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1. Claims and Enrollment Experience
Paid claims basis (Assume one month lag)
Lagged
(UHC)
(UHC + ESI)
1 Month
Month
Subscribers
Members
Member to
Sub Ratio
Medical
Claims
Pharmacy
Claims
Total
Claims
Claims
PSPM
Jun-14
2,779
5,293
1.90
Jul-14
2,750
5,257
1.91
$1,804,754
$571,528
$2,376,281
$855.08
Aug-14
2,786
5,301
1.90
$2,185,193
$480,431
$2,665,625
$969.32
Sep-14
2,765
5,294
1.91
$1,829,198
$488,614
$2,317,812
$831.95
Oct-14
2,772
5,335
1.92
$1,835,723
$517,116
$2,352,839
$850.94
Nov-14
2,777
5,331
1.92
$1,540,026
$528,174
$2,068,200
$746.10
Dec-14
2,773
5,337
1.92
$2,093,619
$562,806
$2,656,425
$956.58
Jan-15
2,727
5,325
1.95
$1,524,126
$531,393
$2,055,519
$741.26
Feb-15
2,719
5,315
1.95
$1,398,770
$405,396
$1,804,166
$661.59
Mar-15
2,719
5,315
1.95
$1,686,698
$480,680
$2,167,378
$797.12
Apr-15
2,713
5,321
1.96
$2,059,721
$599,711
$2,659,431
$978.09
May-15
2,710
5,327
1.97
$1,691,698
$551,775
$2,243,473
$826.93
Jun-15
2,698
5,315
1.97
$1,761,430
$521,177
$2,282,607
$842.29
Jul-15
2,694
5,317
1.97
$1,480,903
$546,898
$2,027,802
$751.59
Aug-15
2,725
5,354
1.96
$1,803,035
$629,096
$2,432,131
$902.80
Sep-15
2,716
5,343
1.97
$1,891,350
$563,590
$2,454,940
$900.90
Oct-15
2,728
5,352
1.96
$2,103,705
$595,668
$2,699,373
$993.88
Nov-15
2,731
5,361
1.96
$1,932,997
$520,388
$2,453,385
$899.33
Dec-15
2,728
5,359
1.96
$1,806,603
$601,254
$2,407,857
$881.68
Jan-16
2,722
5,370
1.97
$1,225,499
$555,221
$1,780,720
$652.76
Feb-16
2,720
5,372
1.98
$1,145,013
$611,669
$1,756,682
$645.36
Mar-16
2,719
5,384
1.98
$1,531,552
$582,615
$2,114,166
$777.27
Apr-16
2,719
5,401
1.99
$1,718,657
$560,663
$2,279,321
$838.29
May-16
2,715
5,394
1.99
$1,758,537
$693,728
$2,452,265
$901.90
Jun-16
2,701
5,383
1.99
$1,906,865
$594,159
$2,501,024
$921.19
Total
Current
32,615
64,322
1.97
$20,304,717
$7,054,948
$27,359,666
$838.87
Prior
32,990
63,751
1.93
$21,410,955
$6,238,800
$27,649,755
$838.13
PSPM
Current
2,718
5,360
1.97
$622.56
$216.31
$838.87
* Adjusted =
$838.33
Prior
2,749
5,313
1.93
$649.01
$189.11
$838.13
* Adjusted =
$812.04
% Change
-1.1%
0.9%
2.1%
-4.1%
14.4%
0.1%
3.2%
* Adjusted for large claimants above $300,000
and an aggregating deductible of $125,000
2. High Cost Claimant History
A. Current experience period: July 1, 2015 through June 30, 2016
UHC claims only, Express Scripts claims not included
6.0%
$300,000
$125,000
Claimant
Paid Amount
Active/
Termed
Trend
Factor
Trended
Paid Amount
Excess Over
ISL Deductible
Claims Over
ISL Deductible
Count
Paid Amount
1
$442,611
N/A
1.097
$485,389
$185,389
$485,389
1
$442,611
2
$256,237
N/A
1.097
$281,003
$0
$0
0
$0
3
$252,866
N/A
1.097
$277,305
$0
$0
0
$0
4
$251,862
N/A
1.097
$276,204
$0
$0
0
$0
5
$239,769
N/A
1.097
$262,943
$0
$0
0
$0
6
$213,015
N/A
1.097
$233,603
$0
$0
0
$0
7
$210,530
N/A
1.097
$230,878
$0
$0
0
$0
8
$208,639
N/A
1.097
$228,804
$0
$0
0
$0
9
$195,478
N/A
1.097
$214,370
$0
$0
0
$0
10
$184,221
N/A
1.097
$202,026
$0
$0
0
$0
11
$183,185
N/A
1.097
$200,889
$0
$0
0
$0
12
$181,907
N/A
1.097
$199,488
$0
$0
0
$0
Total Current
$2,820,320
$3,092,901
$185,389
$485,389
1
$442,611
Medical and Pharmacy Funding Rate Projection For a January 1, 2017 Effective Date
—
Claims and Plan Data
—
Notes
ABC Company
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