80 / 148
B. Prior experience period: July 1, 2014 through June 30, 2015
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
$715,781
N/A
1.162
$832,058
$532,058
$832,058
1
$715,781
2
$646,104
N/A
1.162
$751,062
$451,062
$751,062
1
$646,104
3
$427,964
N/A
1.162
$497,486
$197,486
$497,486
1
$427,964
4
$358,308
N/A
1.162
$416,514
$116,514
$416,514
1
$358,308
5
$329,323
N/A
1.162
$382,821
$82,821
$382,821
1
$329,323
6
$308,106
N/A
1.162
$358,157
$58,157
$358,157
1
$308,106
7
$242,657
N/A
1.162
$282,077
$0
$0
0
$0
8
$212,769
N/A
1.162
$247,333
$0
$0
0
$0
9
$198,944
N/A
1.162
$231,262
$0
$0
0
$0
10
$197,056
N/A
1.162
$229,068
$0
$0
0
$0
11
$179,110
N/A
1.162
$208,206
$0
$0
0
$0
12
$178,911
N/A
1.162
$207,975
$0
$0
0
$0
Total Prior
$3,995,034
$4,644,018
$1,438,098
$3,238,098
6
$2,785,586
3. Premium Equivalent Rate History
A. January 1, 2016 through December 31, 2016
Premium
Base
HDHP
Employee Only
$730.00
$640.00
$520.00
Employee + Spouse
$1,360.00
$1,130.00
$900.00
Employee + 1 Child
$1,070.00
$880.00
$710.00
Employee + 2 or More Children
$1,380.00
$1,130.00
$920.00
Employee + Spouse + 1 Child
$1,700.00
$1,370.00
$1,150.00
Employee + Spouse + 2 or More Children
$2,000.00
$1,630.00
$1,390.00
% Increase - Employee Only rate
5.8%
4.9%
8.3%
B. January 1, 2015 through December 31, 2015
Premium
Base
HDHP
Employee Only
$690.00
$610.00
$480.00
Employee + Spouse
$1,280.00
$1,090.00
$860.00
Employee + 1 Child
$1,010.00
$840.00
$670.00
Employee + 2 or More Children
$1,300.00
$1,090.00
$880.00
Employee + Spouse + 1 Child
$1,600.00
$1,320.00
$1,100.00
Employee + Spouse + 2 or More Children
$1,890.00
$1,580.00
$1,340.00
Notes
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