Higginbotham Sample Self-Funded Client Reporting

ABC Sample Group Financial Reporting

January 01, 2023 Through August 31, 2023

ABC Sample Group 2023 Executive Summary - Medical/Rx Budgeted vs. Total Plan Cost

Employee/Employer Cost

Plan Cost Distribution

78.6% $16,075,408 $825,285, 7%

$14,150,087

$11,120,390

$1,092,242, 10% $8,188,520, 69%

$8,281,962, 74% $1,746,186, 16%

Budgeted Cost

Total Cost

Maximum Cost

$2,931,870, 24%

Employer Cost

Medical Claims Rx Claims Fixed Cost (Reimbursements Removed From Medical Claims)

HSA Contributions

Employee Cost

Large Claims Over $100,000 Medical Claims •

16 - 31.3% Of Total Claims

Scout Energy's year-to-date medical claims are $8,779,876 through August. Your 2023 medical cost is $897.65 on a PEPM basis. That is 7.7% lower than your $972.22 PEPM cost in 2022.

$2,588,109

Scout Energy's year-to-date pharmacy claims are $2,044,306 through August. Your 2023 pharmacy cost is $209.01 on a PEPM basis. That is 11.5% higher than your $187.48 PEPM cost in 2022.

80% 70% 60%

Large Claimants •

$497,915

90%

Pharmacy Claims •

100%

There are 6 claimant(s) exceeding the $200,000 individual stop loss level. The estimated reimbursements are $497,915 for these 6 claimant(s) year-to-date.

50% 40%

$7,738,159

Net Medical/Rx Claims •

30%

Scout Energy's year-to-date net medical/Rx claims are $9,374,204 through August. Your 2023 medical/Rx cost is $958.41 on a PEPM basis. That is 3.8% lower than your $996.19 PEPM cost in 2022.

20% 10%

Budgeted vs. Total Plan Cost •

Scout Energy's budgeted (expected) rates are $1,446.69 year-to-date PEPM while your total plan cost is currently at $1,136.94 PEPM. You are currently running 21.4% under budget.

Note: Budgeted Plan Cost = Premium Equivalent Rates

1

0%

All Other Claims

Claimants over $100K

Reimbursements

ABC Sample Group 2023 Pharmacy Summary

% Of Cost By Pharmacy Tier

Utilization By Pharmacy Tier

Average Cost Per Script $11.49

89.2%

Generic $13.16

10.9%

2023

Generic

88.1% 12.4%

38.1% 39.1% $487.45

9.9%

Brand

2022

Brand $412.31

11.0% 48.5% 51.0% $3,723.93

Specialty

1.0%

Specialty $3,806.26

2023

1.0%

2022

2023

2022

Generic

Brand

Specialty

PEPM Pharmacy Trend

Top 5 Drugs By Cost/Script

$35,148 $209.01 $193.60

$187.48

2021

2022

$170.65 $22,820

$147.41 $16,738

$15,701

$5,762 Ocrevus Inj 300/10Ml

Stelara Inj 90Mg/Ml Skyrizi Inj 150Mg/Ml

Skyrizi Pen Inj 150Mg/Ml

Enbrel Srclk Inj 50Mg/Ml

2019

2

2020

2023

ABC Sample Group Medical/Rx Plan History

$16,000 $13,930

$13,643

$14,000 $12,162

$12,000

$11,105

$10,933

$10,000

$8,455

$9,194

$8,384

$10,721

$11,352

$11,954

$11,059

$11,501

$9,595

$8,543

$8,000 $6,000 $4,000

$2,479

$1,911

$2,142

$1,976

$1,440

$2,000 $0

2019 PEPY

2020 PEPY

Fixed Cost

Average Average Member Employees Members Ratio

Time Period

Carrier

2019 Plan Year 2020 Plan Year 2021 Plan Year 2022 Plan Year 2023 Plan YTD

BCBSTX / QBE BCBSTX / QBE BCBSTX / QBE BCBSTX / QBE BCBSTX / QBE

Time Period (PEPY)

Employee % Fixed Cost Change

2019 PEPY 2020 PEPY 2021 PEPY 2022 PEPY 2023 PEPY

2021 PEPY

Net Paid Claims

872 1,021 1,058 1,149 1,223

17.1% 3.7% 8.6% 6.4%

$2,479 $1,911 $1,440 $1,976 $2,142

2020-2023 Year-to-Date CAGR:

2.9%

1,655 2,095 2,201 2,496 2,729

1.9 2.1 2.1 2.2 2.2

Total Plan Cost

Fixed Costs

Expected Claims

Net Paid Claims

$2,160,863 $8,494,904 $7,370,920 $1,950,398 $11,123,494 $9,382,435 $1,524,342 $11,093,379 $11,345,677 $2,270,155 $13,635,273 $13,736,412 $1,746,186 $11,463,378 $9,374,204

% Expected % Change Change Claims

Net Paid Claims

$9,744 $10,900 $10,483 $11,866 $14,064

$8,455 $9,194 $10,721 $11,954 $11,501

-22.9% -24.6% 37.2% 8.4%

2022 PEPY

11.9% -3.8% 13.2% 18.5%

6.6%

5.8%

Notes: PEPY = Per Employee Per Year Current year PEPY is annualized based on data year to date CAGR = Compounded Annual Growth Rate

3

2023 PEPY

Net Employer Cost

% Change 8.7% 16.6% 11.5% -3.8%

% of Total Plan Employee Net Employer Expected Cost Contributions Cost 87% 84% 102% 101% 82%

$9,531,783 $11,332,833 $12,870,019 $16,006,567 $11,120,390

$2,914,625 $3,503,390 $3,686,105 $4,098,365 $2,931,870

Total Plan Net Employer % Change Cost Cost $10,933 $11,105 $12,162 $13,930 $13,643 5.3%

1.6% 9.5% 14.5% -2.1%

$8,384 $8,543 $9,595 $11,352 $11,059 6.7%

$7,309,298 $8,717,678 $10,153,494 $13,043,887 $9,013,805

% Change 1.9% 12.3% 18.3% -2.6%

ABC Sample Group Claims Experience - PEPM

Net Paid Claims vs. Expected Paid Claims $1,600.00 $1,400.00 $1,200.00 $1,000.00

$800.00 $600.00 $400.00 $200.00 $0.00

Net Claims PEPM

Expected Claims PEPM

Monthly Membership 3000 2500 2000 1500 1000 500 0

Employees

Members

4

Maximum Claims PEPM

ABC Sample Group 2023 Medical/Rx Experience - Aggregate Enrollment1 A

B

Fixed Cost C

D

Stop Loss Admin Fees Premium

Paid Claims / Claims Liability E = (C + D) Total Fixed Cost

F

G

H = (F + G)

Medical

Rx

Total Claims2

I

Total Plan Cost J = (H - I)

ISL Reimb3 Net Claims

Employer Cost

K

L

Expected Plan Cost

Maximum Plan Cost

M = (E + J)

Total Plan Employee Net Employer Cost Contributions Cost

N

O = (M - N)

Month

Employees

Members

Jan-23

1,204

2,690

$103,068

$112,326

$215,393

$788,234

$193,368

$981,602

$0

$981,602

$1,629,139

$1,982,575

$1,196,995

$362,265

$937,785

Feb-23

1,211

2,709

$103,571

$113,035

$216,606

$947,330

$178,233

$831,393

$0

$831,393

$1,639,335

$1,995,017

$1,047,998

$364,760

$787,043

Mar-23

1,217

2,713

$104,002

$113,349

$217,351

$1,215,084

$230,804

$1,445,888

$28,996

$1,416,893

$1,643,771

$2,000,375

$1,634,244

$365,310

$1,372,329

Apr-23

1,228

2,740

$104,793

$114,277

$219,070

$996,053

$207,457

$898,289

$50,934

$847,355

$1,657,058

$2,016,554

$1,066,425

$367,295

$802,005

May-23

1,232

2,759

$105,081

$114,964

$220,045

$1,098,485

$245,977

$1,344,462

$39,176

$1,305,286

$1,667,021

$2,028,766

$1,525,330

$369,340

$1,259,275

Jun-23

1,229

2,748

$104,865

$114,527

$219,392

$1,260,533

$357,429

$1,265,288

$38,577

$1,226,711

$1,660,693

$2,021,019

$1,446,103

$368,330

$1,180,868

Jul-23

1,231

2,735

$105,009

$114,219

$219,228

$1,157,904

$306,850

$1,464,754

$142,791

$1,321,963

$1,656,120

$2,015,343

$1,541,191

$367,085

$1,277,116

Aug-23

1,229

2,738

$104,865

$114,236

$219,101

$1,316,253

$324,188

$1,640,442

$197,441

$1,443,001

$1,656,428

$2,015,760

$1,662,102

$367,485

$1,397,382

Total

9,781

21,832

$835,254

$910,932

$1,746,186

$8,779,876

$2,044,306

$9,872,118

$497,915

$9,374,204 $13,209,564 $16,075,408 $11,120,390

$2,931,870

$9,013,805

Average

1,223

2,729

$104,407

$113,867

$218,273

$1,097,485

$255,538

$1,234,015

$62,239

$1,171,775

$1,651,196

$2,009,426

$1,390,049

$366,484

$1,126,726

$85.40

$93.13

$178.53

$897.65

$209.01

$1,009.32

$50.91

$958.41

$1,350.53

$1,643.53

$1,136.94

$299.75

$921.56

8.4%

-7.7%

11.5%

-10.3%

-60.5%

-3.8%

17.1%

17.3%

-2.1%

0.9%

-2.6%

Sep-23 Oct-23 Nov-23

2023

Dec-23

2022

PEPM % Change

6.4%

9.3%

0.2%

17.3%

Total

13,789

29,948

$1,175,089

$1,095,066

$2,270,155 $13,405,900 $2,585,122 $15,512,502 $1,776,090 $13,736,412 $15,905,427 $19,314,245 $16,006,567

$4,098,365

$13,043,887

Average

1,149

2,496

$97,924

$91,256

$189,180

$1,117,158

$215,427

$1,292,708

$148,007

$1,144,701

$1,325,452

$1,609,520

$1,333,881

$341,530

$1,086,991

$85.22

$79.42

$164.64

$972.22

$187.48

$1,124.99

$128.80

$996.19

$1,153.49

$1,400.70

$1,160.82

$297.22

$945.96

138.6%

-5.8%

37.2%

35.1%

-3.2%

23.2%

551.1%

11.5%

16.1%

15.6%

14.5%

2.4%

18.3%

PEPM % Change

8.6%

13.4%

1

Enrollment may change based on retro active adjustments 2 Includes runout from BCBS and Rx Rebates from CVS caremark 3

Stop loss reimbursements will differ from actual reimbursements from the carrier due to reporting differences

Self Funded Factors

PEPM

Medical/Rx Admin Fee Medical/Rx ISL Premium Medical/Rx ASL Premium Expected Claims Maximum Claims

$85.40 $85.71 $7.42 $1,172.00 $1,465.01

Stop Loss Factors ISL Level ASL Corridor Contract

$200,000 125% 72/12

Claims Position

%

Position to Expected Position to Maximum

81.8% 65.4%

Total vs. Budgeted Cost Total Plan Cost Budgeted Plan Cost Note: Budgeted Plan Cost = Equivalent Rates

5

78.6% $11,120,390 $14,150,087

ABC Sample Group 2023 Medical/Rx Experience - Plan 1 Enrollment1 A

B

Fixed Cost C

D

Stop Loss Admin Fees Premium

Paid Claims / Claims Liability E = (C + D) Total Fixed Cost

F

G

H = (F + G)

Medical

Rx

Total Claims2

I

Total Plan Cost J = (H - I)

ISL Reimb3 Net Claims

Employer Cost

K

L

Expected Plan Cost

Maximum Plan Cost

M = (E + J)

Total Plan Employee Net Employer Cost Contributions Cost

N

O = (M - N)

Month

Employees

Members

Jan-23

644

1,047

$55,129

$52,607

$107,737

$399,241

$113,357

$512,597

$0

$512,597

$761,730

$925,228

$620,334

$173,150

$447,184

Feb-23

647

1,055

$55,335

$53,009

$108,344

$441,615

$121,529

$405,978

$0

$405,978

$767,530

$932,326

$514,322

$174,575

$339,747

Mar-23

650

1,058

$55,548

$53,138

$108,686

$309,526

$127,963

$437,489

$0

$437,489

$769,330

$934,491

$546,175

$174,975

$371,200

Apr-23

655

1,077

$55,895

$53,605

$109,501

$319,092

$115,108

$271,399

$0

$271,399

$776,023

$942,654

$380,900

$176,580

$204,320

May-23

657

1,086

$56,037

$53,943

$109,980

$547,329

$142,489

$689,818

$0

$689,818

$780,917

$948,652

$799,798

$177,825

$621,973

Jun-23

656

1,086

$55,974

$53,900

$109,874

$639,591

$209,875

$661,220

$0

$661,220

$780,328

$947,941

$771,094

$177,665

$593,429

Jul-23

655

1,080

$55,874

$53,673

$109,547

$495,526

$147,380

$642,907

$0

$642,907

$776,997

$943,860

$752,454

$176,765

$575,689

Aug-23

656

1,089

$55,974

$53,968

$109,942

$537,484

$205,093

$742,578

$19,319

$723,259

$781,323

$949,169

$833,200

$177,850

$655,350

Total

5,220

8,578

$445,765

$427,845

$873,610

$3,689,404

$1,182,794

$4,363,986

$19,319

$4,344,667

$6,194,179

$7,524,321

$5,218,277

$1,409,385

$3,808,892

Average

653

1,072

$55,721

$53,481

$109,201

$461,175

$147,849

$545,498

$2,415

$543,083

$774,272

$940,540

$652,285

$176,173

$476,111

$85.40

$81.96

$167.36

$706.78

$226.59

$836.01

$3.70

$832.31

$1,186.62

$1,441.44

$999.67

$270.00

$729.67

Sep-23 Oct-23 Nov-23

2023

Dec-23

2022

PEPM % Change

4.4%

10.4%

0.2%

18.1%

8.3%

-24.8%

32.2%

-22.4%

-97.7%

-9.2%

18.0%

18.3%

-6.7%

2.1%

-9.5%

Total

7,499

11,652

$639,076

$520,248

$1,159,324

$7,050,058

$1,285,657

$8,076,513

$1,204,599

$6,871,914

$7,542,639

$9,138,467

$8,031,238

$1,983,140

$6,048,098

Average

625

971

$53,256

$43,354

$96,610

$587,505

$107,138

$673,043

$100,383

$572,660

$628,553

$761,539

$669,270

$165,262

$504,008

$85.22

$69.38

$154.60

$940.13

$171.44

$1,077.01

$160.63

$916.38

$1,005.82

$1,218.62

$1,070.97

$264.45

$806.52

138.6%

-5.9%

41.3%

34.2%

-14.1%

19.7%

519.5%

4.9%

16.4%

15.8%

8.9%

1.6%

11.5%

PEPM % Change

5.7%

12.8%

1

Enrollment may change based on retro active adjustments 2 Includes runout from BCBS and Rx Rebates from CVS caremark 3

Stop loss reimbursements will differ from actual reimbursements from the carrier due to reporting differences

Self Funded Factors

PEPM

Medical/Rx Admin Fee Medical/Rx ISL Premium Medical/Rx ASL Premium Expected Claims Maximum Claims

$85.40 $74.54 $7.42 $1,019.27 $1,274.08

Stop Loss Factors ISL Level ASL Corridor Contract

Total vs. Budgeted Cost $200,000 125% 72/12

Total Plan Cost Budgeted Plan Cost Note: Budgeted Plan Cost = Equivalent Rates

6

79.9% $5,218,277 $6,531,635

ABC Sample Group 2023 Medical/Rx Experience - Plan 2 Enrollment1 A

B

Fixed Cost C

D

Stop Loss Admin Fees Premium

Paid Claims / Claims Liability E = (C + D) Total Fixed Cost

F

G

H = (F + G)

Medical

Rx

Total Claims2

I

Total Plan Cost J = (H - I)

ISL Reimb3 Net Claims

Employer Cost

K

L

Expected Plan Cost

Maximum Plan Cost

M = (E + J)

Total Plan Employee Net Employer Cost Contributions Cost

N

O = (M - N)

Month

Employees

Members

Jan-23

68

179

$5,821

$6,755

$12,576

$65,210

$3,928

$69,138

$0

$69,138

$98,039

$119,405

$81,714

$13,210

$68,504

Feb-23

68

176

$5,816

$6,663

$12,478

$46,453

$4,667

$34,602

$0

$34,602

$96,681

$117,732

$47,080

$13,030

$34,050

Mar-23

72

184

$6,153

$7,040

$13,193

$41,487

$3,441

$44,928

$0

$44,928

$102,154

$124,394

$58,121

$13,830

$44,291

Apr-23

79

199

$6,742

$7,728

$14,470

$14,403

$4,539

-$693

$0

-$693

$112,124

$136,538

$13,776

$15,130

-$1,354

May-23

80

204

$6,823

$7,874

$14,697

$26,364

$4,102

$30,466

$0

$30,466

$114,245

$139,132

$45,163

$15,400

$29,763

Jun-23

79

194

$6,741

$7,579

$14,320

$19,453

$3,260

$43

$0

$43

$109,936

$133,840

$14,363

$14,900

-$537

Jul-23

77

189

$6,568

$7,436

$14,005

$17,961

$5,363

$23,324

$0

$23,324

$107,873

$131,340

$37,329

$14,590

$22,739

Aug-23

76

186

$6,485

$7,290

$13,775

$38,972

$6,953

$45,926

$0

$45,926

$105,750

$128,743

$59,701

$14,320

$45,381

Total

599

1,511

$51,149

$58,365

$109,514

$270,302

$36,254

$247,733

$0

$247,733

$846,802

$1,031,124

$357,246

$114,410

$242,836

Average

75

189

$6,394

$7,296

$13,689

$33,788

$4,532

$30,967

$0

$30,967

$105,850

$128,891

$44,656

$14,301

$30,355

$85.39

$97.44

$182.83

$451.26

$60.52

$413.58

$0.00

$413.58

$1,413.69

$1,721.41

$596.40

$191.00

$405.40

Sep-23 Oct-23 Nov-23

2023

Dec-23

2022

PEPM % Change

4.8%

-1.7%

0.2%

11.2%

5.8%

-30.1%

-19.3%

-39.6%

-100.0%

-26.2%

10.9%

11.1%

-18.6%

-5.1%

-23.8%

Total

857

2,306

$73,035

$75,094

$148,129

$552,913

$64,270

$587,184

$107,159

$480,025

$1,092,008

$1,327,977

$628,154

$172,410

$455,744

Average

71

192

$6,086

$6,258

$12,344

$46,076

$5,356

$48,932

$8,930

$40,002

$91,001

$110,665

$52,346

$14,368

$37,979

$85.22

$87.62

$172.85

$645.17

$74.99

$685.16

$125.04

$560.12

$1,274.22

$1,549.56

$732.97

$201.18

$531.79

138.6%

-11.6%

28.2%

-10.4%

-20.8%

-15.9%

201.4%

-27.6%

8.5%

8.0%

-19.3%

-4.7%

-23.7%

PEPM % Change

0.2%

-5.4%

1

Enrollment may change based on retro active adjustments 2 Includes runout from BCBS and Rx Rebates from CVS caremark 3

Stop loss reimbursements will differ from actual reimbursements from the carrier due to reporting differences

Self Funded Factors

PEPM

Medical/Rx Admin Fee Medical/Rx ISL Premium Medical/Rx ASL Premium Expected Claims Maximum Claims

$85.39 $90.02 $7.42 $1,230.87 $1,538.58

Stop Loss Factors ISL Level ASL Corridor Contract

$200,000 125% 72/12

Total vs. Budgeted Cost

48.4%

Total Plan Cost Budgeted Plan Cost

$357,246 $737,466

Note: Budgeted Plan Cost = Equivalent Rates

7

ABC Sample Group 2023 Medical/Rx Experience - Plan 3 Enrollment1 A

B

Fixed Cost C

D

Stop Loss Admin Fees Premium

Paid Claims / Claims Liability E = (C + D) Total Fixed Cost

F

G

H = (F + G)

Medical

Rx

Total Claims2

I

Total Plan Cost J = (H - I)

ISL Reimb3 Net Claims

Employer Cost

K

L

Expected Plan Cost

Maximum Plan Cost

M = (E + J)

Total Plan Employee Net Employer Cost Contributions Cost

N

O = (M - N)

Month

Employees

Members

Jan-23

492

1,464

$42,117

$52,964

$95,081

$323,783

$76,083

$399,867

$0

$399,867

$769,369

$937,941

$494,948

$175,905

$422,098

Feb-23

496

1,478

$42,420

$53,363

$95,783

$459,262

$52,037

$390,813

$0

$390,813

$775,124

$944,959

$486,596

$177,155

$413,246

Mar-23

495

1,471

$42,302

$53,171

$95,472

$864,071

$99,400

$963,472

$28,996

$934,476

$772,287

$941,490

$1,029,948

$176,505

$956,838

Apr-23

494

1,464

$42,156

$52,944

$95,100

$662,558

$87,809

$627,583

$50,934

$576,649

$768,910

$937,363

$671,749

$175,585

$599,039

May-23

495

1,469

$42,220

$53,147

$95,367

$524,793

$99,385

$624,178

$39,176

$585,002

$771,859

$940,982

$680,369

$176,115

$607,539

Jun-23

494

1,468

$42,151

$53,047

$95,198

$601,489

$144,294

$604,025

$38,577

$565,448

$770,429

$939,237

$660,647

$175,765

$587,977

Jul-23

499

1,466

$42,567

$53,110

$95,676

$644,417

$154,107

$798,524

$142,791

$655,732

$771,250

$940,144

$751,409

$175,730

$678,689

Aug-23

497

1,463

$42,407

$52,978

$95,384

$739,797

$112,142

$851,939

$178,121

$673,817

$769,355

$937,847

$769,202

$175,315

$696,652

Total

3,962

11,743

$338,340

$424,723

$763,062

$4,820,171

$825,257

$5,260,400

$478,596

$4,781,804

$6,168,583

$7,519,963

$5,544,866

$1,408,075

$4,962,076

Average

495

1,468

$42,292

$53,090

$95,383

$602,521

$103,157

$657,550

$59,824

$597,726

$771,073

$939,995

$693,108

$176,009

$620,260

$85.40

$107.20

$192.60

$1,216.60

$208.29

$1,327.71

$120.80

$1,206.92

$1,556.94

$1,898.02

$1,399.51

$355.40

$1,252.42

Sep-23 Oct-23 Nov-23

2023

Dec-23

2022

PEPM % Change

9.4%

10.2%

0.2%

16.5%

8.7%

13.9%

-8.4%

5.3%

41.3%

2.7%

16.3%

16.5%

3.5%

-0.6%

4.0%

Total

5,433

15,990

$462,977

$499,724

$962,701

$5,802,930

$1,235,195

$6,848,805

$464,331

$6,384,473

$7,270,781

$8,847,801

$7,347,175

$1,942,815

$6,540,045

Average

453

1,333

$38,581

$41,644

$80,225

$483,577

$102,933

$570,734

$38,694

$532,039

$605,898

$737,317

$612,265

$161,901

$545,004

$85.22

$91.98

$177.20

$1,068.09

$227.35

$1,260.59

$85.46

$1,175.13

$1,338.26

$1,628.53

$1,352.32

$357.60

$1,203.76

138.5%

-5.6%

33.0%

42.7%

12.2%

32.6%

1174.6%

24.5%

15.9%

15.5%

25.5%

2.4%

29.1%

PEPM % Change

14.3%

17.1%

1

Enrollment may change based on retro active adjustments 2 Includes runout from BCBS and Rx Rebates from CVS caremark 3

Stop loss reimbursements will differ from actual reimbursements from the carrier due to reporting differences

Self Funded Factors

PEPM

Medical/Rx Admin Fee Medical/Rx ISL Premium Medical/Rx ASL Premium Expected Claims Maximum Claims

$85.40 $99.78 $7.42 $1,364.34 $1,705.43

Stop Loss Factors ISL Level ASL Corridor Contract

Total vs. Budgeted Cost $200,000 125% 72/12

Total Plan Cost Budgeted Plan Cost Note: Budgeted Plan Cost = Equivalent Rates

8

80.6% $5,544,866 $6,880,985

ABC Sample Group 2022 Medical/Rx Experience - Aggregate

2022

Enrollment1

Fixed Cost

A

B

C

D

E = (C + D)

F

G

H = (F + G)

Month

Employees

Members

Admin Fees

Stop Loss Premium

Total Fixed Cost

Medical

Rx

Total Claims

Jan-22

1,118

2,396

$95,721

$88,384

$184,106

$876,556

$82,027

Feb-22

1,129

2,424

$96,501

$89,307

$185,808

$556,817

Mar-22

1,134

2,447

$96,855

$89,756

$186,612

$1,354,323

2021

J = (H - I)

Employer Cost

K

L

M = (E + J)

N

O = (M - N)

ISL Reimb2 Net Claims

Expected Plan Cost

Maximum Plan Cost

Total Plan Employee Net Employer Cost Contributions Cost

$958,583

$127,981

$830,602

$1,284,123

$1,559,127

$1,014,708

$330,565

$119,788

$676,605

$6,268

$670,336

$1,297,377

$1,575,269

$856,144

$334,085

$614,399

$128,412

$1,482,735

$0

$1,482,735

$1,303,840

$1,583,147

$1,669,347

$335,590

$1,426,762

$775,288

Apr-22

1,132

2,445

$96,714

$89,838

$186,551

$1,136,312

$205,165

$1,341,477

$102,499

$1,238,978

$1,305,092

$1,584,727

$1,425,529

$335,970

$1,182,009

1,133

2,433

$96,784

$89,602

$186,386

$1,199,453

$176,050

$1,375,504

$200,746

$1,174,757

$1,301,591

$1,580,392

$1,361,143

$335,070

$1,118,378

Jun-22

1,137

2,440

$97,068

$89,994

$187,062

$788,416

$235,548

$1,023,965

$75,751

$948,214

$1,307,253

$1,587,300

$1,135,276

$336,650

$891,111

Jul-22

1,129

2,412

$96,501

$89,145

$185,646

$939,265

$246,238

$1,185,503

$96,680

$1,088,823

$1,294,995

$1,572,332

$1,274,469

$333,215

$1,031,449

Aug-22

1,131

2,428

$96,643

$89,425

$186,067

$1,468,023

$225,709

$1,489,762

$200,872

$1,288,889

$1,299,048

$1,577,293

$1,474,957

$334,015

$1,232,622

Sep-22

1,182

2,612

$100,257

$94,512

$194,769

$945,676

$261,055

$1,206,731

$135,995

$1,070,737

$1,372,400

$1,666,808

$1,265,505

$353,965

$1,011,115

Oct-22

1,180

2,617

$100,115

$94,467

$194,582

$1,363,839

$281,686

$1,645,525

$308,956

$1,336,570

$1,371,799

$1,666,103

$1,531,152

$354,490

$1,276,252

Nov-22

1,187

2,634

$100,611

$94,943

$195,553

$1,378,056

$286,977

$1,390,484

$183,749

$1,206,735

$1,378,585

$1,674,342

$1,402,288

$356,055

$1,146,783

Dec-22

1,197

2,660

$101,319

$95,693

$197,012

$1,399,162

$336,466

$1,735,628

$336,593

$1,399,036

$1,389,326

$1,687,404

$1,596,048

$358,695

$1,337,718

Total

13,789

29,948

$1,175,089

$1,095,066

$2,270,155 $13,405,900 $2,585,122 $15,512,502 $1,776,090 $13,736,412 $15,905,427 $19,314,245 $16,006,567

$4,098,365

$13,043,887

Average

1,149

2,496

$97,924

$91,256

$189,180

$1,117,158

$215,427

$1,292,708

$148,007

$1,144,701

$1,325,452

$1,609,520

$1,333,881

$341,530

$1,086,991

$85.22

$79.42

$164.64

$972.22

$187.48

$1,124.99

$128.80

$996.19

$1,153.49

$1,400.70

$1,160.82

$297.22

$945.96

-3.2%

23.2%

551.1%

11.5%

16.1%

15.6%

14.5%

2.4%

18.3%

$3,686,105

$10,153,494

% Change

8.6%

13.4%

138.6%

-5.8%

37.2%

35.1%

Total

12,699

26,417

$453,631

$1,070,711

$1,524,342

$9,138,413

$2,458,501 $11,596,915

$251,237

Average

1,058

2,201

$37,803

$89,226

$127,028

$761,534

$204,875

$966,410

$20,936

$945,473

$1,051,477

$1,282,589

$1,072,502

$307,175

$846,124

$35.72

$84.31

$120.04

$719.62

$193.60

$913.21

$19.78

$893.43

$993.60

$1,211.99

$1,013.47

$290.27

$799.55

16.6%

-6.9%

-6.4%

9.5%

1.5%

12.3%

PEPM

2020

I

Total Plan Cost

May-22

PEPM

$11,345,677 $12,617,720 $15,391,065 $12,870,019

% Change

3.7%

5.1%

15.3%

-34.3%

-24.6%

14.0%

13.4%

13.9%

-44.2%

Total

12,246

25,141

$379,259

$1,571,139

$1,950,398

$7,726,876

$2,089,768

$9,816,644

$434,209

$9,382,435 $13,073,891 $15,854,765 $11,332,833

$3,503,390

$8,717,678

Average

1,021

2,095

$31,605

$130,928

$162,533

$643,906

$174,147

$818,054

$36,184

$781,870

$1,089,491

$1,321,230

$944,403

$291,949

$726,473

$30.97

$128.30

$159.27

$630.97

$170.65

$801.62

$35.46

$766.16

$1,067.61

$1,294.69

$925.43

$286.08

$711.88

8.7%

4.8%

6.0%

1.6%

2.7%

1.9%

PEPM

2019

Paid Claims / Claims Liability

% Change Total

17.1%

26.6%

-16.0%

-24.4%

-22.9%

5.4%

15.8%

7.4%

-15.0%

10,462

19,858

$385,734

$1,775,129

$2,160,863

$6,265,061

$1,542,205

$7,807,266

$436,346

$7,370,920 $10,655,767 $12,779,493 $9,531,783

$2,914,625

$7,309,298

Average

872

1,655

$32,144

$147,927

$180,072

$522,088

$128,517

$650,605

$36,362

$614,243

$887,981

$1,064,958

$794,315

$242,885

$609,108

$36.87

$169.67

$206.54

$598.84

$147.41

$746.25

$41.71

$704.54

$1,018.52

$1,221.52

$911.09

$278.59

$698.65

PEPM 1

Enrollment may change based on retro active adjustments

2

Stop loss reimbursements will differ from actual reimbursements from the carrier due to reporting differences

Self Funded Factors

PEPM

Medical/Rx Admin Fee Medical/Rx ISL Premium Medical/Rx ASL Premium Expected Claims Maximum Claims

$85.22 $72.14 $7.28 $988.85 $1,236.06

Stop Loss Factors ISL Level ASL Corridor Contract

$200,000 125% 60/12

Claims Position

%

Position to Expected Position to Maximum

100.7% 80.6%

Total vs. Budgeted Cost Total Plan Cost Budgeted Plan Cost Note: Budgeted Plan Cost = Equivalent Rates

9

95.0% $16,006,567 $16,853,584

ABC Sample Group 2023 Large Claimants - Above $100,000 2023 Large Claimants Large Claimants by Relationship

Large Claimants by Medical/Rx

$6,786,095, 69%

$3,086,023, 31%

5, 33% 6, 40%

$2,914,687, 94%

$171,336, 6%

4, 27%

Employee

Claimant

Spouse

All Others

Dependent

# Last Year

Plan

Relationship

Gender / Age Band

1 Yes - #11 2 No 3 No 4 Yes - #3 5 No 6 No 7 Yes - #7 8 No 9 Yes - #4 10 No 11 No 12 No 13 No 14 No 15 No 16 Yes - #22

Plan 3 Plan 3 Plan 3 Plan 1 Plan 3 Plan 3 Plan 3 Plan 3 Plan 1 Plan 3 Plan 3 Plan 3 Plan 1 Plan 3 Plan 3 Plan 1

Dependent Spouse Student Subscriber Dependent Dependent Spouse Spouse Subscriber Subscriber Spouse Spouse Dependent Subscriber Subscriber Subscriber

Female <1-19 Female 40-49 Male 20-29 Male 50-59 Female <1-19 Female <1-19 Female 40-49 Male 40-49 Male 60-64 Male 60-64 Female 60-64 Female 50-59 Male <1-19 Male 30-39 Male 65+ Male 65+

Currently Status Enrolled Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes

Active Active Active Cobra Active Active Active Active Active Active Active Termed Active Active Active Cobra

Claimants Over $100,000

Medical Paid

Pharmacy Paid

Diagnosis / Category

Medical Paid

Pharmacy Paid

Amount Paid

Chronic renal failure Multiple sclerosis Paroxysmal tachycardia Non-insulin-dependent diabetes mellitus Cerebral infarction Other congenital malformations of the heart Neoplasms Nonrheumatic aortic valve disorders Malignant neoplasm of bronchus and lung Other septicaemia Other spondylopathies Malignant neoplasm of breast Cystic fibrosis Paralytic ileus and intestinal obstruction Malignant neoplasm of colon Pulmonary embolism Total

$558,513 $215,711 $225,565 $183,727 $213,722 $206,929 $196,217 $164,529 $153,476 $154,205 $109,416 $125,411 $109,681 $109,043 $85,271 $103,271 $2,914,687

$6,614 $47,136 $1,237 $35,592 $3,118 $50 $270 $1,366 $3,889 $1,731 $25,450 $3,007 $14,855 $189 $23,195 $3,639 $171,336

$565,126 $262,847 $226,802 $219,319 $216,841 $206,979 $196,487 $165,895 $157,364 $155,936 $134,866 $128,418 $124,535 $109,232 $108,466 $106,910 $3,086,023

10

Change From Amount Over Last Month $200,000 ISL $139,417 $4,381 $39,506 $22,451 $3,411 $4,111 $27,222 $156 $18,702 $25,264 $7,251 $0 $4,710 $5,294 $27,656 $745 $330,278

$365,126 $62,847 $26,802 $19,319 $16,841 $6,979 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $497,915

ABC Sample Group 2022 Large Claimants - Above $100,000 2022 Large Claimants Large Claimants by Relationship

Large Claimants by Medical/Rx

$10,085,796, 65%

$5,426,706, 35%

4, 18%

17, 77%

$5,155,860, 95%

$270,846, 5%

1, 5%

Employee

Claimant

Spouse

All Others

Dependent

# Last Year

Plan

Relationship

Gender / Age Band

1 No 2 No 3 Yes - #13 4 Yes - #2 5 No 6 No 7 No 8 Yes - #18 9 No 10 No 11 No 12 No 13 No 14 No 15 No 16 No 17 No 18 No 19 No 20 No 21 No 22 No

Plan 1 Plan 3 Plan 1 Plan 1 Plan 1 Plan 2 Plan 3 Plan 1 Plan 3 Plan 3 Plan 3 Plan 1 Plan 3 Plan 1 Plan 1 Plan 3 Plan 3 Plan 1 Plan 3 Plan 1 Plan 1 Plan 1

Subscriber Subscriber Subscriber Subscriber Spouse Spouse Spouse Subscriber Subscriber Subscriber Dependent Subscriber Subscriber Subscriber Subscriber Spouse Subscriber Subscriber Subscriber Subscriber Subscriber Subscriber

Male 60-64 Male 40-49 Male 50-59 Male 50-59 Female 60-64 Female 50-59 Female 40-49 Male 60-64 Male 65+ Male 40-49 Female <1-19 Male 60-64 Male 50-59 Male 40-49 Male 60-64 Female 50-59 Male 60-64 Male 30-39 Male 50-59 Male 40-49 Male 65+ Male 65+

Currently Status Enrolled Yes No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes

Claimants Over $100,000

Medical Paid

Pharmacy Paid

Medical Paid

Pharmacy Paid

Amount Paid

Active Hodgkin lymphoma $766,183 Termed Neoplasm of endocrine glands $577,611 Cobra Fibrosis and cirrhosis of liver $506,525 Active Malignant neoplasm of bronchus and lung $342,304 Active Malignant neoplasm of brain $312,798 Active Malignant neoplasms of respiratory system $306,288 Active Secondary malignant neoplasm of other sites $284,548 Active Atrial fibrillation and flutter $183,623 Termed Duodenal ulcer $185,522 Active Injury of intrathoracic organs $175,442 Active Complications of prosthetic implants $159,129 Active Paroxysmal tachycardia $161,072 Active Aortic aneurysm and dissection $164,708 Active Injury of blood vessels at hip and thigh level $151,821 Active Malignant neuroendocrine tumors $152,940 Termed Malignant neoplasm of breast $137,447 Active Atrial fibrillation and flutter $117,282 Active Other diseases of oesophagus $132,198 Active Subarachnoid haemorrhage $124,705 Active Psoriasis, Pharmacy - Stelara $822 Termed Non-insulin-dependent diabetes mellitus $105,142 Active Paralytic ileus and intestinal obstruction $107,749 Total $5,155,860

$808 $2,113 $49,835 $5,085 $21,061 $871 $59 $16,100 $0 $585 $10,328 $7,899 $660 $2,970 $645 $7,805 $16,918 $1,179 $11 $116,619 $7,891 $1,405 $270,846

$766,991 $579,724 $556,360 $347,389 $333,859 $307,159 $284,607 $199,723 $185,522 $176,026 $169,456 $168,971 $165,369 $154,791 $153,585 $145,252 $134,200 $133,377 $124,717 $117,442 $113,034 $109,154 $5,426,706

Diagnosis / Category

11

Change From Amount Over Last Month $200,000 ISL $124,403 $0 $7,125 $19,617 $60,367 $40,474 $152,888 $5,294 $0 $18,420 $38,270 $4,809 $6,365 $5,517 $11,153 $0 $1,151 $14 $8,091 $24,607 $0 $49,425 $577,990

$566,991 $379,724 $356,360 $147,389 $133,859 $107,159 $84,607 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $1,776,090

ABC Sample Group 2023 Pharmacy Utilization #

Brand Name

Therapeutic Class

Pharmacy Tier

Specialty

Claimants

Paid

Scripts

Paid/Script

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Ocrevus Inj 300/10Ml Stelara Inj 90Mg/Ml Skyrizi Inj 150Mg/Ml Skyrizi Pen Inj 150Mg/Ml Enbrel Srclk Inj 50Mg/Ml Humira Pen Inj 40/0.4Ml Enbrel Inj 50Mg/Ml Dimethyl Fum Cap 240Mg Dr Orencia Clck Inj 125Mg/Ml Vraylar Cap 4.5Mg Temozolomide Cap 100Mg Pulmozyme Sol 1Mg/Ml Xeljanz Tab 5Mg Capecitabine Tab 500Mg Xifaxan Tab 550Mg Dupixent Inj 200/1.14 Xolair Inj 150Mg/Ml Dupixent Inj 300/2Ml Vraylar Cap 3Mg Otezla Tab 30Mg Fiasp Inj 100/Ml Opzelura Cre 1.5% Trulicity Inj 4.5/0.5 Vraylar Cap 1.5Mg Trelegy Aer 200Mcg

Psychotherapeutic And Neurological Agents - Misc.

Dermatologicals Dermatologicals Dermatologicals Analgesics - Anti-Inflammatory Analgesics - Anti-Inflammatory Analgesics - Anti-Inflammatory Psychotherapeutic And Neurological Agents - Misc.

Analgesics - Anti-Inflammatory Antipsychotics/Antimanic Agents Antineoplastics And Adjunctive Therapies Respiratory Agents - Misc.

Analgesics - Anti-Inflammatory Antineoplastics And Adjunctive Therapies Anti-Infective Agents - Misc.

Dermatologicals Antiasthmatic And Bronchodilator Agents Dermatologicals Antipsychotics/Antimanic Agents Analgesics - Anti-Inflammatory Antidiabetics Dermatologicals Antidiabetics Antipsychotics/Antimanic Agents Antiasthmatic And Bronchodilator Agents

Brand Brand Brand Brand Brand Brand Brand Generic Brand Brand Generic Brand Brand Generic Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand

Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes No Yes No No No No No

1 1 2 1 3 8 1 1 1 1 1 1 1 2 2 2 2 3 2 2 1 1 2 1 2

$35,148 $68,460 $50,213 $31,402 $103,717 $230,278 $20,404 $8,989 $12,045 $3,615 $10,250 $9,804 $22,688 $30,232 $39,377 $18,471 $37,194 $54,343 $4,895 $8,417 $6,342 $6,622 $14,388 $5,122 $3,837

1 3 3 2 18 41 4 2 3 1 3 3 7 10 14 7 15 22 2 4 4 5 11 4 3

$35,148 $22,820 $16,738 $15,701 $5,762 $5,617 $5,101 $4,494 $4,015 $3,615 $3,417 $3,268 $3,241 $3,023 $2,813 $2,639 $2,480 $2,470 $2,448 $2,104 $1,586 $1,324 $1,308 $1,280 $1,279

$836,251

192

$4,355

41.7%

0.9%

$1,167,301

21,086

58.3%

99.1%

$2,003,552

21,278

$94

Top 25 Pharmacy All Other Pharmacy Total Pharmacy

$55

Pharmacy Tier

Amount

% Cost

Scripts

% Scripts

Avg Cost / Script

Generic Brand Specialty

$217,954 $1,022,193 $763,405

10.9% 51.0% 38.1%

18,976 2,097 205

89.2% 9.9% 1.0%

$11.49 $487.45 $3,723.93

Totals

$2,003,552

100%

21,278

100%

$94.16

12

ABC Sample Group 2022 Pharmacy Utilization #

Brand Name

Therapeutic Class

Pharmacy Tier

Specialty

Claimants

Paid

Scripts

Paid/Script

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Stelara Inj 90Mg/Ml Skyrizi Inj 150Mg/Ml Humira Pen Kit Ps/Uv Humira Pen Inj 40Mg/0.8 Humira Pen Inj 40/0.4Ml Enbrel Inj 50Mg/Ml Enbrel Srclk Inj 50Mg/Ml Cosentyx Pen Inj 150Mg/Ml Xeljanz Tab 5Mg Cimzia Kit 200Mg Dupixent Inj 200/1.14 Rinvoq Tab 15Mg Er Xifaxan Tab 550Mg Dupixent Inj 300/2Ml Temozolomide Cap 140Mg Pulmozyme Sol 1Mg/Ml Otezla Tab 30Mg Xolair Inj 150Mg/Ml Latuda Tab 60Mg Janumet Tab 50-1000 Rexulti Tab 2Mg Rexulti Tab 1Mg Entresto Tab 49-51Mg Synjardy Xr Tab 10-1000 Briviact Tab 100Mg

Dermatologicals Dermatologicals Analgesics - Anti-Inflammatory Analgesics - Anti-Inflammatory Analgesics - Anti-Inflammatory Analgesics - Anti-Inflammatory Analgesics - Anti-Inflammatory Dermatologicals Analgesics - Anti-Inflammatory Gastrointestinal Agents - Misc.

Dermatologicals Analgesics - Anti-Inflammatory Anti-Infective Agents - Misc.

Dermatologicals Antineoplastics And Adjunctive Therapies Respiratory Agents - Misc.

Analgesics - Anti-Inflammatory Antiasthmatic And Bronchodilator Agents Antipsychotics/Antimanic Agents Antidiabetics Antipsychotics/Antimanic Agents Antipsychotics/Antimanic Agents Cardiovascular Agents - Misc.

Antidiabetics Anticonvulsants

Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Generic Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No No No No No No No

1 2 1 1 8 1 2 1 1 1 1 1 3 3 1 1 3 2 1 1 1 2 2 1 1

$90,685 $86,139 $8,507 $71,389 $384,300 $61,793 $92,639 $4,210 $38,594 $3,384 $9,626 $2,978 $38,526 $100,554 $16,188 $2,432 $14,236 $16,011 $1,327 $2,637 $2,567 $12,595 $6,140 $7,220 $11,579

4 5 1 13 71 12 19 1 11 1 3 1 14 37 6 1 8 9 1 2 2 10 5 6 10

$22,671 $17,228 $8,507 $5,491 $5,413 $5,149 $4,876 $4,210 $3,509 $3,384 $3,209 $2,978 $2,752 $2,718 $2,698 $2,432 $1,779 $1,779 $1,327 $1,318 $1,284 $1,260 $1,228 $1,203 $1,158

$1,086,255

253

$4,293

41.6%

0.9%

$1,524,344

27,753

58.4%

99.1%

$2,610,599

28,006

$93

Top 25 Pharmacy All Other Pharmacy Total Pharmacy

$55

Pharmacy Tier

Amount

% Cost

Scripts

% Scripts

Avg Cost / Script

Generic Brand Specialty

$324,724 $1,265,797 $1,020,078

12.4% 48.5% 39.1%

24,668 3,070 268

88.1% 11.0% 1.0%

$13.16 $412.31 $3,806.26

Totals

$2,610,599

100%

28,006

100%

$93.22

13

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Headquarters: 500 W. 13th Street Fort Worth, TX 76102 800.728.2374 Higginbotham.com