doc. no. 34gl-18-2220. - legislature of guam. no. 34gl-18-2220.pdf · doc. no. 34gl-18-2220. -...

Doc. No. 34GL-18-2220.

Doc. N

o. 34GL-18-2220.

Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 May-2018 Jun-2018

Network Expenses $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

FHP Expenses $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Network Expenses $1,389.36 $3,154.89 $5,213.14 $1,259.51 $2,860.97 $1,528.55 $1,674.74

FHP Expenses $0.00 $91.86 $0.00 $0.00 $0.00 $33.96 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$1,389.36 $3,246.75 $5,213.14 $1,259.51 $2,860.97 $1,562.51 $1,674.74

Network Expenses $0.00 $50.00 $275.42 $482.61 $1,046.77 $1,237.82 $562.84

FHP Expenses $0.00 $241.22 $70.59 $373.83 $664.45 $0.00 $0.00

$1,039.77 $1,884.64 $5,645.52 $1,729.20 $2,855.65 $2,531.63 $1,675.18

Formulary Brand $610.25 $861.90 $4,497.53 $1,222.21 $1,335.51 $1,886.81 $274.13

Formulary Generic $429.52 $296.03 $757.85 $506.99 $783.75 $644.82 $1,401.05

Non-Formulary $0.00 $0.00 $390.14 $0.00 $0.00 $0.00 $0.00

Specialty $0.00 $726.71 $0.00 $0.00 $736.39 $0.00 $0.00

$1,039.77 $2,175.86 $5,991.53 $2,585.64 $4,566.87 $3,769.45 $2,238.02


FHP Expenses $14,743.59 $13,365.66 $12,981.18 $5,466.97 $53,173.83 $16,721.13 $10,653.18

$2,175.60 $1,822.09 $1,341.41 $596.10 $670.99 $451.13 $649.80

Formulary Brand $1,542.98 $962.02 $556.62 $402.94 $402.94 $152.08 $403.21

Formulary Generic $632.62 $813.19 $730.05 $141.79 $207.32 $248.89 $196.43

Non-Formulary $0.00 $46.88 $54.74 $51.37 $60.73 $50.16 $50.16

$58,559.62 $55,671.59 $37,265.47 $24,729.46 $110,045.80 $68,576.87 $51,425.30


FHP Expenses $117,798.93 $75,699.84 $134,201.59 $130,388.07 $882,828.46 $293,228.98 $206,407.32

$96,417.28 $111,781.08 $101,721.99 $109,731.48 $160,318.86 $178,076.06 $121,597.42

Formulary Brand $61,962.08 $68,050.70 $58,938.75 $54,306.18 $94,015.70 $102,280.22 $82,589.28

Formulary Generic $29,103.66 $27,719.76 $31,007.97 $33,906.18 $38,562.65 $30,732.49 $30,981.71

Non-Formulary $2,002.52 $3,658.82 $6,016.27 $14,975.13 $16,962.68 $21,971.02 $2,961.59

Specialty $3,349.02 $12,351.80 $5,759.00 $6,543.99 $10,777.83 $23,092.33 $5,064.84

$500,465.70 $334,355.91 $455,897.28 $514,118.58 $1,663,557.26 $859,244.04 $829,588.81


FHP Expenses $80,583.27 $43,679.17 $50,898.23 $35,260.76 $57,219.93 $36,513.40 $29,165.44

Formulary Generic $0.00 ($5.09) $8.49 $0.00 $0.00 $0.00 $0.00

$114,070.15 $75,311.47 $167,098.16 $95,434.91 $180,966.06 $163,672.36 $82,297.70Total Expenses $69,051.33 $118,676.36

$49,435.80 $65,710.83

$19,615.53 $52,965.53

$0.00 $0.00

DENTAL

Medical Expenses

$2,324.69 $3,147.85

$11,019.87 $6,539.31

Total Expenses $526,650.94 $939,227.94

RX Expenses $89,272.87 $104,058.81

$49,826.91 $65,631.70

$26,101.40 $28,739.95

Medical Expenses

$223,260.44 $530,524.52

$214,117.63 $304,644.61

Total Expenses $332,253.71 $31,855.92

PPO

$578.18 $389.10

$757.13 $212.18

$64.64 $796.69

$306,782.36 $15,346.74

$24,071.40 $15,111.21

RX Expenses $1,399.95 $1,397.97

HSA

Medical Expenses

$0.00 $0.00

$0.00 $736.39

Total Expenses $4,304.01 $4,561.37

RX Expenses $4,304.01 $3,712.92

$3,952.63 $1,331.25

$351.38 $1,645.28

Medical Expenses

$0.00 $470.59

$0.00 $377.86

Total Expenses $1,807.01 $9,746.75

GGRSUP03

$1,807.01 $9,684.99

$0.00 $61.76

RX Expenses $0.00 $0.00

GGRSUP02

Medical Expenses

RX Expenses $0.00 $0.00

Total Expenses $76.37 $0.00

Medical Expenses

$76.37 $0.00

$0.00 $0.00

TakeCare Insurance CompanyMed & RX Claims for GOVERNMENT OF GUAMPaid Date From: 10/1/2017 To 7/31/2018Print Date/Time:8/8/2018 2:34 PM

Oct-2017 Apr-2018

GGRSUP01

Copyright @ 2011 TakeCare. All rights reserved TC Confidential Page 1 of 29 Doc. No. 34GL-18-2220.*

Jul-2018 Total

$0.00 $76.37

$0.00 $0.00

$0.00 $0.00

$0.00 $76.37

$78.53 $28,651.69

$0.00 $187.57

$0.00 $0.00

$78.53 $28,839.26

$901.96 $5,028.01

$1,556.58 $3,284.53

$3,228.90 $28,607.42

$978.38 $16,950.60

$677.75 $7,494.42

$0.00 $390.14

$1,572.77 $3,772.26

$5,687.44 $36,919.96

$18,174.46 $611,765.01

$14,362.10 $180,650.24

$772.80 $11,277.84

$579.34 $5,969.41

$133.94 $4,073.54

$59.52 $1,234.89

$33,309.36 $803,693.09

$694,980.78 $3,885,795.96

$232,045.89 $2,591,361.31

$141,572.43 $1,214,548.28

$92,819.78 $730,421.30

$29,150.41 $306,006.18

$10,132.35 $84,152.92

$9,469.89 $93,967.88

$1,068,599.10 $7,691,705.55

$82,774.89 $743,452.13

$42,867.75 $448,769.03

$0.00 $3.40

$125,642.64 $1,192,221.16

Copyright @ 2011 TakeCare. All rights reserved TC Confidential Page 2 of 29 Doc. No. 34GL-18-2220.*

Total Claim Amount

$51.37

$25.00

$76.37

Total Claim Amount

$9,357.13

$5,164.05

$3,994.01

$1,361.63

$1,125.00

$1,084.88

$997.15

$767.53

$685.28

$597.61

$439.77

$419.63

$415.73

$410.91

$301.12

$265.92

$256.34

$175.00

$156.25

$140.92

$90.41

$80.72

$78.05

$74.85

$71.48

$54.29

$50.51

$39.00

$34.60

$28.70

$26.13

$20.04

$16.33

$14.68

$13.38

$11.10

$9.29

$7.96

$1.88

$28,839.26

Inpatient- EKG, X-Ray (Plain Film)

Anesthesia - Facility/OP Hosp Off-Island

ER, Injectables and other medications

Inpatient Diagnostic

Inpatient Ultrasound

Foot Care Services, Specialist

Mammogram, Diagnostic

Surgery

ER, Ambulance

GMH- URGENT CARE

Immunizations

Ultrasound, 26 Modifier

EKG, X-Ray (Plain Film)

Inpatient Surgery Physicians

Standard DME, Home Health

Injectables and other medications

Inpatient Hemodialysis - IP & OP Professional

ER Physicians

Anesthesia - OP Hospital

Surgery Facility, Hospital OP

Nuclear Medicine (radiology)

Routine Lab

Wellness Preventive Incentive

Preventive Care Services - Adult

ER Facility, Emergency

Prescriptions

Hemodialysis - Facility

Inpatient-Hospital Visit-Professional

Specialist, Diagnostic

Prosthetic Supplies/Devices/Implants, Outpatient Hospital

Facility Supplies, Hospital Outpatient

Inpatient-Hospital

Office Visit

GYM PARTNER PAYMENT (Invoice Payments)

Specialist Office Visit

Specialist, Surgery

Surgery Physicians - OP Hospital/Facility


GGRSUP02

Service

Hemodialysis - OP Professional

Hemodialysis - IP & OP Professional

TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM

GGRSUP01

Service


Page 3 of 29 TC Confidential

Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*


Total Claim Amount

$2,229.27

$1,200.00

$785.54

$753.84

$534.26

$499.60

$406.09

$278.81

$263.81

$159.55

$152.26

$152.20

$135.89

$117.25

$113.59

$108.48

$93.91

$75.00

$69.64

$47.18

$33.71

$24.89

$22.57

$21.84

$15.86

$9.51

$4.58

$3.42

$8,312.54

Total Claim Amount

$106,073.62

$64,654.20

$56,412.12

$55,869.29

$47,954.32

$34,287.93

$34,152.96

$28,131.99

$24,627.06

$23,070.96

$21,942.74

$21,765.00

$21,381.77

$21,350.78Inpatient Routine Lab


Inpatient-Maternity

Inpatient-Prescription Items



Inpatient Maternity-Professional

Inpatient Surgery Facility

Urgent Care, within normal business hours

Routine Lab


Immunizations - Well Baby Care (up to 2 yrs. old)


EKG, X-Ray (Plain Film), ER, 26 Modifier


HSA

Service

Inpatient-Hospital

Mental Health - Professional

ER Physicians


Routine Lab


Office Visit, Inpatient


Refraction, Preventive

Lodging




Prescriptions



Specialist, Surgery

Refraction


Eye Glasses / Frames / Contact Lenses

Executive Check-Up


Immunizations

Airfare Travel


GGRSUP03

Service

Office Visit





$20,777.58

$19,835.52

$18,844.64

$13,561.66

$12,500.00

$12,252.32

$11,916.16

$11,731.36

$10,808.54

$9,722.92

$8,011.67

$7,264.30

$6,576.61

$4,463.48

$3,660.66

$3,597.09

$3,519.66

$3,478.53

$3,276.46

$3,069.89

$3,035.99

$2,881.05

$2,818.40

$2,817.51

$2,568.13

$2,083.89

$1,928.33

$1,816.34

$1,566.05

$1,562.40

$1,548.21

$1,474.17

$1,111.32

$1,003.60

$990.35

$905.00

$900.06

$841.12

$810.80

$808.18

$750.24

$696.23

$648.14

$478.56

$468.92

$467.75

$419.43

Inpatient Injectables and other medications




Prescription Items, Hospital OP

Inpatient Physical Therapy

Gym Membership

Inpatient Emergency Room, Admitted

Inpatient-Pacemaker

Surgery

Inpatient-Hospital, PA required



Executive Check-Up


Diagnostic, Hospital Outpatient

ER, CT Scan (radiology)

Well Baby Care (2 - 17 yrs old)

Treatment/Observation Room, Hospital Outpatient


Maternity - OP Professional

CT Scan (radiology)

EEG, Ultrasound



Prosthetic Supplies/Devices/Implants, Outpatient Hospital


MATERNITY PRENATAL VISITS


Anesthesia - IP


Office Visit

Contraceptive

ER Physicians

Surgery Physicians, Outpatient Hospital

Routine Lab, Hospital OP

Immunizations - Well Child Care (3 - 17yrs. old)

Well Child Care - Preventive (0 to 4 yrs old)


Specialist, Surgery


SCREENING MAMMOGRAM FOR WOMEN AGES 40 - 74 YEARS

Facility Supplies

Inpatient-Prosthetics Supplies/Devices/Implants/ (UB Codes only)


Immunizations





$372.68

$365.67

$351.00

$330.00

$295.80

$254.49

$202.88

$201.00

$169.72

$169.66

$165.00

$162.08

$136.29

$133.00

$131.50

$121.08

$115.38

$114.84

$113.49

$76.41

$75.72

$70.20

$56.14

$50.00

$49.49

$41.74

$39.05

$34.66

$21.34

$10.35

$9.51

$9.37

$9.21

$8.38

$3.00

$1.15

$792,415.25

Total Claim Amount

$1,340,753.11

$487,121.79

$453,264.01

$441,436.87

$321,743.91

$272,758.92

$227,510.81

$164,197.32

Urgent Care, within normal business hours



Hemodialysis - OP Professional


PPO

Service

Office Visit

Inpatient-Hospital

Routine Lab


Other Laboratory services

Inpatient Nuclear Medicine (radiology)

EKG, X-Ray (Plain Film), 26 Modifier, Hosp OP

Cardiac Therapy

Inhaled Medication and Administration

MRI (radiology), ER, 26 Modifier

Inpatient CT Scan (radiology)

ER Facility, OP Hospital

EKG, X-Ray (Plain Film), Hospital OP

Prescription Items - Emergency

Ultrasound, TC Modifier

Occupational Therapy, Hospital OP

Consult

Prescriptions


Refraction

Wellness Outcome Based Bonuses

Hearing Screening

Specialty Lab

MRI, Hospital Outpatient

Chiropractic Care

Health Education / Wellness / Disease Management

Maternity, Office Visit

Birthing Center, Outpatient Hospital/Facility

EEG, Ultrasound, ER, 26 Modifier


ER, Surgery

Intra-Ocular Lens, Outpatient Hospital/Facility

Inpatient Radiation Therapy

Labor and Delivery, Outpatient Hospital

GMH- URGENT CARE

ER, Ambulance


Inpatient Cardiac Therapy

Inpatient, MRI (radiology)




$148,450.30

$147,092.35

$117,111.27

$110,102.44

$109,770.00

$104,927.88

$94,059.47

$87,313.35

$86,681.94

$77,410.00

$77,033.50

$75,494.33

$75,050.09

$68,520.00

$66,877.88

$65,914.91

$60,293.93

$59,803.66

$59,634.27

$54,827.55

$53,381.59

$49,941.85

$43,730.18

$38,107.92

$37,814.36

$37,349.16

$36,943.84

$31,257.37

$31,146.12

$30,767.19

$30,359.12

$29,230.69

$28,628.40

$28,608.97

$24,629.41

$22,909.53

$22,330.51

$20,120.80

$19,772.33

$18,948.48

$18,773.91

$18,762.41

$16,418.38

$15,778.19

$15,657.20

$15,176.63

$15,095.90

EEG, Ultrasound


Surgery Physicians, Outpatient Hospital


Routine Lab, Hospital OP

MRI (radiology)

Executive Check-Up

CT Scan (radiology)

Mental Health - Professional

Inpatient CT Scan (radiology)


Refraction

Surgery


Inpatient-Prosthetics Supplies/Devices/Implants/ (UB Codes only)


Airfare Travel


MATERNITY PRENATAL VISITS

Facility Supplies

Prescription Items, Hospital OP

Contraceptive



Inpatient Routine Lab

Chemotherapy

Anesthesia - IP

ER Physicians


Nuclear Medicine (radiology)



SCREENING MAMMOGRAM FOR WOMEN AGES 40 - 74 YEARS


Specialist, Surgery

Immunizations

Inpatient Maternity-Professional


Radiation Therapy

Inpatient Surgery Facility

Immunizations - Well Baby Care (up to 2 yrs. old)

Inpatient-Maternity

Immunizations - Well Child Care (3 - 17yrs. old)


Inpatient-Prescription Items






$13,964.38

$13,869.69

$13,707.24

$13,705.59

$13,151.23

$11,643.67

$11,636.65

$9,744.15

$9,451.17

$9,393.00

$8,765.97

$8,342.89

$7,111.67

$7,089.65

$7,079.79

$6,079.14

$5,269.58

$5,246.40

$5,242.13

$5,216.10

$5,147.32

$5,042.02

$5,003.73

$4,139.54

$4,106.46

$3,475.78

$3,287.13

$3,094.04

$2,836.16

$2,798.83

$2,676.60

$2,556.70

$2,520.00

$2,430.00

$2,078.70

$2,035.87

$2,025.29

$1,532.46

$1,374.04

$1,354.38

$1,277.70

$1,234.04

$1,128.95

$1,124.67

$1,108.83

$1,042.74

$995.22

EKG, X-Ray (Plain Film), 26 Modifier, Hosp OP

Specialist Periodic Exams

Chiropractic Care

Radiation Therapy, OP Hospital

EKG, X-Ray (Plain Film), Hospital OP

Inpatient Radiation Therapy

Cardiac Therapy, Hospital OP

Injectibles and other medications, Outpatient Hospital

EKG, X-Ray (Plain Film), 26 Modifier

Chemotherapy, Outpatient Hospital

Gym Membership


Treatment/Observation Room, Hospital Outpatient

CT Scan 26 Modifier, Hosp OP

Consult

Inpatient-Pacemaker

Prescriptions

Inpatient Physical Therapy


Maternity, Diagnostic

EKG, X-Ray (Plain Film), TC Modifier

Diagnostic, Hospital Outpatient

ER Facility, OP Hospital

ER, CT Scan (radiology)



Inpatient-Treatment/Observation Room

Inpatient-Hospital, PA required

Inpatient, MRI (radiology)

Hospital Visit - Professional, Outpatient Hospital

Maternity - OP Professional


Inpatient Injectables and other medications

Physical Therapy

Inpatient-Labor and Delivery

Well Baby Care (2 - 17 yrs old)



CT Scan, PA Required,Hospital OP

Home Health Services

Home Health, Physical Therapy

Inpatient Emergency Room, Admitted

Chemotherapy Agents


Lodging

MRI, Hospital Outpatient

Birthing Center, Outpatient Hospital/Facility




$924.65

$861.54

$820.15

$808.56

$772.61

$760.39

$733.87

$687.80

$670.46

$659.97

$645.18

$632.71

$596.83

$578.90

$563.45

$560.75

$557.34

$550.15

$484.74

$464.06

$390.62

$356.07

$324.49

$284.02

$263.50

$222.72

$210.12

$197.64

$194.69

$191.97

$156.00

$153.60

$152.59

$140.00

$104.40

$88.82

$71.00

$60.23

$58.50

$57.30

$50.00

$39.52

$37.48

$21.83

$21.34

$19.21

$13.92

Hospital Visit - Professional, Outpatient Hospital/Facility

Ostomy/Colostomy/Urinary Supplies

Diagnostic, 26 Modifier, Hosp OP

Wellness Outcome Based Bonuses

Cast Supplies

Allergy Injectable

Diagnostic, Outpatient Hospital/Facility

Prescription Items - Emergency

Acupuncture

Foot Care Services

CT Scan (radiology), 26 Modifer

Mammogram, Diagnostic, 26 Modifer

Inhaled Medication and Administration

Office Visit, OP Hospital

Other Laboratory services

Inpatient Nuclear Medicine (radiology)

Hospital, Outpatient

Ambulance

Mammogram, Diagnostic, ER, 26 Modifier

MRI, 26 Modifier, Hosp OP

Miscellaneous, Facility - Hospital OP

Inpatient-Skilled Nursing Facility

Ultrasound, Hospital Outpatient

Inpatient Occupational Therapy

Inpatient, Hearing Screening


Inpatient Chemotherapy

Occupational Therapy, Hospital OP

Labor and Delivery, Outpatient Hospital

GMH- URGENT CARE

Hospital Visit - Professional

Mammogram, Diagnostic, TC Modifer

Specialty Lab

ER, Ambulance

Intra-Ocular Lens, Outpatient Hospital/Facility

Specialist Hearing Screening

EEG, Ultrasound, ER, 26 Modifier

Radiation Therapy, w/ Mod 26

Inpatient Hemodialysis - IP & OP Professional

Health Education / Wellness / Disease Management


Physical Therapy, Hospital OP

Anesthesia

Hearing Screening

Maternity, Office Visit

Prosthetics

MRI (radiology), TC Modifier




$8.00

$6,477,157.27

Ultrasound, TC Modifier

67%

33%

GGRSUP01



14%

8%

7%

7%

6%

58%

HSA

Inpatient‐HospitalInpatient Surgery FacilityUrgent Care, within normal business hoursRoutine LabPreventive Care Services ‐ AdultOthers




21%

7%

7%

7%5%

53%

PPO

Office VisitInpatient‐HospitalRoutine LabUrgent Care, within normal business hoursPreventive Care Services ‐ AdultOthers

32%

18%14%

5%

4%

27%

GGRSUP02

Hemodialysis ‐ OP ProfessionalHemodialysis ‐ IP & OP ProfessionalInpatient‐HospitalOffice VisitGYM PARTNER PAYMENT (Invoice Payments)Others

27%

14%

10%9%6%

34%

GGRSUP03

Office VisitGYM PARTNER PAYMENT (Invoice Payments)Eye Glasses / Frames / Contact LensesExecutive Check‐UpSpecialist Office VisitOthers



TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM

DOA1 - GOVGUAM - DEPT. OF ADMINISTRATION (DOA)

HSA Plan

Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total

Subs Only 39 37 37 38 39 39 33 33 34 34 363

Subscriber + Spouse 26 28 28 26 28 28 26 26 24 22 262

Subs + Deps 39 41 41 41 41 41 43 43 43 53 426

Family 139 144 149 153 156 156 159 159 159 169 1,543

Total Members 243 250 255 258 264 264 261 261 260 278 2,594

PPO Plan


Subs Only 196 181 179 180 178 181 178 179 179 181 1,812


Subs + Deps 330 355 360 356 363 359 358 350 346 343 3,520

Family 674 710 717 724 738 743 747 764 765 757 7,339

Total Members 1,296 1,346 1,356 1,356 1,373 1,377 1,371 1,381 1,378 1,371 13,605

DOE1 - GOVGUAM - DEPT. OF EDUCATION (DOE)

HSA Plan


Subs Only 56 53 53 51 53 53 46 45 45 41 496


Subs + Deps 61 63 63 63 63 56 62 60 56 53 600

Family 68 65 77 77 77 85 78 75 75 73 750

Total Members 217 213 225 221 223 224 212 204 200 189 2,128

PPO Plan


Subs Only 223 209 207 201 202 199 180 178 176 170 1,945


Subs + Deps 304 344 352 361 358 362 342 344 348 337 3,452

Family 453 492 498 485 497 494 476 480 485 480 4,840

Spouse + Deps 2 2

Total Members 1,078 1,141 1,149 1,141 1,147 1,143 1,080 1,080 1,089 1,063 11,111

GAA1 - GOVGUAM - GUAM INT'L AIRPORT AUTHORITY

HSA Plan


Subs Only 3 3 3 3 3 3 3 3 3 3 30

Family 4 4 4 4 4 4 4 4 4 4 40

Total Members 7 7 7 7 7 7 7 7 7 7 70

PPO Plan


Subs Only 2 1 2 2 3 3 4 4 4 4 29


Subs + Deps 4 4 4 4 4 4 4 4 4 4 40

Family 30 37 37 37 37 37 37 37 36 36 361

Total Members 44 50 51 51 52 52 53 53 52 52 510

GCC1 - GOVGUAM - GUAM COMMUNITY COLLEGE (GCC)

HSA Plan


Subs Only 3 2 1 1 1 1 1 1 1 1 13


Family 8 4 4 4 4 4 4 4 4 4 44

Total Members 13 8 7 7 7 7 7 7 7 7 77

PPO Plan


Subs Only 14 15 15 15 15 15 15 15 15 15 149


Subs + Deps 33 22 22 22 22 22 22 22 21 21 229

Family 36 53 52 53 53 53 53 53 53 53 512

Total Members 91 96 95 96 96 96 96 96 95 95 952

GHC1 - GOVGUAM - GUAM HOUSING CORPORATION (GHC)

PPO Plan


Subs Only 1 1 1 1 1 1 1 1 1 1 10

Subs + Deps 7 6 6 6 6 6 6 6 6 6 61

Family 9 9 9 9 9 9 9 9 9 9 90

Total Members 17 16 16 16 16 16 16 16 16 16 161

GHU1 - GOVGUAM - GUAM HOUSING & URBAN RENEWAL

HSA Plan


Subs Only 1 1 1 1 1 1 1 1 1 1 10

Family 4 4 4 4 4 4 4 4 4 4 40

Total Members 5 5 5 5 5 5 5 5 5 5 50

PPO Plan


Subs Only 2 2 2 2 2 2 2 2 2 2 20

Subs + Deps 16 16 16 16 16 16 16 16 16 16 160

Family 7 7 7 7 7 7 7 7 7 7 70

Total Members 25 25 25 25 25 25 25 25 25 25 250

GMH1 - GOVGUAM - GUAM MEMORIAL HOSPITAL

HSA Plan


Subs Only 6 6 6 6 6 6 5 5 6 6 58

Subscriber + Spouse 2 4 4 4 2 2 18

Subs + Deps 4 4 4 4 4 4 4 4 4 4 40

Family 14 14 14 14 14 14 14 14 14 14 140

Total Members 26 28 28 28 26 26 23 23 24 24 256

PPO Plan


Subs Only 50 46 49 50 49 46 43 43 42 43 461


Subs + Deps 90 93 100 100 100 100 100 100 101 101 985

Family 167 189 192 192 192 197 197 194 194 194 1,908

Total Members 349 368 381 386 385 385 380 377 377 378 3,766

GPA1 - GOVGUAM - GUAM POWER AUTHORITY (GPA)

HSA Plan


Subs Only 6 6 6 6 6 6 6 6 6 6 60


Subs + Deps 6 10 10 10 10 10 10 10 10 10 96

Page 12 of 29 Copyright @ 2011 TakeCare. All rights reserved

TC Confidential Doc. No. 34GL-18-2220.*


Family 11 9 9 9 9 9 9 9 9 6 89

Total Members 27 27 27 27 27 27 27 27 27 24 267

PPO Plan


Subs Only 25 25 24 24 24 25 25 25 25 26 248


Subs + Deps 49 44 46 45 40 40 39 39 39 39 420

Family 120 144 145 145 151 151 150 150 147 157 1,460

Total Members 222 245 247 246 247 246 242 242 239 250 2,426

GVB1 - GOVGUAM - GUAM VISITORS BUREAU (GVB)

PPO Plan


Subs Only 5 5 4 4 4 4 4 4 4 4 42


Family 5 5 5 5 5 5 5 5 5 5 50

Total Members 12 12 11 11 11 11 11 11 11 11 112

GWA1 - GOVGUAM - GUAM WATERWORKS (GWA)

HSA Plan


Subs Only 4 4 5 5 5 5 5 5 5 4 47

Subs + Deps 7 7 7 7 7 7 7 7 7 7 70

Family 3 3 3 3 3 3 3 3 3 3 30

Total Members 14 14 15 15 15 15 15 15 15 14 147

PPO Plan


Subs Only 16 16 17 17 17 17 20 20 20 19 179


Subs + Deps 45 47 50 56 51 51 51 59 59 57 526

Family 67 81 87 89 97 101 102 102 106 106 938

Total Members 138 152 160 168 171 175 179 187 191 188 1,709

LEG1 - GOVGUAM - GUAM LEGISLATURE (LEG)

HSA Plan


Subs Only 4 4 4 4 3 3 2 2 2 2 30

Subscriber + Spouse 2 3 3 3 3 3 3 1 21

Subs + Deps 2 2 2 2 2 2 2 2 2 2 20

Family 3 3 3 3 3 3 3 3 24

Total Members 11 9 9 12 11 11 10 10 7 5 95

PPO Plan


Subs Only 13 13 13 13 13 14 14 14 14 14 135

Subs + Deps 7 7 7 7 7 7 7 7 7 7 70

Family 22 18 18 18 18 18 18 18 18 18 184

Total Members 42 38 38 38 38 39 39 39 39 39 389

PAG1 - GOVGUAM - PORT AUTHORITY OF GUAM (PAG)

HSA Plan


Subs Only 4 3 3 3 3 3 3 3 3 3 31


Subs + Deps 4 4 4 4 4 4 4 4 4 4 40

Family 13 13 13 17 17 17 17 17 17 17 158

Total Members 25 24 24 28 28 28 28 28 28 28 269

PPO Plan


Subs Only 28 25 25 25 25 25 25 25 26 25 254


Subs + Deps 32 40 43 43 43 45 47 47 47 47 434

Family 136 154 154 161 161 161 161 156 159 165 1,568

Total Members 220 241 244 249 249 251 253 248 252 257 2,464

PUB1 - GOVGUAM - PUBLIC DEFENDER (PUB)

HSA Plan


Subs Only 2 2 2 2 2 2 2 2 2 2 20

Total Members 2 2 2 2 2 2 2 2 2 2 20

PPO Plan


Subs Only 2 2 2 2 2 1 1 1 1 1 15


Subs + Deps 11 12 12 12 12 8 8 8 8 8 99

Family 15 17 17 17 16 16 16 16 16 16 162

Total Members 30 33 33 33 32 27 27 27 27 27 296

RAC1 - GOVGUAM - RETIREMENT FUND ACTIVE

HSA Plan


Subs Only 2 2 2 2 2 2 2 2 2 2 20

Total Members 2 2 2 2 2 2 2 2 2 2 20

PPO Plan


Subs Only 9 9 9 9 9 9 9 10 10 9 92


Subs + Deps 12 12 12 12 12 12 12 12 12 11 119

Family 2 2 2 3 3 3 3 3 3 3 27

Total Members 25 25 25 26 26 26 26 27 27 25 258

RET1 - GOVGUAM - RETIREES

Plan


Subs Only 33 33 35 35 35 35 36 38 37 35 352


Total Members 47 49 51 51 51 51 52 56 55 53 516

HSA Plan


Subs Only 20 20 19 19 19 20 19 19 18 16 189


Subs + Deps 3 3 2 8

Family 23 23 23 23 23 23 23 19 19 19 218

Total Members 59 59 58 56 56 57 56 55 54 51 561

PPO Plan





Subs Only 117 113 117 118 118 119 120 116 115 109 1,162


Subs + Deps 81 88 88 88 89 89 88 88 88 88 875

Family 78 94 98 94 98 98 98 95 92 93 938

Total Members 366 383 393 390 399 398 398 391 389 386 3,893

UOG1 - GOVGUAM - UNIVERSITY OF GUAM (UOG)

HSA Plan


Subs Only 7 6 6 6 8 8 8 8 9 8 74

Subscriber + Spouse 2 2 2 2 2 2 2 14

Subs + Deps 5 2 2 2 2 2 2 2 2 2 23

Family 30 30 30 30 29 29 32 32 32 32 306

Total Members 42 40 40 40 41 41 44 44 43 42 417

PPO Plan


Subs Only 35 36 38 38 37 36 36 37 38 37 368


Subs + Deps 41 38 38 38 38 38 38 36 36 36 377

Family 66 67 67 71 71 71 76 73 73 72 707

Total Members 156 157 159 163 162 161 166 164 163 163 1,614

Grand Total Members: 4,851 5,065 5,138 5,154 5,194 5,195 5,113 5,110 5,106 5,077 51,003


HSA DENTAL PLAN


Subs Only 43 42 42 42 44 44 39 38 39 39 412


Subs + Deps 43 43 43 43 43 41 43 43 43 51 436

Family 155 160 158 159 162 162 165 165 168 178 1,632

Total Members for HSA DENTAL 269 274 272 271 278 276 274 273 275 291 2,753

PPO DENTAL PLAN


Subs Only 182 170 168 169 168 171 167 169 168 170 1,702


Subs + Deps 311 337 342 340 347 343 342 334 328 325 3,349

Family 654 690 697 704 718 723 728 742 746 739 7,141

Total Members for PPO DENTAL 1,237 1,289 1,299 1,301 1,319 1,323 1,319 1,327 1,320 1,314 13,048

Total Members for DOA1 1,506 1,563 1,571 1,572 1,597 1,599 1,593 1,600 1,595 1,605 15,801


HSA DENTAL PLAN


Subs Only 65 61 61 60 60 60 52 54 53 48 574


Subs + Deps 71 74 72 72 65 60 62 60 60 57 653

Family 67 64 76 76 83 91 84 81 86 84 792

Total Members for HSA DENTAL 235 231 241 240 240 243 226 221 225 211 2,313

PPO DENTAL PLAN


Subs Only 206 195 192 186 189 188 168 167 165 160 1,816


Subs + Deps 299 337 347 356 353 357 343 343 343 332 3,410

Family 418 453 462 449 461 461 437 441 446 441 4,469

Total Members for PPO DENTAL 1,001 1,061 1,071 1,059 1,071 1,072 1,012 1,011 1,016 991 10,365

Total Members for DOE1 1,236 1,292 1,312 1,299 1,311 1,315 1,238 1,232 1,241 1,202 12,678


HSA DENTAL PLAN


Subs Only 2 2 2 2 2 2 2 2 2 2 20

Family 5 5 5 5 5 5 5 5 5 5 50

Total Members for HSA DENTAL 7 7 7 7 7 7 7 7 7 7 70

PPO DENTAL PLAN


Subs Only 2 1 2 2 3 3 4 4 4 4 29


Subs + Deps 4 4 4 4 4 4 4 4 4 4 40

Family 26 33 33 33 33 33 33 33 33 33 323

Total Members for PPO DENTAL 40 46 47 47 48 48 49 49 49 49 472

Total Members for GAA1 47 53 54 54 55 55 56 56 56 56 542


HSA DENTAL PLAN


Subs Only 3 3 2 2 2 2 2 2 2 2 22


Subs + Deps 5 5 5 5 5 5 5 5 5 5 50

Family 14 10 10 10 10 10 10 10 10 10 104


PPO DENTAL PLAN


Subs Only 15 15 15 15 15 15 15 15 15 15 150


Subs + Deps 26 22 22 22 22 22 22 22 21 21 222

Family 36 45 44 45 45 45 45 45 45 45 440


Total Members for GCC1 111 110 108 109 109 109 109 109 108 108 1,090


PPO DENTAL PLAN


Subs Only 1 1 1 1 1 1 1 1 1 1 10

Subs + Deps 7 6 6 6 6 6 6 6 6 6 61

Family 9 9 9 9 9 9 9 9 9 9 90


Total Members for GHC1 17 16 16 16 16 16 16 16 16 16 161


HSA DENTAL PLAN


Subs Only 2 2 2 2 2 2 2 2 2 2 20

Family 4 4 4 4 4 4 4 4 4 4 40





PPO DENTAL PLAN


Subs Only 3 3 3 3 3 3 3 3 3 3 30

Subs + Deps 14 14 14 14 14 14 14 14 14 14 140

Family 3 3 3 3 3 3 3 3 3 3 30


Total Members for GHU1 26 26 26 26 26 26 26 26 26 26 260


HSA DENTAL PLAN


Subs Only 8 8 9 9 10 10 9 9 9 9 90


Subs + Deps 4 4 4 4 4 4 4 4 4 4 40

Family 24 24 24 24 24 24 24 24 24 24 240


PPO DENTAL PLAN


Subs Only 40 38 40 41 41 38 35 35 34 35 377


Subs + Deps 88 91 98 98 98 98 98 98 99 99 965

Family 150 167 170 170 170 175 175 172 172 172 1,693

Total Members for PPO DENTAL 310 324 332 337 337 337 334 331 331 332 3,305

Total Members for GMH1 352 368 377 382 381 381 375 372 372 373 3,733


HSA DENTAL PLAN


Subs Only 7 7 7 7 7 7 7 7 7 7 70


Subs + Deps 6 10 10 10 10 10 10 10 10 10 96

Family 11 9 9 9 9 9 9 9 9 6 89


PPO DENTAL PLAN


Subs Only 24 24 23 23 24 25 25 25 25 27 245


Subs + Deps 46 41 43 42 37 37 36 36 36 36 390

Family 126 150 151 151 157 157 156 156 153 160 1,517


Total Members for GPA1 246 269 271 270 272 271 267 267 264 270 2,667


HSA DENTAL PLAN


Family 5 5 5 5 5 5 5 5 5 5 50


PPO DENTAL PLAN


Subs Only 4 4 3 3 3 3 3 3 3 3 32


Family 5 5 5 5 5 5 5 5 5 5 50


Total Members for GVB1 16 16 15 15 15 15 15 15 15 15 152


HSA DENTAL PLAN


Subs Only 2 2 3 3 3 3 3 3 3 2 27

Subs + Deps 10 10 10 10 10 10 10 10 10 10 100

Family 3 3 3 3 3 3 3 3 3 3 30


PPO DENTAL PLAN


Subs Only 16 16 17 17 17 17 20 20 20 19 179


Subs + Deps 48 50 50 51 51 51 51 54 54 52 512

Family 59 73 83 85 86 90 91 91 91 91 840


Total Members for GWA1 144 158 168 171 172 176 180 183 183 179 1,714


HSA DENTAL PLAN


Subs Only 5 5 5 5 4 4 3 3 3 3 40

Subscriber + Spouse 2 3 3 3 3 3 3 1 21

Subs + Deps 3 3 3 3 3 3 3 3 3 3 30

Family 7 7 7 7 7 7 7 7 4 4 64


PPO DENTAL PLAN


Subs Only 13 13 13 13 13 14 14 14 14 14 135

Subs + Deps 7 7 7 7 7 7 7 7 7 7 70

Family 18 14 14 14 14 14 14 14 14 14 144


Total Members for LEG1 55 49 49 52 51 52 51 51 48 46 504


HSA DENTAL PLAN


Subs Only 6 4 4 4 4 4 4 4 4 4 42

Subs + Deps 4 4 4 4 4 4 4 4 4 4 40

Family 9 14 14 22 22 22 22 22 22 22 191


PPO DENTAL PLAN


Subs Only 28 25 25 25 25 25 25 25 26 25 254


Subs + Deps 32 40 43 43 43 45 47 47 47 47 434

Family 125 142 142 153 153 153 153 153 156 162 1,492


Total Members for PAG1 228 251 254 271 271 273 275 275 279 284 2,661





Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total

39 37 37 38 39 39 33 34 34 363

13 14 14 13 14 14 13 12 11 131

14 15 15 15 15 15 16 16 19 156

33 34 34 35 36 36 37 37 39 358

99 100 100 101 104 104 99 99 103 1,008


196 181 179 180 178 181 178 179 181 1,812

48 50 50 48 47 47 44 44 45 467

110 117 118 118 121 120 120 116 116 1,174

150 158 160 162 166 167 168 173 171 1,647

504 506 507 508 512 515 510 512 513 5,100


56 53 53 51 53 53 46 45 41 496

16 16 16 15 15 15 13 12 11 141

22 23 23 23 23 22 24 22 20 225

17 16 19 19 19 20 18 17 16 178

111 108 111 108 110 110 101 96 88 1,040


223 209 207 201 202 199 180 176 170 1,945

48 48 46 47 45 44 41 40 38 436

101 109 111 115 115 116 108 111 109 1,105

101 110 112 110 112 111 107 109 108 1,088

1 1

474 476 476 473 474 470 436 436 425 4,575

HSA DENTAL PLAN


Subs Only 2 2 2 2 2 2 2 2 2 2 20

Subs + Deps 1 1 1 1 1 1 1 1 1 1 10

Family 4 4 4 4 4 4 4 4 4 4 40


PPO DENTAL PLAN


Subs Only 2 2 2 2 2 1 1 1 1 1 15


Subs + Deps 8 9 9 9 9 5 5 5 5 5 69

Family 15 17 17 17 16 16 16 16 16 16 162


Total Members for PUB1 34 37 37 37 36 31 31 31 31 31 336


HSA DENTAL PLAN


Subs Only 2 2 2 2 2 2 2 2 2 2 20



PPO DENTAL PLAN


Subs Only 9 9 9 9 9 9 9 10 10 9 92


Subs + Deps 12 12 12 12 12 12 12 12 12 11 119

Family 2 2 2 3 3 3 3 3 3 3 27


Total Members for RAC1 28 28 28 29 29 29 29 30 30 28 288


DENTAL PLAN


Subs Only 14 14 15 15 15 15 15 16 15 15 149


Total Members for DENTAL 18 16 17 17 17 17 17 20 19 19 177

HSA DENTAL PLAN


Subs Only 20 18 18 18 18 18 18 18 18 16 180


Subs + Deps 3 3 2 8

Family 22 22 22 22 22 22 22 18 18 18 208


PPO DENTAL PLAN


Subs Only 92 91 94 94 90 90 92 90 89 83 905


Subs + Deps 74 77 77 77 85 85 84 84 84 84 811

Family 77 93 97 97 97 97 97 94 91 92 932


Total Members for RET1 383 397 407 409 413 413 416 413 410 404 4,065


HSA DENTAL PLAN


Subs Only 8 7 7 7 9 8 8 8 9 8 79

Subscriber + Spouse 2 2 2 2 2 2 12

Subs + Deps 2 2 2 2 2 2 2 2 2 2 20

Family 25 25 25 25 24 24 27 27 27 27 256


PPO DENTAL PLAN


Subs Only 28 27 29 29 28 28 28 29 30 29 285


Subs + Deps 41 38 38 38 38 38 38 36 36 36 377

Family 66 67 67 71 71 71 76 73 73 72

186

707

Total Members for PPO DENTAL 145 145 147 151 150 150 155

Total Members for UOG1 180 181 183 187 187

151 149 1,495152

189 189 186

48,514


1,862

Grand Total Members 4,609 4,814 4,863 4,829

194

HSA Plan

May-2018

4,941 4,947 4,8714,876 4,899 4,865

Subs Only 33

Subscriber + Spouse 13

Subs + Deps 16

Family 37

Total Subscribers: 99

PPO Plan

May-2018

Subs Only 179


Subs + Deps 118

Family 172



HSA Plan

May-2018

Subs Only 45


Subs + Deps 23

Family 17


PPO Plan

May-2018

Subs Only 178


Subs + Deps 110

Family 108

Spouse + Deps






3 3 3 3 3 3 3 3 3 30

1 1 1 1 1 1 1 1 1 10

4 4 4 4 4 4 4 4 4 40


2 1 2 2 3 3 4 4 4 29

4 4 4 4 4 4 4 4 4 40

2 2 2 2 2 2 2 2 2 20

7 8 8 8 8 8 8 8 8 79

15 15 16 16 17 17 18 18 18 168


3 2 1 1 1 1 1 1 1 13

1 1 1 1 1 1 1 1 1 10

2 1 1 1 1 1 1 1 1 11

6 4 3 3 3 3 3 3 3 34


14 15 15 15 15 15 15 15 15 149

4 3 3 3 3 3 3 3 3 31

10 8 8 8 8 8 8 8 8 82

8 11 11 11 11 11 11 11 11 107

36 37 37 37 37 37 37 37 37 369


1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 1 1 10

2 2 2 2 2 2 2 2 2 20

4 4 4 4 4 4 4 4 4 40


1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 1 1 10

2 2 2 2 2 2 2 2 2 20


2 2 2 2 2 2 2 2 2 20

4 4 4 4 4 4 4 4 4 40

2 2 2 2 2 2 2 2 2 20

8 8 8 8 8 8 8 8 8 80


6 6 6 6 6 6 5 6 6 58

1 2 2 2 1 1 9

1 1 1 1 1 1 1 1 1 10

4 4 4 4 4 4 4 4 4 40

12 13 13 13 12 12 10 11 11 117


50 46 49 50 49 46 43 42 43 461

21 20 20 22 22 21 20 20 20 206

27 27 29 29 29 29 29 29 29 286

39 45 45 45 45 46 46 45 45 446

137 138 143 146 145 142 138 136 137 1,399


6 6 6 6 6 6 6 6 6 60

2 1 1 1 1 1 1 1 1 11

2 3 3 3 3 3 3 3 3 29

3 3 3 3 3 3 3 3 2 29

13 13 13 13 13 13 13 13 12 129


25 25 24 24 24 25 25 25 26 248

14 16 16 16 16 15 14 14 14 149

18 16 17 17 16 16 16 16 16 164

24 28 28 28 29 29 29 28 29 281

81 85 85 85 85 85 84 83 85 842


5 5 4 4 4 4 4 4 4 42

1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 1 1 10

7 7 6 6 6 6 6 6 6 62


4 4 5 5 5 5 5 5 4 47

2 2 2 2 2 2 2 2 2 20

1 1 1 1 1 1 1 1 1 10

7 7 8 8 8 8 8 8 7 77


16 16 17 17 17 17 20 20 19 179

5 4 3 3 3 3 3 3 3 33

16 17 18 19 18 18 18 20 19 183

16 18 19 19 20 21 21 22 22 199

53 55 57 58 58 59 62 65 63 594


HSA Plan

May-2018

Subs Only 3

Family 1


PPO Plan

May-2018

Subs Only 4


Subs + Deps 2

Family 8



HSA Plan

May-2018

Subs Only 1


Family 1


PPO Plan

May-2018

Subs Only 15


Subs + Deps 8

Family 11



PPO Plan

May-2018

Subs Only 1

Subs + Deps 1

Family 2



HSA Plan

May-2018

Subs Only 1

Family 1


PPO Plan

May-2018

Subs Only 2

Subs + Deps 4

Family 2



HSA Plan

May-2018

Subs Only 5

Subscriber + Spouse

Subs + Deps 1

Family 4


PPO Plan

May-2018

Subs Only 43


Subs + Deps 29

Family 45



HSA Plan

May-2018

Subs Only 6


Subs + Deps 3

Family 3


PPO Plan

May-2018

Subs Only 25


Subs + Deps 16

Family 29



PPO Plan

May-2018

Subs Only 4


Family 1



HSA Plan

May-2018

Subs Only 5

Subs + Deps 2

Family 1


PPO Plan

May-2018

Subs Only 20


Subs + Deps 20

Family 21







4 4 4 4 3 3 2 2 2 30

1 2 2 2 2 2 1 14

1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 8

7 6 6 8 7 7 6 5 4 62


13 13 13 13 13 14 14 14 14 135

2 2 2 2 2 2 2 2 2 20

6 5 5 5 5 5 5 5 5 51

21 20 20 20 20 21 21 21 21 206


4 3 3 3 3 3 3 3 3 31

2 2 2 2 2 2 2 2 2 20

1 1 1 1 1 1 1 1 1 10

3 3 3 4 4 4 4 4 4 37

10 9 9 10 10 10 10 10 10 98


28 25 25 25 25 25 25 26 25 254

12 11 11 10 10 10 10 10 10 104

9 11 11 11 11 12 13 13 13 117

31 34 34 35 35 35 35 35 36 344

80 81 81 81 81 82 83 84 84 819


2 2 2 2 2 2 2 2 2 20

2 2 2 2 2 2 2 2 2 20


2 2 2 2 2 1 1 1 1 15

1 1 1 1 1 1 1 1 1 10

3 3 3 3 3 2 2 2 2 25

4 4 4 4 4 4 4 4 4 40

10 10 10 10 10 8 8 8 8 90


2 2 2 2 2 2 2 2 2 20

2 2 2 2 2 2 2 2 2 20


9 9 9 9 9 9 9 10 9 92

1 1 1 1 1 1 1 1 1 10

4 4 4 4 4 4 4 4 4 40

1 1 1 1 1 1 1 1 1 10

15 15 15 15 15 15 15 16 15 152


33 33 35 35 35 35 36 37 35 352

7 8 8 8 8 8 8 9 9 82

40 41 43 43 43 43 44 46 44 434


20 20 19 19 19 20 19 18 16 189

8 8 8 7 7 7 7 7 7 73

1 1 3

6 6 6 6 6 6 6 5 5 57

34 34 33 32 32 33 32 31 29 322


117 113 117 118 118 119 120 115 109 1,162

45 44 45 45 47 46 46 47 48 459

28 29 29 29 30 30 30 30 30 295

22 27 28 27 28 28 28 26 26 267

212 213 219 219 223 223 224 218 213 2,183


7 6 6 6 8 8 8 9 8 74

1 1 1 1 1 1 7

2 1 1 1 1 1 1 1 1 11

7 7 7 7 7 7 8 8 8 74

16 15 15 15 17 17 18 18 17 166


35 36 38 38 37 36 36 38 37 368

7 8 8 8 8 8 8 8 9 81

13 12 12 12 12 12 12 12 12 121

14 14 14 15 15 15 16 15 15 148

69 70 72 73 72 71 72 73 73 718

2,091 2,100 2,120 2,123 2,136 2,133 2,080 2,075 2,048 20,984


43 42 42 42 44 44 39 39 39 412

14 15 15 14 15 15 14 13 12 141

16 16 16 16 16 15 16 16 18 161

36 37 36 36 37 37 38 39 41 375

109 110 109 108 112 111 107 107 110 1,089


HSA Plan

May-2018

Subs Only 2


Subs + Deps 1

Family 1


PPO Plan

May-2018

Subs Only 14

Subs + Deps 2

Family 5



HSA Plan

May-2018

Subs Only 3


Subs + Deps 1

Family 4


PPO Plan

May-2018

Subs Only 25


Subs + Deps 13

Family 34



HSA Plan

May-2018

Subs Only 2


PPO Plan

May-2018

Subs Only 1


Subs + Deps 2

Family 4



HSA Plan

May-2018

Subs Only 2


PPO Plan

May-2018

Subs Only 10


Subs + Deps 4

Family 1



Plan

May-2018

Subs Only 38



HSA Plan

May-2018

Subs Only 19


Subs + Deps 1

Family 5


PPO Plan

May-2018

Subs Only 116


Subs + Deps 30

Family 27



HSA Plan

May-2018

Subs Only 8


Subs + Deps 1

Family 8


PPO Plan

May-2018

Subs Only 37


Subs + Deps 12

Family 15


Grand Total Subscribers: 2,078


HSA DENTAL PLAN

May-2018

Subs Only 38


Subs + Deps 16

Family 38

Total Subscribers for HSA DENTAL 106

PPO DENTAL PLAN

May-2018




182 170 168 169 168 171 167 168 170 1,702

45 46 46 44 43 43 41 39 40 428

102 109 111 112 115 114 114 109 109 1,107

146 154 156 158 162 163 164 169 167 1,606

475 479 481 483 488 491 486 485 486 4,843

584 589 590 591 600 602 593 592 596 5,932


65 61 61 60 60 60 52 53 48 574

16 16 16 16 16 16 14 13 11 147

25 27 26 26 25 25 26 25 23 253

18 17 20 20 21 22 20 20 19 196

124 121 123 122 122 123 112 111 101 1,170


206 195 192 186 189 188 168 165 160 1,816

39 38 35 34 34 33 32 31 29 335

98 105 108 112 112 113 107 108 106 1,077

93 101 104 102 104 104 98 100 99 1,004

436 439 439 434 439 438 405 404 394 4,232

560 560 562 556 561 561 517 515 495 5,402


2 2 2 2 2 2 2 2 2 20

2 2 2 2 2 2 2 2 2 20

4 4 4 4 4 4 4 4 4 40


2 1 2 2 3 3 4 4 4 29

4 4 4 4 4 4 4 4 4 40

2 2 2 2 2 2 2 2 2 20

6 7 7 7 7 7 7 7 7 69

14 14 15 15 16 16 17 17 17 158

18 18 19 19 20 20 21 21 21 198


3 3 2 2 2 2 2 2 2 22

2 2 2 2 2 2 2 2 2 20

2 2 2 2 2 2 2 2 2 20

3 2 2 2 2 2 2 2 2 21

10 9 8 8 8 8 8 8 8 83


15 15 15 15 15 15 15 15 15 150

4 3 3 3 3 3 3 3 3 31

9 8 8 8 8 8 8 8 8 81

8 10 10 10 10 10 10 10 10 98

36 36 36 36 36 36 36 36 36 360

46 45 44 44 44 44 44 44 44 443


1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 1 1 10

2 2 2 2 2 2 2 2 2 20

4 4 4 4 4 4 4 4 4 40

4 4 4 4 4 4 4 4 4 40


2 2 2 2 2 2 2 2 2 20

1 1 1 1 1 1 1 1 1 10

3 3 3 3 3 3 3 3 3 30


3 3 3 3 3 3 3 3 3 30

3 3 3 3 3 3 3 3 3 30

1 1 1 1 1 1 1 1 1 10

7 7 7 7 7 7 7 7 7 70

10 10 10 10 10 10 10 10 10 100


8 8 9 9 10 10 9 9 9 90

3 4 4 4 3 3 2 2 2 29

1 1 1 1 1 1 1 1 1 10

7 7 7 7 7 7 7 7 7 70

19 20 21 21 21 21 19 19 19 199


40 38 40 41 41 38 35 34 35 377

16 14 12 14 14 13 13 13 13 135

26 26 28 28 28 28 28 28 28 276

34 39 39 39 39 40 40 39 39 387

116 117 119 122 122 119 116 114 115 1,175

135 137 140 143 143 140 135 133 134 1,374


7 7 7 7 7 7 7 7 7 70

2 1 1 1 1 1 1 1 1 11

2 3 3 3 3 3 3 3 3 29

3 3 3 3 3 3 3 3 2 29

14 14 14 14 14 14 14 14 13 139

Subs Only 169


Subs + Deps 112

Family 167

Total Subscribers for PPO DENTAL 489

Total Subscriber for DOA1 595


HSA DENTAL PLAN

May-2018

Subs Only 54


Subs + Deps 25

Family 19


PPO DENTAL PLAN

May-2018

Subs Only 167


Subs + Deps 108

Family 99


Total Subscriber for DOE1 515


HSA DENTAL PLAN

May-2018

Subs Only 2

Family 2


PPO DENTAL PLAN

May-2018

Subs Only 4


Subs + Deps 2

Family 7


Total Subscriber for GAA1 21


HSA DENTAL PLAN

May-2018

Subs Only 2


Subs + Deps 2

Family 2


PPO DENTAL PLAN

May-2018

Subs Only 15


Subs + Deps 8

Family 10


Total Subscriber for GCC1 44


PPO DENTAL PLAN

May-2018

Subs Only 1

Subs + Deps 1

Family 2


Total Subscriber for GHC1 4


HSA DENTAL PLAN

May-2018

Subs Only 2

Family 1


PPO DENTAL PLAN

May-2018

Subs Only 3

Subs + Deps 3

Family 1


Total Subscriber for GHU1 10


HSA DENTAL PLAN

May-2018

Subs Only 9


Subs + Deps 1

Family 7


PPO DENTAL PLAN

May-2018

Subs Only 35


Subs + Deps 28

Family 39


Total Subscriber for GMH1 134


HSA DENTAL PLAN

May-2018

Subs Only 7


Subs + Deps 3

Family 3


PPO DENTAL PLAN





24 24 23 23 24 25 25 25 27 245

11 13 13 13 13 12 11 11 11 119

17 15 16 16 15 15 15 15 15 154

26 30 30 30 31 31 31 30 30 300

78 82 82 82 83 83 82 81 83 818

92 96 96 96 97 97 96 95 96 957


1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 1 1 10


4 4 3 3 3 3 3 3 3 32

1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 1 1 10

6 6 5 5 5 5 5 5 5 52

7 7 6 6 6 6 6 6 6 62


2 2 3 3 3 3 3 3 2 27

3 3 3 3 3 3 3 3 3 30

1 1 1 1 1 1 1 1 1 10

6 6 7 7 7 7 7 7 6 67


16 16 17 17 17 17 20 20 19 179

3 2 1 1 1 1 1 1 1 13

17 18 18 18 18 18 18 19 18 181

14 16 18 18 18 19 19 19 19 179

50 52 54 54 54 55 58 59 57 552

56 58 61 61 61 62 65 66 63 619


5 5 5 5 4 4 3 3 3 40

1 2 2 2 2 2 1 14

1 1 1 1 1 1 1 1 1 10

2 2 2 2 2 2 2 1 1 18

9 8 8 10 9 9 8 7 6 82


13 13 13 13 13 14 14 14 14 135

2 2 2 2 2 2 2 2 2 20

5 4 4 4 4 4 4 4 4 41

20 19 19 19 19 20 20 20 20 196

29 27 27 29 28 29 28 27 26 278


6 4 4 4 4 4 4 4 4 42

1 1 1 1 1 1 1 1 1 10

2 4 4 6 6 6 6 6 6 52

9 9 9 11 11 11 11 11 11 104


28 25 25 25 25 25 25 26 25 254

12 11 11 10 10 10 10 10 10 104

9 11 11 11 11 12 13 13 13 117

28 31 31 33 33 33 33 34 35 324

77 78 78 79 79 80 81 83 83 799

86 87 87 90 90 91 92 94 94 903


2 2 2 2 2 2 2 2 2 20

1 1 1 1 1 1 1 1 1 10

1 1 1 1 1 1 1 1 1 10

4 4 4 4 4 4 4 4 4 40


2 2 2 2 2 1 1 1 1 15

1 1 1 1 1 1 1 1 1 10

2 2 2 2 2 1 1 1 1 15

4 4 4 4 4 4 4 4 4 40

9 9 9 9 9 7 7 7 7 80

13 13 13 13 13 11 11 11 11 120


2 2 2 2 2 2 2 2 2 20

1 1 1 1 1 1 1 1 1 10

3 3 3 3 3 3 3 3 3 30


9 9 9 9 9 9 9 10 9 92

1 1 1 1 1 1 1 1 1 10

4 4 4 4 4 4 4 4 4 40

1 1 1 1 1 1 1 1 1 10

15 15 15 15 15 15 15 16 15 152

18 18 18 18 18 18 18 19 18 182


14 14 15 15 15 15 15 15 15 149

2 1 1 1 1 1 1 2 2 14

May-2018

Subs Only 25


Subs + Deps 15

Family 31


Total Subscriber for GPA1 96


HSA DENTAL PLAN

May-2018

Family 1


PPO DENTAL PLAN

May-2018

Subs Only 3


Family 1


Total Subscriber for GVB1 6


HSA DENTAL PLAN

May-2018

Subs Only 3

Subs + Deps 3

Family 1


PPO DENTAL PLAN

May-2018

Subs Only 20


Subs + Deps 19

Family 19


Total Subscriber for GWA1 66


HSA DENTAL PLAN

May-2018

Subs Only 3


Subs + Deps 1

Family 2


PPO DENTAL PLAN

May-2018

Subs Only 14

Subs + Deps 2

Family 4


Total Subscriber for LEG1 28


HSA DENTAL PLAN

May-2018

Subs Only 4

Subs + Deps 1

Family 6


PPO DENTAL PLAN

May-2018

Subs Only 25


Subs + Deps 13

Family 33


Total Subscriber for PAG1 92


HSA DENTAL PLAN

May-2018

Subs Only 2

Subs + Deps 1

Family 1


PPO DENTAL PLAN

May-2018

Subs Only 1


Subs + Deps 1

Family 4


Total Subscriber for PUB1 11


HSA DENTAL PLAN

May-2018

Subs Only 2



PPO DENTAL PLAN

May-2018

Subs Only 10


Subs + Deps 4

Family 1


Total Subscriber for RAC1 19


DENTAL PLAN

May-2018

Subs Only 16





16 15 16 16 16 16 16 17 17 163


20 18 18 18 18 18 18 18 16 180

10 10 10 10 10 10 10 10 10 100

1 1 3

6 6 6 6 6 6 6 5 5 57

36 34 34 34 34 34 34 34 32 340


92 91 94 94 90 90 92 89 83 905

30 30 31 32 32 32 33 34 35 322

25 25 25 25 28 28 28 28 28 268

22 27 28 28 28 28 28 26 26 268

169 173 178 179 178 178 181 177 172 1,763

221 222 228 229 228 228 231 228 221 2,266


8 7 7 7 9 8 8 9 8 79

1 1 1 1 1 1 6

1 1 1 1 1 1 1 1 1 10

6 6 6 6 6 6 7 7 7 64

15 15 15 15 17 16 17 17 16 159


28 27 29 29 28 28 28 30 29 285

5 7 7 7 7 7 7 6 6 66

13 12 12 12 12 12 12 12 12 121

14 14 14 15 15 15 16 15 15 148

60 60 62 63 62 62 63 63 62 620

75 75 77 78 79 78 80 80 78 779

1,954 1,966 1,982 1,987 2,002 2,001 1,951 1,945 1,917 19,655

Total Subscribers for DENTAL 18

HSA DENTAL PLAN

May-2018

Subs Only 18


Subs + Deps 1

Family 5


PPO DENTAL PLAN

May-2018

Subs Only 90


Subs + Deps 28

Family 27


Total Subscriber for RET1 230


HSA DENTAL PLAN

May-2018

Subs Only 8

Subscriber + Spouse

Subs + Deps 1

Family 7


PPO DENTAL PLAN

May-2018

Subs Only 29


Subs + Deps 12

Family 15


Total Subscriber for UOG1 79

Grand Total Subscribers: 1,950



Brand Name Total Claim Cost

ENBREL INJ 50MG/ML $139,515.20

JANUVIA TAB 100MG $109,015.20

LANTUS INJ SOLOSTAR $54,599.40

LEVEMIR INJ FLEXTOUC $39,277.40

IBRANCE CAP 100MG $38,444.28

NOVOLOG INJ FLEXPEN $35,151.35

ENBREL SRCLK INJ 50MG/ML $31,734.31

STELARA INJ 45MG/0.5 $29,365.64

VICTOZA INJ 18MG/3ML $28,521.45

ADVAIR DISKU AER 250/50 $21,992.39Fluticasone-Salmeterol Aer Powder BA 250-50 CG/ OS

Insulin Detemir Soln Pen-injector 100 Unit/ML

Palbociclib Cap 100 MG

Insulin Aspart Soln Pen-injector 100 Unit/ML

Etanercept Subcutaneous Solution Auto-injector 50 G/Ustekinumab Soln Prefilled Syringe 45 MG/0.5ML

Liraglutide Soln Pen-injector 18 MG/3ML (6 MG/ML)

TakeCare Insurance CompanyGOVERNMENT OF GUAM - Top 10 Drug UtilizationStart Date: 10/1/2017 ; End Date: 7/31/2018Print Date/Time:8/8/2018 1:30 PM

Generic Name

Etanercept Subcutaneous Soln Prefilled Syringe 50 G/Sitagliptin Phosphate Tab 100 MG (Base Equiv)

Insulin Glargine Soln Pen-Injector 100 Unit/ML

26%

21%

10%8%

7%

7%

6%

6%5% 4%

Top 10 Drug Utilization

ENBREL INJ 50MG/ML

JANUVIA TAB 100MG

LANTUS INJ SOLOSTAR

LEVEMIR INJ FLEXTOUC

IBRANCE CAP 100MG

NOVOLOG INJ FLEXPEN

ENBREL SRCLK INJ 50MG/ML

STELARA INJ 45MG/0.5

VICTOZA INJ 18MG/3ML

ADVAIR DISKU AER 250/50



Secondary Diagnosis Total Claims

I5023 - Acute on chronic systolic (congestive) heart failure $225,789.68

I2582 - Chronic total occlusion of coronary artery $39,772.99

- Not Assigned $30,030.91

Secondary Diagnosis Total Claims

Z992 - Dependence on renal dialysis $219,937.82


C61 - Malignant neoplasm of prostate $104,476.91

M726 - Necrotizing fasciitis $71,266.30




R6521 - Severe sepsis with septic shock $52,791.48



C775 - Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes

$45,741.31

T7803XA - Anaphylactic reaction due to other fish, initial encounter

$42,592.55


N151 - Renal and perinephric abscess $38,987.09

78959 - Other ascites $32,192.36

I442 - Atrioventricular block, complete $29,405.40


I10 - Essential (primary) hypertension $27,190.42


Generic/Brand Name Total RX Amount

Etanercept Subcutaneous Soln Prefilled Syringe 50 MG/ML $139,515.20

Sitagliptin Phosphate Tab 100 MG (Base Equiv) $108,364.39

Insulin Glargine Soln Pen-Injector 100 Unit/ML $50,277.06

Palbociclib Cap 100 MG $38,444.28

Insulin Detemir Soln Pen-injector 100 Unit/ML $37,569.08

Insulin Aspart Soln Pen-injector 100 Unit/ML $34,543.91

Etanercept Subcutaneous Solution Auto-injector 50 MG/ML $31,734.31

Ustekinumab Soln Prefilled Syringe 45 MG/0.5ML $29,365.64

Liraglutide Soln Pen-injector 18 MG/3ML (6 MG/ML) $28,521.45VICTOZA INJ 18MG/3ML

LANTUS INJ SOLOSTAR

IBRANCE CAP 100MG

LEVEMIR INJ FLEXTOUC

NOVOLOG INJ FLEXPEN

ENBREL SRCLK INJ 50MG/ML

STELARA INJ 45MG/0.5

C541 - Malignant neoplasm of endometrium - ST. LUKE'S MEDICAL CENTER

PPO

Label Name

ENBREL INJ 50MG/ML

JANUVIA TAB 100MG

I2510 - Atherosclerotic heart disease of native coronary artery 1366519027 - GUAM MEMORIAL HOSPITAL

Z460 - Encounter for fitting and adjustment of spectacles and 1275911950 - HINES, MONICA K.

I6521 - Occlusion and stenosis of right carotid artery - UCLA MEDICAL CENTER

Z0000 - Encounter for general adult medical examination 1215930987 - DIAGNOSTIC LABORATORY SERVICES INC.

A419 - Sepsis, unspecified organism 1366519027 - GUAM MEMORIAL HOSPITAL

5724 - Hepatorenal Syndrome - THE QUEENS MEDICAL CENTER

C61 - Malignant neoplasm of prostate 1083946933 - ISLAND CANCER CENTER

C538 - Malignant neoplasm of overlapping sites of cervix uteri - UCLA MEDICAL CENTER

J869 - Pyothorax without fistula 1366519027 - GUAM MEMORIAL HOSPITAL

Y939 - Activity, unspecified - INTERNATIONAL SPORTS CENTER

A4102 - Sepsis due to Methicillin resistant Staphylococcus 1366519027 - GUAM MEMORIAL HOSPITAL

Z0000 - Encounter for general adult medical examination - WELLNESS INCENTIVES

T814XXA - Infection following a procedure, initial encounter 1366519027 - GUAM MEMORIAL HOSPITAL

N186 - End stage renal disease 1295910255 - U.S. RENAL CARE TAMUNING DIALYSIS

I2510 - Atherosclerotic heart disease of native coronary artery - ST. LUKE'S MEDICAL CENTER

N186 - End stage renal disease 1346436441 - U.S. RENAL CARE DEDEDO DIALYSIS

N186 - End stage renal disease 158849541 - U.S. RENAL CARE SINAJANA DIALYSIS

S22089A - Unspecified fracture of T11-T12 vertebra, initial - ST. LUKE'S MEDICAL CENTER

I25119 - Atherosclerotic heart disease of native coronary - THE QUEENS MEDICAL CENTER

I350 - Nonrheumatic aortic (valve) stenosis - ST. LUKE'S MEDICAL CENTER

PPO

Primary Diagnosis NPI + Service Provider

TakeCare Insurance CompanyLarge Claims Report (≥$25,000) - GOVERNMENT OF GUAMStart Date: 10/1/2017 ; End Date: 7/31/2018Print Date/Time:8/8/2018 1:30 PM

HSA

Primary Diagnosis NPI + Service Provider

I2510 - Atherosclerotic heart disease of native coronary artery without angina pectoris

1509959323 - GOOD SAMARITAN HOSPITAL

Page 23 of 29 TC Confidential Doc. No. 34GL-18-2220.*

Days % Cummulative Cum. %1 2.76% 350 2.76%2 1.21% 503 3.96%3 2.67% 842 6.63%4 5.27% 1511 11.90%5 6.51% 2337 18.41%6 2.78% 2690 21.19%7 13.45% 4398 34.64%8 2.64% 4733 37.28%9 2.22% 5015 39.50%

10 3.37% 5443 42.87%11 1.98% 5695 44.86%12 1.26% 5855 46.12%13 1.57% 6054 47.68%14 0.67% 6139 48.35%15 0.83% 6245 49.19%16 0.64% 6326 49.83%17 0.57% 6399 50.40%18 0.50% 6462 50.90%19 1.23% 6618 52.13%20 0.60% 6694 52.73%21 0.44% 6750 53.17%22 0.29% 6787 53.46%23 0.32% 6828 53.78%24 0.44% 6884 54.22%25 0.31% 6923 54.53%26 0.29% 6960 54.82%27 0.25% 6992 55.07%28 0.72% 7084 55.80%29 0.86% 7193 56.66%30 0.76% 7290 57.42%31 1.98% 7542 59.40%32 0.82% 7646 60.22%33 1.58% 7846 61.80%34 1.30% 8011 63.10%35 1.28% 8174 64.38%36 1.60% 8377 65.98%37 0.89% 8490 66.87%38 1.12% 8632 67.99%39 1.55% 8829 69.54%40 1.03% 8960 70.57%41 1.38% 9135 71.95%42 1.35% 9307 73.31%43 0.72% 9399 74.03%44 1.65% 9608 75.68%45 0.95% 9729 76.63% 45 days ~ 76.63%46 0.98% 9853 77.61%47 1.04% 9985 78.65%

124132

13117517292

209121

165163203113142197

9210997

252104200

374156393732

817363

1567656

42825216019985

106

669826353

1708335282

TakeCare Insurance CompanyClaims TAT for GOVGUAM3Parameters: Start Date: 10/1/2017, End Date: 7/31/2018Print Date/Time:8/8/2018 1:29 PM

Claim Count350153339




48 0.19% 10009 78.84%49 0.52% 10075 79.36%50 0.75% 10170 80.10%51 0.63% 10250 80.73%52 0.61% 10328 81.35%53 0.30% 10366 81.65%54 0.10% 10379 81.75%55 0.42% 10432 82.17%56 0.27% 10466 82.44%57 0.36% 10512 82.80%58 0.25% 10544 83.05%59 0.18% 10567 83.23%60 0.50% 10630 83.73%61 0.46% 10688 84.18%62 0.28% 10724 84.47%63 0.24% 10754 84.70%64 0.26% 10787 84.96%65 0.50% 10851 85.47%66 0.14% 10869 85.61%67 0.14% 10887 85.75%68 0.12% 10902 85.87%69 0.78% 11001 86.65%70 0.36% 11047 87.01%71 0.44% 11103 87.45%72 0.39% 11153 87.85%73 0.20% 11179 88.05%74 0.41% 11231 88.46%75 0.44% 11287 88.90%76 0.43% 11341 89.33%77 0.08% 11351 89.41%78 0.09% 11363 89.50%79 0.20% 11388 89.70%80 0.43% 11443 90.13%81 0.41% 11495 90.54%82 0.24% 11525 90.78%83 0.13% 11541 90.90%84 0.17% 11563 91.08%85 0.28% 11598 91.35%86 0.35% 11643 91.71%87 0.13% 11660 91.84%88 0.61% 11738 92.45%89 0.13% 11754 92.58%90 0.66% 11838 93.24%91 0.63% 11918 93.87%92 0.24% 11948 94.11%93 0.42% 12001 94.53%94 0.11% 12015 94.64%95 0.20% 12040 94.83%

1425

781684803053

301622354517

541012255552

465650265256

336418181599

322363583630

783813533446

24669580




96 0.03% 12044 94.86%97 0.03% 12048 94.90%98 0.08% 12058 94.97%99 0.15% 12077 95.12% 99 days ~ 95.12%100 0.09% 12089 95.22%101 0.20% 12114 95.42%102 0.14% 12132 95.56%103 0.20% 12157 95.75%104 0.23% 12186 95.98%105 0.29% 12223 96.27%106 0.21% 12250 96.49%107 0.06% 12257 96.54%108 0.36% 12303 96.90%109 0.23% 12332 97.13%110 0.08% 12342 97.21%111 0.12% 12357 97.33%112 0.06% 12364 97.39%113 0.17% 12386 97.56%114 0.28% 12421 97.83%115 0.03% 12425 97.87%116 0.06% 12432 97.92%117 0.14% 12450 98.06%118 0.02% 12453 98.09%119 0.03% 12457 98.12%120 0.06% 12464 98.17%121 0.05% 12470 98.22%122 0.17% 12491 98.39%123 0.17% 12513 98.56%124 0.09% 12524 98.65%125 0.15% 12543 98.79%132 0.01% 12544 98.80%134 0.01% 12545 98.81%140 0.01% 12546 98.82%142 0.09% 12557 98.91%143 0.01% 12558 98.91%147 0.06% 12565 98.97%148 0.06% 12572 99.02%152 0.02% 12575 99.05%153 0.02% 12577 99.06%154 0.02% 12580 99.09%156 0.03% 12584 99.12%157 0.01% 12585 99.13%159 0.17% 12607 99.30%160 0.13% 12624 99.43%163 0.13% 12641 99.57%165 0.01% 12642 99.57%166 0.01% 12643 99.58%167 0.08% 12653 99.66%

110

41

2217171

177323

1119111

11

3476

2122

7223547

18

277

46291015

122518252937

44

1019




168 0.12% 12668 99.78%170 0.04% 12673 99.82%173 0.01% 12674 99.83%174 0.01% 12675 99.83%175 0.01% 12676 99.84%177 0.02% 12678 99.86%179 0.09% 12689 99.94%180 0.06% 12696 100.00%

Totals:

12

117

12696

15511



Subgroup ID Oct-17 Nov-17 Dec -17 Jan -18 Feb -18 Mar - 18 Apr - 18 May -18 June-18 July- 18 TotalDOA1 334,480.81$ 272,424.56$ 272,542.53$ 271,894.07$ 272,642.51$ 419,797.67$ 281,998.56$ 282,517.99$ 282,667.77$ 283,973.54 $ 2,974,940.01 DOE1 198,898.43$ 228,937.30$ 227,307.54$ 215,400.51$ 225,617.74$ 338,554.86$ 232,107.51$ 115,450.23$ 339,840.63$ 198,467.32 $ 2,320,582.07 GAA1 10,660.68$ 12,495.00$ 12,495.00$ 18,877.68$ 12,765.36$ 11,142.74$ 13,576.67$ 12,765.36$ 19,148.04$ 12,765.36 $ 136,691.89 GCC1 16,316.74$ 19,024.32$ 18,959.67$ 18,895.02$ 18,895.02$ 28,342.53$ 18,895.02$ 18,895.02$ 18,895.02$ 18,895.02 $ 196,013.38 GHC1 2,310.45$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 3,475.65 $ 24,322.90 GHU1 4,444.66$ 4,373.22$ 6,559.83$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22 $ 45,990.25 GMH1 60,781.82$ 71,802.34$ -$ -$ - $109,506.04 148,844.29$ 145,674.27$ 70,585.52$ - $ 607,194.28 GPA1 48,230.13$ 49,835.56$ 71,874.11$ 23,548.33$ 47,262.32$ 57,513.52$ 46,064.94$ 45,437.03$ 71,706.46$ 46,197.95 $ 507,670.35 GVB1 3,871.95$ 2,405.70$ 2,405.70$ 2,405.70$ 2,405.70$ 2,405.70$ 3,608.55$ 2,405.70$ 2,405.70$ 2,405.70 $ 26,726.10 GWA1 25,425.60$ 37,342.62$ 31,334.26$ 30,657.44$ 31,898.02$ 35,311.78$ 33,625.74$ 34,079.64$ 51,202.99$ 40,347.72 $ 351,225.81 LEG1 9,841.73$ 9,242.34$ 9,242.34$ 9,182.11$ 4,693.91$ 14,081.73$ 9,387.82$ 9,008.44$ 8,615.52$ 12,874.62 $ 96,170.56 PAG1 36,455.63$ 47,292.14$ 47,292.14$ 71,587.95$ 47,941.88$ 48,254.81$ 48,132.18$ 48,327.28$ 49,641.22$ 75,154.99 $ 520,080.22 PUB1 4,571.46$ 5,838.90$ 8,067.23$ 3,932.00$ 5,567.91$ 5,331.38$ 5,331.38$ 5,633.56$ 604.36$ 2,109.23 $ 46,987.41 RAC1 5,570.58$ 9,324.48$ 3,108.16$ 9,324.48$ 6,216.32$ 6,404.54$ 6,216.32$ 6,216.32$ 9,324.48$ 5,945.96 $ 67,651.64 RET1 324,382.04$ 43,285.73$ 86,821.56$ 501,272.44$ 386,022.99$ 925,003.54$ 182,549.94$ 207,282.03$ 181,585.45$ 468,567.78 $ 3,306,773.50 UOG1 31,957.33$ 35,519.44$ 35,588.96$ 51,297.36$ 37,640.79$ 38,242.64$ 38,126.10$ 37,491.48$ 33,154.45$ 48,283.11 $ 387,301.66

$1,118,200.04 $ 851,460.75 $ 835,916.13 $1,234,965.41 $1,106,260.79 $2,046,583.80 $1,075,155.34 $ 977,874.67 $1,146,067.93 $1,223,837.17 $ 11,616,322.03

TakeCare Insurance CompanyTotal Monthly Premiums Paid - GOVERNMENT OF GUAMStart Date: 10/1/2017 ; End Date: 07/31/2018Print Date/Time:08/08/2018 10:00 AM

Subgroup NameGOVGUAM - DEPT. OF GOVGUAM - DEPT. OF GOVGUAM - GUAM INT'L GOVGUAM - GUAM GOVGUAM - GUAM HOUSING GOVGUAM - GUAM HOUSING & GOVGUAM - GUAM MEMORIAL GOVGUAM - GUAM POWER GOVGUAM - GUAM VISITORS

GOVGUAM - UNIVERSITY OF Total Premium Paid

GOVGUAM - GUAM GOVGUAM - GUAM GOVGUAM - PORT AUTHORITY GOVGUAM - PUBLIC GOVGUAM - RETIREMENT GOVGUAM - RETIREES

Doc. No. 34GL-18-2220.*

Group ID 17-Oct 17-Nov 17-Dec 18-Jan 18-Feb 18-Mar 18-Apr 18-May 18-Jun 18-Jul Total

GOVGUAM3 $ 16,300.00 $ 50.00 $ 1,025.00 $ 11,925.00 $ 400.00 $ 26,965.00 $ 2,850.00 $ 9,505.00 $ - $ 2,350.00 $ 71,370.00

$ 16,300.00 $ 50.00 $ 1,025.00 $ 11,925.00 $ 400.00 $ 26,965.00 $ 2,850.00 $ 9,505.00 $ - $ 2,350.00 $ 71,370.00

TakeCare Insurance CompanyGym Membership Expenses - GOVERNMENT OF GUAMStart Date: 10/1/2017 ; End Date: 07/31/2018Print Date/Time:08/08/2018 9:00 AM

Group Name

Government Of Guam

Total Premium Paid

Doc. No. 34GL-18-2220.*

doc. no. 34gl-18-2220. - legislature of guam. no. 34gl-18-2220.pdf · doc. no. 34gl-18-2220. -...

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