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WIM Ka <br />HSA Plan <br />Date <br />Subscribers <br />Members <br />Premium <br />Medical <br />Pharmacy <br />Capitation <br />Combined <br />Medical Claims <br />Claims Per <br />Active /Retiree <br />Per Month <br />Loss Ratio <br />January -13 <br />212 <br />390 <br />$162,620 <br />$50,872 <br />$2,083 <br />$4,361 <br />$57,315.90 <br />$270.36 <br />35.25% <br />Total <br />212 <br />390 <br />$162,620.27 <br />$50,871.77 <br />$2,083.01 <br />$4,361.12 <br />$57,315.90 <br />$270.36 <br />35.25% <br />PPO Plan <br />Date <br />Subscribers <br />Members <br />Premium <br />Medical <br />Pharmacy <br />Capitation <br />Combined <br />Medical Claims <br />Claims Per <br />Active /Retiree <br />Per Month <br />Loss Ratio <br />January -13 <br />793 <br />1,270 <br />$658,203 <br />$413,768 <br />$128,819 <br />$14,151 <br />$556,738.54 <br />$702.07 <br />84.58% <br />Total <br />793 <br />1,270 <br />$658,202.86 <br />$413,768.21 <br />1 $128,819.17 <br />$14,151.16 <br />$556,738.54 <br />$702.07 <br />84.58% <br />Combined Plans <br />Date <br />Subscribers <br />Members <br />Premium <br />Medical <br />Pharmacy <br />Capitation <br />Combined <br />Medical Claims <br />Claims Per <br />Active /Retiree <br />Per Month <br />Loss Ratio <br />January -13 <br />1,005 <br />1,660 <br />$820,823.13 <br />$464,639.98 <br />$130,902.18 <br />$18,512.28 <br />$614,054.44 <br />$611.00 <br />74.81% <br />Total <br />1,005 <br />1,660 <br />$820,823.13 <br />$464,639.98 <br />$130,902.18 <br />$18,512.28 <br />$614,054.44 <br />$611.00 <br />74.81% <br />on <br />