Page 4 - Agate Software 2021 Renewal

AGATE SOFTWARE

BCBSM MEDICAL AND VISION RENEWAL

Effective January 1, 2021

Current Renewal Alt # 1
# of Simply Blue PPO Simply Blue PPO Simply Blue PPO
employees $1000 $1000 $1500

Single 32 $376.48 $384.30 $366.29
Two Person 5 $901.85 $920.59 $877.40
Family 15 $1,130.83 $1,154.24 $1,100.24

Est. Monthly Premium 52 $33,519.06 $34,214.15 $32,611.88
Est. Annual Premium $402,228.72 $410,569.80 $391,342.56
Annual Taxes and Fees included
Change in premium 2.07% INCREASE SAVE 2.7%
Benefits
Deductible
In network $1000/$2000 $1000/$2000 $1500/$3000
Out Network $2000/$4000 $2000/$4000 $3000/$6000

Prescription drug copay $15/$50/50%/20%/25% $15/$50/50%/20%/25% $15/$50/50%/20%/25%

Telemedicine Copay $30 $30 $30

Office visit copay $30 PCP/$50 SPEC $30 PCP/$50 SPEC $30 PCP/$50 SPEC

Urgent care copay $60 $60 $60

ER Copay $150 $150 $250

Hospitalization
In patient 80% after deductible 80% after deductible 80% after deductible
Out patient 80% after deductible 80% after deductible 80% after deductible

Lab & X-ray 80% after deductible 80% after deductible 80% after deductible

Embedded Coinsurance Max. $2500/$5000 $2500/$5000 $2500/$5000

Maximum copayment
In network $6350/$12,700 $6350/$12,700 $8150/$16,300
Out network $12,700/$25,400 $12,700/$25,400 $16,300/$32,600
2020 rates increased 7.67%, 2019 rates increased 5.7%, Jan 2018 group moving from small to large group, rates increased 1.2%, 2017 rates increased 3.9%
Premiums include their VSP 12; ($5/$10 $130 Allowance)
Moved renewal from Dec to Jan, beginning Jan 2016. Group moved from large group to small group.
2015 rates increased 2.8%, 2014 rates increased 4.9%, Dec 2013 rates increased 5.1%, 2013 (Jan) Rates increased 4.88%
2012 rates increased 5.9%, 2011 saved 11.6% by moving to SB platform. 2010 rates increased 6.5% by adding 2nd option,
2009 rates increased 7.8%, 2008 rates increased , 19.1% by moving to FB3, 2007 rates increased 5%.

Prepared August 2020