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r: Rhin(:roti~Blue's!' d 4 <br /> )1'Illinui, <br /> City Of Decatur <br /> ASO Projection for the period of <br /> January 1,2026-December 31,2026 <br /> FEE COMPARISON <br /> Renewal Sun Life ISL ASL PPO Final Rates 9/24 <br /> Package Pricing <br /> Discount <br /> Current Renewal Change Contract Total S2/2% <br /> Projected Enrollment 551 547 Included <br /> Single 207 <br /> Family 340 <br /> Administration Fee** $60.10 562.27 3.6% $408,740 <br /> Prescription Drug Rebate Credit**** ($128.45) ($111.59) -13.1% ($732,477) <br /> Medical Rebate Credit ($2.50) ($2.50) 0.0% (516,410) <br /> Additional Services PEPM Fees $2.02 $1.92 -5.0% $12,603 <br /> Total Fee PEPM ($68-83) ($49.90) -27.5% ($327,544) <br /> Individual Stop Loss$250,000 Deductible $268.11 $272.13 0.0% 51,786,261 <br /> Aggregate Stop Loss 125%Attachment Factor 519,395 $4.57 0.0% $29,997 <br /> Total Fixed Costs PEPM $202.21 $226.80 12.1% $1,488,715 <br /> Illinois Access Fee 1.19% 1.12% $76,787 <br /> Projected Average Claim Value PEPM $1,662.90 $1,853.88 11.5% $12,168,868 <br /> Projected Aggregate Claim Factor PEPM $2,078.63 $2,393.89 15.2% $15,713,494 <br /> Total Projected Costs PEPM $1,865.11 $2,080.68 11.6% $13,657,583 <br /> Claims have been adjusted to reflect estimated change to Advantage Network,Performance Select Formulary and Sun Life Aggregate Claims <br /> 'If a third party stoploss camer is selected,a Third-Party Stop Loss Camer fee of 52 00 pepm will apply Move to Sun Life fee is 513.128 <br /> "Administration Fee does not include Advanced Payment Review(APR)services charged at 25%of claims savings. <br /> ""This quote assumes Prime Therapeutics(PBM)Performance Select Biosimilar drug list and Advantage network. <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 /> Props%on and CmrideiOS Clemens a ecesiL <br /> Na for use a disclosure u,4ioa ecesiC,Employm,mei'reepeclra afraiaeJ companies and Ihid-mr,ropresminaves.except nen nnikn permission d5CBSIL <br /> A Division of Meath Care Service Corporation,a Mutual Legal Reserve Company, <br /> an Independent Licensee of the Blue Cross and Blue Shield Association <br />