2025 COKC Dental Renewal.pdf

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Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Proprietary and Confidential Information of BCBSOK

Not for use or disclosure outside BCBSOK, Employer, their respective affiliated companies and third-party representatives, except with written permission of BCBSOK.

06/07/2024

Blue Cross and Blue Shield of OK, a Division of Health Care Service Corporation, a Mutual

Presented by:

Cassie Cramer

City of Oklahoma City Prospective Premium Projection for the period of

January 1, 2025 - December 31, 2025

1/1/2025 FI Dental Renewal

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Current Dental Dental Current Dental Dental

Month Claims Enrollment Month Claims Enrollment Apr-23 2,313 Apr-23 2,904

May-23 $99,377.69 2,319 May-23 $198,750.44 2,920

Jun-23 $103,791.33 2,318 Jun-23 $202,583.48 2,926

Jul-23 $100,745.96 2,324 Jul-23 $151,808.90 2,942

Aug-23 $106,036.33 2,328 Aug-23 $190,108.91 2,981

Sep-23 $90,236.06 2,345 Sep-23 $154,718.01 2,987

Oct-23 $102,790.93 2,349 Oct-23 $154,895.59 2,996

Nov-23 $92,002.01 2,351 Nov-23 $160,213.54 2,996

Dec-23 $93,503.10 2,340 Dec-23 $155,585.08 2,986

Jan-24 $104,271.21 2,245 Jan-24 $184,754.06 3,145

Feb-24 $109,219.70 2,251 Feb-24 $211,994.94 3,142

Mar-24 $106,736.26 2,254 Mar-24 $212,901.99 3,170

Apr-24 $107,972.83 Apr-24 $215,072.78

Total $1,216,683.41 27,737 Total $2,193,387.72 36,095

Cost PEPM $43.87 Cost PEPM $60.77

Prior Dental Dental Prior Dental Dental

Month Claims Enrollment Month Claims Enrollment Apr-22 2,341 Apr-22 2,786

May-22 $96,774.86 2,343 May-22 $189,799.59 2,790

Jun-22 $94,401.38 2,345 Jun-22 $164,511.89 2,796

Jul-22 $82,998.14 2,341 Jul-22 $138,214.37 2,785

Aug-22 $101,286.13 2,331 Aug-22 $169,512.23 2,778

Sep-22 $83,087.17 2,351 Sep-22 $148,592.22 2,785

Oct-22 $92,678.52 2,351 Oct-22 $151,860.30 2,789

Nov-22 $96,542.35 2,357 Nov-22 $171,509.80 2,788

Dec-22 $85,930.76 2,357 Dec-22 $158,603.34 2,795

Jan-23 $105,649.57 2,310 Jan-23 $181,887.87 2,888

Feb-23 $92,538.71 2,299 Feb-23 $175,558.00 2,875

Mar-23 $108,796.34 2,312 Mar-23 $215,248.42 2,901

Apr-23 $105,012.55 Apr-23 $173,131.89

Total $1,145,696.48 28,038 Total $2,038,429.92 33,756 Cost PEPM $40.86 Cost PEPM $60.39

Blue Cross and Blue Shield of OK, a Division of Health Care Service Corporation, a Mutual

Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Proprietary and Confidential Information of BCBSOK

Not for use or disclosure outside BCBSOK, Employer, their respective affiliated companies and third-party representatives, except with written permission of BCBSOK.

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CLAIM EXPERIENCE SUMMARY

Plan 1- Low Plan 2- High

City of Oklahoma City Prospective Premium Projection for the period of

January 1, 2025 - December 31, 2025

1/1/2025 FI Dental Renewal

1Plan 1- Low Prior Current 05/22-04/23 05/23-04/24

A Net Paid Claims $1,145,696 $1,216,683

D Exposures 28,038 27,737

E Average Claim Value (ACV) Per Employee Per Month (PEPM): E = C / D $40.86 $43.86

Annual Trend Rate 6.0% 6.0%

Trend Months (midpoint method) 32.0 20.0

F Trend Factor 16.8% 10.2%

G Trended ACV PEPM: G = E * (1 + F) $47.72 $48.33

H Historical Plan Change Adjustment 0.00% 0.00%

I Enrollment Shift Adjustment 0.00% 0.00%

J Demographic Adjustment 0.00% 0.00%

J¹ Miscellaneous Adjustment -3.80%

M Projected ACV PEPM by Period: M = G * (1 + H) * (1 + I) * (1 + J) * (1 + J¹) $47.72 $46.49

N Experience Period Weighting 0% 100%

O Blended Experience ACV PEPM $46.49

Q Credibility 100%

R Total Projected ACV PEPM: R = O * Q + P * (1 - Q) $46.49

S Projected Plan Change Adjustment 0.00%

T Total Projected ACV PEPM with Adjustments: T = R * (1 + S) $46.49

U Stop Loss Alternate Level Adjustment 1.0000

V Adjusted Projected ACV PEPM: V = T * U $46.49

W Projected Enrollment 2,253

X Number of Months in Policy Period 12

Y Projected Net Paid Claims: Y = V * W * X $1,256,904

Blue Cross and Blue Shield of OK, a Division of Health Care Service Corporation, a Mutual

Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Proprietary and Confidential Information of BCBSOK

Not for use or disclosure outside BCBSOK, Employer, their respective affiliated companies and third-party representatives, except with written permission of BCBSOK.

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CLAIM PROJECTION

DENTAL

City of Oklahoma City Prospective Premium Projection for the period of

January 1, 2025 - December 31, 2025

1/1/2025 FI Dental Renewal

2Plan 2- High Prior Current 05/22-04/23 05/23-04/24

A Net Paid Claims $2,038,430 $2,193,388

D Exposures 33,756 36,095

E Average Claim Value (ACV) Per Employee Per Month (PEPM): E = C / D $60.39 $60.77

Annual Trend Rate 6.0% 6.0%

Trend Months (midpoint method) 32.0 20.0

F Trend Factor 16.8% 10.2%

G Trended ACV PEPM: G = E * (1 + F) $70.54 $66.97

H Historical Plan Change Adjustment 0.00% 0.00%

I Enrollment Shift Adjustment 0.00% 0.00%

J Demographic Adjustment 0.00% 0.00%

J¹ Miscellaneous Adjustment -3.80%

M Projected ACV PEPM by Period: M = G * (1 + H) * (1 + I) * (1 + J) * (1 + J¹) $70.54 $64.43

N Experience Period Weighting 0% 100%

O Blended Experience ACV PEPM $64.43

Q Credibility 100%

R Total Projected ACV PEPM: R = O * Q + P * (1 - Q) $64.43

S Projected Plan Change Adjustment 0.00%

T Total Projected ACV PEPM with Adjustments: T = R * (1 + S) $64.43

U Stop Loss Alternate Level Adjustment 1.0000

V Adjusted Projected ACV PEPM: V = T * U $64.43

W Projected Enrollment 3,178

X Number of Months in Policy Period 12

Y Projected Net Paid Claims: Y = V * W * X $2,457,102

Blue Cross and Blue Shield of OK, a Division of Health Care Service Corporation, a Mutual

Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Proprietary and Confidential Information of BCBSOK

Not for use or disclosure outside BCBSOK, Employer, their respective affiliated companies and third-party representatives, except with written permission of BCBSOK.

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CLAIM PROJECTION

DENTAL

City of Oklahoma City Prospective Premium Projection for the period of

January 1, 2025 - December 31, 2025

1/1/2025 FI Dental Renewal

RENEWAL DPPO

Projected Enrollment

Total Projected Net Claims

Total Benefit Charges

Desired Loss Ratio (DLR)

Preliminary Premium

Required Premium

Premium at Current Rates

Required Premium/Premium at Current Rates

Blue Cross and Blue Shield of OK, a Division of Health Care Service Corporation, a Mutual

Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Proprietary and Confidential Information of BCBSOK

Not for use or disclosure outside BCBSOK, Employer, their respective affiliated companies and third-party representatives, except with written permission of BCBSOK.

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TOTAL PROJECTED COST

5,431

$3,714,006

$3,714,006

92.57%

$4,012,163

$4,012,163

$3,783,917

6.0%

City of Oklahoma City Prospective Premium Projection for the period of

January 1, 2025 - December 31, 2025

1/1/2025 FI Dental Renewal

Plan Name HCSC Primary (Enrollment) Single

Single + 1

Family

HCSC Total

Current Renewal Renewal

HCSC Primary Single $23.05 $24.43 $36.03

Single + 1 $46.13 $48.90 $72.03

Family $73.76 $78.19 $115.25

Premium at Current Rates

Rate Action

Requested Premium at Renewal Rates

Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Proprietary and Confidential Information of BCBSOK

Not for use or disclosure outside BCBSOK, Employer, their respective affiliated companies and third-party representatives, except with written permission of BCBSOK.

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6.0% 6.0%

$1,343,262 $2,667,700

Blue Cross and Blue Shield of OK, a Division of Health Care Service Corporation, a Mutual

$33.99

$67.95

$108.73

$1,267,207 $2,516,710

859 1,050

2,253 3,178

Current

Plan 1- Low Plan 2- High

956 1,444

438 684

January 1, 2025 - December 31, 2025

1/1/2025 FI Dental Renewal

RATE DEVELOPMENT

City of Oklahoma City Prospective Premium Projection for the period of

City of Oklahoma City Prospective Premium Projection for the period of

January 1, 2025 - December 31, 2025

1/1/2025 FI Dental Renewal

CONDITIONS AND CAVEATS

Notwithstanding anything in the renewal or proposal to the contrary, BCBSOK reserves the right to revise or withdraw any term herein or to change our charge for the cost of coverage (premium, fees or other amounts) at any time before or during the contract period if any local, state or federal legislation, regulation, rule or guidance (or amendment or clarification thereto) is enacted or becomes effective/implemented, which would require BCBSOK to pay, submit or forward, on its own behalf or on the Employer Group's behalf, any additional tax, surcharge, fee, or other amount (all of which may be estimated, allocated or pro-rated amounts). BCBSOK also reserves the right to change the premium rates it charges the Employer Group at any time before or during the contract period to the extent that any local, state or federal legislation, regulation, rule or guidance (or amendments or clarifications thereto) is enacted or becomes effective/implemented which results in increased projected claim costs or an increase to BCBSOK's expenses or cost of plan administration.

The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). This health coverage does meet the minimum value standard for the benefits it provides.

After the initial benefit plan design(s) is quoted, HCSC will not be providing a Minimum Value determination for any requested alternative benefit plan design(s). After you have notified HCSC of your final benefit plan design selection(s) for the upcoming policy year or renewal period, a statement indicating whether each selected benefit plan design meets/does not meet Minimum Value standards will be included in the corresponding Summary of Benefits and Coverage document(s) provided by HCSC.

Rates/fees are projected to be effective for the 12-month period beginning on the effective date indicated.

Offer assumes the contract situs will be Oklahoma.

Insured benefits must comply with applicable state mandates.

Unless otherwise indicated, proposal offers assume standard HCSC administration practices/contract provisions/reports/materials and renewal offers assume existing administration practices/contract provisions/reports/materials.

We reserve the right to revise or withdraw our offer if, at any time during the projected coverage period:

- The actual number of enrolled contracts (in total, by product, or by benefit plan), the Single/Family mix, or the Medicare/Non-Medicare mix varies by +/- 10% from our projections.

- The information upon which our projections were based (benefit levels, census/demographics, commissions, etc.) becomes outdated or inaccurate.

Commissions are included in the quoted rates/fees. Upon inquiry from employer groups, HCSC will provide information to the employer group regarding commissions and other compensation paid to the employer's agent by HCSC in connection with the employer's policy or contract with HCSC.

Employer will contribute a minimum of 25% toward the cost of coverage.

A minimum of 75% of eligible employees excluding waivers, or a minimum of 50% of eligible employees including waivers, enroll for coverage.

Offer is contingent upon Underwriting approval of any changes to the plan's eligibility definitions.

This offer expires as of the effective date indicated above.

Blue Cross and Blue Shield of OK, a Division of Health Care Service Corporation, a Mutual

Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Proprietary and Confidential Information of BCBSOK

Not for use or disclosure outside BCBSOK, Employer, their respective affiliated companies and third-party representatives, except with written permission of BCBSOK.

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