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III. Enrollment and Funding Details
Plan Year: January 1, 2016 - December 31, 2016
ABC Company
6 Month Reporting Period: January 1, 2016 - June 30, 2016
A. Enrollment and funding
—
By classification
High Active
463
87
56
104
40
75
825
1,504
Base Active
524
82
77
142
78
145
1,048
2,220
QHDHP Active
206
32
33
62
51
95
478
1,156
High Retiree <65 / Cobra
149
33
4
7
2
3
197
255
Base Retiree <65 / Cobra
46
23
3
6
3
6
87
141
QHDHP Retiree <65 / Cobra
23
9
1
2
1
2
38
57
High Retiree >65
30
4
1
1
0
0
36
42
Base Retiree >65
3
2
0
0
0
1
6
8
QHDHP Retiree >65
1
0
0
0
0
0
1
1
Total
1,444
271
175
325
176
326
2,716
5,384
High Active
$730.00
$1,360.00 $1,070.00 $1,380.00 $1,700.00 $2,000.00 $5,267,328
$1,064
Base Active
$640.00
$1,130.00
$880.00
$1,130.00 $1,370.00 $1,630.00 $5,996,929
$954
QHDHP Active
$520.00
$900.00
$710.00
$920.00
$1,150.00 $1,390.00 $2,435,596
$850
High Retiree <65 / Cobra
$730.00
$1,360.00 $1,070.00 $1,380.00 $1,700.00 $2,000.00 $1,056,148
$893
Base Retiree <65 / Cobra
$640.00
$1,130.00
$880.00
$1,130.00 $1,370.00 $1,630.00 $472,611
$905
QHDHP Retiree <65 / Cobra
$520.00
$900.00
$710.00
$920.00
$1,150.00 $1,390.00 $158,065
$699
High Retiree >65
$730.00
$1,360.00 $1,070.00 $1,380.00 $1,700.00 $2,000.00 $179,298
$830
Base Retiree >65
$640.00
$1,130.00
$880.00
$1,130.00 $1,370.00 $1,630.00 $34,314
$953
QHDHP Retiree >65
$520.00
$900.00
$710.00
$920.00
$1,150.00 $1,390.00
$4,160
$520
Total
$15,604,449
$958
Sub +
Spouse +
1 Child
Average Enrollment
Funding Rates
Funding
Total
Funding
PSPM
Funding
Sub +
Spouse +
2+ Children
Average
Subs
Average
Members
Single
Sub
Sub +
Spouse
Sub +
1 Child
Sub +
Spouse +
2+ Children
Single
Sub
Sub +
Spouse
Sub +
1 Child
Sub +
2+ Children
Sub +
Spouse +
1 Child
Sub +
2+ Children
6