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• <br /> .�� ISlur"(:rrwglSIiuetiltielrl rl1 Illinrrt <br /> City Of Decatur <br /> Asti I'rnpsr.lwrl hit Ihn panni!of Armory 1. <br /> 2071-1)ocr,niher.11,2027 <br /> FEE COMPARISON INCLUDES PACKAGE PRICING DISCOUNT APPLIED <br /> Mature Sun Life - ISL ASL PPO <br /> Current Renewal Change Contract Total <br /> Projected Enrollment 547 555 1.5% <br /> Single 209 <br /> Family 346 <br /> Administration Fee" $62.27 $64.52 3.6% $429,703 <br /> Prescription Drug Rebate Credit*0* ($112.96) ($97.95) -13.3% ($652,347) <br /> Medical Rebate Credit ($2.50) ($2.20) -12.0% ($14,652) <br /> Additional Services PEPM Fees $1.92 $1.92 0.0% $12,787 <br /> Third-Party Stop Loss Carrier Fee $2.00 $2.00 0.0% $13,320 <br /> Total Fee PEPM ($49.27) ($31.71) -35.6% ($211,189) <br /> Individual Stop Loss$250,000 Deductible $272.13 $312.95 15.0% $2,084,247 <br /> Aggregate Stop Loss 125%Attachment $4.57 $4.80 5.0% $31,968 <br /> Total Fixed Costs PEPM $227.43 $286.04 25.8% $1,905,026 <br /> The following Ancillary Lines have been quoted:Basic Life,BlueCare Dental(Insured),Vision <br /> Quoted Fees are only applicable if the above selected Ancillary Lines are sold. <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 8iosimdar 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 /> 10 <br /> A Division 04 Heath Ca.e 50.550 Co.poralon.a Mutual Legal Reserve Company, <br />