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Top 20 Claimants

TOP CONDITION

REL

M/F

AGE

% PLAN

PAID OF

TOTAL

PLAN PAID

MEMBER PAID

PLAN PAID

MEMBER ID

Other minor perinatal

disorder, w comp

SON

M 0

1.27 %

$4,450.00

$93,694.16

WIvRgfLcv+mQcuLJpgcpwg==

Leukemia, wo surg, w a/m

HUSBAND

M 53

1.20 %

$4,280.00

$88,739.82

GeZaYBZ/Yf2BECz+ygv9mg==

Multiple sclerosis, wo surg

WIFE

F

57

1.14 %

$4,601.90

$84,323.14

mfW7uAhTwGc9TDt5DGi82A==

Hyper-funct adrenal gland,

wo surg

HUSBAND

M 59

1.03 %

$3,531.15

$75,727.99

SFLSg+17MOeuhLcL9PDfsw==

Chronic renal failure, w

comp, w comorb

WIFE

F

64

0.94 %

$5,502.09

$69,168.70

TzSslGq9TMMxzLsPtJyxaw==

Mal neo pulmonary, w

comorb, wo surg, w a/m

SUBSCRIBER

F

60

0.93 %

$3,124.26

$68,439.40

eoVAF6xf9BVljJyW1AZPGg==

Adult rheumatoid arthritis,

wo comp, wo comorb

SUBSCRIBER

F

58

0.93 %

$4,238.13

$68,324.39

73izAYytqduA3wPGo4HFhg==

Poisoning & toxic drug

effects, w comorb

DAUGHTER

F

14

0.92 %

$3,638.97

$68,110.31

HuXpBzZfdebzE9nHCL45Xw==

Diverticulitis/diverticulosis,

w comp, w comorb, wo surg

SUBSCRIBER

M 57

0.90 %

$4,886.13

$66,002.91

umKyizyDMZJqYl0CFOioMw==

Cholelithiasis, w comp, w

comorb, w surg

WIFE

F

84

0.89 %

$4,341.32

$65,465.62

qPRNkKHt1uSN7MAC92HugQ==

63.52 %

$1,820,928.28

$4,680,084.42

Remaining Members

Page 10 of 41

Incurred: 2/1/2016 to 1/31/2017

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