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u�Crt ,s Blt4 +� <br /> 09 <br /> City Of Decatur <br /> ASO Projection <br /> for the period <br /> January 1,2022-December 31,2022 <br /> 1/1/2022 ASO Medical Renewal <br /> FEE COMPARISON(BY PRODUCT) <br /> Renewal PPO <br /> Projected Enrollment 545 539 <br /> Single 183 <br /> Family 356 <br /> Illinois Access Fee 1.57% 1.57% 0.0% <br /> Administration Fee" $59.90 $59.60 -0.5% <br /> Prescription Drug Rebate Credit ($95.10) ($70.47) -25.9% <br /> Medical Rebate Credit $0.00 ($2.50) — <br /> Additional Services PCPM Fees $2.52 $2.52 0.0% <br /> Net Administration Fee PCPM ($32.68) ($10.85) <br /> Individual Stop Loss$200,000 Deductible $111.04 $128.61 15.80% $124.33 <br /> Aggregate Stop Loss 125%Attachment Factor $13,698 $17,037 <br /> Total Fixed Costs PCPM $80.45 $120.39 49.6% <br /> Projected Average Claim Value PCPM $1,377.71 $1,549.52 12.5% <br /> Projected Aggregate Claim Factor PCPM $1,722.14 $1,936.90 12.5% <br /> Total Projected Costs PCPM $1,458.16 $1,669.91 14.5% <br /> *If a third party stoploss carrier is selected,a Third-Party Stop Loss Carrier fee of$0.50 pcpm will apply. <br /> —Administration Fee does not Include Advanced Payment Review(APR)services charged at 25%of claims savings. <br /> BCBSIL is actively developing new solutions and processes to help you comply with the Transparency in Coverage Rule and the <br /> Consolidated Appropriations Act,including the No Surprises Act.We are developing these solutions so you can adapt to these new laws <br /> and to demonstrate our commitment to you and our members.As your recent renewal noted,our services and fees may change based <br /> on new laws or regulations that are enacted or may become effective.While our analysis related to the implementation of the legislation <br /> is still under evaluation,we anticipate these new laws and rules will impose some associated costs on your plan.We expect to have <br /> information about specific pricing later this summer and we will communicate as soon as we can. <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 />