$94,333
Total
$1,807,660
$94,022
$84,968
$2,544,691
$2,866,986
$821,998
$322,296
Nov-19
$228,274
$227,991
$641,403
Dec-19
$93,906
$2,873,843
$904,933
$321,896
• Plan design modeling 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
$3,195,739
$2,610,313
YTD Totals
$3,107,681
5,444
2,399
$844,970
$2,788,413
$93,139
$2,252,612
$309,170
$226,129
$319,268.20
Average/PEPM
• Detailed expense (admin., stop- • Contribution analysis PEPM Comparison 28,668 65,051 $38.82 $94.25 $133.07 $942.91 $353.69 $129.41 $1,167.19 $1,300.26
Lagged Lives
YTD Total PEPM (based on lagged enrollment)
$1,300.26
2018 Total PEPM
$1,249.35
loss, medical, pharmacy, dental, Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 3 2019 vs. 2018 Change $1,392.08 6
4.1%
2019 Budget PEPM
-6.6%
2019 Actual vs. Budget
vision) • Clinical reports (Infolock)
Claims Trending
Self Funded Medical
SAMPLE
• Global or plan level reporting • Expense allocation analysis Benefit Incurred But Not Paid Health Plan Reserve as of 3/31/2020 PEPM Claims by Policy Period Quarter PEPM Claims 12-Month Average
3/31/2020
Medical/Rx
Margin: 5%: $6,163,200 $900 $800 $680 $710 $730 $780 $730 $790 $790
$308,000
Total $6,471,200 $700 $650
$600 $500
• Gross and net of employee SAMPLE Medical/Rx Historical and Projected IBNR Month Apr-17 7,478 11,581 11,350 Incurred Claims Paid to 3/31/2020 $4,569,418 $4,715,902 Completion Factor 100.0% 100.0% Total Incurred Claims $4,569,418 $4,715,902 IBNR Estimate $0 $0 $400 $300
SAMPLE
SAMPLE
Incurred But Not Reported Health Plan Reserve as of
Incurred But Not Reported Health Plan Reserve as of
3/31/2020
Covered Members
Covered Employees
Estimate (Med/Rx)
Date (Med/Rx)
7,419
May-17
Jun-17
$10,000,000
7,395
Jul-17
7,366
Aug-17 7,479 11,419 11,307 11,278 $4,560,988 $4,630,174 $6,074,250 100.0% 100.0% 100.0% $4,560,988 $4,630,174 $6,074,250 $0 $0 $0 $200 $65
7,375
$9,000,000 Sep-17 7,353 11,245 11,292 11,246 11,439 11,358 $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 100.0% 100.0% 100.0% 100.0% 100.0% $5,582,412 $5,623,838 $4,794,087 $5,246,241 $4,754,629 $0 $0 $0 $0 $0 $100 $0
Oct-17
Nov-17
7,347
contributions $8,000,000 $7,000,000 $6,000,000 Feb-18 7,498 11,307 11,308 11,323 11,359 11,406 11,347 11,449 $4,868,310 $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% 100.0% $4,868,310 $5,511,525 $5,624,267 $6,008,050 $5,901,319 $5,927,899 $6,032,507 $133 $501 $592 $775 $973 $0 $0 PEPM COST VS ACCRUAL 1Q17 2Q17 3Q17 4Q17 1Q18 2Q18 3Q18 4Q18 1Q19 2Q19 3Q19 4Q19
7,484
Dec-17
Jan-18
7,523
7,486
Mar-18
Apr-18
7,459
7,474
May-18
Jun-18
7,506
Jul-18
7,453
7,520
Aug-18
Oct-18
7,428
$5,000,000 Sep-18 7,490 11,403 11,314 11,208 11,360 $5,424,790 $5,553,954 $6,099,789 $5,264,843 100.0% 100.0% 100.0% 100.0% $5,425,876 $5,554,691 $6,101,171 $5,267,119 $1,087 $738 $1,382 $2,276 Cost Accrual
7,390
Nov-18
7,484
Dec-18
Jan-19 7,612 11,494 $5,622,647 99.9% $5,626,413 $3,765
Mar-19
$4,000,000 Feb-19 7,669 11,567 11,581 $5,231,368 $5,324,577 99.9% 99.9% $5,237,800 $5,330,019 $6,432 $5,442
7,657
Apr-19 7,610 11,519 $6,228,629 99.9% $6,235,891 $7,262 $1,000
7,652
Jun-19
$3,000,000 May-19 7,668 11,603 11,593 $5,444,632 $5,801,540 99.8% 99.7% $5,456,161 $5,820,076 $11,529 $18,536 $900
Jul-19 7,506 11,352 $6,681,959 99.6% $6,711,023 $29,064
Sep-19
7,392
$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
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
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
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Overview — Lockton Total Rewards Practice 24 Lockton Companies
