Executive Summary

Acme Manufacturing
Plan Year: January 1, 2024 - December 31, 2024
Funding January February March April May June July August September October November December YTD  
Rates Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Lives Amount Amount  
Medical/Dental/Vision/RX Plans
Single $234.94 10 2,439 10 2,439 9 2,195 9 2,195 9 2,195 9 2,195 8 1,952 8 1,952 8 1,952 8 1,952 9 2,195 10 2,439 26,102  
Employee/Child $403.83 6 2,423 6 2,423 7 2,827 7 2,423 7 2,423 5 2,015 6 2,423 5 2,015 4 1,613 6 2,423 6 2,423 8 3,224 33,808  
Employee/Spouse $506.45 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 10 5,064 50,713  
Family $631.57 32 20,210 32 20,210 33 20,823 33 20,842 34 21,473 32 20,210 31 19,579 32 20,210 31 19,579 28 17,684 33 20,842 34 21,473 243,154  
Funding Totals 58 29,657 58 29,657 59 30,482 59 30,482 60 31,114 56 28,975 55 28,537 55 28,731 53 27,661 52 26,643 58 30,044 62 31,798 353,778  
 
Actual Cost   Out of Contract
Specific Reinsurance                            
Reimbursement - - - - 31,291 - 88 - - 14,715 - 910 47,004  
Pending - - - - - - - - - 80 - 34,037 34,117  
Aggregate Reinsurance                            
Reimbursement - - - - - - - - - - - - -  
Pending - - - - - - - - - - - - -  
Paid Claims 15,780 9,107 47,530 18,825 57,451 16,774 15,033 14,299 25,542 74,631 12,715 118,280 425,878 24,987
Medical 8,458 1,879 38,905 13,085 53,991 10,009 6,271 6,431 17,362 68,525 7,796 112,540 345,251 16,897
Dental 2,932 2,967 2,527 2,098 553 1,347 2,640 3,303 2,754 1,957 1,189 1,703 25,969 1,250
Vision 272 262 272 672 263 234 252 223 253 231 981 627 675 718
RX 4,389 4,262 6,098 3,642 2,908 5,418 6,122 4,565 5,337 4,149 3,731 4,038 54,657 6,122
PPO Access Fees 232 232 236 236 240 224 220 220 212 208 232 248 2,740  
PPO - Beechstreet $4.00 232 232 236 236 240 224 220 220 212 208 232 248 2,740  
Secondary PPO - % of Savings - - - - - - - - - - - - -  
Administration Fees 2,016 5,835 2,907 2,754 3,104 3,112 2,704 2,803 2,839 2,741 2,617 3,137 36,570  
TPA $25.85 1,714 5,524 2,604 2,448 2,808 2,839 2,418 2,505 2,572 2,455 2,237 2,837 33,051  
Rx Admin 114 122 112 114 101 101 107 119 95 117 2,237 2,837 33,051  
UR $1.50 87 87 89 89 84 84 83 83 80 78 87 93 1,028  
Rx $1.50 87 87 89 89 84 84 83 83 80 78 87 93 1,028  
Newsletter $0.25 15 15 15 15 14 14 14 14 13 13 16 16 171  
Reinsurance 10,198 6,240 7,447 7,094 8,128 7,810 6,729 6,940 7,200 6,787 6,368 7,861 88,804  
HCC Benefits
Contract Type: 15/12 		10,198 6,240 7,447 7,094 8,128 7,810 6,729 6,940 7,200 6,787 6,368 7,861 88,804  
Miscellaneous 0 0 0 0 0 0 0 0 0 0 0 0 0  
Total Actual Cost 28,226 21,415 58,121 29,908 37,631 27,921 24,599 24,463 35,703 69,571 21,932 94,579 472,869  
Net (over)/under Funding 1,431 8,242 (27,638) 1,574 (6,518) 1,054 3,938 4,468 (8,042) (42,929) 8,112 (62,784) (119,091)  
 
PPO savings $2,231 $236 $8,106 $2,836 $36,209 $1,363 $207 $609 $1,163 $4,684 $570 $8,568 $66,882  
Total Covered Employees 58 58 59 59 60 56 55 55 53 52 58 62 685  
Budgeted Plan Cost per Employee $511.32 $511.32 $516.65 $516.65 $518.56 $517.41 $518.86 $522.38 $521.91 $512.36 $518.01 $512.83 $516.46  
Reinsurance per Employee $175.83 $107.59 $126.23 $120.23 $135.47 $139.47 $122.35 $126.19 $135.86 $130.52 $109.79 $126.79 $129.64  
Actual Plan Cost per Employee $486.65 $369.22 $985.09 $489.97 $627.19 $498.57 $447.25 $441.14 $673.85 $1,337.91 $378.15 $1,525.47 $690.32  
Number of Claims Paid 105 78 125 127 100 100 81 120 109 111 82 147 1,285  
Average Cost per Claim $80.56 $24.09 $311.24 $103.03 $539.91 $100.49 $77.42 $53.59 $159.28 $617.34 $95.07 $768.58 $268.68  
Number of Claims per Employee 1.810 1.345 2.119 2.153 1.667 1.786 1.473 2.182 2.057 2.135 1.414 2.371 1.876