Monthly Claim Actual vs Budget Report EE+ EE+ Medical Rx Stop Loss Total Paid Expected Specific/ Total Working Rates Total Cost to EE EE % of Employee Spouse Child(ren) Family Subs Claims Claims Adjustment Claims Claims % to Exp Admin Assessment Cost x Enrollment Working Rates Contrib Total Jan-21 282 121 31 127 561 $503,692 $160,806 ($2,723) $661,775 $827,856 79.9% $23,169 $65,590 $750,534 $851,321 88.2% $166,014 Feb-21 294 122 31 127 574 $414,651 $133,028 $0 $547,679 $845,094 64.8% $23,706 $66,569 $637,955 $863,902 73.8% $168,470 Mar-21 298 122 32 128 580 $1,337,752 $156,348 ($333,150) $1,160,950 $855,849 135.6% $23,954 $67,174 $1,252,078 $871,707 143.6% $169,992 Apr-21 299 122 35 127 583 $826,239 $174,551 ($81,102) $919,688 $859,827 107.0% $24,078 $67,574 $1,011,340 $876,044 115.4% $170,839 May-21 292 121 35 129 577 $685,689 $167,731 ($150,835) $702,585 $849,072 82.7% $23,830 $67,267 $793,682 $872,560 91.0% $170,158 Jun-21 292 119 35 129 575 $935,272 $141,091 ($196,464) $879,899 $846,420 104.0% $23,748 $66,934 $970,580 $868,513 111.8% $169,369 Jul-21 292 120 36 127 575 $851,725 $215,592 ($224,296) $843,021 $844,554 99.8% $23,748 $66,934 $933,702 $867,774 107.6% $169,226 Aug-21 287 118 36 126 567 $687,725 $152,823 ($295,964) $544,584 $832,080 65.4% $23,417 $66,095 $634,096 $856,978 74.0% $167,120 Sep-21 289 118 35 126 568 $916,246 $190,367 ($320,213) $786,400 $835,272 94.1% $23,458 $66,064 $875,922 $856,802 102.2% $167,086 Oct-21 276 119 34 125 554 $494,584 $170,622 ($117,959) $547,247 $820,440 66.7% $22,880 $65,017 $635,144 $843,103 75.3% $164,412 Nov-21 274 119 33 125 551 $777,669 $177,202 ($320,532) $634,339 $815,529 77.8% $22,756 $64,714 $721,810 $839,408 86.0% $163,691 Dec-21 273 117 31 122 543 $737,125 $220,455 ($172,494) $785,086 $803,988 97.6% $22,426 $63,480 $870,993 $823,562 105.8% $160,601 3,448 1,438 404 1,518 6,808 $9,168,369 $2,060,616 ($2,215,732) $9,013,253 $10,035,981 89.8% $281,170 $793,412 $10,087,835 $10,291,673 98.0% $2,006,979 19.9% Jan-22 276 117 34 121 548 $495,582 $144,260 $0 $639,842 $813,072 78.7% $22,967 $102,524 $765,332 $879,439 87.0% $171,491 Feb-22 273 111 33 122 539 $301,497 $123,467 $0 $424,965 $799,062 53.2% $22,589 $100,585 $548,140 $864,209 63.4% $168,521 Mar-22 272 112 33 122 539 $327,990 $152,603 $0 $480,593 $797,567 60.3% $22,589 $100,752 $603,934 $865,422 69.8% $168,757 Apr-22 272 111 30 119 532 $585,482 $189,799 $0 $775,282 $786,006 98.6% $22,296 $98,855 $896,433 $849,651 105.5% $165,682 May-22 271 110 29 117 527 $562,717 $200,860 $0 $763,578 $778,389 98.1% $22,087 $97,667 $883,331 $839,541 105.2% $163,711 Jun-22 261 109 29 118 517 $415,296 $156,429 $0 $571,725 $757,176 75.5% $21,667 $96,622 $690,015 $830,560 83.1% $161,959 Jul-22 263 109 30 120 522 $627,757 $185,361 ($38,041) $775,077 $766,288 101.1% $21,877 $97,644 $894,597 $839,457 106.6% $163,694 Aug-22 266 106 27 119 518 $548,424 $289,186 ($41,896) $795,714 $756,906 105.1% $21,709 $96,061 $913,485 $827,175 110.4% $161,299 Sep-22 270 104 27 119 520 $594,845 $160,354 ($55,016) $700,183 $760,850 92.0% $21,793 $95,937 $817,914 $826,615 98.9% $161,190 Oct-22 274 107 25 123 529 $540,300 $214,845 ($19,549) $735,595 $774,861 94.9% $22,170 $97,710 $855,475 $842,638 101.5% $164,314 Nov-22 272 107 25 123 527 $635,595 $240,789 ($75,261) $801,123 $770,917 103.9% $22,087 $97,501 $920,710 $840,772 109.5% $163,951 Dec-22 278 106 25 125 534 $522,276 $153,570 ($80,810) $595,036 $780,984 76.2% $22,380 $98,399 $715,815 $849,203 84.3% $165,595 3,248 1,309 347 1,448 6,352 $6,157,762 $2,211,523 ($310,574) $8,058,711 $9,342,078 86.3% $266,212 $1,180,257 $9,505,181 $10,154,683 93.6% $1,980,163 20.8% Jan-23 286 102 23 123 534 $381,855 $181,020 $0 $562,875 $787,054 71.5% $22,487 $75,924 $661,286 $837,891 78.9% $163,112 Feb-23 286 98 23 121 528 $600,945 $207,762 $0 $808,707 $781,163 103.5% $22,234 $75,071 $906,012 $824,061 109.9% $160,347 572 200 46 244 1,062 $982,800 $388,782 $0 $1,371,582 $1,568,218 87.5% $44,721 $150,995 $1,567,298 $1,661,952 94.3% $323,459 20.6% Rx Rebates Total Cost Working Rates % to WR 2021 ($377,595) $9,710,240 $10,291,673 94.4% 2022 ($428,018) $9,077,163 $10,154,683 89.4% This is an accumulation of each plan (HSA/HRA/OAPIN) 2022 EBS Services & Capabilities 46