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�— � <br /> � .—_� <br /> City Of Decatur <br /> ASO Projection <br /> January 1,2020-December 37,202Q <br /> 1i112024 A30 Medica�Renewal <br /> CONDITIONS AND CAVEATS <br /> Please refer to the AGA Disclaimer regardi»g benefits and tinai prlcing. <br /> HCSCs current estimate of ths rabates it wi0 receive from fhe PBM,for drugs covered urxler the rtcedicai bene8i on an aggregate basis 4or the poiicy perifld,is appro�mateiy$Q.80 per <br /> empioyee per month. <br /> This quote is conimgent upon the account signing new contract documents in a timey manner.If not signed,then HCSC may withdraw and/or revise Me qupte. <br /> Phartnacy Rebate Credit includes estimate of rebates for all calegories af druga,including specialty drugs,based an our book of business. <br /> R Ihe prescnption drug progrem is not administered by Prime today but is awarded the administration of the prescription drug program,Me medical claim cost will be retluced due to <br /> to the integraUon of tAe medical and prescriptbn drug program. <br /> We reserva the rigbt fo revise or withdraw our offer if,at any time during the projected cavere�penal: <br /> -The acfuai number ot enroiled coniraGs(in total,by product,or by benefit plan),the Singls/Famity mix,or the Medicare/Non-Medicare mix vanes by+/-10%irom our prqedions. <br /> -The information upon which our projections were based{benefit Ievels,censustdertwgraphics,cortxrussions,eta)becomes putdated ar inaxurate. <br /> Wellbaing Manegerr�nt{HeaHh Manageme�t&Advocecy program}is inciuded in the quoted ackn�istraiion tee. <br /> Lock-U requirements for all stop bss proposals and renewats as foliaws: <br /> -Stoa Loss auotes/renewsls released 10 or rrore�nths orior ta ef(ecUve date: <br /> -AIt such offers are illustralive and cannol be locked in.See note belpw. <br /> -SMo��ss ouotes/renewais released 4 to 9 months orior to effective dale� <br /> -Can be bcked in{via wririen acesptance)up to 45 calendar days after quote is reieased. <br /> -After 45 calendar days without written acceptance,those offervs become illustrative.See nole below. <br /> -SMo I,oss quotes/renewals released within 3 manths nnor to effective tlate� <br /> -Can be locked in at any time prior to et6ective date.(Stop Loss cannoi be purchased after ihe poiky period begins.} <br /> Note:For quokslre�ewals that are i1lusUalive or otherxise nai lacked io,HCSC wiii requirelreriew updated cia�m defa which is wvthin 124 days of the quoted effecUve date. <br /> A revisad and final atop loss quote/renewal will be issued at ihat time. <br /> Projected Net Paid Ciaims for non-HMO Medical coverages on these e�dribits include Estimated Value Based Care Payments and Savings. <br /> Value Based Care payments apply tn Stop Loss Goverape. <br /> BCBSIL retains the right ta recoup monetary credits provided,any remaining implementatipn cosls,shared savings or PG incen6ve fees from the plan eponsar in the evant of early termination <br /> of the proposed coverage or contract,eiSher in ds entirety ar with respest to certain custom services ar prograrrrs induded in Uris ofter. <br /> If a third pariy stop bss carrier is setected,a Third-Partp S�p�oss Carrier tee wili apply. <br /> Offer is conSngeM upon proposed Weflbeing Management package desiqn.My rmdifxations to the proposed paeicage <br /> will impael the Wellkremg Managemenl fee and AdminiStrativa Fee <br /> A pMsbn af H+aMM1 Care SerWe+Corpore�on,a MUWeI�apal Reasr.e Compem/. <br /> an intlspe�uRci#lkanceo of tha @tw CwxsarA elua Shkitl AswcYlun <br />