Welcome Doug of Acme Manufacturing, (not Doug? sign out)

Program Information

Company NameAcme Manufacturing
Simplicity Group Number E04000075
Plan Year January 1, 2005 to
December 31, 2005
Simplicity Plan Option HSA Option A:
$1,000 single deductible
$2,000 family deductible
PPO Network Ultima
Specific Stop Loss
Attachment Point
$100,000
Specific Stop Loss Carrier HCC Benefits
Aggregate Attachment Point $400,000
Aggregate Stop Loss Carrier HCC Benefits
Contract Type 15/12

Enrollment & Funding Summary

Type Rate Current Monthly
Enrollment
Monthly Funding Total
Members
Employee $243.94 10 $2439.40 10
Employee/
Child
$403.83 6 $2,422.98 15
Employee/
Spouse
$506.45 10 $5,064.50 20
Family $631.57 32 $20,210.24 159
Total   58 $30,137.12 204

YTD Claims Summary

Claim Type Amount
Medical $345,251
Dental $17,346
Vision $8,623
Rx $54,657
Paid Claims $425,878

Service Team Contact Information

Simplicity Health Plans Susan Smith, Customer Service Representative
444-555-2389
sampleEmail@xyzCorp.com
Claims Administration Jean Trimble, Claims Administrator
321-321-0123
sampleB@xyzCorp.com
Utilization Review Comparison Shopper Prescription Drugs Barb Johnson, RN; Utilization Review Specialist
123-456-7890
sampleC@xyzCorp.com
Case/Disease Management Karen Dietz, RN; Case Manager
987-654-3210
sampleD@xyzCorp.com