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08/21/2012 07 2011 Year-End Medical Insurance Report BUSINESS OF THE CITY COUNCIL YAKIMA, WASHINGTON AGENDA STATEMENT Item No. 7 For Meeting of: August 21, 2012 ITEM TITLE: 2011 Year -End Medical Insurance Report SUBMITTED BY: Cheryl Ann Mattia, Deputy HR Manager Randy Tabert, Chair, Employee Welfare Benefit Program Board CONTACT Cheryl Ann Mattia X6868 PERSON /TELEPHONE: SUMMARY EXPLANATION: Attached is the 2011 Year -End Report for the City of Yakima's Self- Insured Health Care Plan. In reviewing this report, it is important to note that Employee Benefit Management Services, Inc. utilizes a paid claims system of reporting expenditures. This differs from Generally Accepted Accounting Principles (GAAP), used by the City of Yakima for its records. The City recognizes expenditures on a claims incurred basis. Further, the report does not include any revenues or expenditures for City personnel and administrative costs, which are attributable to the City's Health Benefit Reserve Fund. Resolution Ordinance Other Report (specify) Contract: Mail to: Contract Term: . Amount: Expiration Date: Insurance Required? No Funding Source: Phone: APPROVED FOR SUBMITTAL: _ City Manager STAFF RECOMMENDATION: Accept report as submitted. BOARD /COMMISSION RECOMMENDATION: ATTACHMENTS: Click to download ❑ 2012 report to council ❑ report #1 ❑ report #2 ❑ Report #3 ❑ report #4 ❑ report #5 ❑ report #6 ❑ report #7 ❑ report #8 EMSPRI NG August 16, 2012 City Council Members CITY OF YAKIMA 129 North 2nd Street Yakima, WA 98901 Re: Year 2011 Health Care Plan Report 2012 Renewal and Current Status of Plan Dear Council Members: Attached are the Financial Summaries and related reports of the City's Employee Health Plan for calendar year 2011 and mid -year 2012. The 2011 reports were produced by Healthcare Management Administrators, Inc. (HMA) of Bellevue, Washington, and subsequent reports are provided by the new claims administrator - EBMS of Billings, Montana. These reports record actual claims and direct plan expenses on a cash basis of accounting. Though costs continue to rise, this Plan is in compliance with current law and regulations and continues to be well monitored and managed by a cooperative relationship between the City Manager's Office, the Human Resource and Finance Divisions and a voluntary Board representing all employees and bargaining units. Executive Summary Health care costs too much and, therefore, so does health insurance. Since the adoption of Medicare and Medicaid programs in the 1960's, the prevailing "fee for service" method of paying for health care incentivizes providers to do more in order to get paid more. Insurance companies made it possible to finance the ever increasing cost of care, and the fragmented employer -based health plan system forces employers to rely on insurers, preferred provider networks and third party administrators to keep competitive health benefit plans afloat. On top of this, dramatic demographic changes in the United States - not the least of which is the aging of the baby boomers - puts additional pressure on our health care system and costs. Of course, this system has advanced medical technology and patient care so far forward that life expectancies are at record highs and Americans now expect the extraordinary from their doctors, hospitals and pharmacies. Unfortunately, the cost is now equally extraordinary. Health care spending exceeds 17% of our nation's GDP, the highest by both percentage and dollar amount in the world. Federal health care reform has passed and is on its way to full implementation by January 1, 2014. Few people expect reform laws and regulations to slow health care costs and some, including me, expect it to escalate them even further. There is also the real Health Care Plan Report August 16, 2012 Page 2 possibility that we may be nearing the end of the employer -based health care system as we know it. The City of Yakima's Employee Health Care Plan cost $10.6 million last year. Despite legitimate methods and material changes to the Plan in the last two years designed to control costs, the Plan is projected to reach $11.4 million in 2012. With costs rising, the City no longer holds enough cash in its health benefits trust to meet the full State of Washington requirements for single employer self - funded plan reserves. This is a claims versus funding issue, not a trust management problem, and there are specific and attainable proposals to correct the reserve shortfall included in this report. It is also important to note that this report does not factor in the City's LEOFF 1 liability beyond their eligible non - Medicare expenses. Despite the chaos of our American health care system, there are many positive attributes of the City's Plan. First and foremost, the schedule of benefits is still considerably stronger than most benchmark employer plans while at the same time per capita costs are in line with national averages: Exhibit 1.10 Distribution of Annual Premiums for Covered Workers with Family Coverage, 2011 Percentage of Covered Workers: YPPA: $15, sow. City Regular: $15,266* 40°%° Average: ;15,073 30% 24% 20% 173/ 18% 11% 10% 10% 6% II 5% 5% 0% Ill III 1 IIII MI 5 r oc � ce 4 ti y ' , 4 /� ' 4 e t 4 'e p Source. Ka ser /HRET Survey of Employer- Sponsored Health Benefits, 2011 •Raom City of Yakima July 201,1 Trend Accruals effective January 1, 2012 EttSPRING Health Care Plan Report August 16, 2012 Page 3 I find this truly astounding given the average age of our group and the extremely high dependent ratio. An active Employee Benefits Board, proactive Human Resource and Finance staff, and careful selection of vendors have a lot to do with the success of this Plan. In my opinion, however, the greatest advantage we've enjoyed is a competitive stop -loss insurance market that, regardless of the number and magnitude of large claims our Plan generates, still offers reasonable individual and aggregate insurance premiums to protect the City from unexpected and excessive Plan losses in any one year. We all hope this continues. With state -based health insurance exchanges expected to go online in 2013 and a crucial pay -or -play decision all employers will be faced with in 2014, the future of the City's Health Plan will depend on the choices made in the next two years. This report summarizes the current Plan and explores options for keeping it viable. Health Care Reform The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010 and referred to as the Affordable Care Act, federal health care reform or PPACA. Since passage, there have been new regulations continuously published by Health and Human Services, the Department of Labor, the IRS and each state that we are monitoring closely. While there are only a few requirements affecting the City's Plan in 2012, it is a safe assumption that the Plan and the City's role as the Plan Sponsor will change dramatically in the next few years. Please see the attached Health Reform Timeline. There are more articles, analysis and legislative briefs found on our website (www.emspring.com) and many other non - partisan and credible sources like the Kaiser Foundation (www.healthreform.kff.org). This report is not intended to offer a political discussion of health care reform nor predict the outcome of the next election. We are focused exclusively on protecting the current and future interests of the City and the Plan participants. Our first and foremost attention is given to the status of the Plan today and the significant fiscal challenges faced by the City and its employees for the rest of 2012 and beyond. Overview: What is the Plan? The current City of Yakima Employees' Welfare Benefit Program (the "Plan ") became effective April 1, 1994 when the seven separate benefit programs for each collectively bargained group consolidated into one Plan Document. A Board with representatives from all employee groups was formed and became responsible for defining eligibility and covered benefits, monitoring vendors, monthly financial reports and the annual renewal, and making Plan recommendations to the City ugh Health Care Plan Report August 16, 2012 Page 4 Manager. This Board meets every month and is currently chaired by AFSCME representative Randy Tabert. Employee and employer premium contribution levels are subject to bargaining and outside of this Board's responsibilities which, unfortunately, has created a major obstacle for keeping the Plan current with the latest cost containment and cost sharing strategies like incentivized wellness and multi - tiered dependent rates (premiums). There are two sets of benefits and two separate benefit booklets. The City of Yakima Police Patrolman's Association rejected benefit changes approved by the Board and City Manager and thus created the YPPA Health Care Plan in February 2010. The purpose of these two Plans is to attract and retain a healthy and productive workforce by financing the collective health needs of City employees and their eligible dependents. The Plan has been self - funded with stop -loss insurance since the early 1980's. In recent years, the Plan has expanded its scope to include voluntary wellness services designed to encourage healthy lifestyles with very modest quantifiable results. On January 2012, the City of Yakima amended their Regular Employee health plan to increase Deductibles and Out of Pocket Maximums. The Police Patrolman's Association plan followed with their own changes effective July of 2012. Both groups recognized the need to amend the health plan in order to keep it solvent, though most expect more will need to be done. Administration: What is a Self- Funded Health Plan? The City of Yakima assumes the financial risk for providing covered medical, prescription, dental and vision benefits to eligible and participating employees and their dependents. Rather than paying a monthly premium to an insurance company, a self - funded employer pays claims as they are incurred out of general assets. The City of Yakima must also maintain adequate reserves which, by Washington State taw requires 8 to 16 weeks of projected claim expenses be held in cash. The City Finance Department oversees these reserves. HMA (the third party administrator, or TPA - not the owner of Yakima Regional Hospital) managed the Plan and processed medical claims from 1994 until December 2011. In January 2012, the plan moved TPA services to EBMS. Washington Dental Service (WDS) and Vision Service Plan (VSP), though insurers, act only as third party administrators for the City's dental and vision claims. As TPAs, these vendors are paid a flat monthly fee per employee and assume no financial risk for claims. It is the City's money combined with employee payroll contributions that pay for all Plan claims and expenses. SPRING Health Care Plan Report August 16, 2012 Page 5 Financing: Employer and Employee Contributions In 2011, 15% of the net Plan costs were paid with employee contributions through payroll deductions. Per the City Finance Department, this has dropped to 13.8% in 2012 due to bargaining with AFSCME, a freeze on accrual rates in 2010, and the effects of a static cost sharing formula for Fire and Police dependent premiums. Only a few years ago, City employee contributions matched the then current AON /Hewitt Health Initiative benchmark of 22 %. These employee payroll contributions vary by bargaining unit and are outlined below: AFSCME 0 25.75% AFSCME - 17b $50.00 30.51% AFSCME Transit 0 12.17% IAFF Firefighters LEOFF I 0 9.69% IAFF Firefighters LEOFF 11 0 11.00% IAFF Battalion Chiefs LEOFF I 0 24.08% IAFF Battalion Chiefs LEOFF 11 0 27.34% IAFF Fire PERS 0 12.10% IAFF Communications 0 12.10% YPPA LEOFF I 0 5.98% YPPA LEOFF 11 0 7.27% City Management $50.00 30.51% Teamsters #760 Captains Et Lieutenants LEOFF I 0 0% Teamsters #760 Captains Et Lieutenants LEOFF 11 0 0% Teamsters #760 Deputy Fire Chiefs LEOFF I 0 24.08% Teamsters #760 Deputy Fire Chiefs LEOFF 11 0 27.34% Teamsters #760 Public Works Division Manager 0 30.51% Teamsters #760 Public Works Supervisors 0 30.51% The Dependent Contribution Requirement shown above reflects aggregate deductions by group divided by current Plan accrual rates (or premium equivalents). It does not reflect actual current costs, which have increased as projected since the dependent accrual rates were set last year. Health Care Plan Report August 16, 2012 Page 6 Financing: Stop -Loss Insurance To fund very large claims, the City purchases stop -loss insurance. This policy reimburses only for catastrophic claims that exceed a certain amount. That amount, called a stop -loss deductible, was renewed with Sun Life at $225,000 effective January 1, 2012. Since this policy reimburses the City and not the plan participant, this is not considered health insurance under Washington State or Federal (ERISA) law. The City self -funds this Plan for several reasons. First, there are no prepayment requirements as claims are not paid with a monthly premium. The City also maintains its own Plan reserves and keeps any investment income. In addition to having more control over cash flow, the City has ultimate control over the Plan's benefits and can negotiate more favorable administrative fees. For example, administrative and consulting expenses for the Plan in 2011 were 4% of Plan costs; a comparable fully - insured employer can easily pay from four to five times as much in their premium for administration and brokerage. With full PPACA implementation looming in 2014, there has been a substantial resurgence in the interest from employers in self - funded health plans. Actuaries typically analyze three components of health care plans to project future costs: census (who is covered), benefits (what is covered) and administration (how is it funded). Of the three components, who is covered is by far the biggest factor in determining the cost of any healthcare plan. As such, the census has been a major focus for the last year. Census: Who is on the Plan? For the first time in many years, the Plan census has changed dramatically. In July 2011, the City removed 100 LEOFF 1 Medicare Eligible participants from the Plan and placed them on Medicare Supplemental plans. The City now pays their Medicare premiums plus eligible non - Medicare covered expenses which are far more controllable costs. As of July 1, 2012, the Plan covers 784 current and retired employees: 45 are LEOFF 1, 27 are non -LEOFF 1 retirees, and the remaining are active employees, Council Members and self -pay COBRA participants. Counting all dependents, the Plan covers 1,887 total participants. Of the 784 employees, 543 are men and 241 are women. Due to the LEOFF 1 carve -out, over age of 60 (160) employees now represent 3.5 times the number of under age 30 (45) - a far more favorable age mix than the 5 to 1 ratio in previous years. l iIIR.�, Health Care Plan Report August 16, 2012 Page 7 Benefits: What is covered under the Plan? All terms, conditions and benefits are detailed in the Plan Document (also called a Summary Plan Description). The Plan Document was rewritten by EBMS and reviewed by your Benefits Board to include all amendments and facilitate compliance with the latest federal and State regulations. Compliance has been a priority. Effective January 1, 2012, the City Benefits Board elected to relinquish Grandfathered Status in order to amend the health plan to help offset the rising cost of care. The Police employee plan bargained their own compromise effective July 1, 2012. The following is a summary of the benefit changes that were implemented: Effective January 1, 2012. City of Yakima Employee Health Plan amended: • Deductible increased to $400 /Individual (was $200 /Individual). • Out of Pocket Maximum increased to $4,000 /Individual (was $1,200 /Individual) • Office Visits Copay increased to $25 (was $20 Copay) • Emergency Room Copay increased to $200 (was $100 Copay) • Preventive Care benefit expanded to 100% Coinsurance (was $20 copay with limitations) • Implemented Generic Medication incentives Effective July 1, 2012. City of Yakima Patrolman's Association Plan amended: • Deductible increased to $200 /Individual (was $100 /Individual) • Out of Pocket Maximum increased to $1,200 /Individual (was $600 /Individual) • Coinsurance reduced to 60% for out of network providers (was 80 %) • Office Visits Copay increased to $20 (was free for first 5 visits, then $15 copay) • Emergency Room Copay increased to $200 (was $25 Copay) • Preventive Care benefit expanded to 100% Coinsurance (was $15 Copay with limitations) • Implemented Generic Medication incentives It is still too early to determine the financial savings of each of these changes, though year to date reports indicate the results are positive. There continues to be a free choice of providers, though the City's Plan includes First Choice Health network - a preferred network of physicians and hospitals that offers discounts and direct billing. sr „r.� Health Care Plan Report August 16, 2012 Page 8 How much did the Plan cost in 2011? _Medical Paid Claims 57,201,390 67% Stop -Loss Reimbursement -52 5,001 0% Stop -Loss Premium 5391,483 4% Dental Paid Claims Administrative Fees Prescription Paid Claims 5765,809 5467,735 Vision Paid Claims 4% 51,762,692 5116,243 7% 17% 1% Total 2011 Plan Cost: $10,680,351 Total 2011 Plan cost, as shown on the pie chart above, was $10,680,351 versus $10,116,444 in 2010. This represents a 5.5% increase. Like most employer plans, a disproportionate share of the Plan's money is spent on individuals with the highest claims. $3,256,914 of the total cost above was incurred by 32 individuals. The attached Benefit Analysis Report for 2011 provides detail by diagnostic category and shows how every dollar was spent. The Plan includes coordinated disease management, case management, utilization review procedures, PPO network discounts for medical, dental (WDS) and vision (VSP), and aggressive hospital bill audits. As in previous years, we continue to recommend additional benefit design changes, retiree eligibility restrictions and the formal adoption of financial incentives to promote wellness. In fact, I believe that neither the City Plan nor the Police Plan will survive as is beyond 2013 without additional and significant changes and a return to adequate reserve levels. If we divide total annual plan costs by the number of employee participants (which include retirees, 6 months of full LEOFF 1 participation, and COBRA participants), and SPRh G Health Care Plan Report August 16, 2012 Page 9 divide again by 12 months, we get the Total Average Monthly Cost per Employee of $1,067.50 for 2011. Currently, we are negotiating a reimbursement of $404,273.65 that is pended and waiting for itemized bills and a case management audit. We anticipate this reimbursement from the stop -loss insurer is forthcoming, but do not reflect it in our reports until the money is received by the City. If taken into account, it would make the 2012 per capita cost in the bar chart below roughly equivalent to 2011. In other words, we are holding even this year. Average Monthly Cost of Coverage per Employee: 2012 - 7 Months Data 51,135.48 2011 .,. -- _ 0,06750 201 943 ze 2008 5839.50 2007 .� rn. : • • C. Through the first seven months of 2012, we have nine individuals considered a large claimant with a total of $1,028,468 already paid by the Plan. There are 17 individuals on EBMS claims management reports. Due to these substantial large claims, our outlook for 2012 is higher than expected. The positive savings from the schedule of benefit changes made in 2011 and again earlier this year are being overwhelmed by these very large individual claims. Health Care Plan Report August 16, 2012 Page 10 Benchmarking: How do our costs compare to others? Over the last few years, national and regional surveys by Watson Wyatt and Hewitt Associates report average annual increases as shown: Annual Health Care Cost Increases, National Averages 20042012 10.0% 9.2% 9.0% 8.0% 7. ° 7.5/0 7.0% 6.9% 7.0% 6.0% 6.0% 6.0% 5.3% 5.0 °!0 4.0% 3.0% 2.0% 1.0% 0.0% 2004 -05 2005 -06 2006 -07 2007 -08 2008 -09 2009 -10 2010 -11 2011 -12 (pro). ) The City's Plan has averaged a per capita increase just under 7% over the last 5 years, in line with the benchmarks. In addition, annual accrual rates (averaged from all the bargaining units and management rates) for the City's Plan are also tracking very closely with the national averages shown on the following chart: Health Care Plan Report August 16, 2012 Page 11 Exhibit 1.11 Average Annual Premiums for Single and Family Coverage, 1999 -2011 1999 ■ 52196 1 55,791 •Siogle Coverage 2000 = $2.471 56,a38 - $2.689• • Family Coverage 1 2001 $7,061• 2002.3 • 58,003• 2003 lIMMIMMIMMIIMI 53,383* 59,068• 2004 1 53.695• 59,950• 2005 $ 4 . 024• 1 $10,880' 2006 54.242• 511,480• 2007 !4.479 • 1 $12,106• 2008 $4.704` 512,680• S4,824 2009 513,375• 2010 $5,049• 513,770' 2011 1 $5,429• 515,073• 50 52,000 $4,000 56,000 $8,000 $10,000 $12,000 514,000 516,000 • Estimate is statistically different from estimate for the prevous year shown (p <. 05) Source Kaiser/HRET Survey of Empbyer- Sponsored Heath Benefits, 1999.2011. What changed in the last Plan renewal? The 2012 Renewal was presented to the City Manager and Benefits Board on December 15, 2011. The City's stop -loss deductible with Sun Life was renewed with a 9% increase. Sun Life is one of the largest and highest -rated stop -loss insurers in North America, and this policy includes a future renewal increase cap and a "no- laser" agreement (a provision hidden in many contracts that allows the insurer to exclude, or laser, a high cost individual upon renewal). What has been done to control costs? Since the last report to council: • Effective July 1, 2011 successfully moved 89 Medicare eligible LEOFF 1's to a Medicare Part D and Medicare Supplement Plan F for primary coverage. The City of Yakima self - funded plan will reimburse eligible claims resulting in Part D prescription copays. The projected savings for 2012 from this move is $490, 000. EMSPRING Health Care Plan Report August 16, 2012 Page 12 • There are currently 3 Medicare Supplemental eligible LEOFF 1 retirees that rejected the Medicare program. We will continue to work with the individuals during the next Medicare open enrollment and encourage their participation. • Terminated our relationship with HMA and moved our TPA services to EBMS. This resulted in a reduction in fees along with better reporting, disease and case management programs. • Performed a full Dependent Audit and a complete re- enrollment into the new EBMS enrollment system. 181 ineligible dependents were removed from the health plan! • Increase deductibles, out of pocket maximums, copays and incentivized generic prescription utilization. • EBMS wellness support has increased participation in preventive care with flu shots, whopping cough vaccinations and healthy heart checks. • Added a minor waiting period for new hires. What can be done to control future cost increases to the Plan? Can be done now - subject to Benefits Board and City Manager approval: 1. Build, open and operate a City of Yakima Employee Health a Wellness Clinic by March 2013. Estimated partial first year savings could be as high as $300,000. A detailed proposal is being presented to the Employee Benefits Board and City Manager this month. 2. Adopt financial incentives to support full participation in wellness and integrated disease management programs. If the City is to continue sponsoring a plan of any kind, it is time to start focusing on employee health and not health care and health insurance. Like consumer driven plan designs, there is little short term return on investment for wellness, but the long term effects are significant. Successful incentivized wellness programs can reduce health plan costs by as much as 10% over the long term in addition to the benefits of a healthier and more productive workforce. 3. Carve -out transplant coverage and fully- insure the risk for these potential claims. The savings would be a discount applied by the stop -loss carrier, not the reduction in the incidence of transplants. I estimate this to save up to $225,000 if there is a transplant claim. SPRING Health Care Plan Report August 16, 2012 Page 13 Likely subject to bargaining: • Eliminate the composite dependent premium option and adopt a three or four tiered dependent rate structure for all divisions and bargaining units. This would reduce the number of participating dependents since employees would pay separate spouse and child (or children) rates rather than the composite "all dependent" rate. Management is currently the only group with multiple tiered dependent rates. Rate structure could look something like this: $576.50 Employee only $644.93 Spouse $134.70 1 Child $248.67 2+ Children) The full family rate would then be Spouse + 1st Child + 2 Child(ren). A large family would then pay more than the current composite dependent rate; an employee covering just one child would pay less. The savings potential is difficult to calculate as the census change would be unknown, but with year -to -date dependent claims ($2.2 million) exceeding employee claims ($1.9 million), I believe it could reduce net Plan expenses by as much as $500,000 a year. • If the current composite dependent rate structure is retained, increase dependent cost sharing across the board to get back to the 22% contribution benchmark. • Eliminate the dental plan and save $765,000; eliminate the vision plan and save $116,000. • Eliminate early retiree eligibility for a projected net Plan savings of $200,000. • Eliminate eligibility for retired dependents - including retired LEOFF 1 dependents - for a projected net Plan savings of $75,000. • Consider consumer - driven programs (HRAs and HSAs) as alternatives to the current plan. This should not be considered without an integrated and incentivized wellness program. The savings would be determined by the number of employees electing the new HSA /HRA and the amount bargained for City contributions. First and second year savings might be minimal, but the long term potential could be as high as 8 -10 %, or $1 million, of total Plan costs per year. • The City could save more by terminating the current Plan, defining (or fixing) its health care contribution based on current rates using a Health Health Care Plan Report August 16, 2012 Page 14 Reimbursement Arrangement (HRA) and allow employees to go shop for their own coverage. • Consider dropping self - funded health plan and adopting a fully insured HMO Group Health option as a "Base Plan" with "Buy up" options through a commercial insurer. While this would likely cost more in total premiums, it would force more aggressive cost containment and cost shifting as both the City and the bargaining groups would be subject to insurer underwriting requirements. • Only allow dependent coverage if coverage is not available through another employer. This can be difficult to administer, but it is an increasingly common cost containment tactic that employers take to reduce the dependent coverage ratio (dependents /employees) and offset the "coverage shift" effect from other area employers who do not offer affordable health plans to their employees. • Add a waiting period of 60 to 90 days for new hire eligibility. Savings are minimal, though waiting periods are necessary to reduce administrative errors and control adverse selection. Conclusion The extended slow economy has brought unprecedented financial pressure on the City of Yakima, its employees and local taxpayers. The Health Plan faces additional cost pressures and legislative uncertainty. Employers are taking more drastic measures to enable them to offer affordable health coverage to their workforce. I calculate that the City would pay a penalty of roughly $1.5 million should the Employee Health Plan be terminated without an alternative plan in place in 2014. That's the "pay" in the "pay or play" decision. The "play" would be an estimated Health Plan cost of roughly $12 million in 2014. While I don't believe the City is a candidate for early Plan termination, it has to be at least considered if bargaining or other factors prevent the adoption of additional changes to control future Plan costs. The time has come to focus on employee health and not just health care and health benefits. According to the latest National Survey of Employer- Sponsored Health Plans conducted by Mercer, 92% of employers plan to add or strengthen programs to encourage health conscious behavior. The only way for these programs to work is to apply material financial incentives to participate. The City's Employee Benefits Board has considered such incentives in the past, but bargaining has become the road block. Since it is in every employee's interest to keep this Plan viable and affordable, we must overcome these objections and fully adopt and embrace wellness. There are excellent programs and many effective vendors from which to choose. A City SPRING Health Care Plan Report August 16, 2012 Page 15 sponsored onsite health clinic should also be given immediate and serious consideration, as well as reducing the spending on dependent coverage in relation to employee coverage. We can do these things if we work together. "Culture trumps strategy every time." I don't know who to credit for the quote, but I've heard it several times this past year while attending conferences on health care reform and human resource strategies. In context, it means that even if we adopt wellness programs and strategies to incentivize healthier lifestyles, the culture at the City of Yakima needs to change to allow it to flourish and produce positive and profound results. Changing the culture requires leadership, and EmSpring fully supports your efforts and the efforts of the City Manager, Human Resource and Finance Divisions, and all employees and dependents that rely on this Health Plan to maintain their health and lead productive lives. I take great pride in being the advisor to this Plan, and I look forward to any questions or instructions you may have. Sincerely, Dan Fisher, CEO Attachments Health Care Reform: 2012 Compliance Checklist 2011 HMA Financial Summary (Jan -Dec) 2011 -2012 HMA Benefit Analysis Report (Jan -Jun) 2012 HMA Financial Summary Run Out Claims (Jan -July) 2012 EBMS Executive /Financial Summary (Jan -July) 2012 Delta Dental WDS Dental Claims (Jan -July) 2012 VSP Vision Claims (Jan -July) Plan Census: Age Matrix as of 7/31/2012 i . R "ir HealthCareReform ai m ►r► LEGISLATIVE BRIEF Brought to you by EmSpring 2012 Compliance Checklist Health care reform brings a number of changes for employers and health plans in 2012. As employers prepare to comply with new requirements, they need to be aware of how health care reform will affect them in the coming year. This EmSpring Legislative Brief provides a compliance checklist for employers for 2012. Please contact your EmSpring representative for assistance or if you have questions about changes that were required in previous years. GRANDFATHERED PLAN STATUS A grandfathered health plan is one that was in existence when health care reform was enacted on March 23, 2010. Grandfathered plans are exempt from some of the health care reform requirements. A plan's grandfathered status will continue to affect its compliance obligations from year to year. ❑ Determine if you have a grandfathered plan. Contact your EmSpring representative if you have questions about whether your plan is grandfathered or not. ❑ Determine whether your plan will maintain its grandfathered status. If you make certain changes to your plan that go beyond permitted guidelines, your plan is no longer grandfathered. Contact your EmSpring representative if you have questions about changes you have made, or are considering making, to your plat ❑ If you move to a non - grandfathered plan, make sure the plan includes all the additional participant rights and benefits required by health care reform. These rules include first- dollar coverage of preventive care services, an enhanced claim and appeal process, and non - discrimination requirements for insured plans. ANNUAL LIMITS Beginning Jan. 1, 2014, group health plans will no longer be able to impose annual limits on the value of essential health benefits. However, until then, certain minimum annual limits are permitted. Unless your plan received a waiver of the annual limit requirements, you should confirm that any annual limit included in your plan is set at least as high as the following amounts for each applicable plan year: ❑ $750,000 for plan years beginning on or after Sept. 23, 2010, but before Sept. 23, 2011; ❑ $1.25 million for plan years beginning on or after Sept. 23, 2011, but before Sept. 23, 2012; and ❑ $2 million for plan years beginning on or after Sept. 23, 2012, but before Jan. 1, 2014. SUMMARY OF BENEFITS AND COVERAGE El Plans and insurance issuers must provide a Summary of Benefits and Coverage (SBC) to participants and beneficiaries. • The SBC is a concise document - no more than four double -sided pages - providing simple and consistent information about health plan benefits and coverage in plain language. EMSPRING 1 2012 Compliance Checklist • A template for the SBC is available, along with instructions and examples for completing the template and a uniform glossary of terms. ❑ The final SBC regulations provide that plans and issuers must start providing the SBC as follows: • Issuers must provide the SBC to health plans effective Sept. 23, 2012. • Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re- enroll during an open enrollment period beginning with the first day of the first open enrollment period that begins on or after Sept. 23, 2012. • For participants who enroll in coverage other than through an open enrollment period (for example, newly eligible individuals and special enrollees), plans and issuers must provide the SBC beginning on the first day of the first plan year that begins on or after Sept. 23, 2012. 60 -DAY NOTICE OF PLAN CHANGES El Plans and issuers must provide 60 days' notice of any material modifications to the plan that are not related to renewals of coverage. Notice can be provided in an updated SBC or a separate summary of material modifications. WOMEN'S PREVENTIVE CARE GUIDELINES ❑ Effective for plan years starting on or after Aug. 1, 2012, non - grandfathered plans must cover specific preventive health services for women with no cost sharing. These services include well -woman visits, STD screening and contraceptives. Exceptions to contraceptive requirements apply to religious employers. ._DICAL LOSS RATIO (MLR) REBATES ❑ Fully insured plans may receive rebates in August 2012 if they qualify for a rebate from their issuers due to the medical loss ratio (MLR) rules requiring insurance companies to spend a certain percentage of premium dollars on health care. The rebates must be used for the benefit of the plan's enrollees, which may include reducing enrollees' premium payments. W -2 REPORTING ❑ Beginning with the 2012 tax year, employers that are required to issue 250 or more W -2 Forms must report the aggregate cost of employer- sponsored group health coverage on employees' W -2 Forms. • The cost must be reported beginning with the 2012 W -2 Forms, which are issued in January 2013. • This requirement is optional for smaller employers for the 2012 tax year - and until further guidance is issued. • Reporting is for informational purposes only - it does not affect the taxability of benefits. '"' EmSpring Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice lers should contact legal counsel for legal advice 2011 -2012 Zywave, Inc. Ali rights reserved. • 11/11, KP 2/12 2 2012 Compliance Checklist TAX CHANGES FOR AGE 26 COVERAGE ❑ If your state previously required you to impute income for covering dependents up to age 26, check on changes to your state's tax code. All states that impose an income tax should now be in conformity with federal tax law, which permits this coverage to be provided on a tax -free basis. COMPARATIVE EFFECTIVENESS RESEARCH FEES ❑ Self- funded plans must pay a $1 per covered life fee for comparative effectiveness research. Fees are effective with the first renewal after Oct. 1, 2012. Fees increase to $2 the next year and will be indexed for inflation after that. SMALL BUSINESS TAX CREDIT ❑ Small employers that qualify for the tax credit provided by the health care reform law can claim the tax credit by filing Form 8941 (Credit for Small Employer Health Insurance Premiums) with their annual tax filings. • To qualify, employers must have fewer than 25 employees and pay average annual wages of less than $50,000. If you need more information on any of the health care reform topics addressed above, please contact your EmSpring representative. This EmSpring Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice Readers should contact legal counsel for legal advice. c 2011 -2012 Zywave, Inc All rights reserved 11 /11: KP 2/12 3 Group Name: City of Yakima Experience Report Carrier: Sun Life Group Number: BO101 Contract Period: 1/1/2011 - 12/31/2011 Excess Medical Pd Rx Pd Vision Pd Dental Pd Total Paid Avg Cost Single Family Single Family Total Aggregate Current Month Loss Prem Admin Fees Claims Claims Claims Claims Claims Total Cost Per Emp Medical Medical Dental Dental Med Emp Deductible Accrual Balance Jan -11 $33,914 $41,536 $963,438 $149,321 $14,045 $63,360 $1.190,164 $1,265,614 $1,437 362 519 248 476 881 $1,056,997 $860,388 - 8405,225 Feb -11 833,845 $41,042 $527,680 8140426 810,124 874.116 $752,347 $827,234 $944 357 519 246 477 876 $1,050,999 $858,104 $30,871 Mar -11 $33,636 $40,875 8491,873 $219,492 $10.444 $84.828 $806,637 $881,148 $1,009 356 517 256 476 873 $1,047,399 $853.376 427,772 Apr -11 $33,883 $41,308 $442,518 8162,889 $7,154 S68,323 $680,884 $756,076 $865 357 517 257 474 874 $1,048.599 $859,204 8103.128 May -11 $34,059 $41,926 $650,088 $148,394 $6,793 $65.927 $871,202 $947,188 $1,079 364 514 259 472 878 $1,053,398 $864,343 482,845 Jun -11 $33,781 $41,354 $631,690 $146,083 810,996 669 151 $857,920 $933,055 $1.063 364 514 256 471 878 $1,053,398 $857.203 475,853 Jul -11 $31.685 $35,943 $591,300 $148,333 $10,532 845.655 $795,820 $863,447 $1,093 281 509 253 467 790 $947,818 $849,369 - 814,078 Aug -11 $29,447 533,638 $461,434 $90,187 $11,978 $60.862 $624,461 $687,547 $873 279 509 254 466 788 $945,419 8706,520 $18,974 Sep -11 $31,872 $37,601 $629,167 $207.296 $6.830 $65,007 $908,299 $977,773 $1,238 280 510 252 466 790 $947,818 $787,561 - 5190,211 Oct -11 $31.639 $38.689 $783,429 $119,036 $9,057 $43,913 8955,435 $1,025,763 $1,295 283 509 253 468 792 $950,218 $748,834 - 5276,929 Nov -11 $31,886 $37,893 $438,314 $83,240 $7,579 $54.712 $583,845 $653,624 $825 284 508 255 470 792 $950,218 $779,664 $126,040 Dec -11 $31,836 $35,929 5590,458 $147,995 $10,711 $69.954 $819,119 $886,883 51,118 284 509 256 466 793 $951,418 $778,769 - 5108,114 Total YTD 5391,483 $467,735 $7,201,390 51,762,692 8116,243 5765,809 59,846,134 510,705,351 $1,070 3,851 6,154 3,045 5,649 10,005 $12,003,699 59,803,336 - 8902,016 Less Stop Loss Claims $10,680,351 PEPM Current Contract YTD $719 78 $176 18 $11 62 $76.54 $984 12 $1,067.50 $1,070 PEPM Prior Contract Year $622 80 $168 20 $10 89 $81.94 $883.83 $943 26 8981 20 Percentage Change 15.6% 4 7% 6 7% -6 6% 11 3% 13.2% 11.3% Individual Excess Loss Coverage Aggregate Excess Loss Coverage Aggregate Calculation Optional Data /Rates Deductible $225,000 Aggregate Attachment Factors: YTD Deductible: $12,003,699 Annual Maximum $1,000.000 Single $1,199 77 Covered Claims: Accrual Rates Aggregating Specific' NA Family $1,199.77 Medical $7,201.390 Med /Den Employee $575 45 Contract Basis Paid Minimum Attachment 511,545,147 Rx $1.762.692 All dependents $614 68 . Pre - Funding Yes Annual Maximum $1,000,000 Vision $116.243 Covered Benefits: Contract Basis Paid Dental $765.809 LEOFF I Medical Yes Premium (PEPM) $2 60 Total 59,846,134 Med Employee 5807 31 Rx Yes Covered Benefits: Specific Claim Adjustment All Dependents $614 68 Vision NA Medical Yes Claims Above Ind Ded. 525.001 Dental NA Rx Yes Less Agg Spec NA Rx Rebates'? Rates: Vision Yes Net Specific Claims $25.001 Q1 $31,892 32 Single $18 03 Dental Yes Net Total Claims' $9,821.133 Q2 $35.864 40 Family $48 71 Monthly Accomodation NA Aggregate Ded Loss Ratio 81 8% Q3 Lasers: NA Q4 'Terminal Liability NAI +•IMA . Information on this Experience Report is for illustrative purposes only Actual claims and enrollnment figures covered by the excess loss contract may be different. HEALTHCARE MANAGEMENT ADM Date: 08/08/2012 B e n e f i t A n a l y s i s Page: 1 Wednesday August 08, 2012 rbal Group: BO101 CITY OF YAKIMA Period: 01/2011- 06/2012 Mem Total copay * - -- Deductibles - - -* C.O.B. Inel Total Code Description Type Days Charge Amount Co -ins Benefit Savings Amount Paid ABOR ABORTION SERVICES (VOLUNTARY 36.00 1855.00 0.00 0.00 0.00 0.00 1855.00 0.00 ACUP ACUPUNCTURE 106.00 5291.01 0.00 0.00 0.00 0.00 5291.01 0.00 ALLI ALLERGY INJECTIONS 1427.00 29272.50 0.00 2002.64 0.00 250.04 6977.69 17418.73 ALLT ALLERGY TESTING 984.00 11324.20 0.00 571.61 0.00 0.00 4780.79 5064.07 AMB AMBULANCE 1274.00 96120.26 0.00 73.32 0.00 11654.83 45046.54 36876.73 ANES ANESTHESIA SERVICES 19320.00 352987.55 0.00 619.42 0.00 12072.15 154502.94 167301.89 ASST ASSISTANT SURGEON 107.00 188994.53 0.00 84.07 0.00 177.55 162595.34 24964.06 AUDR BILL AUDIT REVENUE 0.00 5704.96 0.00 0.00 0.00 0.00 0.00 5704.96 CHEM CHEMOTHERAPY 1672.00 128589.63 0.00 70.70 0.00 24003.71 52162.97 52172.86 CHIM CHIROPRACTIC - MULT SERVICES 865.00 34078.96 748.99 741.35 0.00 1144.25 10873.77 19542.58 CHIR CHIROPRACTIC SERVICES 2471.00 126365.05 28601.02 3153.62 0.00 3404.70 42215.85 46041.86 CNR MEDICAL- INELIGIBLE SERVICES 299.00 578046.27 0.00 0.00 0.00 0.00 578046.27 0.00 COLO COLONOSCOPY 139.00 144043.31 1255.00 0.00 0.00 3718.30 82836.88 56233.13 CONS CONTRACEPTIVE MGMT SURGERY 9.00 3143.00 0.00 0.00 0.00 0.00 3143.00 0.00 COSM COSMETIC INEL SERVICES 1.00 172.38 0.00 0.00 0.00 0.00 172.38 0.00 D&A DRUG /ALCOHOL INPT R &B PREAUT 132.00 92379.89 0.00 388.59 0.00 18077.07 22288.95 46211.70 D&A1 6TH &+ DRUG & ALCOHOL OUTPT 94.00 7069.00 1170.00 0.00 0.00 1366.00 1723.26 2809.74 D&AO DRUG & ALCOHOL OUTPT 424.00 25249.91 4080.00 269.22 0.00 279.00 7622.41 12122.51 DIA1 KIDNEY DIALYSIS (1ST 42) 12.00 418576.01 0.00 0.00 0.00 19219.62 394542.34 4814.05 DIA2 KIDNEY DIALYSIS (43 +) 2.00 77303.09 0.00 0.00 0.00 4468.15 73765.53 838.19 DIAL KIDNEY DIALYSIS 4.00 12355.30 0.00 0.00 0.00 813.10 11345.85 196.35 DIET DIETARY EDUCATION 102.00 3732.00 340.00 0.00 0.00 319.37 936.61 2136.02 DME DURABLE MEDICAL EQUIPMENT 3196.00 265142.90 0.00 4823.51 0.00 9709.24 143542.28 98914.60 DOMS DOCTORS OFFICE MISCELLANEOUS 173.00 37640.48 0.00 33.47 0.00 6722.22 20967.90 9729.58 DORX DOCTORS OFFICE PRESCRIPTION 52.00 108.00 0.00 0.06 0.00 0.00 87.02 20.89 DOSG DOCTORS OFFICE SURGERY 1093.00 225362.38 0.00 2378.35 0.00 15467.56 82743.57 118733.01 DOSP DOCTORS OFFICE SUPPLY 237.00 20818.95 0.00 0.64 0.00 1053.18 13405.02 6277.89 DOV DOCTORS OFFICE VISIT 8510.00 1126872.81 107153.50 5939.81 0.00 59899.34 294345.03 654230.48 DOV1 DOCTORS OFFICE VISIT 481.00 65494.69 6645.00 0.00 0.00 2692.33 14217.29 41940.07 DOVP ROUTINE GYNECOLOGICAL EXAM 181.00 30423.72 3235.00 0.00 0.00 959.61 5562.34 20493.51 DXT DIAGNOSTIC TESTING 2315.00 487851.86 0.00 21700.67 0.00 13688.17 244165.24 184302.53 EMER EMERGENCY ROOM SERVICES 568.00 1031256.19 36088.00 12255.47 0.00 28630.58 597078.68 308196.07 FLU FLU SHOTS 165.00 2490.94 0.00 0.00 0.00 10.26 696.22 1784.46 HEAR ROUTINE HEARING SERV INEL 31.00 961.00 0.00 0.00 0.00 0.00 961.00 0.00 HH NURSING VISITS IN HOME 100.00 23248.95 0.00 0.00 0.00 83.30 13099.74 10065.91 HH1 NURSING VISITS IN HOME 3.00 864.30 0.00 0.00 0.00 0.00 0.00 864.30 HMAU BILL AUDIT SAVINGS 0.00 33192.65 0.00 0.00 0.00 0.00 33192.65 0.00 HOME HOME HEALTH MISC SERVICES 22281.00 121389.33 0.00 4204.12 0.00 6265.60 55015.55 50745.03 HRB HOSPITAL ROOM & BOARD PREAUT 868.00 1087354.51 0.00 1896.94 0.00 88813.97 348031.37 624128.52 HSPC HOSPICE CARE /TERMINAL ILLNES 40.00 8201.00 0.00 0.00 0.00 0.00 3117.79 4671.55 ICU INTENSIVE CARE UNIT PREAUTH 107.00 244595.31 0.00 0.00 0.00 26667.26 72829.27 142642.40 IMX IMMUNIZATION SERVICES 1721.00 65653.89 0.00 79.34 0.00 968.69 10940.98 53083.84 INEL MEDICAL- INELIGIBLE SERVICES 1241.00 133684.57 0.00 0.00 0.00 0.00 133684.57 0.00 INFR INFERTILITY INELIGIBLE 61.00 4083.12 0.00 0.00 0.00 0.00 4083.12 0.00 INFT INFUSION THERAPY 903.00 94813.26 0.00 332.14 0.00 181.64 45227.64 47771.70 INJT INJECTIONS 9178.00 89165.52 0.00 334.73 0.00 7422.21 40984.29 40041.18 IPD1 INPATIENT DOCTORS VISIT 4.00 790.00 0.00 0.00 0.00 0.00 216.00 574.00 IPDV INPATIENT DOCTORS VISIT 853.00 173996.76 6420.00 51.31 0.00 19804.77 76068.85 70708.70 IPMM MENT /NERV INPT MISC PREAUTH 5.00 3564.92 0.00 0.00 0.00 24.58 3228.20 250.94 HEALTHCARE MANAGEMENT ;ate: 08/08/2012 B e n e f i t A n a l}, s Page: 2 Wednesday August 08, 2012 rbal Group: BO101 CITY OF YAKIMA Period: 01/2011- 06/2012 Mem Total copay * - -- Deductibles - - -* C.O.B. Inel Total Code Description Type Days Charge Amount Co -ins Benefit Savings Amount Paid IPMN MENT /NERV INPT R &B PREAUTH 39.00 49149.00 0.00 0.00 0.00 0.00 42413.00 6462.53 IPMS INPATIENT MISC PREAUTH 1221.00 5224554.17 0.00 0.00 0.00 198751.36 2926726.73 2085646.55 IPNP INPATIENT MISC NO PREAUTH 14.00 122999.95 1245.00 0.00 0.00 5793.56 112048.92 2345.86 IPRH INPATIENT REHABILITATION 34.00 16170.40 0.00 0.00 0.00 0.00 859.44 15310.96 IPSG INPATIENT SURGERY 287.00 630196.12 0.00 854.46 0.00 10095.75 343697.49 261439.62 LAB LABORATORY 14521.00 667827.01 0.00 49542.96 0.00 12202.04 378154.08 197162.12 MAM ROUTINE MAMMOGRAMS AGE 0 -35 695.00 43181.51 3020.00 0.00 0.00 825.72 19139.48 20196.31 MASS MASSAGE THERAPY 71.00 2135.00 0.00 0.00 0.00 0.00 2135.00 0.00 MATD MATERNITY DEPENDENTS 117.00 32352.20 0.00 0.00 0.00 0.00 32352.20 0.00 MED MEDICAL SERVICES 526.00 509875.05 0.00 0.00 0.00 45821.23 425532.16 38521.66 MRCT MRI OR CT -SCAN 425.00 474667.35 0.00 6154.08 0.00 14289.20 329671.46 104512.02 MRX PRESCRIPTION INVOICES 0.00 1868627.11 0.00 0.00 0.00 0.00 20.00 1868607.11 NEUR NEURODEVELOPMENTAL THERAPY 202.00 15485.70 0.00 700.00 0.00 0.00 3914.07 8983.23 NOPM SURGICAL FACILITY - NO PREAU 10.00 21784.24 1500.00 166.24 0.00 0.00 12803.82 6877.83 NOTC NOT COVERED 64.00 12959.97 0.00 0.00 0.00 0.00 12959.97 0.00 OBES OBESITY 159.00 31004.68 0.00 346.34 0.00 0.00 10462.21 18584.48 OONS OUT OF NETWORK SAVINGS 0.00 27423.08 0.00 0.00 0.00 0.00 0.00 27423.08 OPDV OUTPATIENT DOCTORS VISIT 597.00 219600.65 0.00 7954.91 0.00 7132.06 116655.60 71446.09 OPM1 6TH &+ OP MENTAL /NERVOUS 285.00 38740.96 4035.00 0.00 0.00 1382.34 9447.20 23876.42 OPMN OUTPATIENT MENTAL & NERVOUS 1256.00 164201.70 12260.00 1374.66 0.00 6778.92 62257.24 77006.69 OPMS OUTPATIENT MISCELLANEOUS 15191.00 3359526.08 0.00 10385.73 0.00 219961.01 1460394.57 1599572.08 OPRH OUTPATIENT REHABILITATION 9240.00 546178.41 0.00 9267.89 0.00 25977.10 267300.13 214479.81 OPRM OUTPATIENT REHAB - MULT SVCS 2.00 84.00- 0.00 0.00 0.00 0.00 27.20- 56.80 - OPSG OUTPATIENT SURGERY 808.00 772465.44 0.00 5672.09 0.00 22678.00 416751.61 296737.31 PAP ROUTINE PAP SMEAR LAB TEST 224.00 12136.30 0.00 93.75 0.00 323.83 4043.61 7625.43 PROS PROSTHETICS 4.00 300.00 0.00 0.00 0.00 0.00 125.88 124.30 RADT RADIATION THERAPY 91.00 38084.90 0.00 0.00 0.00 24.00 23932.99 13988.61 RX PRESCRIPTIONS 424.00 19918.30 0.00 0.00 0.00 0.00 2987.81 16930.49 SGCT SURGICAL FACILITY FEE PREAUT 279.00 696108.08 0.00 1935.42 0.00 10599.52 371412.80 292442.77 SMOK SMOKING CESSATION 5.00 583.82 0.00 0.00 0.00 0.00 33.01 471.12 SNF SKILLED NURSING FACILITY 45.00 20772.28 0.00 0.00 0.00 7659.44 0.00 13112.84 SPEC OUT OF PLAN PAYMENT 0.00 99606.00 0.00 0.00 0.00 0.00 54783.30 44822.70 SUP MEDICAL SUPPLY 66.00 9692.77 0.00 14.21 0.00 0.00 2768.06 6945.79 TERM TERMED GROUP 0.00 309266.01 0.00 0.00 0.00 0.00 309266.01 0.00 TMJ MEDICAL TMJ SERVICES 1.00 111.80 0.00 0.00 0.00 0.00 111.80 0.00 TRAN TRANSPLANTS 9.00 867.00 0.00 0.00 0.00 80.85 289.38 437.14 VEXM ROUTINE VISION EXAM 101.00 11074.37 0.00 0.00 0.00 0.00 11074.37 0.00 VHDW VISION HARDWARE 5.00 10583.95 0.00 0.00 0.00 0.00 10583.95 0.00 VINL VISION - INELIGIBLE SERVICES 29.00 1009.00 0.00 0.00 0.00 0.00 1009.00 0.00 WELC PREVENTIVE WELLNESS - COPAY 655.00 95244.16 10355.00 396.96 0.00 949.37 22840.11 60577.80 WELL ROUTINE /WELLNESS SERVICES 907.00 69079.94 0.00 105.75 0.00 2073.72 25205.69 41644.24 WELO ROUTINE /WELLNESS OFFICE VISI 20.00 3492.39 0.00 0.00 0.00 122.73 700.17 2669.49 WORK WORKMANS COMPENSATION CLAIMS 8.00 10384.94 0.00 0.00 0.00 0.00 10384.94 0.00 XRAY X -RAY SERVICES 2747.00 698300.82 0.00 23916.52 0.00 15422.65 514949.71 123227.89 cobr not on file 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1399.02 *Totals 94 Benefit codes 135231.00 228151.51 0.00 12272388.76 24679314.43 180887.07 998976.75 10562175.18 Group Name: City of Yakima (exc. Ret Medicare) Experience Report Group Number: BO101 RUN OUT 1/1/2012 - 12/31/2012 Medical Pd Vision Pd Dental Pd Total Paid Month Claims Rx Pd Claims Claims -NA Claims -NA Claims Total Cost Jan -12 $801,767 $62,421 $864,189 $864,189 Feb -12 $248,001 $0 $248,001 $248,001 Mar -12 $164,744 $115 $164,859 $164,859 Apr -12 $142,713 $15 $142,728 $142,728 May -12 $57,554 $0 $57,554 $57,554 Jun -12 $11,872 $0 $11,872 $11,872 Jul-12 $7,798 $10 $7,808 $7,808 Aug -12 $0 $0 Sep -12 $0 $0 Oct -12 $0 $0 Nov -12 $0 $0 Dec -12 $0 $0 Total YTD $1,434,449 $62,561 $1,497,011 $1,497,011 1 I Information on this Experience Report is for illustrative purposes only. Actual claims and enrollnment figures covered by the excess loss contract may be different. Executiv am mar y E i CITY Or fAK1MA l-'„/' ro ve• &merit%tcnarmimt ■, n,y 1'1 7r,17 i:, n3lr)uI, Group:0000218 Benefit Analysis Benefit Analysis Summary Disallowed Charges by Category Count Charges Disallowed Allowed Ded Copay Cob Savings Paid %Paid Charges 7,811,575 Amount % of Gross ALLERGY CARE 153 16,682 6265 10,418 2,392 958 7,068 0.2 Additional Info not Provided 393,997 5.0% ALTERNATE MED 72 4,016 1,423 2,592 1,210 7 1,376 0.0 less Disallowed 2,696,433 AMBULANCE 81 46,900 30,258 16,642 3,454 494 12,694 0 3 Duplicate Charges 894,057 11.4% Allowed 5,115,142 ANESTHESIA 127 101,794 27,675 74,119 14,351 5,701 54,066 1.3 Employee Ineligible 8,473 0 1% AUDITORY 30 1,228 1,228 0 0 0 0 0.0 less Deductible 667,374 Dependent Ineligible 1,419 0.0% CHIROPRACTIC 1290 62,150 21,305 40,845 17,478 559 22,808 0 5 Eligible Benefits 4,447,767 DENTAL 134 18,896 14,496 4,400 880 1,634 1,886 0 0 Managed Care 0 0 0% DME /APPLIANCE 163 31,209 15,088 16,121 5,655 140 10,326 0.2 less COB Reductions 189,562 Not Medically Necessary 6,139 0 1% EMERG ROOM CHRGS 1571 613,361 262,459 350,902 87,778 16,039 247,085 5.8 Paid Benefit 4,258,206 Out of Network 0 0 0% HOME HEALTH CARE 50 39,910 29,606 10,304 714 0 9,590 0 2 INELIGIBLE 210 16,280 16,280 0 0 0 0 0.0 plus Manual Checks 594,783 Plan Limitations 40.152 0.5 INPATIENT PHYS 253 78,291 27,431 50,860 5,589 2,312 42,959 1 0 Total Checks 4,852,988 PPO Savings 1,291.000 16 5% IP HOSP CHARGES 223 1,847,351 660,799 1,186,551 76,627 49,164 1,060,760 24.9 Preexisting Conditions 1,643 0 0% MATERNITY 148 90,730 18,471 72,259 12,203 22,303 37,753 0 9 Number of Claims 14,869 9 MEDICAL MISC 385 29,208 6,926 22,282 3,150 48 19,085 0 4 UCR Reductions 3.034 0 0% OFFICE VISIT 3410 429,547 97,483 332,064 64,740 13,649 253,674 6 0 XC Negotiated Discounts 10,299 0 1% OP PHYSICIAN 655 144,276 62,221 82,055 2,574 1,920 77,560 1 8 OTHER 68 1,088 1,088 0 0 0 0 00 Other 46,222 0.6% OUTPAT HOSP 481 353,744 110,908 242,837 37,617 2.910 202,310 4 8 Totals: $2,696,433 34 5% PEER REVIEW 10 2,482 0 2,482 0 0 2,482 0 1 PRESCRIPTION 7270 768,803 28,148 740,655 966 451 739,239 17.4 Claims Paid by Month Estimate of Incurred but not reported PSYCHIATRIC 831 230,279 86,363 143,917 14,533 707 128,676 3.0 February 12 504.644 Avg $ /day X avg lag = Est incurred but not reported RADIATION /CHEMO 186 116,930 33,156 83,774 900 0 82,874 1 9 March 12 465.710 SLEEP DISORDER 339 51,334 35,210 16,124 3,287 218 12,620 0 3 April 12 712,475 $26,285 X38.50 = $1,011,981 SUBS ABUSE 179 63,333 44,954 18,379 3,180 0 15,199 0.4 May 12 905.167 SURG FACILITY 178 1,000,372 518,472 481,900 70,176 22,568 389,157 9.1 Number of days in sample: 162 SURGERY 326 116,005 20,907 95,098 3,656 1,866 89,576 2.1 June 12 745.237 SURGERY IP 39 66,815 26,739 40.075 6,565 2,020 31,491 0.7 July 12 745.233 Average Cost SURGERY OP 268 196,261 62,182 134,079 22,861 8,975 102,244 2 4 Totals 4,258,206 Average cost per claim: 286.38 THERAPY 3078 241,841 112,688 129,153 33,004 11,502 84,646 2 0 Claim Type Total Paid Per URGENT CARE 11 865 111 754 241 0 513 0 0 EE /Mo VISION 73 5,268 3,894 1,374 806 0 569 0.0 Dental 783 015 WELLNESS 1629 119,098 25,142 93,956 1,408 1,888 90,659 21 Medical 3,518,094 636.99 XRAY/ LAB 6972 905,229 287,058 618,171 169,380 21,529 427,262 10 0 Totals: 7,811,575 2,696,433 5,115,142 667,374 189,562 4,258,206 100.0 Prescriptions 739,329 133 86 Vision 0 0 Census(Age Matrix) Plan Payment by Age, & Clmt Type Top Providers Census Date Male Female Male Female Male Female Total Total Total Age Category Employee Spouse Dependant Name Paid 7/31/2012 Emp Emp Spouse Spouse Dep Dep Med Dent Vision 0 to 19 0 0 989,358 EBMS RX /CVS CAREMARK MGD 735.501 0 to 1 • 0 0 0 0 289 290 579 579 579 20 to 23 10.537 1.201 47.472 YAKIMA VALLEY MEMORIAL HO 717.032 20 to 2 , 0 3 1 1 64 50 119 118 119 24 to 2• 41.901 25,610 13,790 YAKIMA HMA INC 584.780 • • . , 32 13 1 23 14 17 100 100 100 30 to 3'' 209.719 204,639 4,109 SEATTLE CHILDRENS HOSPITA 572.753 30 to 3• 128 40 13 95 1 0 277 277 277 40 to 4' 536,819 333,397 0 MEMORIAL PHYSICIANS PLLC 177.733 40 to 4', 130 61 19 93 0 0 303 301 303 50 to 5' 648.344 325,551 0 VIRGINIA MASON MEDICAL CE 102.369 50 to 59 154 63 20 70 0 0 307 293 307 60 to . 475,019 130.980 0 ORTHOPEDICS NORTHWEST PLL 95.428 60 to 64 81 53 13 18 0 0 165 108 165 65 and Olde 53.465 203,009 0 LAPALOMA TREATMENT CENTER CANCER INSTITUTES OF WASH 81.713 65 and Olde 18 8 3 8 0 0 37 27 37 Vendors_ 3,285 0 0 81,022 Total 543 241 70 308 368 357 1,887 1,803 1,887 Total - 1,979,090 1,224,386 1,054,729 YAKIMA UROLOGY ASSOCIATES 57.701 Average Ag • 47 9 49.5 50.0 44.6 12.7 13.1 34.2 31.4 34. ' Claims cost paid to vendors YAKIMA PHYSICIAN ANNEE T STHH ESES IA A ASSOSSO AA 46.645 Version° 3 0 Run Date Thursday, August 02, 2012 5 42 PM Page 1 of 1 Group Utilization Washington Dental Service Washington Dental Service is a member of the Delta Dental Plans Association Group Number: 00564 Group Name: City of Yakima Reporting Month: 07/31/2012 Benefit Period: 01/01/2012 - 12/31/2012 Subscriber Spouse Dependent Total Mouth Mouth YTD Moufi, Mouth YTD Number of Claims 95 91 60 53' 143 1972 2 298 2,421 Number of Patients 84 49 51 26' 124 2 259 1,232 Submitted $ 36,322 34 $ 347,577.9 $ 15,196 06 $ 192.429 9' $ 33,500 49 $ 270.65 $ 85,018.89 $ 810,674 20 Less Over Fees -$ 7,237.00 -$ 57,857.1 -$ 3,319 00 -$ 42,013 01 -$ 8,042.50 -$ 43,4 -$ 18,598.50 -$ 143,290.16 Gross S 29.085.34 $ 289.720 8 $ 11,877 06 $ 150,416 9' $ 25,457 99 $ 227.25 $ 66.420 39 $ 667,384 04 Less Elective Care -S 24 00 -$ 5.518.0 -$ 394.00 -$ 2.386.01 -$ 420.00 -$ 5,4 -$ 838.00 -$ 13.373 00 Less Benefit Exclusions -S 3,938.00 -$ 39,249.5 -$ 849.00 -$ 23,153 81 -$ 2,976.05 -5 31,7 -5 7,763 05 -$ 94,1 17.04 Allowed 5 25,123.34 $ 244,953.2 5 10,634.06 5 124,877.1; $ 22,061 94 $ 190,05 $ 57,819 34 5 559.894.00 Less Co- Payment -S 5,222.70 -$ 59,299.3 -$ 1.245 15 -$ 26,864 9' -$ 730 70 -$ 48,1 -$ 7.198.55 -$ 134.279.10 Net S 19.900.64 5 185.653.9 $ 9.388.91 $ 98.012.21 5 21.331 24 $ 141,9 $ 50.620.79 5 425.614.90 Lcss Deductible 5 0.00 $ 0.0 $ 0.00 $ 0 01 $ 0 00 $ $ 0 00 $ 0.00 Persons Affected 0 0 1 0 0 0 0 Less COB -S 989 40 -$ 1,577 8 -$ 389.05 -$ 17,061.01 -$ 1,051.30 -$ 5.6 -$ 2,429 75 -$ 24.329 20 Persons Affected I 12 6 7 5 20 100 Less Over -Max -S 1,847.90 -S 15,532.3 -$ 191.70 -$ 3.981 41 -$ 1,627.70 -S 7,8 -$ 3.667 30 -S 27 314 78 Persons Affected 8 3 3 1 2 13 68 Less Ortho Over -Max S 0.00 $ 0 0 $ 0.00 $ 0 01 $ 0.00 $ $ 0.00 $ 0 00 Persons Affected 0 0 1 0 0 0 Paid S 17,063.34 $ 168.543.6 $ 8.808 16 $ 76.969 81 $ 18,652 24 $ 128.4 $ 44.523.74 $ 373,970.92 Paid Non Member S 1,607.90 $ 1 1,021.8 $ 228.00 $ 1,962.1 ' $ 391 54 $ 7,9 $ 2.227.44 5 20.888 99 *AVERAGES* Allow /Claim S 264.46 $ 268.59 $ 177.23 $ 231.68 $ 154.28 $ 195.54 $ 194.02 $ 231.07 Paid/Claim S 179 61 $ 184.81 $ 146 80 5 142.8C $ 130.44 $ 132.16 $ 149.41 $ 154.34 Allow/Person S 299.09 $ 494 86 $ 208.51 $ 471 23 $ 177 92 $ 402.68 $ 223 24 $ 454 46 Paid /Person 5 203.14 $ 340 45 $ 172.71 $ 290 45 $ 150.42 $ 272.16 $ 171.91 5 303 55 *BENEFIT BREAKDOWN* 1 Prevent/Diagnost Allowed S 5.930.00 $ 67,000.01 $ 4,697 00 $ 37,387.98 $ 13.521 00 $ 77,353.85 $ 24.148 00 $ 181,741.81 Prevent/Diagnost Net S 5.930 00 $ 67,000.01 $ 4,697.00 $ 37,387.9€ $ 13,521.00 $ 77.552.25 5 24.148.00 5 181,940.23 Prevent/Diagnost Persons 57 461 40 245 88 449 185 1.159 Prevent/Diagnost Claims 59 607 42 355 96 583 197 1,545 Basic Services Allowed $ 10,526 00 $ 77,404.32 5 3,652.00 $ 39,826 31 $ 6.969 00 $ 47.680.00 $ 21.147.00 $ 164.910.63 Basic Services Net S 9,595.30 $ 70,132 18 $ 3,421.60 $ 35,994 96 $ 6.253 80 $ 41,920.70 5 19.270.70 S 148.047 84 Basic Services Pcrsons 44 251 18 122 19 122 81 495 Basic Services Claims 49 395 21 196 21 156 91 751 Special Rest Allowed S 8.189.00 5 61.293.01 $ 2,029.50 $ 34,923 00 $ 155 00 $ 3.321.00 $ 10.373.50 5 99.537.00 Special Rest Net S 4,094 50 $ 30,827.01 $ 1,014.75 $ 17.497.91 $ 139.50 $ 2.037 30 5 5.248 75 $ 50.362 20 Special Rest Persons 10 7C 3 37 3 10 16 117 Special Rest Claims 10 81 3 45 3 11 16 136 Prosthodontics Allowed S 349.00 $ 28,862 01 $ 0.00 $ 6.867.00 $ 0 00 $ 343.00 $ 349 00 $ 36.072.00 Prosthodontics Net S 174 50 $ 14.431.0C $ 0.00 $ 3.433.50 $ 0.00 $ 171.50 5 174 50 $ 18.036 00 Prosthodontics Per 2 16 0 8 0 1 2 25 The inforn stained in this report is privileged. confidential and protected from disclosure This report is a rr the sole use of the individual and entity to which it is addressed !/:you are not the inter, pient . any dissen ,i, distribution or copying is strictly prohibited. If you have received this report in error, please n,.. - ie sender and destroy the original. Groff Utilization Washington Dental S Washington Dental Service is a membc..,. the Delta Dental Plans Association Group Number: 00564 Group Name: City of Yakima Reporting Month: 07/31/2012 Benefit Period: 01/01/2012 - 12/31/2012 Subscriber . Slime IlltpelMeat t Moab YID Moab Ma DINA YID YTD Prosthodontics Claims 3 21 0 17 0 1 3 39 Ortho Allowed S 129.34 $ 10,393 97 $ 255.56 $ 5,872,87 $ 1,416.94 $ 61,365 70 $ 1 $ 77.632.54 Ortho Net $ 106 34 $ 3,263.72 $ 255.56 $ 3.697 87 $ 1,416 94 $ 20.267.04 $ 1,778 84 $ 27,228.63 Ortho Persons 3 S 4 7 32 46 39 62 Ortho Claims 3 36 4 33 33 280 40 349 July 2012 Premium: $50,704.94 Employees: 803 YTD Premium: $ 417,812.41 Average YTD Employees: 810 The information contained to this report is privileged, confidential and protected from disclosure This report is intended for the sole use of the individual and entity to which it is addressed. If you are not the intended recipient . any dissemination, distribution or copying is strictly prohibited. If you have received this report in error. please notify the sender and destroy the original vsp Client Utilization Report For: CITY OF YAKIMA • Client ID 12328220 Summary Page 1 Contract Type. ASP Run Date 08/14/12 Client Type Individually Rated NBR GAIN/ AVG CLM #CLMS PAID REV/ PERIOD COVERED GROSS $ RETENTION $ RETN % NET $ CLAIM $ LOSS $ PLR % COST PAID FREQ MBR 2009 10,881 $126,710 $28,624 22 6 $98,087 $98,087 $0 100 $145 10 676 62 $2 63 2010 10,745 $145,182 $28,339 19 5 $116,843 $116,843 $0 100 $144 43 809 75 $2 64 2011 10,286 $143,949 $27,708 19.2 $116,242 $116,242 $0 100 $132 85 875 85 $2 69 AUG 873 $14,243 $2,266 15.9 $11,978 $11,978 $0 100 $130.19 92 105 $260 SEP 792 $9,140 $2,310 25 3 $6,830 $6,830 $0 100 $119.82 57 72 $2 92 OCT 794 $11,346 $2,289 202 $9,057 $9,057 $0 100 $141.51 64 81 $2.88 NOV 796 $9,893 $2,314 23 4 $7,579 $7,579 $0 100 $126.32 60 75 $2 91 DEC 881 $13,015 $2,304 17 7 $10,711 $10,711 $0 100 $120 35 89 101 $2 62 JAN 805 $23,711 $2,123 9 0 $21,588 $21,588 $0 100 $168.66 128 159 $2 64 FEB 824 $13,434 $2,161 16.1 $11,273 $11,273 $0 100 $161 04 70 85 $2 62 MAR 809 $14,824 $2,135 14.4 $12,689 $12,689 $0 100 $156 66 81 100 $2 64 APR 825 $13,022 $2,135 16.4 $10,888 $10,888 $0 100 $149 15 73 88 $2 59 MAY 808 $8,331 $2,109 25.3 $6,222 $6,222 $0 100 $141 40 44 54 $2 61 JUN 785 $9,292 $2,077 22.4 $7,214 $7,214 $0 100 $126 57 57 73 $2 65 JUL 788 $9,960 * $2,071 20.8 $7,890 $7,890 $0 100 $125 23 63 80 $2 63 LTM 9,780 $150,212 * $26,294 17 5 $123,918 $123,918 $0 100 $141 14 878 90 $2.69 CC 15,930 $236,524 * $42,519 18 0 $194,005 $194,005 $0 100 $139 47 1,391 87 $2.67 YTD 5,644 $92,575 * $14,811 16.0 $77,764 $77,764 $0 100 $150 71 516 91 $2 62 MEMBERSHIP AVERAGES MEMBERS SPOUSE DEPENDENTS REV/ CLM IND PNL CLMS # AVG MBR CLMS # AVG SP CLMS # AVG DEP SP+ PERIOD MBR $ RATE % PERIOD $ CLMS COST % $ CLMS COST % $ CLMS COST % DEP 2009 $2.63 $9 01 $11 64 81 AUG $5,801 44 $131.83 48 $3,446 25 $137.84 27 $2,731 23 $118.74 25 52 2010 $2.64 $10 87 $13 51 81 SEP $2,559 20 $127.97 35 $1,785 12 $148.71 21 $2,486 25 $99.44 44 65 2011 $2.69 $11.30 $13.99 81 OCT $4,887 30 $162.91 47 $2,058 16 $128.61 25 $2,112 18 $117 32 28 53 Q1 $2.63 $18.68 $21.31 76 NOV $3,020 26 $116.14 43 $1,911 16 $119.46 27 $2,648 18 $14712 30 57 Q2 $2.61 $10.06 $12.67 82 DEC $6,041 47 $128.52 53 $2,336 18 $129.77 20 $2,334 24 $97.27 27 47 Q3 $2.63 $10.01 $12 64 81 JAN $9,208 57 $161.54 45 $5,935 33 $179.85 26 $6,445 38 $169.61 30 55 LTM $2 69 $12 67 $15 35 79 FEB $5,261 30 $175.37 43 $3,539 20 $176.94 29 $2,473 20 $123.65 29 57 CC $2.67 $12 18 $14 84 80 MAR $5,203 34 $153.02 42 $3,331 20 $166.53 25 $4,156 27 $153.92 33 58 YTD $2 62 $13 78 $16 40 79 APR $5,558 36 $154.38 49 $2,558 17 $150.48 23 $2,772 20 $138 60 27 51 MAY $3,049 20 $152.44 45 $1,779 11 $161.74 25 $1,394 13 $10721 30 55 JUN $3,843 31 $123.96 54 $866 9 $96 26 16 $2,505 17 $147 36 30 46 JUL $4,709 36 $130.79 57 $1,353 10 $135.31 16 $1,828 17 $10753 27 43 ADJ - Adjustments TOT $59,137 411 $143.89 47 $30,897 207 $149 26 24 $33,884 260 $130 32 30 53 CC - Current Contract LTM - Last Twelve Months YTD - Ye T^ Date This report is solely intended for the '' `the contract holder and is not to be shared ' - Aste vte Estimates Due to Non or Partial Payment EIS /UTIL002 EBMS Fmp/ '... nenc / ?l Managrenen:t SeeVICes, Inc Age Matrix CITY OF YAKIMA Group. 0000218 As of . 7/31/2012 Emp & Family Medical: Male Female Male Female Male Female Total Age Category Emp Emp Spouse Spouse Dep Dep Medical 0 to 29 10 1 0 13 290 248 562 30 to 34 27 5 5 32 0 0 69 35 to 39 40 8 5 51 0 0 104 40 to 44 41 9 6 38 0 0 94 44 to 49 29 8 9 24 0 0 71 50 to 54 20 1 5 13 0 0 39 55 to 59 11 2 2 6 0 0 21 60to64 1 0 1 0 0 0 2 Totals: 179 34 33 177 290 248 962 Emp Only Medical: Male Female Male Female Male Female Total Age Category Emp Emp Spouse Spouse Dep Dep Meaical 0 to 29 15 7 0 0 0 0 22 30 to 34 15 8 0 0 0 0 23 35 to 39 19 8 0 0 0 0 27 40 to 44 13 15 0 0 0 0 28 44 to 49 14 11 0 0 0 0 25 50 to 54 20 18 0 0 0 0 38 55 to 59 38 18 0 0 0 0 56 60 to 64 47 45 0 0 0 0 92 65 to 69 9 6 0 0 0 0 15 70 and Over 4 2 0 0 0 0 6 Totals: 194 138 0 0 0 0 332 Emp, Spouse, 1 Dep Medical: Male Female Male Female Male Female Total Age Category Emp Emp Spouse Spouse Dep Dep Medical 0 to 29 1 2 2 3 28 34 70 30 to 34 4 2 0 5 0 0 11 35 to 39 9 1 3 7 0 0 20 40to44 6 2 1 8 0 0 17 44 to 49 6 4 2 12 0 0 24 50to54 8 4 4 5 0 0 21 55 to 59 8 0 2 2 0 0 12 60 to 64 2 2 2 1 0 0 7 65 to 69 0 0 1 1 0 0 2 Totals: 44 17 17 44 28 34 184 Version 1.0.0 Run Date: 8/14/2012 7:06:07 PM Page 1 of 2 Emp & Spouse Medical: Male Female Male Female Male Female Total Age Category Emp Emp Spouse Spouse Dep Dep Medical 01o29 5 0 0 8 0 0 13 30 to 34 3 0 0 0 0 0 3 35 to 39 0 2 0 0 0 0 2 40 to 44 0 0 1 1 0 0 2 44 to 49 6 1 0 9 0 0 16 50 to 54 14 4 2 17 0 0 38 55 to 59 23 8 5 26 0 0 62 60 to 64 31 5 10 17 0 0 63 65 to 69 4 0 1 6 0 0 11 70 and Over 1 0 1 1 0 0 3 Totals: 87 20 20 85 0 0 213 Emp & 1 Dep Medical: Male Female Male Female Male Female Total Age Category Emp Emp Spouse Spouse Dep Dep Medical 0 to 29 1 3 0 0 14 16 34 30to34 3 1 0 0 1 0 5 35 to 39 3 2 0 0 0 0 5 40 to 44 1 1 0 0 0 0 2 44 to 49 2 3 0 0 0 0 5 50 to 54 1 2 0 0 0 0 3 55 to 59 5 2 0 0 0 0 7 60 to 64 0 1 0 0 0 0 1 Totals 16 15 0 0 15 16 62 Emp & Children Medical: Male Female Mate Female Male Female Total Age Category Emp Emp Spouse Spouse Dep Dep Medical 0 to 29 0 3 0 0 35 59 97 30to34 1 0 0 0 0 0 1 35 to 39 4 3 0 0 0 0 7 40 to 44 5 6 0 0 0 0 11 44 to 49 7 1 0 0 0 0 8 50 to 54 4 3 0 0 0 0 7 55 to 59 2 1 0 0 0 0 3 Totals: 23 17 0 0 35 59 134 Totals: Medical Male Female Male Female Male Female Total Age Category Emp Emp Spouse Spouse Dep Dep Medical 0 to 29 32 16 2 24 367 357 798 30 to 34 53 16 5 37 1 0 112 35 to 39 75 24 8 58 0 0 165 40 to 44 66 33 8 47 0 0 154 44 to 49 64 28 11 45 0 0 149 50 to 54 67 32 11 35 0 0 146 55 to 59 87 31 9 34 0 0 161 60 to 64 81 53 13 18 0 0 165 65 to 69 13 6 2 7 0 0 28 70 and Over 5 2 1 1 0 0 9 Totals: 543 241 70 306 368 357 1,887 Version 1.0.0 Run Date: 8/14/2012 7:06:07 PM Page 2 of 2