1. West Valley Mission Community College District
March 9, 2010

2. PPO Claim Report West Valley Mission Community College District
Blue Shield PPO
Rolling 12 Month Period: February 1, January 31, 2010
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
12 Month Total
Enrollment
Total Employees
736
734
733
732
728
726
725
724
8,745
Monthly Premium - Medical
$615,311
$613,650
$612,682
$611,159
$637,922
$634,430
$631,091
$630,070
$630,929
$7,491,034
Paid Claims
PPO Medical
$373,887
$564,040
$443,965
$548,245
$507,978
$592,088
$531,516
$693,569
$560,950
$545,039
$425,797
$456,965
$6,244,039
Total Medical Claims
Claims over Specific Stop Loss $0
$953,497
Total Net Paid Claims
$5,290,542
Average Claim Cost Per Employee
$508.00
$768.45
$605.68
$746.93
$693.96
$813.31
$732.12
$956.65
$774.79
$752.82
$588.12
$630.30
$604.98
Fixed Expenses
PEPM
Administration
$99.14
$72,967
$72,769
$72,670
$72,570
$72,174
$71,976
$71,877
$71,777
$866,979
Stop Loss
$52.14
$38,377
$38,273
$38,221
$38,169
$37,960
$37,856
$37,804
$37,752
$455,993
Total Fixed Expenses
$111,345
$111,042
$110,891
$110,739
$110,134
$109,832
$109,680
$109,529
$1,322,972
Total Plan Cost
$485,232
$675,082
$554,856
$659,287
$618,717
$702,222
$641,348
$803,249
$670,479
$654,568
$535,326
$566,645
$6,613,514
Gain/(Loss)
$130,079
($61,432)
$57,826
($45,637)
($7,558)
($64,300)
($6,918)
($172,158)
($40,409)
($24,498)
$94,744
$64,284
$877,520
Paid Loss Ratio
78.9%
110.0%
90.6%
107.4%
101.2%
110.1%
101.1%
127.3%
106.4%
103.9%
85.0%
89.8%
88.3%

3. Renewal Projection West Valley Mission Community College District
Blue Shield PPO
Renewal Projection for July 2010
Gross Paid Claims
$6,244,039
Pooled Claim Credit
($953,497)
Net Paid Claims
$5,290,542
Change in Reserve
$89,939
Pool Charge
$455,964
Incurred Medical Claims
$5,836,446
Total Employees
8,745
Incurred Medical Claims PEPM
$667.40
Trend Factor (14.5% for 17 months)
1.2115
Expected Medical Claims PEPM
$808.53
Retention
$99.14
Needed Premium PEPM
$907.67
Current Premium PEPM
$870.25
Percentage Increase
4.30%

4. Plan Design Option Projections
West Valley Mission Community College District
Blue Shield
Medical Plan Design Alternatives
HMO (Current Plan Design - $5 copay / 100%)
Change to $10 copay / 100%
-2.44%
Change to $10 copay / $250 per hosp admit
-4.15%
Change to $10 copay / $100 per day for hosp
-5.06%
Change to $10 copay / $200 per day for hosp
-6.43%
Change to $15 copay / $500 per hosp admit
-6.44%
Change to $20 copay / $250 per hosp admit
-6.46%
Change to $20 copay / $500 per hosp admit
-7.55%
Change to $25 copay / $500 per hosp admit
-9.09%

5. Plan Design Option Projections
West Valley Mission Community College District
Blue Shield
Medical Plan Design Alternatives
PPO (Current Plan Design - $250 ded, 100% / 80%)
Change to $0 ded in net, $500 out net, 90% / 70%, $1K/$2K/$3K in-net, $3K/$6K/$9K out net OOP
-2.93%
Change to $250 ded, 90% / 70%, $1K/$2K in-net, $3K/$6K out net OOP
-8.29%
Change to $500 ded, 90% / 70%, $2K/$4K/$6K in-net, $5K/$10K/$15K out net OOP
-14.95%
Change to $1000 ded, 90% / 70%, $3K/$6K/$9K in-net, $6K/$12K/$18K out net OOP
-21.74%

6. Plan Design Option Projections
West Valley Mission Community College District
Kaiser
Medical Plan Design Alternatives
HMO (Current Plan Design - $5 copay / 100%)
Change to $10 copay / 100%
-1.56%
Change to $10 copay / $250 per hosp admit
-2.30%
Change to $15 copay / $250 per hosp admit
-3.80%
Change to $20 copay / $250 per hosp admit
-5.30%
Change to $25 copay / $500 per hosp admit
-8.20%

7. Utilization Review
INPATIENT UTILIZATION

8. Utilization Review
OUTPATIENT UTILIZATION

9. Utilization Review
PROFESSIONAL UTILIZATION

10. Claims Analysis CLAIMS BY DIAGNOSIS
Other includes all other diagnosis codes that did not account for at least 2% of total costs.

11. Demographic Information
ENROLLMENT TIER DATA

12. Demographic Information
AGE BRACKET DATA

13. Drug Claim Report West Valley Mission Community College District
Prescription Drugs - Walgreens
Rolling 12 Month Period: March 1, February 28, 2010
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Total
Claims
Retail Claims
2,019
1,877
1,896
1,981
1,949
1,942
859
809
831
912 3
15,078
Mail Order Claims
483
543
519
532
574
295
314
349
329 1
4,422
Monthly Total Claims
2,502
2,360
2,439
2,500
2,481
2,516
1,154
1,123
1,180
1,241
19,500
Plan Cost
Retail Cost
$142,269
$135,110
$141,584
$141,762
$145,879
$151,963
$72,549
$73,904
$66,263
$77,053 $0
$72
$1,148,408
Mail Order Cost
$96,805
$107,409
$101,154
$102,830
$109,726
$113,265
$66,799
$60,584
$74,795
$65,136
$16
$898,519
Total Net Paid Claims
$239,074
$242,519
$242,738
$244,592
$255,605
$265,228
$139,348
$134,488
$141,058
$142,189
$2,046,927
Average Cost Per Claim
$95.55
$102.76
$99.52
$97.84
$103.02
$105.42
$120.75
$119.76
$119.54
$114.58
$16.00
$24.00
$104.97

14. Drug Claim Report West Valley Mission Community College District
Prescription Drugs - Envision
Rolling 12 Month Period: March 1, February 28, 2010
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Total
Claims
Retail Claims
945
1,119
988
1,173
1,889
1,759
7,873
Mail Order Claims
233
191
186
243
487
561
1,901
Monthly Total Claims
1,178
1,310
1,174
1,416
2,376
2,320
9,774
Plan Cost
Retail Cost
$59,349
$78,112
$68,818
$76,195
$168,762
$135,602
$586,838
Mail Order Cost
$46,043
$30,013
$30,761
$46,757
$94,071
$109,606
$357,251
Total Net Paid Claims $0
$105,392
$108,125
$99,579
$122,952
$262,833
$245,208
$944,089
Average Cost Per Claim
$89.47
$82.54
$84.82
$86.83
$110.62
$105.69
$96.59

15. Drug Claim Report West Valley Mission Community College District
Prescription Drugs - Combined Group
Rolling 12 Month Period: March 1, February 28, 2010
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Total
Claims
Retail Claims
2,019
1,877
1,896
1,981
1,949
1,942
1,804
1,928
1,819
2,085
1,889
1,762
22,951
Mail Order Claims
483
543
519
532
574
528
505
535
572
488
561
6,323
Monthly Total Claims
2,502
2,360
2,439
2,500
2,481
2,516
2,332
2,433
2,354
2,657
2,377
2,323
29,274
Plan Cost
Retail Cost
$142,269
$135,110
$141,584
$141,762
$145,879
$151,963
$131,898
$152,016
$135,081
$153,248
$168,762
$135,674
$1,735,246
Mail Order Cost
$96,805
$107,409
$101,154
$102,830
$109,726
$113,265
$112,842
$90,597
$105,556
$111,893
$94,087
$109,606
$1,255,770
Total Net Paid Claims
$239,074
$242,519
$242,738
$244,592
$255,605
$265,228
$244,740
$242,613
$240,637
$265,141
$262,849
$245,280
$2,991,016
Average Cost Per Claim
$95.55
$102.76
$99.52
$97.84
$103.02
$105.42
$104.95
$99.72
$102.22
$99.79
$110.58
$105.59
$102.17

16. Appendix
REPORT BACK-UP

17. Appendix

18. Appendix

19. Appendix

20. Appendix

21. Appendix