| 
								    Renewal Expectation 
<br />10 
<br />Orange County Government 
<br />Subscribers 
<br />Total 
<br />Claims 
<br />Stop Loss 
<br />Credits 
<br />Net 
<br />Claims 
<br />HSA 
<br />August -13 
<br />1,012 
<br />$609,311.64 
<br />$0 
<br />$609,311.64 
<br />$21,341.70 
<br />September -13 
<br />1,006 
<br />$494,158.67 
<br />$0 
<br />$494,158.67 
<br />$21,341.70 
<br />October -13 
<br />1,013 
<br />$636,751.28 
<br />$0 
<br />$636,751.28 
<br />$21,754.10 
<br />November -13 
<br />1,016 
<br />$946,271.22 
<br />$0 
<br />$946,271.22 
<br />$21,857.20 
<br />December -13 
<br />1,015 
<br />$631,855.00 
<br />$0 
<br />$631,855.00 
<br />$21,857.20 
<br />January -14 
<br />979 
<br />$614,054.44 
<br />$0 
<br />$614,054.44 
<br />$23,718.00 
<br />February -14 
<br />980 
<br />$685,672.00 
<br />$0 
<br />$685,672.00 
<br />$24,072.00 
<br />March -14 
<br />974 
<br />$995,490.59 
<br />$134,831 
<br />$860,659.59 
<br />$23,364.00 
<br />April -14 
<br />985 
<br />$607,744.02 
<br />$125,351 
<br />$482,393.02 
<br />$24,544.00 
<br />May -14 
<br />985 
<br />$635,821.26 
<br />$13,128 
<br />$622,693.26 
<br />$24,308.00 
<br />June -14 
<br />984 
<br />$651,854.42 
<br />$44,024 
<br />$607,830.42 
<br />$24,072.00 
<br />July -14 
<br />981 
<br />$908,800.00 
<br />$10,944 
<br />$897,856.00 
<br />$24,190.00 
<br />Total 
<br />11,930 
<br />$8,417,784.53 
<br />$328,278.00 
<br />$8,089,506.53 
<br />$252,229.90 
<br />Self- funded Calculation 
<br />Of the 13% increase, 
<br />Care Reform 
<br />5 %. 
<br />Health 
<br />is responsible for 
<br />Current PPO Plan Design 
<br />2015 Renewal 
<br />Claims - Without Benefit Change 
<br />$8,089,507 
<br />Trend 2015 -8% 
<br />111.30% 
<br />Trended 2015 Claims 
<br />$9,003,621 
<br />Administration 
<br />$495,095 
<br />Stop Loss Insurance 
<br />$1,276,868 
<br />PPACA - Fee for Comparative Effectiveness Research Agency 
<br />$3,188.00 
<br />PPACA - Transitional Reinsurance Fee - 2014 - 2016 
<br />$72,621.96 
<br />Copays Accumulate to Out of Pocket Maximum - 5% 
<br />$450,181.04 
<br />HSA Cost - $1,416 
<br />$288,864.00 
<br />Clinic Costs 
<br />$0.00 
<br />2015 Cost 
<br />$11,590,439 
<br />Current Contribution 
<br />$9,938,644 
<br />HSA Contribution Budget - $1,416 
<br />$288,864 
<br />Total Contribution for 2014 
<br />$10,227,508 
<br />Percentage Change over 2014 
<br />113.33% 
<br />U., 
<br />
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