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City Of Decatur <br /> ASO Projection <br /> January 1,2019-December 31,2019 <br /> 1/1/2019 ASO Medical Renewal <br /> CONDITIONS AND CAVEATS <br /> Please refer to the ACA Disclaimer regarding benefits and final pricing. <br /> This quote is contingent upon the account signing new contract documents in a timely manner.If not signed,then HCSC may withdraw and/or revise the quote. <br /> Pharmacy Rebate Credit includes estimate of rebates for all categories of drugs,including specialty drugs,based on our book of business <br /> We reserve the right to revise or withdraw our offer if,at any time during the projected coverage period' <br /> -The actual number of enrolled contracts(in total,by product,or by benefit plan),the Single/Family mix,or the Medicare/Non-Medicare mix varies by-/-10%from our projections. <br /> -The information upon which our projections were based(benefit levels,census/demographics,commissions,etc.)becomes outdated or inaccurate. <br /> Wellbeing Management(Healthcare Management program)Is included in the quoted administration fee. <br /> Projected Net Paid Claims for non-HMO Medical coverages on these exhibits include Estimated Value Based Care Payments and Savings. <br /> Value Based Care payments apply to Stop Loss Coverage. <br /> BCBSIL retains the right to recoup monetary credits provided,any remaining implementation costs,shared savings or PG incentive fees from the plan sponsor in the event of early termination <br /> of the proposed coverage or contract,either in its entirety or with respect to certain custom services or programs included in this offer. <br /> Offer is contingent upon proposed Wellbeing Management package design Any modifications to the proposed package <br /> will impact the Wellbeing Management fee and Administrative Fee. <br /> A Dm of HBaM Cara Ser wa CoIporaibn,a M-1 Legal Reserve Company. <br /> an Independent Lke d-Me Cross end Blue Sh-Asso—n <br />