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CITY OF SUNNY ISLES BEACH <br /> Executive Summary <br /> Current Year Analysis <br /> Medical Plan <br /> As of December,2014,the enrollment totaled 173 employees of which 24 were enrolled in the Lower HMO Plan <br /> Options. Administrative, Medical and Pharmacy Claims totaled$116,488 in December, 2014 which is 86%of the <br /> CIGNA Expected Claims Liability of$134,750. <br /> YTD for the Current Plan Year,the Administrative, Medical and Pharmacy Claims totaled $1,545,701 through <br /> December,2014 which is 115%of the CIGNA Expected Claims Liability of$1,277,183. If claims as costs remain <br /> on budget for the remaining 2 months of the Plan Year,we project the total Administrative, Medical and <br /> Pharmacy Claims to total$1,815,201 which will 112%of the CIGNA Expected Claims Liability of$1,452,699 or a <br /> deficit claims funding of$64,836. <br /> Under the Level Funded Contract, CIGNA would provide a premium credit for the 2015-16 Plan Year of 50%, <br /> after calculation of terminal liability,of any surplus in claims funding for the 2014-15 Plan Year. With paid claims <br /> exceeding claims funding amounts,there will be no premium credit extended by CIGNA under the Level Funded <br /> Contract for the 2014-15 Plan Year. <br /> Medical Plan Utilization Summary <br /> During March—November, 2014,the average enrollment was 167 Employees and 154 Dependents for a total <br /> average Membership of 321. During the same period, 279 members had Medical claims, 269 of which claims <br /> totaled under$10,000. Of the claims paid during this period, 77.5%of claims were paid to CIGNA In-Network <br /> Providers which is below the CIGNA Norm of 88.4%. Medical claims totaled$655,480 during this period,of <br /> which 42 Emergency Room visits contributed to$69,189 or 10.6%of total medical claims utilization. <br /> Pharmacy Plan Utilization Summary <br /> During March—November,2013, 1,578 Pharmacy Scripts were filled totaling$178,125 in paid claims. Of the <br /> total scripts,96.1%were filled at a Retail Pharmacy with the remaining claims being filled through CIGNA's Mail <br /> Order Program. Total claims paid at Retail Pharmacies totaled$85,626 and Mail Order totaled$92,499.40. <br /> Dental Plan <br /> As of November, 2013,the total enrollment in the DPPO is 123. During the period of March—November, 2013, <br /> total premium paid was$71,969.86 and total claims paid was$70,288.60 or a Loss Ratio of 97.7%. <br /> 1iPage <br /> 11 rr lti f•FtT <br /> Y4tRitAkf♦ <br />