HomeMy WebLinkAboutDelta Dental-6/6/2016 City of Waterloo
d DELTA DENTAL Group#92179
Rating Period 7/1/16 through 6/30/17
Financial Exhibit •
Delta Dental PPOSM
Current Enrollment
Experience Period Claims Paid 1/1/15 through 12/31/15 Single Family
144 503
Claims Paid 1/1/15 through 12/31/15 $490,198
Adjustment of Claims to Incurred Basis $15,161
Incurred Claims $505,359 Projected Claim Factors 7/1/15 through 6/30/16
Trend in Claims $30,625 Single Family,
Projected Claims Based on Current Experience $535,984 $24.27 $77.15
Claims and Enrollment Fluctuation Adjustment ($28,368)
Projected Annual Claims Based on Current Enrollment $507,616
Fixed Fees Per Contract
Operating Costs $3.92 $30,435 Fixed Fees
Network Access Fee $0.25 $1,941 Cost Per Contract
Broker Fee $0.00 $0 Current Renewal
$4.02 $4.17
Subtotal Fixed Fees $4.17 $32,376 Suggested Rates 7/1/15 through 6/30/16
Single Family
$25.82 $82.07
Projected Annual Expense $539,992
I acknowledge acceptance of this renewal at the rates shown above.
Percent of Premium Contributed by Employer: Single % Family %
Total Employees nrolled: Total Employees Eligible:
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Signature of roup Administrator E-Mail A dress Date
Please sign add return to fax#888-337-5157
DELTA DENTAL OF IOWA