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City Of Decatur <br /> ASO Projectlon <br /> January 1,20Y0-Dacember 31.20M <br /> 7N/2020 ASO Medical Renewal <br /> CONDITIONS AND CAVEATS <br /> Please refer to the ACA Disclaimer regarding ben�ts and£nal pricing. <br /> NONnthstanding am/tNng in the renewal or Proposal to the coMrary,BCBSIL reservea the ngMto revise or withdrew our offer,or to change our adminiatra4ve teea(and/or pass-through amounis) <br /> at any hme before or during the wntract penod(all ofwhwh may be eshmates,allocated or pro-reted amounls)if any bcal,state o�federal IegislaEon,regulahon,rule or guidance <br /> (or amendmenta or clarificationa thereto)ia enac[ed or�ecomea eRechveAmqemeMed,which would increase pro�ected daim coats or BCBSIL's e:penses or cost ot qan admin�stration,or would <br /> oMem�se require BCBSIL to pay,submit or forvrerd,on i�ovm behal(or on the Emqoyer Group's behalf,any additlonal tax,surcharge,fee,or other amount. <br /> NOTICE:ACA provided for the eatablishment of a temporary reinaurence program(s)Por a thrce(3)year perwA(2014-2016),which is Nnded by reinaurance contribuhons("Reinsurance Fees")colleded <br /> from health insurence isauers end selFfunded group health plens,baginrung in 2014 Intorma6on as to howthese fees are calculated is provided hy federal antl state govemments Federal regula6ons <br /> establiah a fia(per member,per monih fee <br /> ACA also prowdea that sNf-funded pen sponsora are reepons�We for tha Reineurence Fee BCBSILwill not assist m the remittance of those fees to Me fe0erel govemment,however,upon request, <br /> we can make available to our self-funtleNASO customere,existing Aata and informetlon that may Ee helpFW in datermining,reportlng on,an0 remirong their Reinsurance Fee amounts. <br /> The total annual Health Stop Loss premiums anE ACV factora are based upon Ma total po�ecled enrollment and contrect distnbWon as indicated on this exhibit <br /> Significant chenges in the above eta[ed enrollment and contract distrihutlon vnll require a review and adjustment of the fees and factors. <br /> Thia renevral ie being provided for the penod indicated ebove <br /> This renewal ofier expres as of the effective data indicated above <br /> 7his renewal offer assumes HCSC vnll remain the axcluwve carrier for Medical and Rz coverege. <br /> Upon inquiry hom employar groups,BC&S will prwide iMormatlon to the emdq'er group regartlmg commsaons and oMer compensaBon paid <br /> to tha empoyeYs agent by BCBS in connectlon vnth the employeYs pdicy or corRract with BCBS. <br /> The renewal is being oRered on a paid basis. <br /> Health Paid Claims sub�ect to Stop Loss ara claims paid dunng the policy penotl inAicated above. <br /> Health Pa�d Claims subjectto Individual SYop Loss are paid claime(rom the Pollowing line(s)of coverege�Medcal,Drug,Illinois Accesa Fee <br /> Health Paid Claims sub�eq to Aggregate Stop Loas are paid claims fran t�e tollowing line(s)ot coverage.Medical,Drug,Illinois Access Fee <br /> HCSC reaerves the nght to ad�uat the Average Claim Value if one or more ofthe follaring occura vnthin the coverage penod. <br /> -t�e AccounYs compoaihon changes(i.e.tlemogrephics) <br /> -the AccounYs number of covered employeea increasee or deaeases by more than 10% <br /> -the AccounPs benefit program changes <br /> The mmimum Aggregate At[echmeM Pantwas calculated as 90%otthe ASL Limit per coMract per month <br /> multipiad by the pro�ected cumulaUve contracts for the period <br /> Apgregate Heatth Stop Loas premium is payade annually and is due by the fret day of the pohcy periotl <br /> Indrvidual HeaIM Stop Loss premiums are payada on the firat tlay o(each month <br /> A�ry amount in e�ccass of Me Indrvidual Health Stop Loss limit will not be induded in the Aggregate Health Stop Loss Settlement <br /> HCSC's pharmacy benefit manager,PRIME TherepeuEca(PBM),hdtls rebate coMracte vnth pharmaceWcal manufeciwars HCSC may,in some dreumstances,provide the Employarvnth <br /> a Rebete Credt,but auch Rebate Credit may not equal the eMire amount of the rebatea prowded to HCSC by the PBM. <br /> Employera t�at do not usa Pnme Tharepeutics as theu pharmacy benefit menager are NOT e6gide for a Rebate Credit <br /> HCSC's current esOmate otthe rebates it will recerve fiom the PBM,for drugs covered under the pharmaq benefit,for t�e emdoyere covered members,ia approximately$23 i6 per <br /> 8IXIFII <br /> Caparelm,v MUNeI Lpal Rwave canqny, <br />