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09 <br /> . U1#eQ f3ift mel <br /> City Of Decatur <br /> ASO Projection <br /> for the period <br /> January 1,2021 -December 31,2021 <br /> 1/1/2021 ASO Medical Renewal <br /> FEE COMPARISON (BY PRODUCT) <br /> Please refer to the ACA Disclaimer regarding benefits and final pricing. <br /> Renewal PPO <br /> Projected Enrollment 557 545 -2.2% <br /> Single 175 <br /> Family 370 <br /> Illinois Access Fee 1.57% 1.57% 0.0% <br /> Administration Fee $59.02 $59.90 1.5% <br /> Prescription Drug Rebate Credit ($56.72) ($95.10) 67.7% <br /> Additional Services PCPM Fees $2.52 $2.52 0.0% <br /> Net Administration Fee PCPM $4.82 ($32.68) -778.0% <br /> Individual Stop Loss$200,000 Level $91.50 $111.04 21.4% <br /> Aggregate Stop Loss 125%Aft. Pt. $13,698 $13,698 0.0% <br /> Total Fixed Costs PCPM $98.37 $80.45 -18.1% <br /> Projected Average Claim Value PCPM $1,325.48 $1,377.71 3.9% <br /> Projected Aggregate Limit PCPM $1,656.85 $1,722.14 3.9% <br /> Total Projected Costs PCPM $1,423.85 $1,458.16 2.4% <br /> 'If a third party stoploss carrier is selected,a Third-Party Stop Loss Carrier fee of$0.50 pcpm will apply. <br /> Proprietary and Confidential Information of BCBSIL <br /> Not for use or disclosure outside BCBSIL,Employer,their respective affiliated <br /> companies and third-party representatives,except with written permission of BCBSIL. <br />