consultative analytics reporting

Consultative Analytics Reporting Client Resources Portal User Guide

1

Published 02172014 Client Resources Portal-Consultative Analytics Reports_V- 4 Rev 04092014

Revision History

Version Date Author(s) Revision Notes

(note major changes additions deletions within each section)

10 02172014 mwithington Initial creation of CRP-CAP user guide

20 02252014 ComplianceLegal Medical and dental glossary definition modifications Cigna Copyright Statement

30 03192014 mwithington Guaranteed CostFully Insured Accounts ndash Pg 14

40 4092014 mwithington

PDF attachments for Medical and Dental Glosseries ndash Appendix B Product Structure prefix defined ndash 0 Incurred Start and End Dates ndash Current and Base ndash Page 11

2


Table of Contents

10 CAP Quick Start Guide 4

11 Objectives 5

12 Consultative Analytics Reports Overview 5

13 Getting Started 6

20 Welcome to Client Resources Portal Home Screen 7

21 Consultative Analytics Overview Window 8

22 Creating a CAP Request 9

23 Naming your Request 10

24 Product Structure Selection 10

25 Report Selection 11

26 Parameters Incurred Current and Base Period Dates 11

27 Submitting your Request 12

28 Alert Notification Message Product and Report Selections Do Not Correspond 13

29 Alert Notification Message Guaranteed Cost 14

210 Alert Notification Message Minimum Subscriber Threshold 15

211 Alert Notification Message Overlapping Dates 16

30 My Request Queue Report Pickup 17

31 My Request Queue Report Status Error 18

32 My Request Queue Report Status Not Available 19

33 My Request Queue Viewing Parameters 20

40 Posted Reports Queue 21

Appendix A ndash Sample Reports 22

Appendix BmdashGlossary Medical and Dental Terms 23 24 25 26 27 28 29 30

Cigna Disclaimer Notice 24

3


Figures List

Figure 1 Client Resources Portal Employer Log-in 6

Figure 2 Client Resources Portal Welcome Screen 7

Figure 3 Consultative Analytics reports Overview Window 8

Figure 4 Alert Notification Message Product and Report Selection does not Correspond 13

Figure 5 Alert Notification Message Guaranteed Cost 14

Figure 6 Alert Notification Message Reports do not Pass Minimum Subscriber Threshold for

Accounts when PHI is NO 15

Figure 7 Alert Notification Message Overlapping Parameters (Dates) 16

Figure 8 My Request Queue Statuses Error 18

Figure 9 My Request Queue statuses Not Available 19

Figure 10 My Request Queue Parameters 20

Figure 11 Posted Reports Queue 21

4


10 Consultative Analytics Reports - Quick Start Guide

A Quick Start Guide to requesting reports for users that prefer to jump right in and read the details

later

Create CAP Report Request

1 Log-in to the CRP

2 Group - Options Defaults to group number Enter group or Select from dropdown box

and click the Go command button

3 Click the Reports link on the Main Welcome Page

4 Click the Consultative Analytical Reports Link to open and view Consultative Analytics Reports

Overview Options

5 Click the ldquoCreate a New CAP Requestrdquo Link

6 Provide a name for your report or leave the screen generated default name

7 Select the desired product structure (s)

8 Select the reports for your package

9 Select the parameters desired ( incurred dates-current and base)

10 Submit your request (allow 24 to 48 hours to process)

My Request Queue - Pick up Report

1 Repeat steps 1 through 3 from section 20

2 Click the ldquoMy Request Queuerdquo

3 If the status is completed click on the Pickup Icon

4 Click the download command buttonicon

Posted Reports Queue


2 Click the ldquoPosted Request Queuerdquo

3 If the status is completed click the Pickup Icon


5


11 Objectives

Informational guidance on how to use the Consultative Analytics Reports functions to generate and achieve the desired output

shy Illustrate the steps to create a new report request through the Consultative Analytics Report functionality via the Client Resources Portal website

shy Select product structure that can be utilized in performing client analytics shy Complete the steps to pickup completed reports from the Request Queues

12 Consultative Analytics Reports (CAP) Overview

shy Consultative Analytical Reports are Cignas self-service client reporting tool for health plan utilization

shy Utilization reporting that is currently available in the Client Resources Portal platform

CP 265 Dental Summary CP 266 Dental Utilization by Type of Service CP 900 HCST Healthcare Spend amp Trend-Incurred CP 902 HCST Pharmacy-Incurred CP 905 HCST Facilities

HCST is defined as Healthcare Spend amp Trend

shy CAP includes data across all lines of business including Medical Pharmacy and Dental for

an integrated viewpoint CAP Report Links -Users with permission will see CAP reports link

shy Main page- Consultative Analytical Platform

Create a new CAP Request

My Request Queue

Posted Report Queue

6


13 Getting Started

Access

shy If you currently have access to the Client Resources Portal your existing user

credentials automatically grant permission to enter the Constultative Analyical Reports area

shy If you do not currently have access to the Client Reources Portal you will receive

a new user ID and temporary password via secure email

Logging In

shy Copy the link into your browser to access the Client Resources Portal wwwcignaclientresourcescom

shy Enter your username and password and click the submit command button to

navigate to the Portalrsquos Welcome screen where you will be able to access the Consultative Analytical Reports area

Figure 1

Client Resources Portal ndash Plan Administration Welcome Page

7


20 Welcome to Client Resources Portal Home Screen Return to Table of Contents

If you have access to only one group number the group number field box will automatically default to that account number upon login If you have access to multiple group account numbers you can select the desired account from a dropdown menu Note All accounts used in the following examples are fictitious

From the Main Client Resources Welcome Screen

1 If your group account number did not automatically default in the field box enter it If you have multiple accounts select desired account from dropdown box Click the GO command button

Figure 2 CRP Welcome Screen

8


21 Consultative Analytics Reports (CAP) Overview Window

The Consultative Analytics Reports link located under the ldquoReportsrdquo heading is only visible to those who have permission

On the Main Client Resources Welcome Screen 2 Click the ldquo Reports ldquo heading 3 Click the Consultative Analytics Reports link to launch the reports overview window

(figure 3)

Figure 3 Consultative Analytics Reports Overview Window

9


22 Creating a CAP Request

CAP Report Links are positioned on the main client resources menu page and on the left side navigation menu ( shown in Figure 3) Options are as follows

Consultative Analytical Platform (main CAP link)

Create a new CAP Request Create and submit new report request

My Request Queue View your submitted report requests check submission status pickup completed reports

Posted Report Queue View CAP reports that have been posted by the Internal Cigna team for this account

From the Consultative Analytics Reports Overview Screen

4 Click the Create a new CAP Request link to navigate to the Create a New CAP

Utilization Request screen

10


23 Naming your Request

New CAP Utilization Screen - This is where you will begin to build your report package There are five action steps on the New CAP Utilization screen that will need to be completed to submit your report request The steps are as follows

Name your request Select product structure (s) Select reports Select parameters (dates) Submit your request

5 The screen default will automatically generate a report name date and time stamp

To change the name click in the field box and enter the desired name for your report

24 Product Selection

6 Select the product structure (s) you want to include in your report The default selects all available products to include in your report To deselect all click in the ldquoSelect Allrdquo checkbox and select the product structure desired At a high level the first character represents if the product is for Dental (D) Medical (M) or Pharmacy (R) and the next three characters represent the type such as Open Access Plus (OAP) or Performance (PER) The remaining four numbers are planbenefit specific please contact your client manageraccount manager for additional details

11


25 Report Selection

7 Select the desired reports (refer to appendix A to view sample report slides)

26 Parameters

Incurred Reporting

bull CAP reports are on an incurred basis for all funding types bull Incurred provides a better method for assessing the impact of plan design changes as

it allows time periods to be a 11 match bull Incurred basis increases accuracy by measuring utilization when it happens rather

than when the claim is paid bull Incurred ndash Allows user to specify the incurred dates of service The dates entered here

should be the dates you wish to analyze Selecting Dates

bull Incurred Current and Base ndash Select date range for current and base period analysis bull Current start and end dates represent the most recent time period bull Base start and end dates represent the prior time period

8 Click the Current period dropdown box to select your start and end date 9 Click the Base period dropdown box to select your start and end date

12


27 Submitting your Request

10 Review the information selected for your report package 11 If you want to start over click the Reset command button This action will clear the

form An alert message will verify that you want to continue to reset Cancel or click okay

12 If you want to proceed and submit your request click the submit command button to launch the request confimation window

13 In the confirmation request window Click the OK command button to navigate to

your Request Queue where you can view the request status as Submitted

If your report request does not successfully submit and you receive an alert notification message review the message for additional details and instructions (alert notifications will be visible along the top of the page)

13


28 Alert Notifications Message ndash Product and Report Selection does not

Correspond

If your report request did not submit due to product structure selections vs report content selections and you received an alert notification message review the message and adjust your report parameters as necessary

Figure 4

Alert Notification Message-Product and Report Selection does not

Correspond

14


29 Alert Notifications Messages ndash Guaranteed Cost

Guaranteed cost Fully Insured Accounts-If an account is identified as guaranteed cost

Fully Insured and the subscriber count is less than 100 for medicalpharmacy or less than 200 for dental for the account as a whole then the user will be displayed with a message upon first entering the page The account is ineligible for CAP reporting and the request cannot be submitted

If this message is displayed for an account that has more than 100 subscribers be sure that

you have selected all product structure to ensure all subscribers are captured in the request

Figure 5

Alert Notification Message ndash Guaranteed Cost

15


210 Alert Notifications Messages ndash Minimum Subscriber Threshold

Figure 6

Alert Notification Message-Reports do not Pass Minimum Subscriber

Threshold for Accounts When PHI is NO

16


211 Alert Notifications Messages ndash Overlapping Dates

The cause of the overlapping dates alert notification message as Shown in Figure 7 where the date range selected for the current period is 82012 through 072013 The Base period date range is 82011 to 072013 The base and current periods are overlapping To correct this change the base period end date to 072012

Figure 7

Alert Notification Message- Overlapping Dates

Corrected dates shown below

17


30 My Request Queue ndash Report Pickup Return to Table of Contents

The My Request Queue heading rows include

CRP Request ID Request Date Report Title Status Comments Report Pickup and Parameters

Report Statuses are reported under the Report Status heading There are four statuses to note

Submittedndash Your request has been submitted and is being processed

Completed ndash Your request is approved completed and ready for pickup

ErrormdashAfter the request has been submitted the request queue will display comments for any Error status instructing the user on why the request errored out and tips for submitting a successful request

Not AvailablemdashThis status is used when a request runs successfully and there is insufficient data to produce report output the request queue will display comments for any Not Available status instructing users on the issue or problem

1 To access your Reports Queue repeat steps 1 through 3 then Click on the My Request

Queue link on the Main Welcome Page

To pick up a completed report The reports Queue view defaults on 30 days You can change the time period by clicking on the dropdown box and selecting desired period

2 Under the report pickup heading click the pickup report icon to launch download pop-up window

3 Click on the report view icon to open and or click the download button

18


31 My Request Queue Statuses Error Figure 8

My Request Queue- Report Status Error

19


32 My Request Queue Status Not Available

Figure 9

My Request Queue-Report Statuses-Not Available

20


33 My Request Queue ndash Viewing Parameters

1 To view the report parameters Click the magnyfying glass icon to open the parameters

window

Figure 10

My Request Queue-Report Parameters

21


40 Posted Reports Queue Return to Table of Contents

Posted Reports Queue allows you to view CAP reports that have been posted by the Internal Cigna team for this account

From the Main Welcome screen

1 Consultative Analytics Platform 2 Click the Posted Reports Queue link

Figure 11


3 Click the dropdown box to select desired view request dates 4 Click the Report Pickup Icon to launch the

22


Appendix A

Sample Reports Return to Table of Contents

CRP-CAP Dental Report Sample

See PDF attachment for file name

cap_request_dental_crp_sampleppt

CRP-CAP Health Care Trend and Spend Report

Sample


cap_tc_excel_request_crp_samplexls

23


Appendix B

Glossary of Terms (Medical)


Glossery of Terms - Medical

Glossary of Terms (Dental)


Glossary of Terms - Dental

24


ldquoCignardquo and the ldquoTree of Liferdquo logo are registered service marks of Cigna Intellectual Property

Inc licensed for use by Cigna Corporation and its operating subsidiaries All products and

services are provided by or through such operating subsidiaries including Cigna Health and Life

Insurance Company and Connecticut General Life Insurance Company and not by Cigna

Corporation

March 10 2014 copy 2014 Cigna


Additional Plan Design Savings Savings generated from contractual limitations and benefits exclusions Adjunctive General Services Palliative treatments consultations emergency care second opinions and anesthesia Age Maximum Savings due to age limits on fluoride treatments sealants orthodontic services and other services Alternate Benefit Provision This provision includes a three-tier claim review process monitored by Dental Claim Analysts Dental Reviewers and Dental Consultants Under this process proposed treatment plans are examined by Dental Reviewers and approved denied or referred to Dental Consultants for alternate treatment decisions Where appropriate the Dental Consultant will recommend alternate treatments considered to be less costly and consistent with professional dental standards Annual Maximum Savings due to a patient reaching the maximum payment under the plan often per calendar year Average Area Charge Average charge based on the number of dentist in the geographical area pertaining to your membership Basic Restorative Dental treatments or procedures performed to repair and restore individual teeth due to decay erosion trauma or improper function Basic services may include fillings oral surgery endodontics (root canals) and periodontics (tissuebone treatment) Benefit Option This code is used to identify different Cigna product lines purchased by a customer Charges The amount charged by a dentist for dental services rendered Children Children are defined as child step-child handicapped child eligible students and adult dependent Claim Branch This term describes the different ways an account can be sub-divided into groups for reporting purposes based on the account structure Coinsurance The percentage of covered expenses paid by the member when costs are being shared by both the plan and the individual member Coordination of Benefits (COB)

The amount saved when your Cigna-administered plan pays secondary to the employees primary plan It represents the difference between what Cigna pays and (COB) what it would have paid if it were primary Covered Employees The number of Covered Employees for the reporting period equals the number of active employees in the first reporting period month and includes any active employee additions made in the following months within the reporting period To be counted as a covered employee addition the employee must have had at one day of coverage


Deductible An amount specified in plan design that must be paid by member for covered expenses in a benefit period before the plan will pay benefits DiagnosticPreventive Dental treatments or procedures focused on the prevention and diagnosis of dental diseases These services may include oral examinations cleanings X-rays sealants and fluoride treatments Endodontics The dental specialty that concentrates on the treatment of root canals or other injuriesdiseases of the pulp or nerve of the tooth Frequency Maximum Savings due to frequency limits on examinations cleanings radiographs crowns and other services Ineligible Charges Ineligible Charges include savings attributable to limitations of the plan (Missing Tooth Limitation AgeFrequency AnnualLifetime Maximums) charges submitted for ineligible participants application of Alternate Benefit Provisions which may be a result of the Pre-Determination of Benefits (PDB) process services that exceed the maximum reimbursable charge limits per service or the Scheduled Plan benefits if applicable and Utilization Management Services In-Network Services rendered by providers who are part of a network and with whom Cigna has a contractual relationship Major Restorative Dental treatments or procedures targeting the restoration of teeth using services such as crowns inlays or onlays Major services also may include prosthodontics (ie dentures) Member An individual who is eligible for coverage and enrolled under a dental plan Includes employee and any covered dependents Missing Tooth Limitation A contractual provision which limits or excludes payment for the replacement of teeth that are missing prior to the patients effective date of plan coverage Norm Norm refers to the comparison group based on book of business or industry experience for the defined parameters Norms are annualized unless otherwise stated Oral Surgery Non-surgical and surgical extractions and other surgical procedures Orthodontics Dental treatments or procedures performed to correct misalignments of the teeth and restore the teeth to their proper alignment and bite function Services may include braces or retainers Other Savings Other Savings is a category in which savings is captured when a claim has multiple plan design savings reasons Out-of-Network Services rendered by providers who are not part of the Cigna network based on your benefit plan design


Paid Claims That portion of the dentists charges paid by Cigna to a patient or provider for dental services covered under the benefit plan Patient A unique individual participant (employee or dependent) who received one or more dental services during the reporting period in-network andor out-of-network Periodontics Scaling and root planing surgical procedures of the gingivabone and other gum-related treatment Pre-Determination of Benefits (PDB) A process that allows the patient and dentist learn what benefits are provided by the dental plan in advance of treatment The PDB process provides the dentist and participant with a detailed explanation of what specific benefits are available at the time the claim is reviewed so that the dentist may discuss the information with the patient before treatment is rendered and expenses are incurred Savings from this process are also realized through the avoidance of more costly dental treatments where a less costly alternative is recommended Provider Discounts The difference between the contracted payment amount and the average area charge for a procedure Scheduled Plan Savings Savings due to the application of set scheduled dollar payment amounts for dental services set forth in a scheduled benefit plan Services The number of individual dental procedures rendered by dental care providers Utilization Management The set of administrative practices used on behalf of purchasers of dental benefits to manage the necessity appropriateness frequency and mix of dental services It entails practices used in claims review for predetermination or payment of benefits statistical review of individual provider utilization profiles and appropriate follow-up procedures


ACE inhibitors Inhibitors of Angiotensin-Converting Enzyme are a group of pharmaceuticals that are used in treatment of hypertension and congestive heart failure Active with Disease Management Engaged customers with ongoing interactions with a case manager Active with Pharmacy Services Engaged customers with ongoing interactions focused on coordinating medication refills Acute An illness of short duration (as opposed to chronic illness) Acute Major Experienced episodes of care greater than $500 that are not a chronichealthymaternity Acute Minor Experienced episodes of care less than $500 that are not chronichealthymaternity and have a low amount of facility related costs Admission An overnight confinement to a facility Admissions Reviewed Activity performed by a case manager prior to a scheduled admission to identify and address any issues challenges or gaps Asthma Inhaled Corticosteroids Asthma Inhaled Corticosteroids are often prescribed as a treatment for asthma Average Cost Sum of total paid claims divided by count of individuals incurring costs for medical and pharmacy services Brand Name

The proprietary or trade name of the medication

Breast Cancer Screening

Measures the percent of qualified women 40-69 years of age that are compliant with mammogram screening

Capitation

Arrangement where network providers receive a set dollar amount of money per covered member assigned to

their practice even if no services rendered

Cardiac catheterization

A medical procedure used to diagnose and treat certain heart conditions

Case Management

Coordination of services to help meet a patients health care needs usually when the patient requires multiple

services from multiple providers


Catastrophic Term used to describe when a member has accumulated payments in excess of $50000 for a specified time period Centers of Excellence Network hospitals that have achieved the highest (three star) scores for cost efficiency and effectiveness in treating selected proceduresconditions based on publicly-available patient data

Cervical Cancer Screening

Measures the percent of qualified members greater than 29 years of age who received at least one pap smear

Chronic

Defined as an illness or sickness that is not curable but may be controlled with treatment

Chronic Obstructive Pulmonary Disease (COPD) Defines a group of diseases characterized by airflow obstruction and includes chronic bronchitis and emphysema Churn Those members who either enrolled or disenrolled or did both during the analysis period (includes newborns) Coinsurance A cost sharing benefit feature between the insured (customer) and the insurer (Cigna) which represents their respective responsibility for a covered expense typically expressed as a pair of percentages Colon Cancer Screening Colorectal Cancer Screening (CRC) can detect pre-malignant polyps and guide their removal which in theory can prevent the development of colon cancer Co-managed Engaged customers working together with TheraCare and another Health Advocacy program(s) Condition Status Engaged customers that have completed a condition-specific assessment that measures disease severity Convenience Care Treatment for common family ailments such as strep throat pinkeye and athletes foot Coordination of Benefits (COB)

The amount saved when your Cigna-administered plan pays secondary to the employees primary plan It represents the difference between what Cigna pays and (COB) what it would have paid if it were primary Copay Predetermined fees for medical services covered by a benefit plan which are paid by the member at the time of service Coronary angioplasty A medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery narrowed by atherosclerosis improving blood flow


Coronary Artery Bypass Graft (CABG) Surgery where blood flow is rerouted through a new artery or vein that is grafted around diseased sections of coronary arteries Cost Share Benefit plan arrangement requiring that the participant pay a portion of the costs This includes copayments coinsurance and deductibles Covered Charges Net charges minus the items not covered by the benefit plan Items not covered include charges for ineligible services network discounts etc CT A diagnostic imaging scan also called a Cat Scan (computed tomography) Declining Engaged customers that have completed an assessment two times and have demonstrated a worsening of their condition Deductible An amount specified in plan design that must be paid by member for covered expenses in a benefit period before the plan will pay benefits Demographic Risk Score Risks based on gender and age of the member Denied Charges Amounts not covered due to lack of information about the claim Diabetes retinopathy Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults Diagnostic Testing Refers to other significant testing procedures not named - examples include doppler electrocardiograph cardiac ultrasound and sleep studies Did Not Engage Reached customers who declined to engage with TheraCare Discounts Amounts reduced by a contractual fee arrangement with network participating providers prompt pay arrangements or Hospital Savings Program (HSP) Emergency Room - Diagnostic Groupings Musc - Musculoskeletal ENT - EarNoseThroat Skin - Skin Resp - Respiratory Circ - Circulatory Dig - Digestive Inj - Injury

Glossary of Terms (Medical) Engaged Reached customers who have an ongoing interaction with TheraCare Episode Risk Group (ERG) Uses pre-determined weights and a members profile to calculate a risk score This risk assessment is intended to evaluate current and future risks Episode Treatment Group (ETG) An illness classification methodology derived by analyzing actual claim experience and clinical review Esophagitis (digestive) Inflammation of the lining of the esophagus the tube that carries food from the throat to the stomach Evaluation and Management (EampM) EampM services refer to visits and consultations furnished by physicians Facility A site where health care services are delivered including hospitals convalescent units skilled nursing facilities and birthing centers Facility Outpatient Refers to services and costs that are incurred at a facility but did not result in an admission Fee for Service Compensating providers for rendering patient care which is based on an as services are rendered basis Gaps In Care Occurs when individuals do not receive or adhere to care that is consistent with medically proven guidelines for prevention and treatment Gastroenteritis (digestive) A condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract) Generic Drug A prescription drug that has the same active-ingredient formula as a brand-name drug Generic Efficiency This metric illustrates the rate of generic utilization for drugs in which a generic option is available HbA1c Test Glycohemoglobin blood test measures the average blood glucose level over the past 120 days Health Advisor (HA) Health specialists provide highly personalized management outreach and coaching to help members navigate through healthcare choices Health Advocacy Health Advocacy is the term Cigna uses to describe the process we use to improve health and lower costs for our customers and members Health Information Lines (HIL)

Provides customers with telephonic access to a health specialist and audio library when they have a health

question or need information about available treatment options


Healthy Babies Program

A voluntary prenatal program which offers expectant parents educational materials to encourage early prenatal

care and promote a healthy pregnancy Healthy Pregnancies Healthy Babies Program (HPHB) HPHB is a comprehensive maternity management program where goal is to reduce the number of pre-term and underweight babies ICD-9 International Statistical Classification of Disease used for morbidity and mortality statistics reimbursement systems and automated decision support Identified for Outreach Distinct customers targeted for TheraCare contact based on taking a specialty medication for their targeted condition Improving Engaged customers that have completed an assessment two times and have demonstrated an improvement in the status of their condition In-Network Services rendered by providers who are part of a network and with whom Cigna has a contractual relationship Inpatient Refers to services and costs that are incurred during a facility admission LDL-C Screening Blood test which measures low-density lipoprotein cholesterol Lipotropics Drugs which are designed to lower cholesterol and triglyceride levels which help reduce amount of overall fatty substances in the blood Mail Order Drugs A feature of a pharmacy program that enables a participant to send their prescription (and any applicable copay) directly to a mail-order vendor Maintenance Drugs Medications that are prescribed for long-term treatment of chronic conditions such as diabetes high blood pressure or asthma Major Diagnostic Categories (MDC) Industry standard groupings of ICD-9 diagnostic codes which relate to various body systems for inpatient and outpatient claims Major Joint (musculoskeletal) Examples of what comprises this category are major joint and limb reattachments hip or knee replacement Medication Adherence Reflection of the degree to which the patient is adhering to the prescribed medication treatment regimen


Medication Adherence Rate (MPR) MPR is calculated as the sum of the days supply (from claims) for a medication during a defined period of time divided by the number of days elapsed during the period MRI Magnetic Resonance Imaging - a type of diagnostic test Network Dollar Penetration All charges submitted by in-network providers as a percentage of overall charges NICU Neonatal Intensive Care Unit which provides a high level of intensive care to premature infants No Change Engaged customers that have completed an assessment two times and have not demonstrated an improvement or worsening of their condition Non-Preferred Brand Drug Drugs in the third tier of a pharmacy program brand-name drugs that either have generic equivalents or may have one or more preferred brand options Non-Users A member that had no episode of care medical or pharmacy Norm Norm refers to the comparison group based on book of business or industry experience for the defined parameters Norms are annualized unless otherwise stated Office visit Services delivered by a physician clinician or practitioner within the confines of a professional office setting Orthopedic A branch of medicine concerned with the correction or prevention of deformities disorders or injuries of the skeleton (tendons and ligaments) Other Medical (cardiac) Some examples of what comprises this category hypertension vascular procedures and angina Other Surgical (cardiac) Some examples of what comprises this category major cardiovascular procedures circulatory disorders and pacemaker Out-of-Network Services rendered by providers who are not part of the Cigna network based on your benefit plan design Outpatient Refers to services and costs that are incurred outside of a facility admission Pathology The study and diagnosis of disease through examination of organs tissues bodily fluids and whole bodies PET scan Positron Emission Tomography scan (specialized imaging)


Pharmacy Payments Includes prescription drug expenses paid under a pharmacy program These expenses would not include drugs covered under the medical benefit plan PHS PHS requires precertification of coverage primarily for inpatient care PHS+ PHS+ required precertification of coverage for both inpatient care and certain select outpatient services Pre-Certification Process of confirming eligibility and collecting information prior to inpatient admissions and selected ambulatory procedures and services Predictive Model System of using historical claims data to stratify members and identify those who can best benefit from case management andor disease management Preferred Brand Drug Drugs in the second tier of a Cigna two or three tier pharmacy program which have no generic equivalent Preventive Care Measures taken to prevent illness or injury and may include examinationsscreening tests tailored to an individuals age health and family history Primary Care Practitioner Include physicians and nonphysician primary care practitioners whom members are able to select as primary care practitioners Productivity Score Engaged customers that have completed a productivity assessment that measures absenteeism and presenteeism between their first and most recent measure Professional This category includes primary care physicians specialists (oncologists cardiologists neurologists obstetricians etc) surgeons etc Radiology Radiology is the medical specialty directing medical imaging technologies to diagnose and treat diseases Reached Identified customers who have had a conversation with TheraCare Retail Relates to services rendered by participating retail pharmacies Script A dispensed prescription Services per 1000 Count of medical and pharmacy services normalized per 1000 customers


Specialty Case Management Case management programs targeted to impact specific diseases and conditions - examples include oncology rehab and high risk maternity Spinal fusion A surgical procedure used to correct problems with the bones (vertebrae) of the back (spine) Therapeutic Class Major therapeutic classes include Central Nervous System Cardiovascular Hormonal Anti-infectives Pain AllergyRespiratory and other drugs Total Paid Sum of total medical and pharmacy paid claims Total Population Total customers eligible for the TheraCare benefit Total Value (Medication Adherence) Cost savings associated with customers whose medication adherence rate (MPR) shifted from below to above 80 between their first and most current measure Adherence value is based on a Cigna study of differences in medical costs associated with customers who became adherent versus those who remained non-adherent Total Value (Productivity) The value of productivity is based on the difference in the percent productivity between a members first measure and most current multiplied by the median income calculated by the US Bureau of Labor Statistics Unable to Reach Number of customers identified for outreach that TheraCare was able to contact by phone Unique Claimants A count of members who had one or more claims processed for a benefit plan during a specified time period Valve Replacement Example of what comprises this category cardiac valve and other major cardiothoracic procedures Well Visits Designed to discuss general health and any problems then focus on general disease prevention and health maintenance on a regular basis

Consultative Analytics

Sample Company

Copyright 2014 Cigna - Confidential amp Privileged - Not for Distribution

SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company

Current Period reflects claims incurred between Jan 2013 and Oct 2013 paid through Dec 2013
Base Period reflects claims incurred between Jan 2012 and Oct 2012 paid through Dec 2012

Comments

middot Net effective discount decreased from 154 to 149 a decrease of 05

middot Network Utilization decreased from 541 to 532 a decrease of 09

middot The number of unique members receiving a cleaning increased from 623 to 649 an increase of 26

Demographic Summary

Base

Current

Trend

Average Number of Employees

338

428

264

Average Number of Members

771

972

260

Average Member Age

282

287

18

Services per Claimant

53

56

57

of Members Using Plan

681

703

22

of Unique Members Receiving a Cleaning

623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22

In Network Discounts

$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549

Net Effective Discount

154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986

Savings as of submitted

219

273

54

Utilization Management

and Utilization Review Savings

$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835

Total Savings as of submitted

$29327

523

68

Employer Paid Amount

$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8

Dental - Utilization by Type of Service

Sample Company


Comments

middot There is an increase in cost in 6 categories and a decrease in cost in 2 categories for an overall cost trend of 111

middot There is an increase in services per thousand in 6 categories and a decrease in services per thousand in 2 categories for an overall utilization trend of 97

middot High utilization for DiagnosticPreventive services can lead to lower usage of other service categories

Employer Paid by Service Type - PMPM

Base

Current

Trend

DiagnosticPreventive

$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111

Services per 1000 Members by Type

Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Additional Plan Design Savings
Savings generated from contractual limitations and benefits exclusions
Adjunctive General Services
Palliative treatments consultations emergency care second opinions and anesthesia
Age Maximum
Savings due to age limits on fluoride treatments sealants orthodontic services and other services
Alternate Benefit Provision
This provision includes a three-tier claim review process monitored by Dental Claim Analysts Dental Reviewers and Dental Consultants Under this process proposed treatment plans are examined by Dental Reviewers and approved denied or referred to Dental Consultants for alternate treatment decisions Where appropriate the Dental Consultant will recommend alternate treatments considered to be less costly and consistent with professional dental standards
Annual Maximum
Savings due to a patient reaching the maximum payment under the plan often per calendar year
Average Area Charge
Average charge based on the number of dentist in the geographical area pertaining to your membership
Basic Restorative
Dental treatments or procedures performed to repair and restore individual teeth due to decay erosion trauma or improper function Basic services may include fillings oral surgery endodontics (root canals) and periodontics (tissuebone treatment)
Benefit Option
This code is used to identify different Cigna product lines purchased by a customer

Charges
The amount charged by a dentist for dental services rendered
Children
Children are defined as child step-child handicapped child eligible students and adult dependent
Claim Branch
This term describes the different ways an account can be sub-divided into groups for reporting purposes based on the account structure
Coinsurance
The percentage of covered expenses paid by the member when costs are being shared by both the plan and the individual member
Coordination of Benefits (COB)
The amount saved when Cigna is the secondary insurer It represents the difference between what Cigna pays and (COB) what it would have paid if it were primary
Covered Employees
The number of Covered Employees for the reporting period equals the number of active employees in the first reporting period month and includes any active employee additions made in the following months within the reporting period To be counted as a covered employee addition the employee must have had atone day of coverage
Deductible
An amount specified in plan design that must be paid by member for covered expenses in a benefit period before the plan will pay benefits
Dental treatments or procedures focused on the prevention and diagnosis of dental diseases These services may include oral examinations cleanings X-rays sealants and fluoride treatments

Glossary

Endodontics
The dental specialty that concentrates on the treatment of root canals or other injuriesdiseases of the pulp or nerve of the tooth
Frequency Maximum
Savings due to frequency limits on examinations cleanings radiographs crowns and other services
Ineligible Charges
Ineligible Charges include savings attributable to limitations of the plan (Missing Tooth Limitation AgeFrequency AnnualLifetime Maximums) charges submitted for ineligible participants application of Alternate Benefit Provisions which may be a result of the Pre-Determination of Benefits (PDB) process services that exceed the maximum reimbursable charge limits per service or the Scheduled Plan benefits if applicable and Utilization Management Services
In-Network
Services rendered by providers who are part of a network and with whom Cigna has a contractual relationship
Major Restorative
Dental treatments or procedures targeting the restoration of teeth using services such as crowns inlays or onlays Major services also may include prosthodontics (ie dentures)
Member
An individual who is eligible for coverage and enrolled under a dental plan Includes employee and any covered dependents
Missing Tooth Limitation
A contractual provision which limits or excludes payment for the replacement of teeth that are missing prior to the patients effective date of plan coverage

Norm
Norm refers to the comparison group based on book of business or industry experience for the defined parameters Norms are annualized unless otherwise stated
Oral Surgery
Non-surgical and surgical extractions and other surgical procedures
Orthodontics
Dental treatments or procedures performed to correct misalignments of the teeth and restore the teeth to their proper alignment and bite function Services may include braces or retainers
Other Savings
Other Savings is a category in which savings is captured when a claim has multiple plan design savings reasons
Out-of-Network
Services rendered by providers who are not part of the Cigna network based on your benefit plan design
Paid Claims
That portion of the dentists charges paid by Cigna to a patient or provider for dental services covered under the benefit plan
Patient
A unique individual participant (employee or dependent) who received one or more dental services during the reporting period in-network andor out-of-network
Periodontics
Scaling and root planing surgical procedures of the gingivabone and other gum-related treatment

Glossary

Pre-Determination of Benefits (PDB)
A process that allows the patient and dentist learn what benefits are provided by the dental plan in advance of treatment The PDB process provides the dentist and participant with a detailed explanation of what specific benefits are available at the time the claim is reviewed so that the dentist may discuss the information with the patient before treatment is rendered and expenses are incurred Savings from this process are also realized through the avoidance of more costly dental treatments where a less costly alternative is recommended
Provider Discounts
The difference between the contracted payment amount and the average area charge for a procedure
Scheduled Plan Savings
Savings due to the application of set scheduled dollar payment amounts for dental services set forth in a scheduled benefit plan
Services
The number of individual dental procedures rendered by dental care providers
Utlization Management
The set of administrative practices used on behalf of purchasers of dental benefits to manage the necessity appropriateness frequency and mix of dental services It entails practices used in claims review for predetermination or payment of benefits statistical review of individual provider utilization profiles and appropriate follow-up procedures

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012

Catastrophic Threshold

$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure

Status = Division = Products = DPPONAOAP

Package Parameters

PMPMBCOverrideNo

Normative Values

201212

ENVESTNET ASSET MANAGEMENT3330120

PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012

Incurred Runout 012013 to 122013 012012 to 122012

Catastrophic Threshold $25000

Package 406029

Package Name Package 1

Structure Status = Division = Products = DPPOOAP

Package Parameters PMPMBCOverrideNo

Healthcare Spend and Trend -- Facilities

600100

Base January 2012- October 2012

Current January 2013 - October 2013

Top Facilities

Facility Information Base

Name State Zip Code Unique Claimants Outpatient Visits Admissions Bed Days Inpatient Spend Outpatient Spend Total Spend Employer Paid Cost Share

DUKE UNIVERSITY HOSPITAL NC 27710 3 11 2 25 $134313 $4460 $138773 $137257 $1516

UNIVERSITY HOSPITAL CO 80246 5 36 2 8 $110611 $5501 $116112 $114751 $1360

SWEDISH MEDICAL CENTER WA 98107 5 11 3 11 $24478 $13353 $37831 $34842 $2989

WHITE PLAINS HOSPITAL CENTER NY 10601 1 16 1 8 $28253 $8419 $36672 $35586 $1086

NORTHWESTERN MEMORIAL HOSPITAL IL 60611 16 11 7 14 $22887 $9040 $31927 $24023 $7904

EL CAMINO HOSPITAL CA 94040 8 9 2 4 $3710 $16913 $20623 $16575 $4048

GULF COAST MEDICAL CENTER FL 33912 1 2 1 2 $17808 $1730 $19538 $17966 $1572

LITTLETON HOSPITAL CO 80210 4 5 1 2 $5746 $10595 $16341 $15496 $845

SOUTH SHORE HOSPITAL MA 02190 5 4 2 5 $9669 $5297 $14965 $10971 $3994

ROSE MEDICAL CENTER CO 80220 6 10 2 5 $10532 $4250 $14781 $12245 $2536

SWEDISH COVENANT HOSPITAL IL 60625 2 3 2 8 $13540 $471 $14011 $13243 $768

CHRIST HOSPITAL AND MEDICAL CENTER-ADVOCATE IL 60453 2 2 1 1 $11300 $953 $12253 $10638 $1615

MEDICAL CENTER OF AURORA CO 80011 6 12 1 1 $2069 $10065 $12134 $9456 $2678

ALEXIAN BROTHERS MEDICAL CENTER IL 60007 2 3 2 8 $8579 $2451 $11030 $9110 $1920

NOVANT HEALTH HUNTERSVILLE MEDICAL CENTER NC 28078 1 1 1 3 $8806 $1631 $10437 $8652 $1785

PORTER HOSPITAL CO 80210 1 3 1 1 $3862 $6083 $9945 $8111 $1834

EXEMPLA LUTHERAN MEDICAL CENTER CO 80263 3 5 2 3 $7145 $2590 $9735 $7895 $1840

LENOX HILL HOSPITAL NY 10075 3 1 2 5 $8925 $80 $9005 $8346 $659

NEW YORK METHODIST HOSPITAL NY 11215 2 4 2 4 $8946 $0 $8946 $7455 $1490

SKY RIDGE MEDICAL CENTER CO 80124 3 2 1 2 $6200 $933 $7133 $5865 $1268

SWEDISH MEDICAL CENTER CO 80113 5 3 2 2 $3950 $2606 $6556 $5474 $1082

Facility Information Current


ST JOSEPHS HOSPITAL NORTH FL 33558 2 3 2 8 $63838 $3381 $67219 $65145 $2074

MASSACHUSETTS GENERAL HOSPITAL MA 02114 9 28 1 3 $39143 $21507 $60650 $53367 $7283

BRIGHAM AND WOMENS HOSPITAL MA 02115 4 32 2 5 $31487 $26410 $57897 $52707 $5189

ST VINCENTS MEDICAL CENTER CT 06606 2 4 1 5 $45104 $3715 $48819 $46857 $1963



NORTHSHORE UNIVERSITY HEALTH SYSTEM IL 60026 14 29 1 1 $4079 $23880 $27959 $23229 $4730

CHILDRENS HOSPITAL COLORADO CO 80218 11 26 1 2 $7529 $18234 $25763 $19504 $6259


AVISTA HOSPITAL CO 80027 6 10 2 4 $7544 $11586 $19130 $16109 $3022

PLAINVIEW HOSPITAL NY 11803 1 2 1 1 $17127 $625 $17752 $16723 $1028



MEDICAL CITY DALLAS HOSPITAL TX 75230 1 1 1 10 $15847 $291 $16137 $15184 $953

COMMUNITY HOSPITAL IN 46321 2 5 1 2 $6538 $6614 $13151 $13151 $0

CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607

PORTER REGIONAL HOSPITAL IN 46383 4 9 2 2 $4189 $5103 $9291 $6584 $2707

LAS COLINAS MEDICAL CENTER TX 75039 1 1 1 3 $7631 $1170 $8801 $6728 $2073

HIGHLINE MEDICAL CENTER WA 98168 3 7 2 2 $7079 $850 $7929 $5587 $2342

PSL MEDICAL CTR CO 80218 4 4 0 0 $1780 $1000 $2780 $1482 $1298

MAYO CLINIC ARIZONA AZ 85038 1 8 1 5 $1184 $870 $2054 $2054 $0

Healthcare Spend and Trend -- Pharmacy - Incurred

600100



Pharmacy

Key Indicators Base Current Change Norm

Average Number of Employees 330 419 268

Average Number of Members 763 949 244

Ingredient Cost PMPM $6697 $7405 106 $000

Plan Cost PMPM $6838 $7528 101

Employer Paid PMPM $5854 $6596 127 $000

Cost Share PMPM $984 $932 -53 $000

Cost Share as percent of Ingredient Cost 147 126 -21 00

Scripts PMPY 68 69 14 00

Retail Adjusted Scripts PMPY 75 76 16 00

Average Ingredient Cost per script $11750 $12812 90 $000

Generic Rx Utilization Rate 766 798 32 00

Mail Order Fill Rate - Percent of total 46 46 -00 00

Mail Order Fill Rate - Retail adjusted 118 119 01 00

Formulary Brand Compliance Rate 766 747 -19 00

$000 $000 00 $000

Average Cost generic script $1077 $997 -75 $000

Average Cost Preferred script $3273 $3019 -78 $000

Average Cost Non-Preferred Script $4581 $5936 296 $000

Specialty Ingredient Cost PMPM 238 295 237 00

Specialty Scripts PMPY 13 09 -319 00

Specialty as Percent of Total Employer Paid 0 0 40 0

Analysis of Charges and Payments - Pharmacy

TOTAL IN NETWORK OUT OF NETWORK

WATERFALL Base Current Change Base Current Base Current

Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45

Member Cost Share $75101 $88480 178 $75101 $88462 $0 $18

Sales Tax $1645 $1657 08 $1645 $1657 $0 $0

Submitted Charges $757561 $1045329 380 $757561 $1041219 $0 $4110

Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45

Medical amp Pharmacy Payments by Dollar Range

BASE

Range Employer Paid Plan Amount of Total Payments Number of Unique Claimants Payments Per Unique Claimants

lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS

Range Employer Paid Plan Amount of Total Payments Number of Unique Claimants Payments per Unique Claimant of Total Payments Payments per Unique Claimants

lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606

Minor Therapeutic Classes

Rank by Current period plan spend

BASE CURRENT CHANGE NORM

Top 15 Plan Spend PMPM of Scripts of Claimants Plan Spend PMPM of Scripts of Claimants Plan Spend PMPM of Scripts of Claimants Plan Spend PMPM

MultipleLateral Sclerosis $757 8 2 $981 11 2 296 375 00 $000

Antineoplastics $787 68 8 $721 51 8 -84 -250 00 $000

Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000

Antidepressants $485 464 69 $374 530 98 -228 142 420 $000

Anti-Inflam Disease Modifiers $114 3 2 $349 8 3 2072 1667 500 $000

Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000

Top Drugs By Total Plan Spend

Current Rank Top 20 Drug Name Indication Tier of Scripts Plan Spend Employer Paid Cost Share Base Rank

1 GILENYA Multiple Sclerosis Non-Preferred Brand 11 $93117 $92282 $835 2

2 GLEEVEC Cancer Preferred Brand 10 $66518 $66518 $0 1

3 PULMOZYME Cystic Fibrosis Preferred Brand 2 $30214 $30074 $140 NA

4 XOLAIR Asthma Preferred Brand 3 $28214 $27996 $217 3

5 METHYLPHENIDATE ER ADHDNarcolepsy Generic 79 $19345 $18053 $1292 5

6 CYMBALTA Depression Preferred Brand 53 $17555 $15865 $1690 4

7 HUMIRA Arthritis Preferred Brand 2 $14926 $14926 $0 NA

8 ENBREL Arthritis Preferred Brand 5 $11505 $11380 $125 45

9 ATRIPLA HIV Non-Preferred Brand 5 $9500 $9275 $225 6

10 CREON Cystic Fibrosis Preferred Brand 2 $8332 $8192 $140 NA

11 LIALDA Crohns Disease Preferred Brand 10 $7975 $7725 $250 9

12 ONE TOUCH ULTRA TEST STRIPS Diabetes SuppliesOther 24 $7823 $7183 $640 11

13 ADDERALL XR ADHD Preferred Brand 25 $7512 $6887 $625 43

14 LEVALBUTEROL HCL Asthma Generic 12 $7099 $6959 $140 NA

15 AMPHETAMINE SALT COMBO ADHD Generic 64 $6821 $5811 $1010 25

16 LOVENOX Blood thinner Non-Preferred Brand 3 $6782 $6617 $165 NA

17 CIMZIA Crohns Disease Non-Preferred Brand 1 $6708 $3821 $2887 14

18 LUNESTA Sedative Non-Preferred Brand 25 $6050 $5159 $891 13

19 ORACEA Infection Preferred Brand 14 $6016 $5666 $350 20

20 NUVIGIL Narcolepsy Non-Preferred Brand 13 $5904 $4896 $1008 30

Top 25 specific drug therapeutic classes ranked by of scripts

Current Rank Drug Name Tier Indication Scripts Ingredient Cost per Script

1 SERTRALINE HCL Generic Depression 118 $1976

2 LISINOPRIL Generic Hypertension 117 $1097

3 AMOXICILLIN Generic Infection 110 $1023

4 HYDROCODONE-ACETAMINOPHEN Generic Pain 105 $2137

5 FLUTICASONE PROPIONATE Generic Nasal Congestion 94 $3130

6 SYNTHROID Preferred Brand Thyroid 93 $2689

7 AZITHROMYCIN Generic Infection 90 $2286

8 LEVOTHYROXINE SODIUM Generic Thyroid 87 $1067

9 METHYLPHENIDATE ER Generic ADHDNarcolepsy 79 $24337

10 AMPHETAMINE SALT COMBO Generic ADHD 64 $10471

11 SIMVASTATIN Generic Cholesterol 64 $1644

12 METFORMIN HCL ER Generic Diabetes 63 $7571

13 CITALOPRAM HBR Generic Depression 63 $1045

14 MONTELUKAST SODIUM Generic Asthma 62 $5695

15 ATORVASTATIN CALCIUM Generic Cholesterol 61 $3772

16 FLUOXETINE HCL Generic Depression 56 $1345

17 OMEPRAZOLE Generic Ulcer Heartburn 55 $3224

18 CYMBALTA Preferred Brand Depression 53 $32709

19 LOSARTAN POTASSIUM Generic Hypertension 50 $2410

20 ZOLPIDEM TARTRATE Generic Sedative 50 $1799

21 BUPROPION XL Generic Depression 49 $5055

22 MICROGESTIN FE Generic Contraception 48 $2641

23 AMLODIPINE BESYLATE Generic Hypertension 48 $1508

24 ALPRAZOLAM Generic Anxiety 48 $595

25 VALACYCLOVIR Generic Antivirals 46 $7037

Top 25 specific drug therapeutic classes ranked cost per scripts

Current Rank Drug Name Unique Individuals Bio-Pharmaceutical Indication Ingredient Cost per Script Ingredient Cost Scripts

1 PULMOZYME 1 Y Cystic Fibrosis $15107 $30214 2

2 XOLAIR 1 Y Asthma $9405 $28214 3

3 GILENYA 2 N Multiple Sclerosis $8465 $93117 11

4 HUMIRA 1 Y Arthritis $7463 $14926 2

5 CIMZIA 1 Y Crohns Disease $6708 $6708 1

6 GLEEVEC 1 N Cancer $6652 $66518 10

7 CAYSTON 1 N Infection $5758 $5758 1

8 VANCOMYCIN HCL 1 N Infection $4246 $4246 1

9 CREON 2 N Cystic Fibrosis $4164 $8328 2

10 VALCYTE 1 N Antivirals $2720 $5440 2

11 ENBREL 1 Y Arthritis $2301 $11505 5

12 LOVENOX 1 N Blood thinner $2261 $6782 3

13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2

15 MEPRON 1 N Infection $1702 $3405 2

16 ZYVOX 1 N Infection $1602 $1602 1

17 HUMATROPE 1 Y Growth Hormone $1559 $1559 1

18 SIMCOR 1 N Cholesterol $1154 $3463 3

19 VANOS 1 N Itching Inflammation $1141 $1141 1

20 ANDROGEL 2 N Hormone Replacement $1092 $2183 2

21 SOLODYN 1 N Infection $891 $1782 2

22 PENTASA 2 N Crohns Disease $874 $3497 4

23 ENOXAPARIN SODIUM 1 N Blood thinner $800 $800 1

24 LIALDA 2 N Crohns Disease $779 $7786 10

25 ASACOL HD 1 N Crohns Disease $777 $777 1

Pharmacy Scripts and Cost by Age Category

Average Number of Prescriptions by Age Category Base Current Change Average Pharmacy Payments by Age Category Base Current Change

lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79

of Prescriptions by Age Category Base Current Change of Payments by Age Category Base Current Change

lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00

Percent of Prescriptions Base Current Change Percent of Payments Base Current Change

Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25

Average Prescriptions Base Current Change Average Payment per Unique Claimant Base Current Change

Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01

Top 10 Drugs for Top 5 Therapeutic Classes by Number of Prescriptions

Pharmacy Statistics by Therapeutic Class Including Brand Name

Base Current Base - Current Change

Therapeutic Class Brand Name Number of Prescriptions Days Supply Number of Claimants Plan Amount Number of Prescriptions Days Supply Number of Claimants Plan Amount Number of Prescriptions Days Supply Number of Claimants Plan Amount

Contraceptivesoral Microgestin Fe 30 1008 6 $1035 48 1344 7 $1347 333 -1000 1202 301

Contraceptivesoral Loestrin 24 Fe 70 2184 13 $6034 44 1344 9 $4046 -385 -428 -280 -329

Contraceptivesoral Necon 18 684 3 $666 31 791 3 $880 156 -1000 1067 322

Contraceptivesoral Apri 5 140 1 $130 27 721 3 $744 4150 -1000 8271 4714

Contraceptivesoral Gianvi 4 112 1 $248 22 672 6 $1484 5000 -1000 6125 4977

Contraceptivesoral Reclipsen 16 448 2 $423 20 560 2 $572 250 -1000 1172 351

Contraceptivesoral Sprintec 4 112 2 $83 16 448 3 $316 3000 -1000 6259 2823

Contraceptivesoral Trinessa 0 0 0 $0 15 420 3 $344 00 00 00 00

Contraceptivesoral Syeda 3 84 1 $205 15 476 3 $1143 4667 -1000 5551 4590

Contraceptivesoral Levora-28 11 308 1 $321 15 420 2 $430 364 -1000 1037 340

Contraceptivesoral All Other 205 7116 53 $13548 258 8784 67 $15902 234 -504 415 174

Contraceptivesoral Subtotal 366 12196 65 $22693 511 15980 79 $27209 310 -562 515 199

Selective Serotonin Reuptake Inhibitor (Ssris) Sertraline Hcl 81 2718 27 $1359 118 4020 38 $2518 479 504 1598 852

Selective Serotonin Reuptake Inhibitor (Ssris) Citalopram Hbr 65 1950 19 $716 63 1890 25 $757 -31 -168 867 57

Selective Serotonin Reuptake Inhibitor (Ssris) Fluoxetine Hcl 62 1840 17 $912 56 1654 20 $861 -101 95 -224 -57

Selective Serotonin Reuptake Inhibitor (Ssris) Escitalopram Oxalate 35 1170 15 $4898 38 1297 16 $1908 109 516 -705 -611

Selective Serotonin Reuptake Inhibitor (Ssris) Paroxetine Hcl 27 810 6 $1602 34 1020 6 $2077 259 -236 520 297

Selective Serotonin Reuptake Inhibitor (Ssris) Fluvoxamine Maleate 0 0 0 $0 5 150 1 $1302 00 00 00 00

Selective Serotonin Reuptake Inhibitor (Ssris) Luvox Cr 9 270 2 $2308 3 90 1 $973 -667 -667 -559 -578

Selective Serotonin Reuptake Inhibitor (Ssris) Prozac 1 30 1 $207 0 0 0 $0 -1000 00 -1000 -1000

Selective Serotonin Reuptake Inhibitor (Ssris) Lexapro 9 270 5 $1300 0 0 0 $0 -1000 -1000 -1000 -1000

Selective Serotonin Reuptake Inhibitor (Ssris) Subtotal 289 9058 51 $13304 317 10121 70 $10396 117 17 -301 -219

Analgesics Narcotics Hydrocodone-Acetaminophen 77 549 59 $1213 105 1057 68 $2502 925 246 2550 1062

Analgesics Narcotics Tramadol Hcl 45 527 6 $606 33 599 12 $469 137 -344 -28 -225

Analgesics Narcotics Oxycodone-Acetaminophen 26 78 24 $240 32 133 30 $352 705 393 837 467

Analgesics Narcotics Oxycodone Hcl 5 26 4 $86 26 392 11 $660 14077 2352 12785 6699

Analgesics Narcotics Fentanyl 0 0 0 $0 22 660 3 $2664 00 00 00 00

Analgesics Narcotics Methadone Hcl 5 150 1 $99 7 161 2 $156 73 194 664 569

Analgesics Narcotics Morphine Sulfate Er 1 5 1 $10 6 157 3 $174 30400 -1000 00 16426

Analgesics Narcotics Endocet 3 8 3 $38 3 14 3 $53 750 500 322 417

Analgesics Narcotics Tramadol Hcl Er 0 0 0 $0 2 60 1 $189 00 00 00 00

Analgesics Narcotics Oxycontin 0 0 0 $0 2 14 2 $57 00 00 00 00

Analgesics Narcotics All Other 4 74 2 $1256 4 41 4 $639 -446 00 -980 -491

Analgesics Narcotics Subtotal 166 1417 75 $3548 242 3288 89 $7916 1320 797 1535 1231

Thyroid Hormones Synthroid 52 1800 12 $1512 93 3240 24 $2715 800 773 1796 796

Thyroid Hormones Levothyroxine Sodium 65 2070 25 $614 87 3090 22 $1103 493 224 3772 795

Thyroid Hormones Armour Thyroid 10 300 1 $127 19 570 5 $234 900 846 00 846

Thyroid Hormones Liothyronine Sodium 8 225 2 $225 9 270 2 $219 200 125 -105 -23

Thyroid Hormones Levoxyl 22 780 5 $324 8 300 3 $141 -615 -620 -379 -565

Thyroid Hormones Np Thyroid 6 180 1 $60 4 120 1 $28 -333 -531 00 -531

Thyroid Hormones Tirosint 2 56 1 $90 3 84 1 $135 500 500 00 500

Thyroid Hormones Cytomel 0 0 0 $0 1 30 1 $182 00 00 00 00

Thyroid Hormones Subtotal 165 5411 24 $2952 224 7704 38 $4758 424 492 1499 612

Penicillins Amoxicillin 104 1092 94 $1372 110 1076 96 $1367 -15 157 -334 -04

Penicillins Amox Tr-Potassium Clavulanate 40 486 33 $1435 42 399 34 $1291 -179 -134 -81 -100

Penicillins Penicillin V Potassium 6 51 5 $74 12 116 12 $189 1275 1188 2874 1546

Penicillins Dicloxacillin Sodium 0 0 0 $0 2 17 2 $52 00 00 00 00

Penicillins Ampicillin Trihydrate 1 30 1 $15 1 5 1 $8 -833 -154 -1000 -437

Penicillins Subtotal 151 1659 114 $2896 167 1613 122 $2907 -28 101 -103 04

ALL Other Classes ALL Other Drugs 3212 87380 1500 $476379 4025 111548 1913 $661331 277 243 409 388

Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369

Healthcare Spend and Trend Detail - Incurred

600100



Financial Overview

Population Base Current Change

Avg Members 763 949 244

Avg Employees 331 419 268

Population by Tier Base Current Change

Employees 331 419 268

Spouses 151 180 192

Dependents 282 350 242

Average Contract Size 231 226

Total Plan Spend PMPM

Plan Spend Base Current Change Base Current Change

Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101

Total Combined Spend $2721174 $3201262 176 $357 $337 -54

Total Employer Paid PMPM

Employer Paid Base Current Change Base Current Change

Medical Employer Paid $1852523 $2058222 111 $243 $217 -107

Pharmacy Employer Paid $446671 $626037 402 $59 $66 127

Total Combined Employer Paid $2299193 $2684259 167 $301 $283 -61

Cost Share Percent PMPM

Member Cost Share Base Current Base Current Change

Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15

Network Discounts Base Current Change

Total 563 497 -117


Plan Spend by MSC Base Current Change Base Current Change

Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims

Catastrophic Claimants Base Current Change

Claimants per 1000 189 190 06

Number of Claimants 12 15 250

Average Cost per Claim $68736 $55236 -196

of Total Spend 303 259 -146

Number of Claimants Average Cost Per Claimant

Relationship Base Current Change Base Current Change

Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male

of Members by Age Band and Gender Base Current Change Base Current Change

lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male

Plan Spend by Age Band and Gender Base Current Change Base Current Change

lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male

PMPM Spend by Age Band and Gender Base Current Change Base Current Change

lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166

Plan Spend PMPM PMPM (NET OF CATS)

Relationship Base Current Change Base Current Change Base Current Change

Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined

Number of Claimants of Total Plan Spend Plan Spend

Group Base Current Change Base Current Change Base Current Change

MusculoskelFractureSprainStrain 181 212 171 165 164 -01 $349933 $390400 116

Pregnancy Childbirth Puerperium 30 23 -233 118 81 -37 $250764 $193128 -230

Gastrointestinal (Including Mouth) 95 100 53 46 78 31 $98420 $185077 880

Reproductive 129 171 326 57 78 20 $121576 $184213 515

InternalExternal Injury 64 72 125 21 77 55 $45406 $181843 3005

Renal And Urologic 50 53 60 94 73 -22 $200047 $172865 -136

NeurologicalCerebrovascular 49 72 469 46 70 23 $98299 $165785 687

Neoplasms 104 125 202 53 69 16 $112605 $164382 460

General Medical Diagnoses 374 433 158 63 69 06 $133488 $162817 220

HeartCirculatory 62 73 177 104 52 -52 $221435 $123821 -441

Ear Nose And Throat (Inc Upp Resp) 209 261 249 30 52 22 $63652 $122489 924

Endocrine Nutritional Metabolic 106 120 132 22 22 -01 $47539 $51434 82

Mental Disorders 68 88 294 26 22 -04 $54496 $51417 -57

Skin And Non-Malignant Breast 117 149 274 16 19 03 $34826 $45006 292

Lower Respiratory System 107 193 804 15 19 04 $31259 $44934 437

Infectious And Parasitic 128 153 195 11 19 08 $22608 $44284 959

Immune Disorders 51 63 235 14 12 -02 $29112 $28776 -12

Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340

Blood And Blood Forming Organs 29 25 -138 05 05 00 $9616 $10941 138

Substance Use Disorders 1 4 3000 00 02 02 $801 $4994 5238

Biliary Tract And Liver 8 7 -125 00 02 01 $857 $3928 3584

ICD9 Major Inpatient

Number of Admissions of Total Plan Spend Plan Spend


MusculoskelFractureSprainStrain 2 6 2000 149 279 129 $69695 $113127 623



HeartCirculatory 3 2 -333 195 139 -56 $90838 $56419 -379



Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00


Immune Disorders 0 1 00 00 10 10 $0 $4079 00


Blood And Blood Forming Organs 0 1 00 00 06 06 $0 $2497 00

Endocrine Nutritional Metabolic 0 1 00 00 03 03 $0 $1184 00

Mental Disorders 0 0 00 00 00 00 $0 $0 00

Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient

Inpatient Spend Base Current Change

Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142

Plan Amount PMPM $61 $43 -300

Utilization Base Current Change

Admissions 42 36 -143

Bed Days 126 109 -135

ALOS 300 303 09

Admits per K 660 455 -310

Bed Days per K 1981 1379 -304

Average Payment per Day $3703 $3723 06

Average Payment per Admission $11108 $11273 15

DRG Severity Index 088 118 340

Inpatient Maternity amp Newborns

BASE CURRENT CHANGE

Maternity Utilization Admits per 1000 of Total Admits Admits per 1000 of Total Admits Admits per 1000

Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE

Maternity Spend Average Spend per Admission Spend per Bed Day Average Spend per Admission Spend per Bed Day Average Spend per Admission Spend per Bed Day

Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE

Newborn Utilization Admits per 1000 of Total Admits Admits per 1000 of Total Admits Admits per 1000

Normal 157 667 76 750 -517

Premature 16 67 13 125 -195

Full Term with Compl 63 267 13 125 -799

Total 236 1000 101 1000 -571

BASE CURRENT CHANGE

Newborn Spend Average Spend per Admission Spend per Bed Day Average Spend per Admission Spend per Bed Day Average Spend per Admission Spend per Bed Day

Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449

Full Term with Compl $0 $0 $0 $0 00 00

Full Term with Compl $35824 $4777 $2220 $1110 -938 -768

Total $10341 $2927 $1954 $977 -811 -666

Outpatient

Outpatient Spend Base Current Change

Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276

Plan Amount PMPM $82 $84 27


Surgery per k 708 835 180

Diagnostic per k 13160 11764 -106

ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11

Surgery CostService $1646 $2547 547

Diagnostic CostService $303 $274 -96

ER CostVisit $1223 $1391 137

UC CostVisit $165 $157 -52

Other CostService $301 $290 -35

Network Base Current Change

Office Visit 984 960 -25

Spend 992 954 -39

Professional

Professional Spend -- Inpatient Base Current Change

Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602


Utilization per K Spend Per Service

Professional Inpatient Base Current Change Base Current Change

Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42

Professional Spend -- Outpatient Base Current Change

Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239



Professional Outpatient Base Current Change Base Current Change

Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101

Professional Office Visits Base Current Change

Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319


Plan Cost per Office Visit $160 $171 70

Plan Cost per PCP Visit $156 $163 46

Plan Cost per Specialist Visit $167 $184 97

Utilization per K Spend Per Visit

Professional Office Visits Base Current Change Base Current Change

EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297

Analysis of Charges and Payments - Medical


Base Current Change Base Current Base Current


Total Unique Claimants 717 873 218 714 864 93 162

Plan Utilization 9395 9198 -21 9355 9103 1219 1707


WATERFALL (FFS Only) Base Current Change Base Current Base Current


Charges Denied Due to Lack of Information $54591 $9499 -826 $52656 $4138 $1934 $5361

Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667

Amounts above MRC $0 $0 00 $0 $0 $0 $0

Pre-Existing Conditions $1712 $2356 376 $1712 $2061 $0 $295

Ineligible Claimants $1529 $290 -810 $529 $290 $1000 $0

Plan Max Exceeded $13090 $124 -991 $13090 $124 $0 $0

Covered by Medicare $291 $319573 1098965 $291 $316871 $0 $2702

Other Reasons Not Covered $496280 $139762 -718 $285960 $66769 $210319 $72993

Total Amounts Not Covered $2906394 $2676398 -79 $2655031 $2581741 $251363 $94656

Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778

DeductibileCopay $224231 $294702 314 $192805 $228848 $31426 $65853

Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117

Member Cost Sharing $346880 $428522 235 $304393 $347552 $42487 $80970

COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873

INCLUDES ALL CLAIMS PAID IN NETWORK INCLUDING CLAIMS NOT SUBJECT TO STANDARD DISCOUNT RATE GUARANTEE CALCULATIONS

Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0

Network Penetration amp Discounts

Base Current

MSC Plan Amount In Network Discounts Plan Amount In Network Discounts

Inpatient Facility $466518 1000 613 $405828 1000 486

Outpatient Facility $627721 953 646 $801551 991 567

Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base

In Network Out of Network

MSC Number of Claimants Considered Charges Plan Amount Number of Claimants Considered Charges Plan Amount

Inpatient Facility 41 $869533 $336113 1 $305936 $130405

Outpatient Facility 404 $1675141 $592884 12 $96719 $34838

Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current



Inpatient Facility 34 $873336 $448909 0 $29442 -$43082


Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059

Network Base Current Change Norm

Admissions In Network 10000 10000 00

of Office Visits In Network 9842 9598 -24

Medical Payments by Dollar Range

BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

1


Revision History

Version Date Author(s) Revision Notes

(note major changes additions deletions within each section)

10 02172014 mwithington Initial creation of CRP-CAP user guide

20 02252014 ComplianceLegal Medical and dental glossary definition modifications Cigna Copyright Statement

30 03192014 mwithington Guaranteed CostFully Insured Accounts ndash Pg 14

40 4092014 mwithington

PDF attachments for Medical and Dental Glosseries ndash Appendix B Product Structure prefix defined ndash Page 10 Incurred Start and End Dates ndash Current and Base ndash Page 11

2


Table of Contents


11 Objectives 5























3


Figures List













4




later


1 Log-in to the CRP





Overview Options

















5


11 Objectives













My Request Queue

Posted Report Queue

6


13 Getting Started

Access





Logging In




Figure 1


7







8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

2


Table of Contents


11 Objectives 5























3


Figures List













4




later


1 Log-in to the CRP





Overview Options

















5


11 Objectives













My Request Queue

Posted Report Queue

6


13 Getting Started

Access





Logging In




Figure 1


7







8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

3


Figures List













4




later


1 Log-in to the CRP





Overview Options

















5


11 Objectives













My Request Queue

Posted Report Queue

6


13 Getting Started

Access





Logging In




Figure 1


7







8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

4




later


1 Log-in to the CRP





Overview Options

















5


11 Objectives













My Request Queue

Posted Report Queue

6


13 Getting Started

Access





Logging In




Figure 1


7







8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

5


11 Objectives













My Request Queue

Posted Report Queue

6


13 Getting Started

Access





Logging In




Figure 1


7







8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

6


13 Getting Started

Access





Logging In




Figure 1


7







8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

7







8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

8





(figure 3)


9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

9











10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

10









11


25 Report Selection


26 Parameters

Incurred Reporting







12









13



Correspond


Figure 4


Correspond

14







Figure 5


15



Figure 6



16




Figure 7



17















18




19



Figure 9


20




window

Figure 10


21






Figure 11



22


Appendix A






Sample



23


Appendix B







24






Corporation














Capitation





Case Management







Chronic




















Sample Company


SM

Table of Contents

bull Dental

bull HCST

Plan cost amp trend

Dental Summary

Sample Company


Comments




Demographic Summary

Base

Current

Trend


338

428

264


771

972

260

Average Member Age

282

287

18


53

56

57


681

703

22


623

649

26

$60

$45

$30

$15

$0

Base

Current

$1408

$2244

$2512

$2791

$3921

$5035

Cost Share PMPM

Paid Amount PMPM

Plan Spend PMPM

Claims Summary

Base

Current

Trend

Charges

$355733

$568492

598

Charges in Network

$192298

$302256

572

DNSP Charges

$16685

$39487

1367

Network Utilization

541

532

-09

DNSP Utilization

47

69

22


$51738

$77124

491

DNSP Discounts

$2879

$7477

1597

Total Discounts

$54617

$84601

549


154

149

-05

Total Utilization

587

601

14

Plan Design Savings

$78079

$155066

986


219

273

54



$29327

$57667

966


82

101

19

Savings as of paid

151

213

62

Total Savings

$162023

$297333

835


$29327

523

68


$193710

$271159

400

Paid Amount PEPM

$5728

$6343

107

Paid Amount PMPM

$2512

$2791

111

PAGE 3 OF 8


Sample Company


Comments





Base

Current

Trend


$1402

$1475

52

Basic Restorative

$316

$432

367

Major Restorative

$262

$387

474

Endodontics

$156

$097

-377

Periodontics

$127

$137

80

Oral Surgery

$105

$085

-192

Orthodontics

$114

$117

19

Other Services

$030

$062

1046

Total

$2512

$2791

111


Base

Current

Trend


32934

33710

24

Basic Restorative

4078

5474

342

Major Restorative

872

1693

942

Endodontics

389

259

-333

Periodontics

1401

1446

32

Oral Surgery

918

1001

90

Orthodontics

1385

1223

-117

Other Services

1230

2570

1090

Total

43206

47376

97

PAGE 4 OF 8

Glossary

Age Maximum
Annual Maximum
Average Area Charge
Basic Restorative
Benefit Option

Charges
Children
Claim Branch
Coinsurance
Covered Employees
Deductible

Glossary

Endodontics
Frequency Maximum
Ineligible Charges
In-Network
Major Restorative
Member

Norm
Oral Surgery
Orthodontics
Other Savings
Out-of-Network
Paid Claims
Patient
Periodontics

Glossary

Provider Discounts
Services

Report Parameters

Global Parameters

Overall Dates

Current

Base

Incurred

012013 to 102013

012012 to 102012

Incurred Runout

012013 to 122013

012012 to 122012


$25000

Exclude Pharmacy

No

Package 406029

Package Name

Package 1

Structure


Package Parameters

PMPMBCOverrideNo

Normative Values

201212


PAGE 8 OF 8

CP_900

CP_902

CP_905

Report Parameters

Report Parameters

Accounts 600100

Structure ID 999999

Global Parameters

Current Base

Incurred 012013 to 102013 012012 to 102012



Package 406029





600100



Top Facilities









































CMC NORTHEAST NC 28025 6 9 1 1 $2497 $7022 $9519 $7913 $1607







600100



Pharmacy







Cost Share PMPM $984 $932 -53 $000









$000 $000 00 $000










Dispensing Fee $6793 $7771 144 $6793 $7771 $0 $0

Gross Cost $511008 $702852 375 $511008 $702807 $0 $45


Sales Tax $1645 $1657 08 $1645 $1657 $0 $0


Discounts $246554 $342477 389 $246554 $338412 $0 $4065

Eligible $511008 $702852 375 $511008 $702807 $0 $45


BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 184 $0

lt=$100 $1485 $2425 009 48 $51

gt$100lt=$500 $50742 $68754 260 241 $285

gt$500lt=$1000 $57754 $84220 319 116 $726

gt$1000lt=$2500 $184197 $262536 994 164 $1601

gt$2500lt=$5000 $220642 $289440 1096 81 $3573

gt$5000lt=$10000 $307808 $387323 1466 53 $7308

gt$10000lt=$25000 $433251 $533558 2020 36 $14821

gt$25000lt=$50000 $272862 $303656 1149 9 $33740

gt$50000lt=$75000 $168221 $175543 665 3 $58514

gt$75000lt=$100000 $0 $0 000 0 $0

gt$100000 $522732 $534222 2022 4 $133555

Total $2219696 $2641676 10000 939 $2813

CURRENT NORMS


lt$0 $0 $0 00 0 $0 00 $0

$0 $0 $0 00 261 $0 00 $0

lt=$100 $2194 $3556 01 70 $51 00 $0

gt$100lt=$500 $58043 $77943 25 289 $270 00 $0

gt$500lt=$1000 $77542 $105134 34 147 $715 00 $0

gt$1000lt=$2500 $206436 $309046 100 193 $1601 00 $0

gt$2500lt=$5000 $241777 $328091 106 92 $3566 00 $0

gt$5000lt=$10000 $373446 $489962 159 70 $6999 00 $0

gt$10000lt=$25000 $503832 $601048 194 40 $15026 00 $0

gt$25000lt=$50000 $443308 $476307 154 14 $34022 00 $0

gt$50000lt=$75000 $341800 $362988 117 6 $60498 00 $0

gt$75000lt=$100000 $325086 $336391 109 4 $84098 00 $0

gt$100000 $0 $0 00 0 $0 00 $0

Total $2573464 $3090466 1000 1186 $2606







Asthma Related $741 246 88 $661 338 125 -108 374 420 $000

Stimulants $443 177 31 $514 229 38 159 294 226 $000



Cystic Fibrosis $000 0 0 $318 2 1 00 00 00 $000

Contraceptives $329 389 70 $314 528 87 -46 357 243 $000

Acne Agents $174 56 24 $195 58 30 119 36 250 $000

Insulins $133 51 8 $170 74 9 273 451 125 $000

Antivirals $112 70 26 $150 79 31 344 129 192 $000

Tetracyclines $163 62 20 $150 91 34 -82 468 700 $000

Lipid Lowering $144 128 26 $141 209 37 -20 633 423 $000

Antiulcer $129 181 46 $140 170 42 84 -61 -87 $000

Hypoglycemics $122 104 11 $139 135 17 135 298 545 $000

Other $2206 2342 1044 $2212 2973 1316 03 269 261 $000





















































2 XOLAIR 1 Y Asthma $9405 $28214 3




6 GLEEVEC 1 N Cancer $6652 $66518 10







13 ATRIPLA 1 N HIV $1900 $9500 5

14 ABSORICA 1 N Acne $1817 $3634 2














lt1 01 00 -598 lt1 $135 $45 -665

1-17 09 08 -83 1-17 $259 $454 756

18-29 10 13 308 18-29 $902 $723 -198

30-39 21 17 -166 30-39 $670 $1015 515

40-49 15 15 20 40-49 $608 $514 -155

50-59 12 13 102 50-59 $1959 $1699 -133

60-64 01 02 1123 60-64 $1790 $913 -490

AVERAGE 68 69 15 AVERAGE $759 $819 79


lt1 14 06 -09 lt1 04 01 -03

1-17 132 120 -13 1-17 80 126 46

18-29 144 186 42 18-29 206 156 -50

30-39 301 248 -53 30-39 229 293 64

40-49 222 223 01 40-49 143 120 -23

50-59 175 190 15 50-59 308 290 -18

60-64 11 24 13 60-64 31 13 -18

AVERAGE 1000 1000 00


Female 596 575 -20 Female 547 572 25

Male 404 425 20 Male 453 428 -25


Female 8716 8673 -05 Female $768 $881 148

Male 5194 5462 52 Male $750 $749 -01























































Total Total 4349 117121 523 $521772 5486 150254 640 $714517 283 178 402 369


600100



Financial Overview






Spouses 151 180 192





Medical Spend $2199402 $2486745 131 $288 $262 -91

Pharmacy Spend $521772 $714517 369 $68 $75 101









Medical 158 172 $45 $45 -07

Pharmacy 144 124 $10 $9 -53

Total Cost Share 155 161 $55 $54 -15


Total 563 497 -117



Inpatient $466518 $405828 -130 $61 $43 -300

Outpatient $627721 $801551 277 $82 $84 27

Professional $870027 $919727 57 $114 $97 -150

OMS $229787 $350526 525 $30 $37 227

Capitation $5349 $9112 704 $1 $1 370

Pharmacy $521772 $714517 369 $68 $75 101


Catastrophic Claims








Employee 3 6 1000 $66595 $60086 -98

Spouse 7 6 -143 $58236 $58673 08

Dependent 2 3 500 $108695 $38662 -644

Demographics

Female Male


lt1 06 07 01 13 14 01

1-17 150 142 -08 145 143 -02

18-29 75 77 01 106 108 02

30-39 111 104 -07 133 129 -04

40-49 82 84 02 84 91 07

50-59 39 42 03 46 48 02

60-64 03 04 01 05 05 -00

65+ 00 00 00 00 01 01

TOTAL 467 460 -07 533 540 07

Female Male


lt1 20 12 -08 110 44 -65

1-17 96 74 -22 59 77 18

18-29 51 58 07 32 62 30

30-39 160 207 47 30 35 05

40-49 216 131 -84 123 71 -51

50-59 34 76 43 60 133 73

60-64 01 00 -00 09 17 08

65+ 00 00 00 00 01 01

TOTAL 577 560 -17 423 440 17

Female Male


lt1 $941 $427 -546 $2279 $1029 -549

1-17 $177 $130 -263 $113 $165 457

18-29 $187 $190 16 $85 $183 1150

30-39 $400 $498 245 $63 $82 291

40-49 $729 $390 -465 $408 $266 -349

50-59 $237 $452 907 $363 $897 1469

60-64 $47 $30 -360 $469 $1044 1223

65+ $0 $0 $45 $884 18457

TOTAL $343 $304 -112 $221 $257 166



Employee 336 417 81 $277 $319 152 $218 $235 78

Spouse 390 328 -62 $704 $584 -170 $459 $394 -141

Dependent 274 255 -19 $264 $233 -119 $185 $196 63

ICD9 Major Combined






Reproductive 129 171 326 57 78 20 $121576 $184213 515




Neoplasms 104 125 202 53 69 16 $112605 $164382 460










Newborns 23 14 -391 80 12 -68 $169262 $27644 -837

Eye 68 85 250 11 07 -05 $23904 $15771 -340













Newborns 15 8 -467 332 39 -294 $155110 $15629 -899

Neoplasms 0 1 00 00 36 36 $0 $14591 00







Reproductive 2 0 -1000 43 00 -43 $20107 $0 -1000


Inpatient


Plan Amount $466518 $405828 -130

Cost Share $26837 $28599 66

Paid Amount $439681 $377229 -142




Bed Days 126 109 -135

ALOS 300 303 09


Bed Days per K 1981 1379 -304





BASE CURRENT CHANGE


Normal 204 812 89 778 -567

Csection 47 188 25 222 -464

Other 00 00 00 00 00

Total 252 1000 114 1000 -547

BASE CURRENT CHANGE


Normal $5769 $2586 $6435 $3753 115 451

Csection $8402 $1680 $10475 $3492 247 1078

Other $0 $0 $0 $0 00 00

Total $6262 $2277 $7332 $3666 171 610

BASE CURRENT CHANGE


Normal 157 667 76 750 -517

Premature 16 67 13 125 -195


Total 236 1000 101 1000 -571

BASE CURRENT CHANGE


Normal $841 $421 $1394 $643 657 529

Premature $3402 $1134 $5046 $5046 483 3449



Total $10341 $2927 $1954 $977 -811 -666

Outpatient


Plan Amount $627721 $801551 277

Cost Share $118565 $151672 279

Paid Amount $509156 $649879 276





ER per k 1525 1455 -46

UC per k 645 557 -137

Other per k 9135 9234 11



ER CostVisit $1223 $1391 137





Spend 992 954 -39

Professional


Plan Amount $202531 $82905 -591

Cost Share $25552 $12402 -515

Employer Paid $176979 $70504 -602




Anesthesia 377 253 -330 $1719 $987 -426

Obstetrics 425 126 -702 $1789 $1892 58

IP Visit 1305 1088 -166 $142 $128 -96

Surgery 660 202 -694 $1589 $664 -582

Newborn Care 550 177 -678 $385 $374 -31

Consult 126 177 408 $245 $248 14

Lab 5692 2834 -502 $8 $14 748

ER 110 63 -425 $241 $547 1270

Pathology 157 202 287 $133 $119 -102

Radiology 1053 405 -616 $51 $43 -147

Other 1116 417 -626 $137 $142 42


Plan Amount $667496 $836822 254

Cost Share $159281 $207263 301

Employer Paid $508215 $629558 239




Anesthesia 535 721 349 $762 $865 135

Surgery 4167 4465 72 $277 $349 260

Consult 1635 1341 -180 $276 $257 -70

Prev Med 6682 6945 39 $134 $138 28

Diagnostic 2170 2555 178 $141 $130 -76

EampM 25535 25490 -02 $105 $106 09

Radiology 7704 7147 -72 $108 $97 -106

MHSA 5063 4579 -96 $105 $96 -94

RehabTherapy 28270 26299 -70 $43 $37 -152

Lab 24371 19645 -194 $23 $23 -08

Other 26006 24908 -42 $56 $61 101


Plan Amount $312114 $420000 346

Cost Share $49291 $73375 489

Employer Paid $262823 $346625 319







EampM 24733 24908 07 $105 $106 13

Prev Med 6525 6856 51 $135 $137 16

OMS Drugs 6352 6439 14 $55 $76 372

ImmunInject 9780 9538 -25 $26 $27 35

Surgery 1352 1670 235 $143 $146 25

Lab 8286 9690 169 $16 $17 57

Radiology 1572 1429 -91 $73 $95 300

Diagnostic 959 1379 438 $82 $89 82

RehabTherapy 1038 2049 975 $31 $32 40

Allergy 2626 1796 -316 $26 $27 34

Other 4072 5591 373 $50 $35 -297











Net Charges $5026861 $5132517 21 $4701019 $4929082 $325842 $203435

Discounts $2299447 $2154569 -63 $2299447 $2154569 $0 $0

Plan Exclusions $94046 $59724 -365 $54003 $41057 $40044 $18667








Covered Charges $2120467 $2456119 158 $2045988 $2347341 $74478 $108778


Coinsurance $122649 $133821 91 $111588 $118704 $11061 $15117


COB $274 $82814 301706 $274 $81824 $0 $990

Payments $1773025 $1947427 98 $1741197 $1919525 $31828 $27902

Total Medical $2119905 $2375950 121 $2045590 $2267077 $74315 $108873


Choice Fund Summary

Measures Current

EMPLOYER FUNDED

Medical $0

Pharmacy $0


Base Current




Professional $870027 954 451 $919727 915 445

All Other $155639 978 399 $248844 948 337

Total $2119905 966 563 $2375950 964 497

Base





Professional 703 $1344808 $738017 82 $196313 $132010

All Other 336 $193049 $116044 15 $40595 $39594

Total 714 $4082530 $1783058 93 $639563 $336847

Current





Professional 857 $1388625 $771637 136 $223204 $148091

All Other 423 $262408 $173883 31 $79249 $74961

Total 864 $4332250 $2177891 162 $367212 $198059





BASE


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 228 $0

lt=$100 $1506 $2269 008 38 $60

gt$100lt=$500 $56758 $74636 320 273 $273

gt$500lt=$1000 $59097 $84572 333 120 $705

gt$1000lt=$2500 $148905 $217579 840 141 $1543

gt$2500lt=$5000 $129788 $175149 732 51 $3434

gt$5000lt=$10000 $247890 $313290 1398 45 $6962

gt$10000lt=$25000 $339092 $423594 1913 31 $13664

gt$25000lt=$50000 $226934 $252007 1280 8 $31501

gt$50000lt=$75000 $47218 $50384 266 1 $50384

gt$75000lt=$100000 $95355 $98256 538 1 $98256

gt$100000 $420481 $428171 2372 3 $142724

Total $1773025 $2119905 10000 940 $2255

CURRENT


lt$0 $0 $0 000 0 $0

$0 $0 $0 000 321 $0

lt=$100 $2285 $3636 012 60 $61

gt$100lt=$500 $65549 $88392 337 334 $265

gt$500lt=$1000 $66893 $95414 343 134 $712

gt$1000lt=$2500 $170051 $263612 873 165 $1598

gt$2500lt=$5000 $199769 $272522 1026 74 $3683

gt$5000lt=$10000 $270211 $358285 1388 51 $7025

gt$10000lt=$25000 $394936 $466607 2028 31 $15052

gt$25000lt=$50000 $262394 $283616 1347 8 $35452

gt$50000lt=$75000 $276850 $295828 1422 5 $59166

gt$75000lt=$100000 $238490 $248037 1225 3 $82679

gt$100000 $0 $0 000 0 $0

Total $1947427 $2375950 10000 1186 $2003

Report Parameters

Accounts	600100

Structure ID	999999

Global Parameters

		Current		Base

	Incurred		012013 to 102013		012012 to 102012

	Incurred Runout		012013 to 122013		012012 to 122012

	Catastrophic Threshold	$25000

Package	406029

	Package Name	Package 1

	Structure	Status = Division = Products = DPPOOAP

	Package Parameters	PMPMBCOverrideNo

Healthcare Spend and Trend -- Facilities

600100

Base January 2012- October 2012

Current January 2013 - October 2013

Top Facilities

Facility Information	Base

Name	State	Zip Code	Unique Claimants	Outpatient Visits	Admissions	Bed Days	Inpatient Spend	Outpatient Spend	Total Spend	Employer Paid	Cost Share

DUKE UNIVERSITY HOSPITAL	NC	27710	3	11	2	25	$134313	$4460	$138773	$137257	$1516

UNIVERSITY HOSPITAL	CO	80246	5	36	2	8	$110611	$5501	$116112	$114751	$1360

SWEDISH MEDICAL CENTER	WA	98107	5	11	3	11	$24478	$13353	$37831	$34842	$2989

WHITE PLAINS HOSPITAL CENTER	NY	10601	1	16	1	8	$28253	$8419	$36672	$35586	$1086

NORTHWESTERN MEMORIAL HOSPITAL	IL	60611	16	11	7	14	$22887	$9040	$31927	$24023	$7904

EL CAMINO HOSPITAL	CA	94040	8	9	2	4	$3710	$16913	$20623	$16575	$4048

GULF COAST MEDICAL CENTER	FL	33912	1	2	1	2	$17808	$1730	$19538	$17966	$1572

LITTLETON HOSPITAL	CO	80210	4	5	1	2	$5746	$10595	$16341	$15496	$845

SOUTH SHORE HOSPITAL	MA	02190	5	4	2	5	$9669	$5297	$14965	$10971	$3994

ROSE MEDICAL CENTER	CO	80220	6	10	2	5	$10532	$4250	$14781	$12245	$2536

SWEDISH COVENANT HOSPITAL	IL	60625	2	3	2	8	$13540	$471	$14011	$13243	$768

CHRIST HOSPITAL AND MEDICAL CENTER-ADVOCATE	IL	60453	2	2	1	1	$11300	$953	$12253	$10638	$1615

MEDICAL CENTER OF AURORA	CO	80011	6	12	1	1	$2069	$10065	$12134	$9456	$2678

ALEXIAN BROTHERS MEDICAL CENTER	IL	60007	2	3	2	8	$8579	$2451	$11030	$9110	$1920

NOVANT HEALTH HUNTERSVILLE MEDICAL CENTER	NC	28078	1	1	1	3	$8806	$1631	$10437	$8652	$1785

PORTER HOSPITAL	CO	80210	1	3	1	1	$3862	$6083	$9945	$8111	$1834

EXEMPLA LUTHERAN MEDICAL CENTER	CO	80263	3	5	2	3	$7145	$2590	$9735	$7895	$1840

LENOX HILL HOSPITAL	NY	10075	3	1	2	5	$8925	$80	$9005	$8346	$659

NEW YORK METHODIST HOSPITAL	NY	11215	2	4	2	4	$8946	$0	$8946	$7455	$1490

SKY RIDGE MEDICAL CENTER	CO	80124	3	2	1	2	$6200	$933	$7133	$5865	$1268

SWEDISH MEDICAL CENTER	CO	80113	5	3	2	2	$3950	$2606	$6556	$5474	$1082

Facility Information	Current

Name	State	Zip Code	Unique Claimants	Outpatient Visits	Admissions	Bed Days	Inpatient Spend	Outpatient Spend	Total Spend	Employer Paid	Cost Share

ST JOSEPHS HOSPITAL NORTH	FL	33558	2	3	2	8	$63838	$3381	$67219	$65145	$2074

MASSACHUSETTS GENERAL HOSPITAL	MA	02114	9	28	1	3	$39143	$21507	$60650	$53367	$7283

BRIGHAM AND WOMENS HOSPITAL	MA	02115	4	32	2	5	$31487	$26410	$57897	$52707	$5189

ST VINCENTS MEDICAL CENTER	CT	06606	2	4	1	5	$45104	$3715	$48819	$46857	$1963

NORTHWESTERN MEMORIAL HOSPITAL	IL	60611	16	29	4	10	$13841	$33404	$47245	$37697	$9548

NOVANT HEALTH HUNTERSVILLE MEDICAL CENTER	NC	28078	1	1	1	5	$34945	$1863	$36808	$35089	$1719

NORTHSHORE UNIVERSITY HEALTH SYSTEM	IL	60026	14	29	1	1	$4079	$23880	$27959	$23229	$4730

CHILDRENS HOSPITAL COLORADO	CO	80218	11	26	1	2	$7529	$18234	$25763	$19504	$6259

SWEDISH MEDICAL CENTER	WA	98107	6	15	2	4	$10995	$13964	$24959	$20207	$4752

AVISTA HOSPITAL	CO	80027	6	10	2	4	$7544	$11586	$19130	$16109	$3022

PLAINVIEW HOSPITAL	NY	11803	1	2	1	1	$17127	$625	$17752	$16723	$1028

EL CAMINO HOSPITAL	CA	94040	5	3	2	4	$16800	$867	$17667	$15934	$1733

SKY RIDGE MEDICAL CENTER	CO	80124	3	1	2	6	$15345	$1523	$16868	$14054	$2814

MEDICAL CITY DALLAS HOSPITAL	TX	75230	1	1	1	10	$15847	$291	$16137	$15184	$953

COMMUNITY HOSPITAL	IN	46321	2	5	1	2	$6538	$6614	$13151	$13151	$0

CMC NORTHEAST	NC	28025	6	9	1	1	$2497	$7022	$9519	$7913	$1607

PORTER REGIONAL HOSPITAL	IN	46383	4	9	2	2	$4189	$5103	$9291	$6584	$2707

LAS COLINAS MEDICAL CENTER	TX	75039	1	1	1	3	$7631	$1170	$8801	$6728	$2073

HIGHLINE MEDICAL CENTER	WA	98168	3	7	2	2	$7079	$850	$7929	$5587	$2342

PSL MEDICAL CTR	CO	80218	4	4	0	0	$1780	$1000	$2780	$1482	$1298

MAYO CLINIC ARIZONA	AZ	85038	1	8	1	5	$1184	$870	$2054	$2054	$0

Healthcare Spend and Trend -- Pharmacy - Incurred

600100

Base January 2012- October 2012

Current January 2013 - October 2013

Pharmacy

Key Indicators		Base		Current		Change		Norm

Average Number of Employees		330		419		268

Average Number of Members		763		949		244

Ingredient Cost PMPM		$6697		$7405		106		$000

Plan Cost PMPM		$6838		$7528		101

Employer Paid PMPM		$5854		$6596		127		$000

Cost Share PMPM		$984		$932		-53		$000

Cost Share as percent of Ingredient Cost		147		126		-21		00

Scripts PMPY		68		69		14		00

Retail Adjusted Scripts PMPY		75		76		16		00

Average Ingredient Cost per script		$11750		$12812		90		$000

Generic Rx Utilization Rate		766		798		32		00

Mail Order Fill Rate - Percent of total		46		46		-00		00

Mail Order Fill Rate - Retail adjusted		118		119		01		00

Formulary Brand Compliance Rate		766		747		-19		00

	$000		$000		00		$000

Average Cost generic script		$1077		$997		-75		$000

Average Cost Preferred script		$3273		$3019		-78		$000

Average Cost Non-Preferred Script		$4581		$5936		296		$000

Specialty Ingredient Cost PMPM		238		295		237		00

Specialty Scripts PMPY		13		09		-319		00

Specialty as Percent of Total Employer Paid		0		0		40		0

Analysis of Charges and Payments - Pharmacy

	TOTAL				IN NETWORK			OUT OF NETWORK

WATERFALL		Base		Current		Change		Base		Current		Base		Current

Dispensing Fee		$6793		$7771		144		$6793		$7771		$0		$0

Gross Cost		$511008		$702852		375		$511008		$702807		$0		$45

Member Cost Share		$75101		$88480		178		$75101		$88462		$0		$18

Sales Tax		$1645		$1657		08		$1645		$1657		$0		$0

Submitted Charges		$757561		$1045329		380		$757561		$1041219		$0		$4110

Discounts		$246554		$342477		389		$246554		$338412		$0		$4065

Eligible		$511008		$702852		375		$511008		$702807		$0		$45

Medical amp Pharmacy Payments by Dollar Range

	BASE

Range		Employer Paid		Plan Amount		of Total Payments		Number of Unique Claimants		Payments Per Unique Claimants

lt$0		$0		$0		000		0		$0

$0		$0		$0		000		184		$0

lt=$100		$1485		$2425		009		48		$51

gt$100lt=$500		$50742		$68754		260		241		$285

gt$500lt=$1000		$57754		$84220		319		116		$726

gt$1000lt=$2500		$184197		$262536		994		164		$1601

gt$2500lt=$5000		$220642		$289440		1096		81		$3573

gt$5000lt=$10000		$307808		$387323		1466		53		$7308

gt$10000lt=$25000		$433251		$533558		2020		36		$14821

gt$25000lt=$50000		$272862		$303656		1149		9		$33740

gt$50000lt=$75000		$168221		$175543		665		3		$58514

gt$75000lt=$100000		$0		$0		000		0		$0

gt$100000		$522732		$534222		2022		4		$133555

Total		$2219696		$2641676		10000		939		$2813

	CURRENT						NORMS

Range		Employer Paid		Plan Amount		of Total Payments		Number of Unique Claimants		Payments per Unique Claimant		of Total Payments		Payments per Unique Claimants

lt$0		$0		$0		00		0		$0		00		$0

$0		$0		$0		00		261		$0		00		$0

lt=$100		$2194		$3556		01		70		$51		00		$0

gt$100lt=$500		$58043		$77943		25		289		$270		00		$0

gt$500lt=$1000		$77542		$105134		34		147		$715		00		$0

gt$1000lt=$2500		$206436		$309046		100		193		$1601		00		$0

gt$2500lt=$5000		$241777		$328091		106		92		$3566		00		$0

gt$5000lt=$10000		$373446		$489962		159		70		$6999		00		$0

gt$10000lt=$25000		$503832		$601048		194		40		$15026		00		$0

gt$25000lt=$50000		$443308		$476307		154		14		$34022		00		$0

gt$50000lt=$75000		$341800		$362988		117		6		$60498		00		$0

gt$75000lt=$100000		$325086		$336391		109		4		$84098		00		$0

gt$100000		$0		$0		00		0		$0		00		$0

Total		$2573464		$3090466		1000		1186		$2606

Minor Therapeutic Classes

Rank by Current period plan spend

	BASE				CURRENT				CHANGE				NORM

Top 15		Plan Spend PMPM		of Scripts		of Claimants		Plan Spend PMPM		of Scripts		of Claimants		Plan Spend PMPM		of Scripts	of Claimants	Plan Spend PMPM

MultipleLateral Sclerosis		$757		8		2		$981		11		2		296		375	00	$000

Antineoplastics		$787		68		8		$721		51		8		-84		-250	00	$000

Asthma Related		$741		246		88		$661		338		125		-108		374	420	$000

Stimulants		$443		177		31		$514		229		38		159		294	226	$000

Antidepressants		$485		464		69		$374		530		98		-228		142	420	$000

Anti-Inflam Disease Modifiers		$114		3		2		$349		8		3		2072		1667	500	$000

Cystic Fibrosis		$000		0		0		$318		2		1		00		00	00	$000

Contraceptives		$329		389		70		$314		528		87		-46		357	243	$000

Acne Agents		$174		56		24		$195		58		30		119		36	250	$000

Insulins		$133		51		8		$170		74		9		273		451	125	$000

Antivirals		$112		70		26		$150		79		31		344		129	192	$000

Tetracyclines		$163		62		20		$150		91		34		-82		468	700	$000

Lipid Lowering		$144		128		26		$141		209		37		-20		633	423	$000

Antiulcer		$129		181		46		$140		170		42		84		-61	-87	$000

Hypoglycemics		$122		104		11		$139		135		17		135		298	545	$000

Other		$2206		2342		1044		$2212		2973		1316		03		269	261	$000

Top Drugs By Total Plan Spend

Current Rank		Top 20 Drug Name		Indication		Tier		of Scripts		Plan Spend		Employer Paid		Cost Share		Base Rank

1		GILENYA		Multiple Sclerosis		Non-Preferred Brand		11		$93117		$92282		$835		2

2		GLEEVEC		Cancer		Preferred Brand		10		$66518		$66518		$0		1

3		PULMOZYME		Cystic Fibrosis		Preferred Brand		2		$30214		$30074		$140		NA

4		XOLAIR		Asthma		Preferred Brand		3		$28214		$27996		$217		3

5		METHYLPHENIDATE ER		ADHDNarcolepsy		Generic		79		$19345		$18053		$1292		5

6		CYMBALTA		Depression		Preferred Brand		53		$17555		$15865		$1690		4

7		HUMIRA		Arthritis		Preferred Brand		2		$14926		$14926		$0		NA

8		ENBREL		Arthritis		Preferred Brand		5		$11505		$11380		$125		45

9		ATRIPLA		HIV		Non-Preferred Brand		5		$9500		$9275		$225		6

10		CREON		Cystic Fibrosis		Preferred Brand		2		$8332		$8192		$140		NA

11		LIALDA		Crohns Disease		Preferred Brand		10		$7975		$7725		$250		9

12		ONE TOUCH ULTRA TEST STRIPS		Diabetes		SuppliesOther		24		$7823		$7183		$640		11

13		ADDERALL XR		ADHD		Preferred Brand		25		$7512		$6887		$625		43

14		LEVALBUTEROL HCL		Asthma		Generic		12		$7099		$6959		$140		NA

15		AMPHETAMINE SALT COMBO		ADHD		Generic		64		$6821		$5811		$1010		25

16		LOVENOX		Blood thinner		Non-Preferred Brand		3		$6782		$6617		$165		NA

17		CIMZIA		Crohns Disease		Non-Preferred Brand		1		$6708		$3821		$2887		14

18		LUNESTA		Sedative		Non-Preferred Brand		25		$6050		$5159		$891		13

19		ORACEA		Infection		Preferred Brand		14		$6016		$5666		$350		20

20		NUVIGIL		Narcolepsy		Non-Preferred Brand		13		$5904		$4896		$1008		30

Top 25 specific drug therapeutic classes ranked by of scripts

Current Rank		Drug Name			Tier		Indication		Scripts		Ingredient Cost per Script

1		SERTRALINE HCL			Generic		Depression		118		$1976

2		LISINOPRIL			Generic		Hypertension		117		$1097

3		AMOXICILLIN			Generic		Infection		110		$1023

4		HYDROCODONE-ACETAMINOPHEN			Generic		Pain		105		$2137

5		FLUTICASONE PROPIONATE			Generic		Nasal Congestion		94		$3130

6		SYNTHROID			Preferred Brand		Thyroid		93		$2689

7		AZITHROMYCIN			Generic		Infection		90		$2286

8		LEVOTHYROXINE SODIUM			Generic		Thyroid		87		$1067

9		METHYLPHENIDATE ER			Generic		ADHDNarcolepsy		79		$24337

10		AMPHETAMINE SALT COMBO			Generic		ADHD		64		$10471

11		SIMVASTATIN			Generic		Cholesterol		64		$1644

12		METFORMIN HCL ER			Generic		Diabetes		63		$7571

13		CITALOPRAM HBR			Generic		Depression		63		$1045

14		MONTELUKAST SODIUM			Generic		Asthma		62		$5695

15		ATORVASTATIN CALCIUM			Generic		Cholesterol		61		$3772

16		FLUOXETINE HCL			Generic		Depression		56		$1345

17		OMEPRAZOLE			Generic		Ulcer Heartburn		55		$3224

18		CYMBALTA			Preferred Brand		Depression		53		$32709

19		LOSARTAN POTASSIUM			Generic		Hypertension		50		$2410

20		ZOLPIDEM TARTRATE			Generic		Sedative		50		$1799

21		BUPROPION XL			Generic		Depression		49		$5055

22		MICROGESTIN FE			Generic		Contraception		48		$2641

23		AMLODIPINE BESYLATE			Generic		Hypertension		48		$1508

24		ALPRAZOLAM			Generic		Anxiety		48		$595

25		VALACYCLOVIR			Generic		Antivirals		46		$7037

Top 25 specific drug therapeutic classes ranked cost per scripts

Current Rank		Drug Name			Unique Individuals		Bio-Pharmaceutical		Indication		Ingredient Cost per Script		Ingredient Cost		Scripts

1		PULMOZYME			1		Y		Cystic Fibrosis		$15107		$30214		2

2		XOLAIR			1		Y		Asthma		$9405		$28214		3

3		GILENYA			2		N		Multiple Sclerosis		$8465		$93117		11

4		HUMIRA			1		Y		Arthritis		$7463		$14926		2

5		CIMZIA			1		Y		Crohns Disease		$6708		$6708		1

6		GLEEVEC			1		N		Cancer		$6652		$66518		10

7		CAYSTON			1		N		Infection		$5758		$5758		1

8		VANCOMYCIN HCL			1		N		Infection		$4246		$4246		1

9		CREON			2		N		Cystic Fibrosis		$4164		$8328		2

10		VALCYTE			1		N		Antivirals		$2720		$5440		2

11		ENBREL			1		Y		Arthritis		$2301		$11505		5

12		LOVENOX			1		N		Blood thinner		$2261		$6782		3

13		ATRIPLA			1		N		HIV		$1900		$9500		5

14		ABSORICA			1		N		Acne		$1817		$3634		2

15		MEPRON			1		N		Infection		$1702		$3405		2

16		ZYVOX			1		N		Infection		$1602		$1602		1

17		HUMATROPE			1		Y		Growth Hormone		$1559		$1559		1

18		SIMCOR			1		N		Cholesterol		$1154		$3463		3

19		VANOS			1		N		Itching Inflammation		$1141		$1141		1

20		ANDROGEL			2		N		Hormone Replacement		$1092		$2183		2

21		SOLODYN			1		N		Infection		$891		$1782		2

22		PENTASA			2		N		Crohns Disease		$874		$3497		4

23		ENOXAPARIN SODIUM			1		N		Blood thinner		$800		$800		1

24		LIALDA			2		N		Crohns Disease		$779		$7786		10

25		ASACOL HD			1		N		Crohns Disease		$777		$777		1

Pharmacy Scripts and Cost by Age Category

Average Number of Prescriptions by Age Category		Base		Current		Change			Average Pharmacy Payments by Age Category		Base		Current		Change

lt1		01		00		-598			lt1		$135		$45		-665

1-17		09		08		-83			1-17		$259		$454		756

18-29		10		13		308			18-29		$902		$723		-198

30-39		21		17		-166			30-39		$670		$1015		515

40-49		15		15		20			40-49		$608		$514		-155

50-59		12		13		102			50-59		$1959		$1699		-133

60-64		01		02		1123			60-64		$1790		$913		-490

AVERAGE		68		69		15			AVERAGE		$759		$819		79

of Prescriptions by Age Category		Base		Current		Change			of Payments by Age Category		Base		Current		Change

lt1		14		06		-09			lt1		04		01		-03

1-17		132		120		-13			1-17		80		126		46

18-29		144		186		42			18-29		206		156		-50

30-39		301		248		-53			30-39		229		293		64

40-49		222		223		01			40-49		143		120		-23

50-59		175		190		15			50-59		308		290		-18

60-64		11		24		13			60-64		31		13		-18

					AVERAGE		1000		1000		00

Percent of Prescriptions		Base		Current		Change			Percent of Payments		Base		Current		Change

Female		596		575		-20			Female		547		572		25

Male		404		425		20			Male		453		428		-25

Average Prescriptions		Base		Current		Change			Average Payment per Unique Claimant		Base		Current		Change

Female		8716		8673		-05			Female		$768		$881		148

Male		5194		5462		52			Male		$750		$749		-01

Top 10 Drugs for Top 5 Therapeutic Classes by Number of Prescriptions

Pharmacy Statistics by Therapeutic Class Including Brand Name

		Base					Current					Base - Current Change

Therapeutic Class		Brand Name		Number of Prescriptions		Days Supply		Number of Claimants		Plan Amount		Number of Prescriptions		Days Supply		Number of Claimants	Plan Amount	Number of Prescriptions	Days Supply	Number of Claimants	Plan Amount

Contraceptivesoral		Microgestin Fe		30		1008		6		$1035		48		1344		7	$1347	333	-1000	1202	301

Contraceptivesoral		Loestrin 24 Fe		70		2184		13		$6034		44		1344		9	$4046	-385	-428	-280	-329

Contraceptivesoral		Necon		18		684		3		$666		31		791		3	$880	156	-1000	1067	322

Contraceptivesoral		Apri		5		140		1		$130		27		721		3	$744	4150	-1000	8271	4714

Contraceptivesoral		Gianvi		4		112		1		$248		22		672		6	$1484	5000	-1000	6125	4977

Contraceptivesoral		Reclipsen		16		448		2		$423		20		560		2	$572	250	-1000	1172	351

Contraceptivesoral		Sprintec		4		112		2		$83		16		448		3	$316	3000	-1000	6259	2823

Contraceptivesoral		Trinessa		0		0		0		$0		15		420		3	$344	00	00	00	00

Contraceptivesoral		Syeda		3		84		1		$205		15		476		3	$1143	4667	-1000	5551	4590

Contraceptivesoral		Levora-28		11		308		1		$321		15		420		2	$430	364	-1000	1037	340

Contraceptivesoral		All Other		205		7116		53		$13548		258		8784		67	$15902	234	-504	415	174

Contraceptivesoral		Subtotal		366		12196		65		$22693		511		15980		79	$27209	310	-562	515	199

Selective Serotonin Reuptake Inhibitor (Ssris)		Sertraline Hcl		81		2718		27		$1359		118		4020		38	$2518	479	504	1598	852

Selective Serotonin Reuptake Inhibitor (Ssris)		Citalopram Hbr		65		1950		19		$716		63		1890		25	$757	-31	-168	867	57

Selective Serotonin Reuptake Inhibitor (Ssris)		Fluoxetine Hcl		62		1840		17		$912		56		1654		20	$861	-101	95	-224	-57

Selective Serotonin Reuptake Inhibitor (Ssris)		Escitalopram Oxalate		35		1170		15		$4898		38		1297		16	$1908	109	516	-705	-611

Selective Serotonin Reuptake Inhibitor (Ssris)		Paroxetine Hcl		27		810		6		$1602		34		1020		6	$2077	259	-236	520	297

Selective Serotonin Reuptake Inhibitor (Ssris)		Fluvoxamine Maleate		0		0		0		$0		5		150		1	$1302	00	00	00	00

Selective Serotonin Reuptake Inhibitor (Ssris)		Luvox Cr		9		270		2		$2308		3		90		1	$973	-667	-667	-559	-578

Selective Serotonin Reuptake Inhibitor (Ssris)		Prozac		1		30		1		$207		0		0		0	$0	-1000	00	-1000	-1000

Selective Serotonin Reuptake Inhibitor (Ssris)		Lexapro		9		270		5		$1300		0		0		0	$0	-1000	-1000	-1000	-1000

Selective Serotonin Reuptake Inhibitor (Ssris)		Subtotal		289		9058		51		$13304		317		10121		70	$10396	117	17	-301	-219

Analgesics Narcotics		Hydrocodone-Acetaminophen		77		549		59		$1213		105		1057		68	$2502	925	246	2550	1062

Analgesics Narcotics		Tramadol Hcl		45		527		6		$606		33		599		12	$469	137	-344	-28	-225

Analgesics Narcotics		Oxycodone-Acetaminophen		26		78		24		$240		32		133		30	$352	705	393	837	467

Analgesics Narcotics		Oxycodone Hcl		5		26		4		$86		26		392		11	$660	14077	2352	12785	6699

Analgesics Narcotics		Fentanyl		0		0		0		$0		22		660		3	$2664	00	00	00	00

Analgesics Narcotics		Methadone Hcl		5		150		1		$99		7		161		2	$156	73	194	664	569

Analgesics Narcotics		Morphine Sulfate Er		1		5		1		$10		6		157		3	$174	30400	-1000	00	16426

Analgesics Narcotics		Endocet		3		8		3		$38		3		14		3	$53	750	500	322	417

Analgesics Narcotics		Tramadol Hcl Er		0		0		0		$0		2		60		1	$189	00	00	00	00

Analgesics Narcotics		Oxycontin		0		0		0		$0		2		14		2	$57	00	00	00	00

Analgesics Narcotics		All Other		4		74		2		$1256		4		41		4	$639	-446	00	-980	-491

Analgesics Narcotics		Subtotal		166		1417		75		$3548		242		3288		89	$7916	1320	797	1535	1231

Thyroid Hormones		Synthroid		52		1800		12		$1512		93		3240		24	$2715	800	773	1796	796

Thyroid Hormones		Levothyroxine Sodium		65		2070		25		$614		87		3090		22	$1103	493	224	3772	795

Thyroid Hormones		Armour Thyroid		10		300		1		$127		19		570		5	$234	900	846	00	846

Thyroid Hormones		Liothyronine Sodium		8		225		2		$225		9		270		2	$219	200	125	-105	-23

Thyroid Hormones		Levoxyl		22		780		5		$324		8		300		3	$141	-615	-620	-379	-565

Thyroid Hormones		Np Thyroid		6		180		1		$60		4		120		1	$28	-333	-531	00	-531

Thyroid Hormones		Tirosint		2		56		1		$90		3		84		1	$135	500	500	00	500

Thyroid Hormones		Cytomel		0		0		0		$0		1		30		1	$182	00	00	00	00

Thyroid Hormones		Subtotal		165		5411		24		$2952		224		7704		38	$4758	424	492	1499	612

Penicillins		Amoxicillin		104		1092		94		$1372		110		1076		96	$1367	-15	157	-334	-04

Penicillins		Amox Tr-Potassium Clavulanate		40		486		33		$1435		42		399		34	$1291	-179	-134	-81	-100

Penicillins		Penicillin V Potassium		6		51		5		$74		12		116		12	$189	1275	1188	2874	1546

Penicillins		Dicloxacillin Sodium		0		0		0		$0		2		17		2	$52	00	00	00	00

Penicillins		Ampicillin Trihydrate		1		30		1		$15		1		5		1	$8	-833	-154	-1000	-437

Penicillins		Subtotal		151		1659		114		$2896		167		1613		122	$2907	-28	101	-103	04

ALL Other Classes		ALL Other Drugs		3212		87380		1500		$476379		4025		111548		1913	$661331	277	243	409	388

Total		Total		4349		117121		523		$521772		5486		150254		640	$714517	283	178	402	369

Healthcare Spend and Trend Detail - Incurred

600100

Base January 2012- October 2012

Current January 2013 - October 2013

Financial Overview

Population		Base		Current		Change

Avg Members		763		949		244

Avg Employees		331		419		268

Population by Tier		Base		Current		Change

Employees		331		419		268

Spouses		151		180		192

Dependents		282		350		242

Average Contract Size		231		226

	Total Plan Spend				PMPM

Plan Spend		Base		Current		Change		Base		Current		Change

Medical Spend		$2199402		$2486745		131		$288		$262		-91

Pharmacy Spend		$521772		$714517		369		$68		$75		101

Total Combined Spend		$2721174		$3201262		176		$357		$337		-54

	Total Employer Paid				PMPM

Employer Paid		Base		Current		Change		Base		Current		Change

Medical Employer Paid		$1852523		$2058222		111		$243		$217		-107

Pharmacy Employer Paid		$446671		$626037		402		$59		$66		127

Total Combined Employer Paid		$2299193		$2684259		167		$301		$283		-61

	Cost Share Percent			PMPM

Member Cost Share		Base		Current		Base		Current		Change

Medical		158		172		$45		$45		-07

Pharmacy		144		124		$10		$9		-53

Total Cost Share		155		161		$55		$54		-15

Network Discounts		Base		Current		Change

Total		563		497		-117

	Total Plan Spend				PMPM

Plan Spend by MSC		Base		Current		Change		Base		Current		Change

Inpatient		$466518		$405828		-130		$61		$43		-300

Outpatient		$627721		$801551		277		$82		$84		27

Professional		$870027		$919727		57		$114		$97		-150

OMS		$229787		$350526		525		$30		$37		227

Capitation		$5349		$9112		704		$1		$1		370

Pharmacy		$521772		$714517		369		$68		$75		101

Total Combined Spend		$2721174		$3201262		176		$357		$337		-54

Catastrophic Claims

Catastrophic Claimants		Base		Current		Change

Claimants per 1000		189		190		06

Number of Claimants		12		15		250

Average Cost per Claim		$68736		$55236		-196

of Total Spend		303		259		-146

	Number of Claimants				Average Cost Per Claimant

Relationship		Base		Current		Change		Base		Current		Change

Employee		3		6		1000		$66595		$60086		-98

Spouse		7		6		-143		$58236		$58673		08

Dependent		2		3		500		$108695		$38662		-644

Demographics

	Female				Male

of Members by Age Band and Gender		Base		Current		Change		Base		Current		Change

lt1		06		07		01		13		14		01

1-17		150		142		-08		145		143		-02

18-29		75		77		01		106		108		02

30-39		111		104		-07		133		129		-04

40-49		82		84		02		84		91		07

50-59		39		42		03		46		48		02

60-64		03		04		01		05		05		-00

65+		00		00		00		00		01		01

TOTAL		467		460		-07		533		540		07

	Female				Male

Plan Spend by Age Band and Gender		Base		Current		Change		Base		Current		Change

lt1		20		12		-08		110		44		-65

1-17		96		74		-22		59		77		18

18-29		51		58		07		32		62		30

30-39		160		207		47		30		35		05

40-49		216		131		-84		123		71		-51

50-59		34		76		43		60		133		73

60-64		01		00		-00		09		17		08

65+		00		00		00		00		01		01

TOTAL		577		560		-17		423		440		17

	Female				Male

PMPM Spend by Age Band and Gender		Base		Current		Change		Base		Current		Change

lt1		$941		$427		-546		$2279		$1029		-549

1-17		$177		$130		-263		$113		$165		457

18-29		$187		$190		16		$85		$183		1150

30-39		$400		$498		245		$63		$82		291

40-49		$729		$390		-465		$408		$266		-349

50-59		$237		$452		907		$363		$897		1469

60-64		$47		$30		-360		$469		$1044		1223

65+		$0		$0			$45		$884		18457

TOTAL		$343		$304		-112		$221		$257		166

	Plan Spend				PMPM				PMPM (NET OF CATS)

Relationship		Base		Current		Change		Base		Current		Change		Base	Current	Change

Employee		336		417		81		$277		$319		152		$218	$235	78

Spouse		390		328		-62		$704		$584		-170		$459	$394	-141

Dependent		274		255		-19		$264		$233		-119		$185	$196	63

ICD9 Major Combined

	Number of Claimants				of Total Plan Spend				Plan Spend

Group		Base		Current		Change		Base		Current		Change		Base	Current	Change

MusculoskelFractureSprainStrain		181		212		171		165		164		-01		$349933	$390400	116

Pregnancy Childbirth Puerperium		30		23		-233		118		81		-37		$250764	$193128	-230

Gastrointestinal (Including Mouth)		95		100		53		46		78		31		$98420	$185077	880

Reproductive		129		171		326		57		78		20		$121576	$184213	515

InternalExternal Injury		64		72		125		21		77		55		$45406	$181843	3005

Renal And Urologic		50		53		60		94		73		-22		$200047	$172865	-136

NeurologicalCerebrovascular		49		72		469		46		70		23		$98299	$165785	687

Neoplasms		104		125		202		53		69		16		$112605	$164382	460

General Medical Diagnoses		374		433		158		63		69		06		$133488	$162817	220

HeartCirculatory		62		73		177		104		52		-52		$221435	$123821	-441

Ear Nose And Throat (Inc Upp Resp)		209		261		249		30		52		22		$63652	$122489	924

Endocrine Nutritional Metabolic		106		120		132		22		22		-01		$47539	$51434	82

Mental Disorders		68		88		294		26		22		-04		$54496	$51417	-57

Skin And Non-Malignant Breast		117		149		274		16		19		03		$34826	$45006	292

Lower Respiratory System		107		193		804		15		19		04		$31259	$44934	437

Infectious And Parasitic		128		153		195		11		19		08		$22608	$44284	959

Immune Disorders		51		63		235		14		12		-02		$29112	$28776	-12

Newborns		23		14		-391		80		12		-68		$169262	$27644	-837

Eye		68		85		250		11		07		-05		$23904	$15771	-340

Blood And Blood Forming Organs		29		25		-138		05		05		00		$9616	$10941	138

Substance Use Disorders		1		4		3000		00		02		02		$801	$4994	5238

Biliary Tract And Liver		8		7		-125		00		02		01		$857	$3928	3584

ICD9 Major Inpatient

	Number of Admissions				of Total Plan Spend				Plan Spend

Group		Base		Current		Change		Base		Current		Change		Base	Current	Change

MusculoskelFractureSprainStrain		2		6		2000		149		279		129		$69695	$113127	623

Pregnancy Childbirth Puerperium		18		9		-500		245		163		-83		$114379	$65992	-423

InternalExternal Injury		0		2		00		00		157		157		$0	$63851	00

HeartCirculatory		3		2		-333		195		139		-56		$90838	$56419	-379

Gastrointestinal (Including Mouth)		2		2		00		17		102		85		$7815	$41483	4308

NeurologicalCerebrovascular		0		1		00		00		39		39		$0	$15846	00

Newborns		15		8		-467		332		39		-294		$155110	$15629	-899

Neoplasms		0		1		00		00		36		36		$0	$14591	00

Ear Nose And Throat (Inc Upp Resp)		0		1		00		00		19		19		$0	$7529	00

Immune Disorders		0		1		00		00		10		10		$0	$4079	00

Infectious And Parasitic		0		1		00		00		09		09		$0	$3601	00

Blood And Blood Forming Organs		0		1		00		00		06		06		$0	$2497	00

Endocrine Nutritional Metabolic		0		1		00		00		03		03		$0	$1184	00

Mental Disorders		0		0		00		00		00		00		$0	$0	00

Reproductive		2		0		-1000		43		00		-43		$20107	$0	-1000

Renal And Urologic		0		0		00		18		00		-18		$8574	$0	-1000

Inpatient

Inpatient Spend		Base		Current		Change

Plan Amount		$466518		$405828		-130

Cost Share		$26837		$28599		66

Paid Amount		$439681		$377229		-142

Plan Amount PMPM		$61		$43		-300

Utilization		Base		Current		Change

Admissions		42		36		-143

Bed Days		126		109		-135

ALOS		300		303		09

Admits per K		660		455		-310

Bed Days per K		1981		1379		-304

Average Payment per Day		$3703		$3723		06

Average Payment per Admission		$11108		$11273		15

DRG Severity Index		088		118		340

Inpatient Maternity amp Newborns

	BASE			CURRENT			CHANGE

Maternity Utilization		Admits per 1000		of Total Admits		Admits per 1000		of Total Admits		Admits per 1000

Normal		204		812		89		778		-567

Csection		47		188		25		222		-464

Other		00		00		00		00		00

Total		252		1000		114		1000		-547

	BASE			CURRENT			CHANGE

Maternity Spend		Average Spend per Admission		Spend per Bed Day		Average Spend per Admission		Spend per Bed Day		Average Spend per Admission		Spend per Bed Day

Normal		$5769		$2586		$6435		$3753		115		451

Csection		$8402		$1680		$10475		$3492		247		1078

Other		$0		$0		$0		$0		00		00

Total		$6262		$2277		$7332		$3666		171		610

	BASE			CURRENT			CHANGE

Newborn Utilization		Admits per 1000		of Total Admits		Admits per 1000		of Total Admits		Admits per 1000

Normal		157		667		76		750		-517

Premature		16		67		13		125		-195

Full Term with Compl		63		267		13		125		-799

Total		236		1000		101		1000		-571

	BASE			CURRENT			CHANGE

Newborn Spend		Average Spend per Admission		Spend per Bed Day		Average Spend per Admission		Spend per Bed Day		Average Spend per Admission		Spend per Bed Day

Normal		$841		$421		$1394		$643		657		529

Premature		$3402		$1134		$5046		$5046		483		3449

Full Term with Compl		$0		$0		$0		$0		00		00

Full Term with Compl		$35824		$4777		$2220		$1110		-938		-768

Total		$10341		$2927		$1954		$977		-811		-666

Outpatient

Outpatient Spend		Base		Current		Change

Plan Amount		$627721		$801551		277

Cost Share		$118565		$151672		279

Paid Amount		$509156		$649879		276

Plan Amount PMPM		$82		$84		27

Utilization		Base		Current		Change

Surgery per k		708		835		180

Diagnostic per k		13160		11764		-106

ER per k		1525		1455		-46

UC per k		645		557		-137

Other per k		9135		9234		11

Surgery CostService		$1646		$2547		547

Diagnostic CostService		$303		$274		-96

ER CostVisit		$1223		$1391		137

UC CostVisit		$165		$157		-52

Other CostService		$301		$290		-35

Network		Base		Current		Change

Office Visit		984		960		-25

Spend		992		954		-39

Professional

Professional Spend -- Inpatient		Base		Current		Change

Plan Amount		$202531		$82905		-591

Cost Share		$25552		$12402		-515

Employer Paid		$176979		$70504		-602

Plan Amount PMPM		$27		$9		-671

	Utilization per K				Spend Per Service

Professional Inpatient		Base		Current		Change		Base		Current		Change

Anesthesia		377		253		-330		$1719		$987		-426

Obstetrics		425		126		-702		$1789		$1892		58

IP Visit		1305		1088		-166		$142		$128		-96

Surgery		660		202		-694		$1589		$664		-582

Newborn Care		550		177		-678		$385		$374		-31

Consult		126		177		408		$245		$248		14

Lab		5692		2834		-502		$8		$14		748

ER		110		63		-425		$241		$547		1270

Pathology		157		202		287		$133		$119		-102

Radiology		1053		405		-616		$51		$43		-147

Other		1116		417		-626		$137		$142		42

Professional Spend -- Outpatient		Base		Current		Change

Plan Amount		$667496		$836822		254

Cost Share		$159281		$207263		301

Employer Paid		$508215		$629558		239

Plan Amount PMPM		$87		$88		08

	Utilization per K				Spend Per Service

Professional Outpatient		Base		Current		Change		Base		Current		Change

Anesthesia		535		721		349		$762		$865		135

Surgery		4167		4465		72		$277		$349		260

Consult		1635		1341		-180		$276		$257		-70

Prev Med		6682		6945		39		$134		$138		28

Diagnostic		2170		2555		178		$141		$130		-76

EampM		25535		25490		-02		$105		$106		09

Radiology		7704		7147		-72		$108		$97		-106

MHSA		5063		4579		-96		$105		$96		-94

RehabTherapy		28270		26299		-70		$43		$37		-152

Lab		24371		19645		-194		$23		$23		-08

Other		26006		24908		-42		$56		$61		101

Professional Office Visits		Base		Current		Change

Plan Amount		$312114		$420000		346

Cost Share		$49291		$73375		489

Employer Paid		$262823		$346625		319

Plan Amount PMPM		$41		$44		82

Plan Cost per Office Visit		$160		$171		70

Plan Cost per PCP Visit		$156		$163		46

Plan Cost per Specialist Visit		$167		$184		97

	Utilization per K				Spend Per Visit

Professional Office Visits		Base		Current		Change		Base		Current		Change

EampM		24733		24908		07		$105		$106		13

Prev Med		6525		6856		51		$135		$137		16

OMS Drugs		6352		6439		14		$55		$76		372

ImmunInject		9780		9538		-25		$26		$27		35

Surgery		1352		1670		235		$143		$146		25

Lab		8286		9690		169		$16		$17		57

Radiology		1572		1429		-91		$73		$95		300

Diagnostic		959		1379		438		$82		$89		82

RehabTherapy		1038		2049		975		$31		$32		40

Allergy		2626		1796		-316		$26		$27		34

Other		4072		5591		373		$50		$35		-297

Analysis of Charges and Payments - Medical

	TOTAL				IN NETWORK			OUT OF NETWORK

	Base		Current		Change		Base		Current		Base		Current

Average Number of Members		763		949		244

Total Unique Claimants		717		873		218		714		864		93		162

Plan Utilization		9395		9198		-21		9355		9103		1219		1707

	TOTAL				IN NETWORK			OUT OF NETWORK

WATERFALL (FFS Only)		Base		Current		Change		Base		Current		Base		Current

Submitted Charges		$5081452		$5142016		12		$4753676		$4933220		$327776		$208796

Charges Denied Due to Lack of Information		$54591		$9499		-826		$52656		$4138		$1934		$5361

Net Charges		$5026861		$5132517		21		$4701019		$4929082		$325842		$203435

Discounts		$2299447		$2154569		-63		$2299447		$2154569		$0		$0

Plan Exclusions		$94046		$59724		-365		$54003		$41057		$40044		$18667

Amounts above MRC		$0		$0		00		$0		$0		$0		$0

Pre-Existing Conditions		$1712		$2356		376		$1712		$2061		$0		$295

Ineligible Claimants		$1529		$290		-810		$529		$290		$1000		$0

Plan Max Exceeded		$13090		$124		-991		$13090		$124		$0		$0

Covered by Medicare		$291		$319573		1098965		$291		$316871		$0		$2702

Other Reasons Not Covered		$496280		$139762		-718		$285960		$66769		$210319		$72993

Total Amounts Not Covered		$2906394		$2676398		-79		$2655031		$2581741		$251363		$94656

Covered Charges		$2120467		$2456119		158		$2045988		$2347341		$74478		$108778

DeductibileCopay		$224231		$294702		314		$192805		$228848		$31426		$65853

Coinsurance		$122649		$133821		91		$111588		$118704		$11061		$15117

Member Cost Sharing		$346880		$428522		235		$304393		$347552		$42487		$80970

COB		$274		$82814		301706		$274		$81824		$0		$990

Payments		$1773025		$1947427		98		$1741197		$1919525		$31828		$27902

Total Medical		$2119905		$2375950		121		$2045590		$2267077		$74315		$108873

INCLUDES ALL CLAIMS PAID IN NETWORK INCLUDING CLAIMS NOT SUBJECT TO STANDARD DISCOUNT RATE GUARANTEE CALCULATIONS

Choice Fund Summary

Measures		Current

EMPLOYER FUNDED

Medical		$0

Pharmacy		$0

Network Penetration amp Discounts

	Base				Current

MSC		Plan Amount		In Network		Discounts		Plan Amount		In Network		Discounts

Inpatient Facility		$466518		1000		613		$405828		1000		486

Outpatient Facility		$627721		953		646		$801551		991		567

Professional		$870027		954		451		$919727		915		445

All Other		$155639		978		399		$248844		948		337

Total		$2119905		966		563		$2375950		964		497

	Base

	In Network				Out of Network

MSC		Number of Claimants		Considered Charges		Plan Amount		Number of Claimants		Considered Charges		Plan Amount

Inpatient Facility		41		$869533		$336113		1		$305936		$130405

Outpatient Facility		404		$1675141		$592884		12		$96719		$34838

Professional		703		$1344808		$738017		82		$196313		$132010

All Other		336		$193049		$116044		15		$40595		$39594

Total		714		$4082530		$1783058		93		$639563		$336847

	Current

	In Network				Out of Network

MSC		Number of Claimants		Considered Charges		Plan Amount		Number of Claimants		Considered Charges		Plan Amount

Inpatient Facility		34		$873336		$448909		0		$29442		-$43082

Outpatient Facility		493		$1807881		$783462		33		$35317		$18089

Professional		857		$1388625		$771637		136		$223204		$148091

All Other		423		$262408		$173883		31		$79249		$74961

Total		864		$4332250		$2177891		162		$367212		$198059

Network		Base		Current		Change		Norm

Admissions In Network		10000		10000		00

of Office Visits In Network		9842		9598		-24

Medical Payments by Dollar Range

	BASE

Range		Employer Paid		Plan Amount		of Total Payments		Number of Unique Claimants		Payments Per Unique Claimants

lt$0		$0		$0		000		0		$0

$0		$0		$0		000		228		$0

lt=$100		$1506		$2269		008		38		$60

gt$100lt=$500		$56758		$74636		320		273		$273

gt$500lt=$1000		$59097		$84572		333		120		$705

gt$1000lt=$2500		$148905		$217579		840		141		$1543

gt$2500lt=$5000		$129788		$175149		732		51		$3434

gt$5000lt=$10000		$247890		$313290		1398		45		$6962

gt$10000lt=$25000		$339092		$423594		1913		31		$13664

gt$25000lt=$50000		$226934		$252007		1280		8		$31501

gt$50000lt=$75000		$47218		$50384		266		1		$50384

gt$75000lt=$100000		$95355		$98256		538		1		$98256

gt$100000		$420481		$428171		2372		3		$142724

Total		$1773025		$2119905		10000		940		$2255

	CURRENT

Range		Employer Paid		Plan Amount		of Total Payments		Number of Unique Claimants		Payments Per Unique Claimants

lt$0		$0		$0		000		0		$0

$0		$0		$0		000		321		$0

lt=$100		$2285		$3636		012		60		$61

gt$100lt=$500		$65549		$88392		337		334		$265

gt$500lt=$1000		$66893		$95414		343		134		$712

gt$1000lt=$2500		$170051		$263612		873		165		$1598

gt$2500lt=$5000		$199769		$272522		1026		74		$3683

gt$5000lt=$10000		$270211		$358285		1388		51		$7025

gt$10000lt=$25000		$394936		$466607		2028		31		$15052

gt$25000lt=$50000		$262394		$283616		1347		8		$35452

gt$50000lt=$75000		$276850		$295828		1422		5		$59166

gt$75000lt=$100000		$238490		$248037		1225		3		$82679

gt$100000		$0		$0		000		0		$0

Total		$1947427		$2375950		10000		1186		$2003

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