Acme Manufacturing
Plan Year: January 1, 2024 - December 31, 2024
| Carrier: |
HCC Life Insurance Company |
Aggregate Contract Type: |
15/12 |
Specific Contract Type: |
15/12 |
Effective: |
12/01/2016 |
| Group: |
Acme Manufacturing |
|
|
Specific Deductible |
$30,000 |
Covered: |
Medical / Dental / Vision / RX |
| Policy Number : |
T0718001 |
Aggregate Factors: |
Employee: |
$169.40 |
|
|
|
|
| |
|
|
Employee/Child: |
$368.53 |
|
|
|
|
| |
|
|
Employee/Spouse: |
$439.62 |
|
|
|
|
| |
|
|
Family: |
$527.85 |
|
|
|
|
| Month |
Enrollment |
Loss Fund |
Paid Claims |
Out of Contract |
Subtotal Subject to Loss Funding |
Extra Contractual Payments |
Voids & Refunds |
Specific Reimbursements |
Specific Pending |
Net Claims |
Aggregate (Under) / Over |
Aggregate Filed |
Monthly % of Aggregate |
| Employee |
Employee
/Child |
Employee
/Spouse |
Family |
Month |
YTD |
Medical |
Dental |
Vision |
RX |
| January |
10 |
6 |
10 |
32 |
24,481 |
24,481 |
8,458 |
2,932 |
272 |
4,389 |
20 |
15,759 |
0 |
0 |
0 |
0 |
15,759 |
(8,722) |
0 |
64% |
| February |
10 |
6 |
10 |
32 |
24,481 |
48,963 |
1,879 |
2,967 |
262 |
4,262 |
0 |
9,107 |
0 |
0 |
0 |
0 |
9,107 |
(15,374) |
0 |
37% |
| March |
9 |
7 |
10 |
33 |
25,208 |
74,172 |
38,905 |
2,527 |
272 |
6,098 |
(2,328) |
49,858 |
0 |
0 |
0 |
0 |
49,858 |
24,649 |
0 |
198% |
| April |
9 |
7 |
10 |
33 |
25,208 |
99,380 |
13,085 |
2,098 |
672 |
3,642 |
0 |
18,824 |
0 |
0 |
0 |
0 |
18,824 |
(6,383) |
0 |
74% |
| May |
9 |
7 |
10 |
34 |
25,736 |
125,117 |
53,991 |
553 |
263 |
2,908 |
0 |
57,450 |
0 |
126 |
31,291 |
0 |
26,033 |
296 |
0 |
101% |
| June |
9 |
5 |
10 |
32 |
23,943 |
149,060 |
10,--9 |
1,347 |
234 |
5,418 |
0 |
16,774 |
0 |
0 |
0 |
0 |
16,774 |
(7,169) |
0 |
70% |
| July |
8 |
6 |
10 |
31 |
23,615 |
172,675 |
6,271 |
2,640 |
252 |
6,122 |
0 |
15,033 |
0 |
0 |
88 |
0 |
14,945 |
(8,669) |
0 |
63% |
| August |
8 |
5 |
10 |
32 |
23,774 |
196,450 |
6,431 |
3,303 |
223 |
4,565 |
(267) |
14,566 |
0 |
67 |
0 |
0 |
14,499 |
(9,274) |
0 |
61% |
| September |
8 |
4 |
10 |
31 |
22,877 |
219,318 |
17,362 |
2,754 |
253 |
5,337 |
0 |
25,451 |
0 |
0 |
0 |
0 |
25,451 |
2,573 |
0 |
111% |
| October |
8 |
6 |
10 |
28 |
22,031 |
241,359 |
68,525 |
1,957 |
231 |
4,149 |
0 |
74,630 |
0 |
0 |
14,715 |
80 |
59,835 |
37,804 |
0 |
271% |
| November |
8 |
6 |
10 |
33 |
24,840 |
266,199 |
7,796 |
1,189 |
981 |
3,731 |
0 |
12,715 |
0 |
0 |
0 |
0 |
12,715 |
(12,124) |
0 |
51% |
| December |
10 |
8 |
10 |
34 |
26,274 |
292,474 |
112,540 |
1,703 |
627 |
4,038 |
(4,143) |
122,423 |
0 |
0 |
910 |
34,037 |
87,476 |
61,202 |
0 |
332% |
| Totals |
107 |
72 |
120 |
385 |
|
292,474 |
345,251 |
25,696 |
4,508 |
54,657 |
(6,719) |
432,597 |
0 |
193 |
47,004 |
34,117 |
34,117 |
58,808 |
0 |
120% |
| YTD Claims |
| Total Claims Paid |
$425,877 |
| Less Out of Contract (1) |
($6,719) |
| Less Extra Contractual Payments |
$0 |
| Less Voids & Refunds |
$193 |
| Less Specific Reimbursements |
$47,004 |
| Less Pending Specific Reimbursements |
$34,117 |
| Subtotal |
$351,282 |
| Less Aggregate Deductible |
$292,474 |
| * YTD Aggregate Claim |
$58,808 |
| YTD Loss Ratio |
120% |
- (1) Out of Contract - claims incurred before 3/01/2014
- * (Negative) number indicates net claim amount less than deductible (no aggregate claims)
- * Positive number indicates the Aggregate Attachment Point has been exceeded (possible aggregate claim)
|