Claim Reports - Attachment 1.pdf

EMBASSY OF THE UNITED STATES OF AMERICA

Medica I/Dental/Vision Experience Reports - Experience Summary

Policy(s) 330488 Period Feb 2009 - Jun 2009 Division(s) ALL

Billed Paid Incurred Incurred Benefit Premium Claims Claims Loss Ratio

Experience Rated Coverages

Drugs

Employee $38,251 $41,642 $38,253 100.0%

Dependent $67,836 $40,962 $39,812 58.7%

Total $106,086 $82,603 $78,065 73.6%

Healthcare

Employee $22,224 $24,181 $20,000 90.0%

Dependent $43,174 $10,903 $8,926 20.7%

Total $65,398 $35,084 $28,926 44.2%

Dental

Employee $48,791 $53,306 $54,736 112.2%

Dependent $52,267 $48,249 $45,360 86.8%

Total $101,059 $101,555 $100,095 99.0%

Vision

Employee $6,373 $5,453 $4,379 68.7°h

Dependent $11,521 $5,813 $5,438 47.2/

Total $17,894 $11,266 $9,816 54.9%

Total Experience Rated Coverages $290,437 $230,509 $216,903 74.7%

Pooled Coverages

Healthcare

Employee $4,608 $0 $392 8.5 /~

Dependent $8,454 $5,731 $6,043 71.5%

Total $13,061 $5,731 $6,435 49.3%

GMA/Best Doctors

Employee $473 $0 $3 0.6% ~fl fl ~ https ://groupnet-pa.greatwestlife. comlgnlPA 1 21139193 O8ELEOIG3 8DSM9 1 0C7/GroupGnpaFi... 07/20/2009

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Total Pooled Coverages $13,534 $5,731 $6,438 47.6%

Note: Pooled claims prior to August 2006 will not be displayed.

As Quebec drug pooling is not reflected in this report prior to July 2006, GroupNet experience reports may not be consisb your renewal reports. Please refer to the Help document for details.

Date created: July20, 2009 https ://groupnet-pa.greatwestlife.comJgnJPAl2 1139193 O8ELEOIG3 8DSM9 1 0C7/GroupGnpaFi... 07/20/2009

Medical/Dental/Vision Experience Reports - Experience Summary

Policy(s) 330488 Period Feb 2008 - Jan 2009 Division(s) ALL

Billed Paid Incurred Incurred Benefit Premium Claims Claims Loss Ratio

Experience Rated Coverages

Drugs

Employee $85,715 $102,598 $101,985 119.0%

Dependent $149,480 $80,036 $79,852 53.4%

Total $235,195 $182,634 $181,837 77.3%

Healthcare

Employee $48,239 $64,015 $61,208 126.9%

Dependent $95,719 $35,935 $36,911 38.6%

Total $143,958 $99,950 $98,119 68.2%

Dental

Employee $115,886 $108,501 $107,821 93.0%

Dependent $122,131 $111,039 $112,417 92.0%

Total $238,017 $219,540 $220,238 92.5%

Vision

Employee $14,190 $20,167 $21,400 150.8%

Dependent $25,209 $14,579 $15,455 61.3%

Total $39,398 $34,746 $36,855 93.5%

Total Experience Rated Coverages $656,568 $536,870 $537,049 81.8%

Pooled Coverages

Healthcare

Employee $9,721 $0 $326 3.4%

Dependent $17,753 $32,393 $32,922 185.4%

Total $27,474 $32,393 $33,249 121.0%

GMA/Best Doctors

Employee $1,134 $0 $2 0.2% T,~I~I ~1 1~4 tfl fl ~)OI..

https ://groupnet-pa. greatwestlife. comlgniPA 1 _2 1139193 O8ELEOIG3 8DSM9 1 0C7/GroupGnpaFi... 07/20/2009

Total Pooled Coverages $28,609 $32,393 $33,251 116.2%

Note: Pooled claims prior to August 2006 will not be displayed.

As Quebec drug pooling is not reflected in this report prior to July 2006, GroupNet experience reports may not be consist your renewal reports. Please refer to the Help document for details.

https ://groupnet-pa.greatwestlife.comlgnlPAj_2 1139193 O8ELEOIG38DSM9 1 0C7/GroupGnpaFi... 07/20/2009 a

Medical/Dental/Vision Experience Reports - Experience Summary

Policy(s) 330488 Period Feb 2007 - Jan 2008 Division(s) ALL

Billed Paid Incurred Incurred Benefit Premium Claims Claims Loss Ratio

Experience Rated Coverages

Drugs

Employee $60,750 $111,743 $112,056 184.5%

Dependent $105,461 $82,786 $82,638 78.4%

Total $166,211 $194,528 $194,694 ll7.1%

Healthcare

Employee $62,016 $78,049 $81,870 132.0%

Dependent $121,828 $31,054 $31,142 25.6%

Total $183,844 $109,103 $113,013 61.5%

Dental

Employee $149,215 $114,263 $112,336 75.3%

Dependent $154,847 $99,359 $95,873 61.9%

Total $304,062 $213,623 $208,209 68.5%

Vision

Employee $20,404 $10,900 $11,694 57.3%

Dependent $35,953 $7,995 $8,438 23.5%

Total $56,357 $18,895 $20,132 35.7%

Total Experience Rated Coverages $710,473 $536,149 $536,047 75.4%

Pooled Coverages

Healthcare

Employee $8,906 $6,183 $5,197 58.4%

Dependent $16,487 $1,332 ($876) 0.0%

Total $25,393 $7,515 $4,321 17.0%

GMA/Best Doctors

Employee $1,140 $0 $0 0.0% T,.4~I ~1 lAfl ~fl ~fl fl nO!...

https ://groupnet-pa.greatwestlife.com/gnJPAl _2 1139193 O8ELEOIG3 8DSM9 1 0C7/GroupGnpaFi... 07/20/2009

Total Pooled Coverages $26,533 $7,515 $4,321 l6.3%

Note: Pooled claims prior to August 2006 will not be displayed.

As Quebec drug pooling is not reflected in this report prior to July 2006, GroupNet experience reports may not be consist your renewal reports. Please refer to the Help document for details.

https ://groupnet-pa.greatwestlife. comlgnlPA 1_2 1139193 O8ELEOIG3 8DSM9 1 0C7/GroupGnpaFi... 07/20/2009

Medical/Dental/Vision Experience Reports - Experience Summary

Policy(s) 330488 Period Feb 2006 - Jan 2007 Division(s) ALL

Billed Paid Incurred Incurred Benefit Premium Claims Claims Loss Ratio

Experience Rated Coverages

Drugs

Employee $56,944 $107,063 $107,847 189.4%

Dependent $99,881 $84,996 $86,251 86.4%

Total $156,824 $192,059 $194,098 123.8%

Healthcare

Employee $42,570 $58,945 $61,934 145.5%

Dependent $84,143 $30,609 $29,259 34.8%

Total $126,713 $89,554 $91,193 72.0%

Dental

Employee $136,727 $130,599 $132,026 96.6%

Dependent $142,310 $128,903 $131,950 92.7°h

Total $279,037 $259,502 $263,976 94.6%

Vision

Employee $16,638 $4,927 $4,821 29.0%

Dependent $29,513 $4,667 $4,713 16.0%

Total $46,152 $9,594 $9,534 20.7%

Total Experience Rated Coverages $608,726 $550,709 $558,801 91.8%

Pooled Coverages

Healthcare

Employee $12,351

Dependent $24,425

Total $36,776

GMA/Best Doctors

Employee $1,144 T,.*~I ~1 1A~ https ://groupnet-pa.greatwestlife.comlgnlPA_1_2 1139193 O8ELEOIG3 8DSM9 1 0C7/GroupGnpaFi... 07/20/2009

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Total Pooled Coverages $37,920

Note: Pooled claims prior to August 2006 will not be displayed.

As Quebec drug pooling is not reflected in this report prior to July 2006, GroupNet experience reports may not be consisb your renewal reports. Please refer to the Help document for details.

https ://groupnet-pa. greatwestlife.comlgnlPA_1 _2 1139193 O8ELEOIG3 8DSM9 1 0C7/GroupGnpaFi... 07/20/2009