Spreadsheet: 0c387165-d6e6-4837-8967-f8b33f20e127
Sheet: Retiree Claims History by Plan

City of Carrollton
[NAME] Plan
December 2012
2012 |  | Red Plan ($500 Deductible) |  |  |  | White Plan ($1000 Deductible) |  |  |  | Blue Plan ($2500 Deductible) |  |  |  | High Dental |  |  | Low Dental
Period |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Census | Dental |  | Census | Dental
January |  | 17 | 9778.08 | 3781.26 |  | 21 | 26769.87 | 1955.72 |  |  |  |  |  | 50 | 4614.01
February |  | 16 | 15667.31 | 5916.04 |  | 22 | 11948 | 1961.04 |  |  |  |  |  | 50 | 3540.89
March |  | 17 | 12850.24 | 5428.67 |  | 22 | 3086.36 | 2672.26 |  |  |  |  |  | 51 | 273.11
April |  | 18 | 4749.51 | 5706.52 |  | 22 | 902.33 | 3205.16 |  |  |  |  |  | 51 | 1594.86
May |  | 19 | 11047.44 | 8508.62 |  | 23 | 4016.28 | 2349.37 |  |  |  |  |  | 53 | 1289.05
June |  | 18 | 32696.49 | 5581.43 |  | 22 | 12227.42 | 2556.8 |  |  |  |  |  | 53 | 795.93
July |  | 19 | 6710.17 | 6215.17 |  | 21 | 5200.2 | 2781.61 |  |  |  |  |  | 54 | 1982.95
August |  | 18 | 11471.86 | 5697.47 |  | 21 | 3536.94 | 2491.6 |  |  |  |  |  | 54 | 3370.26
September |  | 18 | 15839.64 | 6403.75 |  | 21 | 3962.96 | 1995.56 |  |  |  |  |  | 54 | 3241.3
October |  | 19 | 27739.88 | 8214.61 |  | 21 | 1899.11 | 2981.42 |  |  |  |  |  | 55 | 1944.66
November |  | 18 | 20100.63 | 8091.82 |  | 21 | 8608.98 | 2978.35 |  |  |  |  |  | 55 | 1346.57
December |  | 19 | 77258.44 | 10542.43 |  | 20 | 1688.46 | 3827.82 |  |  |  |  |  | 53 | 831.2
Total
2011 |  | Advantage Plan ($500 Deductible) |  |  |  | Basic Plan ($1000 Deductible) |  |  |  | HRA Plan ($2500 Deductible) |  |  |  | High Dental |  |  | Low Dental
Period |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Census | Dental |  | Census | Dental
January |  | 15 | 11062.81 | 2238.08 |  | 22 | 4354.42 | 3633.4 |  |  |  |  |  | 46 | 0
February |  | 15 | 5634.5 | 3215.6 |  | 23 | 14277.17 | 1900.83 |  |  |  |  |  | 48 | 3481.62
March |  | 14 | 5276.48 | 2962.73 |  | 23 | 7644.84 | 3064.02 |  |  |  |  |  | 47 | 3980.27
April |  | 15 | 3762.59 | 2484.42 |  | 24 | 5921.39 | 3564.56 |  |  |  |  |  | 49 | 1123.64
May |  | 16 | 34369.51 | 4051.87 |  | 26 | 4433.64 | 2944.29 |  |  |  |  |  | 51 | 2035.02
June |  | 16 | 12582.14 | 3857.55 |  | 26 | 22118.54 | 2599.27 |  |  |  |  |  | 52 | 3817.9
July |  | 16 | 21398.21 | 3359.81 |  | 26 | 29085.53 | 1377.25 |  |  |  |  |  | 52 | 5134.86
August |  | 16 | 47715.64 | 3749.41 |  | 26 | 34682.06 | 3620.76 |  |  |  |  |  | 52 | 1315.38
September |  | 16 | 9620.71 | 5848.05 |  | 26 | 23025.58 | 2813.84 |  |  |  |  |  | 52 | 1059.68
October |  | 16 | 2366.57 | 5503.17 |  | 26 | 34235.45 | 2710.36 |  |  |  |  |  | 52 | 421.22
November |  | 15 | 15155.12 | 5740.11 |  | 24 | 10478.71 | 4134.19 |  |  |  |  |  | 52 | 3446.19
December |  | 16 | 18312.44 | 5990.47 |  | 23 | 6598.21 | 5973.94 |  |  |  |  |  | 52 | 958.07
Total
2010 |  | Advantage Plan ($0 Deductible) |  |  |  | Basic Plan ($1000 Deductible) |  |  |  | Catastrophic Plan ($2500 Deductible) |  |  |  | High Dental |  |  | Low Dental
Period |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Census | Dental |  | Census | Dental
January |  | 23 | 65340.66 | 13629.78 |  | 12 | 10535.18 | 1508.89 |  |  |  |  |  | 40 | 2916.94 |  | 0 | 502.4
February |  | 27 | 159638.24 | 14571.7 |  | 12 | 5711.32 | 1627.05 |  |  |  |  |  | 43 | 2580.44 |  | 1 | 0
March |  | 27 | 140264.59 | 8266.86 |  | 12 | 1812.77 | 2763.55 |  |  |  |  |  | 42 | 2448.17 |  | 1 | 1157.6
April |  | 26 | 15279.2 | 13417.39 |  | 12 | 2194.49 | 3074.54 |  |  |  |  |  | 42 | 4182.96 |  | 1 | 649.6
May |  | 26 | 197947.5 | 9807.32 |  | 12 | 187.03 | 1067.16 |  |  |  |  |  | 45 | 2997.3 |  | 1 | 500
June |  | 25 | 16566.14 | 9721.84 |  | 13 | 376.75 | 4525.39 |  |  |  |  |  | 46 | 635.07 |  | 1 | 315.2
July |  | 25 | 59594.84 | 12459.67 |  | 13 | 318.29 | 2711.29 |  |  |  |  |  | 46 | 2365.47 |  | 1 | 295.29
August |  | 25 | 15948.19 | 11536.42 |  | 13 | 532.41 | 1230.04 |  |  |  |  |  | 46 | 3153.6 |  | 1 | 1114.42
September |  | 24 | 46046.78 | 10715.42 |  | 13 | 424.6 | 1400.39 |  |  |  |  |  | 45 | 1508.3 |  | 1 | 232.69
October |  | 24 | 95010.51 | 12858.84 |  | 13 | 2112.77 | 2957.48 |  |  |  |  |  | 45 | 4447 |  | 1 | 212.88
November |  | 24 | 10741.37 | 2407.56 |  | 14 | 10483.23 | 1094.58 |  |  |  |  |  | 45 | 1161.29 |  | 1 | 120
December |  | 24 | 37046.74 | 12984.35 |  | 14 | 494.91 | 802.51 |  |  |  |  |  | 45 | 2534.22 |  | 1 | 89.6
Total
2009 |  | Advantage Plan ($0 Deductible) |  |  |  | Basic Plan ($1000 Deductible) |  |  |  | Catastrophic Plan ($2500 Deductible) |  |  |  | High Dental |  |  | Low Dental
Period |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Med EE | Medical | Prescription |  | Census | Dental |  | Census | Dental
January |  | 28 | 42245.05 | 11506.79 |  | 15 | 5806.43 | 2311.89 |  |  |  |  |  | 42 | 5643.65 |  | 0 | 59.2
February |  | 28 | 64198.08 | 10759.77 |  | 15 | 539.37 | 2027.35 |  |  |  |  |  | 42 | 7235.6 |  | 0 | 481.6
March |  | 28 | 61962.92 | 13075.08 |  | 14 | 2227.44 | 1878.96 |  |  |  |  |  | 41 | 1112.4 |  | 0 | 0
April |  | 28 | 127746.31 | 10800.85 |  | 14 | 4681.61 | 3910.84 |  |  |  |  |  | 41 | 2328.31 |  | 0 | 266.4
May |  | 28 | 41673.97 | 11747.37 |  | 12 | 23773.81 | 1087.76 |  |  |  |  |  | 40 | 2911.88 |  | 0 | 145.6
June |  | 28 | 16735.19 | 14728.2 |  | 12 | 840.47 | 2094.49 |  |  |  |  |  | 40 | 536.34 |  | 0 | 200
July |  | 27 | 32563.57 | 12531.57 |  | 12 | 493.58 | 1992.69 |  |  |  |  |  | 40 | 3256.35 |  | 0 | 99.2
August |  | 27 | 63682.42 | 12439.97 |  | 12 | 1736.46 | 1933.67 |  |  |  |  |  | 40 | 734.56 |  | 0 | 548
September |  | 26 | 146894.82 | 9831.62 |  | 12 | 4131.23 | 1808.34 |  |  |  |  |  | 39 | 2146.29 |  | 0 | 73.6
October |  | 25 | 107353.42 | 9466.67 |  | 12 | 1662.88 | 683.32 |  |  |  |  |  | 40 | 2045.56 |  | 0 | 208
November |  | 25 | 102426.65 | 14922.99 |  | 12 | 1282.69 | 1647.44 |  |  |  |  |  | 40 | 2132.8 |  | 0 | 0
December |  | 25 | 210488.06 | 8388.85 |  | 12 | 5256.83 | 3985.21 |  |  |  |  |  | 40 | 1266.95 |  | 0 | 85.6
Total