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Reinsurance |
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By Group Code Report Date: 03/08/2004
Report Period: 01/01/2004 - 12/31/2004 Contract
Group Information Summary
Coverages Included Dental, Medical, RX Aggregate Claims Paid $135,203.40
Accomodation Yes Less Aggregate Liabili $190,897.54
Specific Deductible $50,000
Spec Contract Terms 24/12 Estimated Claim Amount ($55,694.14)
Agg Contract Terms 24/12
Factors
Aggre. Counter
-----------------------------------------
Employee 325.77
EE + Spouse 878.80
EE + Children 878.80
Family 878.80
Enrollment
Ag. Count RX Medical Dental
EE EE+SP E+CHLD FAMILY EE EE+SP E+CHLD FAMILY EE EE+SP E+CHLD FAMILY EE EE+SP E+CHLD FAMILY
Month
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Jan 03 60 23 21 42 62 23 21 42 62 23 21 42 60 23 21 42
Feb 03 62 23 21 42 64 23 21 42 64 23 21 42 62 23 21 42
Total 122 46 42 84 126 46 42 84 126 46 42 84 122 46 42 84
Aggregate Liability
EE EE+SP EE+CHILD FAMILY TOTAL
Month
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Jan 04 $19,546.20 $20,212.40 $18,454.80 $36,909.60 $95,123.00
Feb 04 $20,197.74 $20,212.40 $18,454.80 $36,909.60 $95,774.54
Total $39,743.94 $40,424.80 $36,909.60 $73,819.20 $190,897.54
Aggregate Claims Paid Claims not Covered by Aggregate Total Claims Paid
Month Dental Medical RX Total Dental Medical RX Total Dental Medical RX Total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Jan 04 $6,309.70 $19,869.84 $6,003.57 $32,183.11 $22.00 $0.00 $133.01 $155.01 $6,331.70 $19,869.84 $6,136.58 $32,338.12
Feb 04 $5,279.00 $69,659.28 $7,304.62 $82,242.90 $0.00 $0.00 $179.55 $179.55 $5,279.00 $69,659.28 $7,484.17 $82,422.45
Mar 04 $5,239.80 $11,481.24 $4,056.35 $20,777.39 $0.00 $0.00 $85.50 $85.50 $5,239.80 $11,481.24 $4,141.85 $20,862.89
Apr 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
May 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Jun 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Jul 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Aug 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Sep 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Oct 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Nov 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Dec 04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Total $16,828.50 $101,010.36 $17,364.54 $135,203.40 $22.00 $0.00 $398.06 $420.06 $16,850.50 $101,010.36 $17,762.60 $135,623.46
Reinsurance
Requestor: ReportCaster
Report Date: 03/08/2004
Sort fields: Selected values:
Group: 99999
Reinsurance Code: 99999
PLAN: Combined
LOCATION: Combined
Benefit Types(s): D, M, P
Date: CONT
Report Period: 01/01/2004 - 12/31/2004
Contract AS of Date: 02/29/2004