Page 24 - Lockton Total Rewards Practice
P. 24
Financial reporting
Financial reporting Financial reporting Additional reports include: Monthly Medical/Rx Projection
Extensive and customizable financial reporting
12-Month Renewal Projection
˗ Utilization reports
capabilities
Self Funded Medical - Status Quo
˗ Cash & Accrual (C&A) Reports — Finance/HR executive
dashboards
˗ Non-domestic utilization analytics
˗ Demographic analysis
˗ Domestic Steerage and JV utilization ˗ Domestic leakage Projected Lives (Nov-19) PEPM Total Medical Total
3,707
˗ Budget vs. claim reports ˗ Enrollment reports
˗ Certified IBNR reports ˗ Network discounts (Domestic and Experience (Dec-18 - Nov-19) 3,772
Average Lagged Lives (1 Month)
Non-Domestic)
$38,184,500
˗ Large claim reports ˗ Network disruption Total Claims $833.66 $37,729,657
$843.71
-$10.05
-$454,843
ISL Adjustments
˗ Year over Year (YOY) or rolling 12 months
Claims Net ISL Adjustments
Extensive and Additional reports ˗ Detailed expense (admin., stop-loss, medical, pharmacy, ˗ Contribution analysis Annual Trend $892.01 7.0% 7.0% 0.0% 14 $40,370,733 Note: Trend
˗ Plan design modeling
dental, vision)
assumptions take into
Trending Months
˗ Global or plan level reporting
˗ Clinical reports (InfoLock)
Effective Trend
account domestic
˗ Gross and net of employee contributions
chargemaster increases
Trended Claims
annually and changes in
Claim Fluctuation Corridor
Plan Design Adjustment
customizable inancial include Projected Claims $892.01 1.0000 $40,370,733 domestic drug pricing
$1,337,562
Administration Fees
$30.07
$11.13
Stop Loss Fees
$495,269
$0.00
$0
Estimated Rx Claims Savings
reporting capabilities • Utilization reports Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 1 Projected Cost $933.22 $42,203,564 4
Current Accrual
$40,084,594
$901.15
3.56%
% Change in Current Accrual
$890.12
Actual Cost
$39,593,962
-$490,632
-1.22%
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.
November 30, 2019
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
$25,076,238
$55,724,973
$30,648,735
Inpatient hospital
Total Plan Costs
Fixed Costs
Adjustments
= Fixed +
Premium)
$141,756
$2,512,347
$2,512,347
$2,798,615
$2,491,964
$141,228
$5,585,742
$5,004,311
$2,875,265
$8,372,206
$30,423,576
$7,879,575
$2,347,635
$28,075,941
Professional
$140,998
$140,651
$2,571,296
$11,156,468
$10,450,871
• 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
$13,780,842
$3,329,971
$141,010
$2,803,103
June-18
$19,845
$2,818,647
$2,960,222
$11,755,327
$500,576
$2,765,534
$738
$2,624,883
$2,785,631
July-18
Plan Year Ending 12/31/19
August-18
$3,525,080
$2,810,564
$222,319
$3,383,081
$39,661
$2,509,503
September-18
$2,650,996
$2,803,528
Other
$3,047,477
October-18
$2,907,057
$1,584,597
$491,274
$10,576
$1,574,021
$2,761,428
$2,781,392 Total Fixed
Specific Stop-
Month/Year
$2,274,797
Total
November-18
$40,127
Total Sub-
Admin Fee
$2,414,380
scribers
Costs
Claims
Members
Loss Premium
$33,490,389
$3,239,682
($450k)
$2,795,963
December-18
$90,583
$3,098,325
$33,188
$107,634
$33,490,389 $140,822
$0
$33,490,389
$34,384,213
Jan-19
$942,392
$32,691,492
5,747
3,806
Total all services
$82,633,060
$3,205,023 $141,856
3,834
$33,420
5,784
$108,437
$0
$0 Feb-19
3,828
$0 Mar-19
$2,970,669
5,790
$3,228,417 $141,738
$3,205,023
$0
$108,267
$3,111,491
$33,471
January-19
$6,433,440
$2,737,865
$2,596,009
February-19
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
Average/PEPM
$37.05
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
(based on lagged enrollment)
Rolling Twelve Actual Plan Costs
$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
Expected Plan Costs
$3,000,000
Rolling Twelve Expected Plan Costs
Large Claims Adjustments
Percent of Expected
2019 YTD Actual
Percent of Expected
Actual vs. Budget
Cost
2018 Actual
2018 Budget
Total Accrual
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
Claims
Loss
Plan Cost
Tax ID
Provider
Claims ($175k)
Claims
Premium
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
Jan-19
$2,979,824
2,405
$2,254,931
$3,299,858
$320,033
$226,671
$724,894
5,471
$93,362
$0
Feb-19
$92,896
$777,111
$225,540
$3,241,591
$318,437
$2,146,731
$688
$2,923,154
$3,266,494
$318,303
$225,446
$2,948,190
$855,677
$2,478,921
Apr-19
$386,407
$92,857
JV Partner 3
$221,631
$898,619
$2,934,763
May-19
30-0000003
$92,819
$225,352
$318,170
$576,279
$3,252,934
$2,257,775
• 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
$2,090,771
$318,836
$2,903,452
Jul-19
$388,500
$225,823
$882,345
$2,584,616
$93,013
$92,469
$884,324
$316,973
$3,276,385
$469,760
$224,504
$2,544,848
$2,959,412
JV Partner 5
$870,380
$225,540
$92,896
$3,437,396
$2,630,017
$328,505
$381,438
Sep-19
30-0000005
$318,437
$3,118,959
$939,423
Oct-19
$2,804,168
$447,031
$323,360
$1,988,416
$94,333
$2,480,808
$229,028
Total
$821,998
Nov-19
$228,274
$2,866,986
$84,968
$94,022
$322,296
$1,807,660
$2,544,691
$2,873,843
$3,195,739
$641,403
$2,610,313
$904,933
$227,991
$93,906
$321,896
Dec-19
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
$2,252,612
$319,268.20
$2,788,413
2,399
$93,139
$309,170
5,444
$844,970
$226,129
$3,107,681
$353.69
$94.25
$942.91
Average/PEPM
$133.07
$129.41
$1,300.26
$1,167.19
$38.82
• Clinical reports (Infolock) PEPM Comparison 28,668 65,051 $1,300.26
Lagged Lives
YTD Total PEPM (based on lagged enrollment)
• Detailed expense (admin., stop- 2018 Total PEPM $1,249.35
2019 vs. 2018 Change
4.1%
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) 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
Medical/Rx
• Global or plan level reporting Margin: 5%: $308,000 $800 $700 $600 $650 $680 $710 $730 $730
$6,163,200
$6,471,200
Total
SAMPLE
SAMPLE
3/31/2020
Incurred But Not Reported Health Plan Reserve as of Incurred But Not Reported Health Plan Reserve as of $500 $400
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 Members
Covered Employees
Estimate (Med/Rx)
Date (Med/Rx)
SAMPLE Medical/Rx Historical and Projected IBNR
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
7,419
Jun-17
7,479
7,366
Aug-17
Sep-17
7,353
7,375
Oct-17
Nov-17
7,347
7,484
Dec-17
7,523
Jan-18
Feb-18
7,498
Apr-18
7,459
$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
May-18
Jun-18
7,506
7,453
Jul-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
7,520
Aug-18
7,428
Oct-18
7,390
Nov-18
Dec-18
7,484
7,612
Jan-19
7,669
Feb-19
Mar-19
7,657
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
7,392
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
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
Surgery Partners — Lockton Beneits Practice overview 24 Lockton Companies
Financial reporting Financial reporting Additional reports include: Monthly Medical/Rx Projection
Extensive and customizable financial reporting
12-Month Renewal Projection
˗ Utilization reports
capabilities
Self Funded Medical - Status Quo
˗ Cash & Accrual (C&A) Reports — Finance/HR executive
dashboards
˗ Non-domestic utilization analytics
˗ Demographic analysis
˗ Domestic Steerage and JV utilization ˗ Domestic leakage Projected Lives (Nov-19) PEPM Total Medical Total
3,707
˗ Budget vs. claim reports ˗ Enrollment reports
˗ Certified IBNR reports ˗ Network discounts (Domestic and Experience (Dec-18 - Nov-19) 3,772
Average Lagged Lives (1 Month)
Non-Domestic)
$38,184,500
˗ Large claim reports ˗ Network disruption Total Claims $833.66 $37,729,657
$843.71
-$10.05
-$454,843
ISL Adjustments
˗ Year over Year (YOY) or rolling 12 months
Claims Net ISL Adjustments
Extensive and Additional reports ˗ Detailed expense (admin., stop-loss, medical, pharmacy, ˗ Contribution analysis Annual Trend $892.01 7.0% 7.0% 0.0% 14 $40,370,733 Note: Trend
˗ Plan design modeling
dental, vision)
assumptions take into
Trending Months
˗ Global or plan level reporting
˗ Clinical reports (InfoLock)
Effective Trend
account domestic
˗ Gross and net of employee contributions
chargemaster increases
Trended Claims
annually and changes in
Claim Fluctuation Corridor
Plan Design Adjustment
customizable inancial include Projected Claims $892.01 1.0000 $40,370,733 domestic drug pricing
$1,337,562
Administration Fees
$30.07
$11.13
Stop Loss Fees
$495,269
$0.00
$0
Estimated Rx Claims Savings
reporting capabilities • Utilization reports Pro\2019\LIPO LIfePoint\19Health Capabilities 23271.pptx 1 Projected Cost $933.22 $42,203,564 4
Current Accrual
$40,084,594
$901.15
3.56%
% Change in Current Accrual
$890.12
Actual Cost
$39,593,962
-$490,632
-1.22%
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.
November 30, 2019
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
$25,076,238
$55,724,973
$30,648,735
Inpatient hospital
Total Plan Costs
Fixed Costs
Adjustments
= Fixed +
Premium)
$141,756
$2,512,347
$2,512,347
$2,798,615
$2,491,964
$141,228
$5,585,742
$5,004,311
$2,875,265
$8,372,206
$30,423,576
$7,879,575
$2,347,635
$28,075,941
Professional
$140,998
$140,651
$2,571,296
$11,156,468
$10,450,871
• 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
$13,780,842
$3,329,971
$141,010
$2,803,103
June-18
$19,845
$2,818,647
$2,960,222
$11,755,327
$500,576
$2,765,534
$738
$2,624,883
$2,785,631
July-18
Plan Year Ending 12/31/19
August-18
$3,525,080
$2,810,564
$222,319
$3,383,081
$39,661
$2,509,503
September-18
$2,650,996
$2,803,528
Other
$3,047,477
October-18
$2,907,057
$1,584,597
$491,274
$10,576
$1,574,021
$2,761,428
$2,781,392 Total Fixed
Specific Stop-
Month/Year
$2,274,797
Total
November-18
$40,127
Total Sub-
Admin Fee
$2,414,380
scribers
Costs
Claims
Members
Loss Premium
$33,490,389
$3,239,682
($450k)
$2,795,963
December-18
$90,583
$3,098,325
$33,188
$107,634
$33,490,389 $140,822
$0
$33,490,389
$34,384,213
Jan-19
$942,392
$32,691,492
5,747
3,806
Total all services
$82,633,060
$3,205,023 $141,856
3,834
$33,420
5,784
$108,437
$0
$0 Feb-19
3,828
$0 Mar-19
$2,970,669
5,790
$3,228,417 $141,738
$3,205,023
$0
$108,267
$3,111,491
$33,471
January-19
$6,433,440
$2,737,865
$2,596,009
February-19
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
Average/PEPM
$37.05
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
(based on lagged enrollment)
Rolling Twelve Actual Plan Costs
$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
Expected Plan Costs
$3,000,000
Rolling Twelve Expected Plan Costs
Large Claims Adjustments
Percent of Expected
2019 YTD Actual
Percent of Expected
Actual vs. Budget
Cost
2018 Actual
2018 Budget
Total Accrual
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
Claims
Loss
Plan Cost
Tax ID
Provider
Claims ($175k)
Claims
Premium
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
Jan-19
$2,979,824
2,405
$2,254,931
$3,299,858
$320,033
$226,671
$724,894
5,471
$93,362
$0
Feb-19
$92,896
$777,111
$225,540
$3,241,591
$318,437
$2,146,731
$688
$2,923,154
$3,266,494
$318,303
$225,446
$2,948,190
$855,677
$2,478,921
Apr-19
$386,407
$92,857
JV Partner 3
$221,631
$898,619
$2,934,763
May-19
30-0000003
$92,819
$225,352
$318,170
$576,279
$3,252,934
$2,257,775
• 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
$2,090,771
$318,836
$2,903,452
Jul-19
$388,500
$225,823
$882,345
$2,584,616
$93,013
$92,469
$884,324
$316,973
$3,276,385
$469,760
$224,504
$2,544,848
$2,959,412
JV Partner 5
$870,380
$225,540
$92,896
$3,437,396
$2,630,017
$328,505
$381,438
Sep-19
30-0000005
$318,437
$3,118,959
$939,423
Oct-19
$2,804,168
$447,031
$323,360
$1,988,416
$94,333
$2,480,808
$229,028
Total
$821,998
Nov-19
$228,274
$2,866,986
$84,968
$94,022
$322,296
$1,807,660
$2,544,691
$2,873,843
$3,195,739
$641,403
$2,610,313
$904,933
$227,991
$93,906
$321,896
Dec-19
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
$2,252,612
$319,268.20
$2,788,413
2,399
$93,139
$309,170
5,444
$844,970
$226,129
$3,107,681
$353.69
$94.25
$942.91
Average/PEPM
$133.07
$129.41
$1,300.26
$1,167.19
$38.82
• Clinical reports (Infolock) PEPM Comparison 28,668 65,051 $1,300.26
Lagged Lives
YTD Total PEPM (based on lagged enrollment)
• Detailed expense (admin., stop- 2018 Total PEPM $1,249.35
2019 vs. 2018 Change
4.1%
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) 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
Medical/Rx
• Global or plan level reporting Margin: 5%: $308,000 $800 $700 $600 $650 $680 $710 $730 $730
$6,163,200
$6,471,200
Total
SAMPLE
SAMPLE
3/31/2020
Incurred But Not Reported Health Plan Reserve as of Incurred But Not Reported Health Plan Reserve as of $500 $400
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 Members
Covered Employees
Estimate (Med/Rx)
Date (Med/Rx)
SAMPLE Medical/Rx Historical and Projected IBNR
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
7,419
Jun-17
7,479
7,366
Aug-17
Sep-17
7,353
7,375
Oct-17
Nov-17
7,347
7,484
Dec-17
7,523
Jan-18
Feb-18
7,498
Apr-18
7,459
$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
May-18
Jun-18
7,506
7,453
Jul-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
7,520
Aug-18
7,428
Oct-18
7,390
Nov-18
Dec-18
7,484
7,612
Jan-19
7,669
Feb-19
Mar-19
7,657
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
7,392
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
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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Surgery Partners — Lockton Beneits Practice overview 24 Lockton Companies
