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City Of Decatur <br /> ASO Projection <br /> for the period <br /> January 1,2020-December 31,2020 <br /> 1/1/2020 ASO Medical Renewal <br /> FEE COMPARISON(BY PRODUCT) <br /> Please refer to the ACA Disclaimer regarding benefits and final pricing. <br /> Mature PPD <br /> Cwrsnt Renewat � <br /> Projected Enrollment 561 557 -0.7°/a <br /> Single �$� <br /> Family 370 <br /> Illinois Access Fee 1.57% 1.57% 0.0% <br /> Administration Fee $59.02 $59.02 0.0% <br /> Prescription Drug Rebate Credit ($49.36) ($56.72) 14.9% <br /> Additional Services PCPM Fees $2.52 $2.52 0.0% <br /> NetAdministration Fee PCPM $12.18 $4.82 -60.4% <br /> Individual Stop Loss$200,000 Level $76.06 $91.50 20.3% <br /> Aggregate Stop Loss 125%Att.Pt. $13,698 $14,174 <br /> Total Fixed Costs PCPM $90.27 $98.44 9.1% <br /> Projected Average Claim Value PCPM $1,271.67 $1,325.48 4.2% <br /> Projected Aggregate Limit PCPM $1,589.59 $1,656.85 4.2% <br /> Total Projected Costs PCPM $1,361.94 $1,423.92 4.6% <br /> Mf a third party stoploss canier is se%cted,a Third-Party Stop Loss Canier/ee of$0.50 pcpm wil/appty. <br /> A Drvision of Heatth Care Service Corporffiion,a Mutual Legal Reserve Company, <br /> an IntlepentleM Licensee of ihe Blue Cross and Blue Shield AssoGation <br />