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Actuarial Valuation under GASB 43/45 <br />Data Request, continued <br />Claims Cost Information <br />Three Years of Monthly Claims Experience -split by Actives, Pre-65 Retirees, Post-65 <br />Retirees and by Medical, Dental, and Prescription Drugs. <br />List of Large Claims for the last three years (over $30,000). <br />Three Years of Monthly Enrollment by Coverage Tier, split by Plan Option, that <br />corresponds to the Claims Experience. <br />Other Health Plan Information <br />Retiree Rates and Retiree Participant Contributions (Medical and Dental) for the current <br />and the past three years -split by active, Pre and Post-65. <br />Employee Group Contracts and/or Summary Plan Descriptions for all health care <br />benefits, split by active, Pre-65 and Post-65, if plan designs are different. Identify plan <br />changes over the last three years and for the current year. <br />Retiree Medical Plan Document- including eligibility requirements. <br />Underwriting Exhibits for the current and past two years for Actives, Pre~5 Retirees, <br />and Post-65 Retirees. <br />Medicare Part Ddirection/decision. <br />Plan Asset Information <br />Funding Vehicle materials to be used for the OPEBs, if any. <br />Hildi Incorporated 12 <br />