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BlueCross BlueShiekl <br /> rtir 9 of li iltois <br /> City Of Decatur <br /> ASO Projection <br /> for the period <br /> January 1,2023-December 31,2023 <br /> 1/112023 ASO Medical Renewal <br /> FEE COMPARISON(BY PRODUCT) <br /> Renewal PPO <br /> Current- RenewalChange <br /> Projected Enrollment 539 546 1.3% <br /> Single 199 <br /> Family 347 <br /> Illinois Access Fee 1.57% 1.49% -5.1% <br /> Administration Fee" $59.60 $60.49 1.5% <br /> Prescription Drug Rebate Credit ($70.47) ($78.44) -11.30% <br /> Medical Rebate Credit ($2.50) ($2.50) 0.0% <br /> Additional Services PCPM Fees $2.52 $2.52 0.0% <br /> Net Administration Fee PCPM ($10.85) ($17.93) -65.30% <br /> Individual Stop Loss$200,000 Deductible $128.61 $134.71 4.7% <br /> Aggregate Stop Loss 125%Attachment Factor $17,037 $17,569 3.1% <br /> Total Fixed Costs PCPM $120.39 $119.46 -0.8% <br /> Projected Average Claim Value PCPM $1,549.52 $1,577.38 1.8% <br /> Projected Aggregate Claim Factor PCPM $1,936.90 $1,971.73 1.8% <br /> Total Projected Costs PCPM $1,669.91 $1,696.84 1.6% <br /> "Na third party stoploss carrier is selected,a Third-Party Stop Loss Carrier fee o/50.50 pcpm will apply. <br /> *'Administration Fee does not include Advanced Payment Review(APR)services charged at 25%or claims savings. <br /> Blue Cross and Blue Shield of IL,a Division of Health Care Service Corporation,a Mutual <br /> Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association <br /> Proprietary and Confldendal Information of BCSSIL <br /> Not for use or disc osure outside SCBSIL,Employer,Meir respective affiliated <br /> companies and third-party representatives,except with written permission of BCBSIL. <br />