HomeMy WebLinkAboutStop Loss Accounting 01-02Stewart C. Miller & Co., Inc.
Janua~ 15,2003
Ms. Cissy Ellis
City of Jeffersonville
City-County Building
501 East Court Avenue
Jeffersonville, IN 47130
Dear Cissy:
Enclosed is the y~ar-end Stop Loss accounting for the policy year April 1, 2001 to March
31, 2002. Recall the Stop Loss carrier is Union Labor Life Insurance Co. (ULLICO).
Should you have any questions concerning the completion of Schedule A (Form 5500),
please contact Jackie Christian of ULLICO at 202-682-6654.
Kind regards,
Sherri ~lamison
Marketing & Commumcations Supervisor
Enclosure
cc: Culpepper Group
Benefit Administrators
3440 Kossuth Street
Post Office Box 5769
Lafayette, IN 47903-5769 '
Toll-Free (800) 552-6550
Local (765) 447-8803
FAX (765) 449-4338
www.scmiller.eom
O~her Locations:
Administrative Procedures
Merrillville, Indiana
Professional Benefit Administrators
Norton, Ohio
YEAR END ACCOUNTING REPORT
Policyholder Name: City of Ieffersonville
Policyholder Group Number: C-9486
Plan Year: April 1,2001 to March 31, 2002
SPECIFIC STOP
LOSS LEVEL: $75,000
Premium Paid: $87.852
AGGREGATE STOP LOSS
RETENTION: 125%
Premium Paid: $23,085
Conversion Premium: $0
TOTAL PREMIUM:- $110,937
FINAL AGGREGATE ATTACHMENT POINT:
MONTHLY AVERAGE NUMBER
RETENTION MONTHLY OF
CLASS F~CTOR LIVES MONTHS
M01 $263.63 90 12
C02 $738.13 161 12
TOTAL
ANNUAL
RETENTION(a)
$283,139
$1,422,377
Class Definitions _ _
MO I Single Active and Early Retirees
C02 Active and Early Retiree and their Dependents
TOTAL ANNUAL AGGREGATE RETENTION:
MINIMUM ANNUAL AGGREGATE RETENTION:
$1,705.515
$1,511,239
TOTAL PAID CLAIMS:
$1,708,821
Less reimbursement for claims in excess of
Specific Stop Less level:
$127,373
NET PAID CLAIMS: $1,581,448
(a) The To~al Ai~n-fi~il R6t~nti0n is based On the total annual lives an each billing class times the Monthly Retention
Factor of the billing class. "~