Laserfiche WebLink
<br />Attachment A Schedule <br /> <br />Cass County Personnel <br /> <br />Contract Period: January 1. 2008 through December 31, 2008 <br /> <br />Paid Claims Basis <br /> <br />Stop-Loss Insurance coverages are based on Plan Benefits incurred In the period January 1, 1984 through <br />December 31 , 2008 and paid during the Contract Period. Individual Stop-Loss Attachment Point is $65,000 per <br />Member and the Aggregate Stop-Loss Attachment is 120% of expected Plan Benefits paid during the Contract <br />Period. <br /> <br />1. Expected monthly enrollment levels: <br /> <br />Single: <br />Single Plus Dependent: <br />Family: <br /> <br />SO 100 8"()7 <br />166 Contracts <br />76 Contracts <br />108 Contracts <br /> <br />SC 100 OOA 8-07 <br />1 Contracts <br />o Contracts <br />2 Contracts <br /> <br />DSC 225 <br />193 Contracts <br /> <br />117 Contracts <br /> <br />2. Aggregate Stop-Loss Attachment Point per Subscriber: (x 12 for Contract Period) <br /> <br />Single: $355.16 $366.88 <br />Single Plus Dependent: 625.09 645.72 <br />Family: 923.43 953.90 <br /> <br />$52.80 <br /> <br />137.70 <br /> <br />3. Aggregate Stop-Loss Attachment Point. maximum administrative fees (net of BlueCar~ fees and compensation) <br />and conversion coverage costs per Contract Period based on the figures shown in Section 1 and 2 above. <br /> <br />Aggregate Stop-Loss Attachment Point: <br />Maximum administrative fees and conversion coverage costs: <br /> <br />$2,817,238 <br />$194,389 (6.9% of Claims) <br /> <br />4. Monthly premium for stop-loss coverage (aggregate and individual): <br /> <br />Single: $43.98 <br />Single Plus Dependent: 77.38 <br />Family: 114.32 <br /> <br />$43.98 <br />77.38 <br />114.32 <br /> <br />5. Summary of estimated Maximum Contract Period Cost at enrollment levels in Section 1 above: <br /> <br />Aggregate Stop-Loss Attachment Point: <br />Maximum administrative fees and conversion coverage costs: <br />Stop-Loss coverage premium: <br /> <br />Total Maximum Cost <br /> <br />$2,817,238 <br />194,389 . <br />309,609 <br /> <br />$3,321,236 <br /> <br />In addition to the total maximum cost, applicable BlueCardilll fees and compensation will apply. <br /> <br />The parties have caused this Agreement to be executed by their respective authorized officers. <br /> <br />CASS COUNTY PERSONNEL <br />Box 2806 <br />Fargo, North Dakota 58108 <br /> <br />BLUE CROSS BLUE SHIELD <br />OF NORTH DAKOTA <br />4510 13th Avenue S <br />Fargo, North Dakota 58121-0001 <br /> <br />By: ~\\'^"",u=9'"I ...., ~ ~\Ji.. <br />Vice President, Actuarial <br />Title: and Membership Services <br /> <br />By: <br /> <br />Title: ~'(fY)a)\ \ ~ CvlLrtty Gmm;CS\on <br /> <br />Date: <br />RX: Creditable <br />Group Numbers: 10033 <br /> <br />Date: <br /> <br />'8... l"4 ... o~ <br />Includes all 2007 Rewrite <br />