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I. Cost Versus Funding
Plan Year: January 1, 2016 - December 31, 2016
ABC Company
6 Month Reporting Period: January 1, 2016 - June 30, 2016
A. Cost versus funding
—
By plan and active/Cobra/retiree status
High Active
825
$299,238 $3,953,223 $1,536,496
$0
$5,489,719 $1,109 $5,788,957 $1,169 $5,267,328 $1,064
109.9%
Base Active
1,048 $379,986 $2,622,280 $983,546
$0
$3,605,826
$574
$3,985,812
$634
$5,996,929
$954
66.5%
QHDHP Active
478
$180,449 $1,444,779 $406,628
$0
$1,851,406
$646
$2,031,855
$709
$2,435,596
$850
83.4%
High Retiree <65 / Cobra
197
$71,501 $847,713 $374,256
$0
$1,221,969 $1,033 $1,293,469 $1,093 $1,056,148
$893
122.5%
Base Retiree <65 / Cobra
87
$31,550 $199,221 $179,676
$0
$378,897
$726
$410,446
$786
$472,611
$905
86.8%
QHDHP Retiree <65 / Cobra
38
$14,224
$77,527
$7,147
$0
$84,673
$375
$98,898
$438
$158,065
$699
62.6%
High Retiree >65
36
$13,055 $137,100 $106,996
$0
$244,096
$1,130
$257,151
$1,191
$179,298
$830
143.4%
Base Retiree >65
6
$2,176
$4,271
$3,246
$0
$7,517
$209
$9,693
$269
$34,314
$953
28.2%
QHDHP Retiree >65
1
$504
$0
$0
$0
$0
$0
$504
$63
$4,160
$520
12.1%
Adjustments
$11
$64
$75
$75
Total
2,716 $992,683 $9,286,123 $3,598,055
$0
$12,884,178 $791 $13,876,861 $852 $15,604,449 $958
88.9%
B. Employee versus employer funding
—
By plan and active/Cobra status
High Active
825
$5,267,328 $1,064
$1,455,647
$294
27.6%
$3,811,681
$770
72.4%
Base Active
1,048
$5,996,929
$954
$968,517
$154
16.2%
$5,028,412
$800
83.8%
QHDHP Active
478
$2,435,596
$850
$380,698
$133
15.6%
$2,054,898
$717
84.4%
High Retiree <65 / Cobra
197
$1,056,148
$893
$1,056,148
$893
100.0%
$0
$0
0.0%
Base Retiree <65 / Cobra
87
$472,611
$905
$472,611
$905
100.0%
$0
$0
0.0%
QHDHP Retiree <65 / Cobra
38
$158,065
$699
$158,065
$699
100.0%
$0
$0
0.0%
High Retiree >65
36
$179,298
$830
$179,298
$830
100.0%
$0
$0
0.0%
Base Retiree >65
6
$34,314
$953
$34,314
$953
100.0%
$0
$0
0.0%
QHDHP Retiree >65
1
$4,160
$520
$4,160
$520
100.0%
$0
$0
0.0%
Total
2,716
$15,604,449 $958
$4,709,458
$289
30.2%
$10,894,991 $669
69.8%
PSPM
Funding
% Employer
Funding
% Employee
Funding
Claims
Total Cost (Claims + Fixed)
Total Funding
Medical
Claims
Pharmacy
Claims
> Specific
Claims
Net
Claims
PSPM
Claims
Total
Cost
PSPM
Cost
Total
Funding
Subs
Fixed
Costs
PSPM
Funding
Loss
Ratio
Employer Funding (Total Less Employee)
Employee Funding
Total Funding (EE + ER)
Subs
PSPM
Funding
Employer
Funding
Total
Funding
Employee
Funding
PSPM
Funding
2