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The Lakeside Health Plan

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Overview The first 6 months of the Lakeside Health Plan’s costs have run above both the prior year’s spend and expected budget. An increase in unforeseen large claimant activity from dependents is contributing to this overestimated spend. Although this year’s plan spend through the first 6 months is higher than anticipated, the past several years for the Lakeside plan saw reduced cost and surpluses to budget. For the 2014/2015 plan year, the Lakeside Health Plan budgeted an $11,879 PEPY cost. The year finished at $11,236 PEPY or $132,236 below budget. Medical claims were -3.1% below the prior year, and RX spend was a 14.1% increase; changes were made to the 2015/2016 plan year to counter the increased drug spend. The plan saw large reductions in large claimant spend due to both stop loss negotiations resulting in the removal of lasers and DialysisPPO. During the 2013/2014 plan year, the health plan total cost ended almost 25% below the expected budget. Net paid claims were down -7.4% or $447,827 over the budget. On a PEPY basis, Lakeside had budgeted a $14,995 net cost per employee. The plan year ended at an $11,301 PEPY cost or $676,350 below the expected total cost. This was largely due to a large claimant with $250,000 exposure in the form of a laser coming off the plan with only $46k in claims. Stop loss reimbursements dropped 35%, which helped to secure a 3% total renewal. Lakeside also heavily invested in the plan, implementing both Healics’ coaching, increased

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