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ImportantRateSheetDetails <br />FixedCosts <br />Thesearecomponentsofyourgroup'sTotalBilledRate,disclosedforthepurposeoftransparentreportingandaccounting.Alladditionalcomponentsofyourrates <br />areestimatedbypoolmanagement,andincludeexpectedclaimsandqualityimprovementprogramcosts.Thevarianceinactualvsexpectedclaimsimpactspool <br />reserves,andisariskmanagedforthebenefitofallpoolmembers,asdescribedintheJointPowersAgreementandreviewedindetailduringeachAnnualMeeting <br />ofpoolmembers. <br />SpecificStopAggregateHPAdminBrokerServices <br />LossPremiumStopLossFeesFeeTotalFixedCosts <br />$36.70$1.41$13.99$18.04$70.14 <br />Single <br />Family$96.48$3.78$34.74$18.04$153.04 <br />StopLossInsurance <br />Theseprovisionsareinplacetoprotectthepool'sabilitytoprovidemembergroupsriskfreepremiumequivalentsasatotalbilledrate. <br />*12/18(claimsincurred1/1/2022through12/31/22andpaidthrough6/30/2023) <br />*$250,000SpecificDeductibleperMember,UnlimitedLifetimeMaximum <br />*AggregateAttachmentPoint110%ofExpectedClaims <br />HealthPartnersAdministration <br />ThirdPartyAdministrativeServices,ProviderNetwork,PharmacyBenefitManagement,Case&DiseaseManagement,EmployeeAssistanceProgram,andStopLoss <br />InsuranceservicesprovidedtothepoolbyHealthPartnersAdministrators,Inc. <br />BrokerServices <br />Sourcewelldoesnotprovidecertainservicesthatareprovidedbybrokers,agents,andbenefitsconsultants,asdetailedonour"BrokerAcknowledgement"form. <br />Anyservicesprovidedbyabrokertothegrouparetobenegotiatedbythegroupandthebroker,thetermsforwhicharenotmaintainedbySourcewell,withthe <br />exceptionofanyamountofcommissionrequestedbyyourgroup,whichwe'velistedinthefixedcostsummary,aspartoftheTotalBilledRates,andwilladminister <br />onyourbehalf. <br />ActuarialValue <br />Actuarialvalues(AV's)approximatethepercentageofclaimsthatareexpectedtobepaidbytheplanforagivenpopulation,basedonapplyingthescheduled <br />benefitsagainsttheclaimsexperienceofalargenationalpopulation.AV'sarecalculatedusingthemostrecentlyavailableACAAVcalculatorfromtheCentersfor <br />MedicareandMedicaidServices(CMS).ActuarialvaluewillincreasesignificantlywithevenmodestamountsofemployercontributionstoHSAs,HRAs,orVEBAs,and <br />thusareveryhelpfulforgroupsreviewingwaystoimpactplandesignwithoutsacrificingplanvalue. <br />Wellness <br />Populationhealthmanagementandwellnessprogramshavebeenputinplacebythepoolforthebenefitofpoolgroupmembers,tohelpimprovehealthplan <br />qualityandpositivelyimpactlongtermhealthoutcomes.Detailsoftheseprograms,thevendorsinvolved,andthevalueoftheseprogramsareexplainedonour <br />"UnderstandingtheValue"disclosure,whichwasdeliveredtoyoualongwiththisratesheet. <br />Contingencies <br />QuoteiscontingentuponreviewandapprovaloftheUnderwritingRequirementsandProvisionsandSourcewellBoardApproval. <br />AnyrenewalrateincreasecapsinthisproposalarenullandvoidifyourgroupdecidestoconducttheirownRFPprocessratherthanbenefitfromourpool's"Better <br />Together"renewalprocess. <br />RatesassumecompliancewithallSourcewellProvisions(seeenclosed).Forexample,cashinlieuofwaiverscannotexceed50%ofthelowestcostƦƌğƓ͸ƭsingle <br />premium. <br />