Page 1 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
Dec-12 DHMO ALL-ALL COVERED MEMBERS $19,072 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 24 47
30002-IBT 500 (HDQT) $0 7 13
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 19
30006-UTU (RRD) $0 42 115
30007-BMWE (RRD) $0 23 53
30008-BLE (RRD) $0 33 97
30009-POLICE FOTP (HDQT) $0 11 33
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 4
30012-TWU 2013 (RRD) $0 42 97
30013-BRC (RRD) $0 3 6
30014-MGMT (CTD) $0 22 52
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 25 65
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 3 6
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $19,072 293 704
Dec-2012 Total $19,072 293 704
Jan-13 DHMO ALL-ALL COVERED MEMBERS $17,976 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 25 48
30002-IBT 500 (HDQT) $0 7 13
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 19
30006-UTU (RRD) $0 41 111
30007-BMWE (RRD) $0 23 53
Page 2 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30008-BLE (RRD) $0 33 97
30009-POLICE FOTP (HDQT) $0 11 33
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 4
30012-TWU 2013 (RRD) $0 40 90
30013-BRC (RRD) $0 3 6
30014-MGMT (CTD) $0 22 51
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 25 64
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 4 8
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 2 2
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,976 294 696
Jan-2013 Total $17,976 294 696
Feb-13 DHMO ALL-ALL COVERED MEMBERS $19,544 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 25 48
30002-IBT 500 (HDQT) $0 7 13
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 19
30006-UTU (RRD) $0 41 113
30007-BMWE (RRD) $0 23 52
30008-BLE (RRD) $0 33 96
30009-POLICE FOTP (HDQT) $0 11 34
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 90
30013-BRC (RRD) $0 3 6
30014-MGMT (CTD) $0 22 48
Page 3 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 25 64
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 4 7
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 3 3
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $19,544 295 693
Feb-2013 Total $19,544 295 693
Mar-13 DHMO ALL-ALL COVERED MEMBERS $17,301 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 25 48
30002-IBT 500 (HDQT) $0 6 11
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 19
30006-UTU (RRD) $0 41 114
30007-BMWE (RRD) $0 23 54
30008-BLE (RRD) $0 33 96
30009-POLICE FOTP (HDQT) $0 11 34
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 90
30013-BRC (RRD) $0 3 6
30014-MGMT (CTD) $0 22 48
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 25 64
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 3 6
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 3 3
Page 4 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
81022-COBRA $0 1 1
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,301 294 694
Mar-2013 Total $17,301 294 694
Apr-13 DHMO ALL-ALL COVERED MEMBERS $17,987 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 25 48
30002-IBT 500 (HDQT) $0 6 11
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 19
30006-UTU (RRD) $0 41 113
30007-BMWE (RRD) $0 23 54
30008-BLE (RRD) $0 32 92
30009-POLICE FOTP (HDQT) $0 11 33
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 90
30013-BRC (RRD) $0 3 6
30014-MGMT (CTD) $0 22 48
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 25 64
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 3 6
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 1 1
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 1 2
81022-COBRA $0 1 1
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,987 292 688
Apr-2013 Total $17,987 292 688
Page 5 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
May-13 DHMO ALL-ALL COVERED MEMBERS $17,741 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 25 48
30002-IBT 500 (HDQT) $0 6 11
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 20
30006-UTU (RRD) $0 41 112
30007-BMWE (RRD) $0 23 53
30008-BLE (RRD) $0 32 92
30009-POLICE FOTP (HDQT) $0 11 33
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 39 89
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 22 48
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 9
30018-IBEW (RRD) $0 25 64
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 3 6
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 2 2
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,741 290 684
May-2013 Total $17,741 290 684
Jun-13 DHMO ALL-ALL COVERED MEMBERS $17,802 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 25 47
30002-IBT 500 (HDQT) $0 6 11
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 20
Page 6 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30006-UTU (RRD) $0 41 111
30007-BMWE (RRD) $0 23 53
30008-BLE (RRD) $0 32 92
30009-POLICE FOTP (HDQT) $0 11 33
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 89
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 22 47
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 9
30018-IBEW (RRD) $0 25 64
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 3 6
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 2 2
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,802 291 681
Jun-2013 Total $17,802 291 681
Jul-13 DHMO ALL-ALL COVERED MEMBERS $17,679 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 23 43
30002-IBT 500 (HDQT) $0 6 11
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 20
30006-UTU (RRD) $0 40 109
30007-BMWE (RRD) $0 23 53
30008-BLE (RRD) $0 32 92
30009-POLICE FOTP (HDQT) $0 11 33
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 90
Page 7 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 21 45
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 9
30018-IBEW (RRD) $0 24 61
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 1 1
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 2 4
81022-COBRA $0 1 1
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,679 287 673
Jul-2013 Total $17,679 287 673
Aug-13 DHMO ALL-ALL COVERED MEMBERS $17,433 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 23 43
30002-IBT 500 (HDQT) $0 7 12
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 40 107
30007-BMWE (RRD) $0 22 50
30008-BLE (RRD) $0 32 91
30009-POLICE FOTP (HDQT) $0 11 33
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 89
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 20 44
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 9
Page 8 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30018-IBEW (RRD) $0 24 61
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
30024-UTU 1594 (VICTORY) $0 5 9
81022-COBRA $0 1 1
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,433 283 658
Aug-2013 Total $17,433 283 658
Sep-13 DHMO ALL-ALL COVERED MEMBERS $17,433 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 53
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 6 10
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 41 108
30007-BMWE (RRD) $0 22 47
30008-BLE (RRD) $0 32 86
30009-POLICE FOTP (HDQT) $0 11 32
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 86
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 21 48
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 23 58
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 1 1
81022-COBRA $0 1 1
81024-UTU 1594 (VICTORY) $0 1 2
Page 9 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
PRODUCT TYPE Total $17,433 284 640
Sep-2013 Total $17,433 284 640
Oct-13 DHMO ALL-ALL COVERED MEMBERS $17,433 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 55
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 6 10
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 41 111
30007-BMWE (RRD) $0 22 48
30008-BLE (RRD) $0 32 88
30009-POLICE FOTP (HDQT) $0 11 31
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 87
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 20 44
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 23 58
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 1 1
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 2 4
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,433 284 647
Oct-2013 Total $17,433 284 647
Nov-13 DHMO ALL-ALL COVERED MEMBERS $17,310 0 0
Page 10 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30000-MGMT-FREQ = 2 (RRD) $0 25 56
30001-MGMT (HDQT) $0 22 38
30002-IBT 500 (HDQT) $0 6 10
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 41 111
30007-BMWE (RRD) $0 22 48
30008-BLE (RRD) $0 32 88
30009-POLICE FOTP (HDQT) $0 11 30
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 40 86
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 40
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 23 58
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
30024-UTU 1594 (VICTORY) $0 5 9
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 2 3
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,310 281 641
Nov-2013 Total $17,310 281 641
Dec-13 DHMO ALL-ALL COVERED MEMBERS $18,123 0 0
30000-MGMT-FREQ = 2 (RRD) $0 24 54
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 6 10
30003-MGMT (VICTORY) $0 1 1
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 39 103
Page 11 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30007-BMWE (RRD) $0 22 48
30008-BLE (RRD) $0 32 88
30009-POLICE FOTP (HDQT) $0 11 30
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 38 82
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 40
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 11
30018-IBEW (RRD) $0 23 58
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
30024-UTU 1594 (VICTORY) $0 5 9
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 1 1
81024-UTU 1594 (VICTORY) $0 1 1
PRODUCT TYPE Total $18,123 275 623
Dec-2013 Total $18,123 275 623
Jan-14 DHMO ALL-ALL COVERED MEMBERS $17,859 0 0
30000-MGMT-FREQ = 2 (RRD) $0 23 53
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 39 103
30007-BMWE (RRD) $0 22 48
30008-BLE (RRD) $0 32 88
30009-POLICE FOTP (HDQT) $0 10 27
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 39 86
30013-BRC (RRD) $0 3 7
Page 12 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30014-MGMT (CTD) $0 18 40
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 11
30018-IBEW (RRD) $0 23 58
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
30024-UTU 1594 (VICTORY) $0 5 9
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 1 1
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,859 272 621
Jan-2014 Total $17,859 272 621
Feb-14 DHMO ALL-ALL COVERED MEMBERS $17,793 0 0
30000-MGMT-FREQ = 2 (RRD) $0 23 53
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 39 102
30007-BMWE (RRD) $0 22 48
30008-BLE (RRD) $0 32 88
30009-POLICE FOTP (HDQT) $0 9 25
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 38 85
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 40
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 11
30018-IBEW (RRD) $0 23 60
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 2 4
Page 13 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30024-UTU 1594 (VICTORY) $0 5 9
81020-SMWIA,BRC,UTUB,BLE, BRS, TCU, IAMAW,TWU 2013 (COBR $0 1 2
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,793 270 620
Feb-2014 Total $17,793 270 620
Mar-14 DHMO ALL-ALL COVERED MEMBERS $17,661 0 0
30000-MGMT-FREQ = 2 (RRD) $0 23 53
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 39 102
30007-BMWE (RRD) $0 22 49
30008-BLE (RRD) $0 32 88
30009-POLICE FOTP (HDQT) $0 9 25
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 38 84
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 40
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 23 60
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 1 2
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,661 268 617
Mar-2014 Total $17,661 268 617
Apr-14 DHMO ALL-ALL COVERED MEMBERS $17,661 0 0
Page 14 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30000-MGMT-FREQ = 2 (RRD) $0 25 56
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 10 17
30006-UTU (RRD) $0 38 100
30007-BMWE (RRD) $0 22 49
30008-BLE (RRD) $0 31 87
30009-POLICE FOTP (HDQT) $0 9 25
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 38 84
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 39
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 23 60
30019-UTU 1594 (COBRA) $0 1 1
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 1 2
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,661 268 616
Apr-2014 Total $17,661 268 616
May-14 DHMO ALL-ALL COVERED MEMBERS $17,266 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 56
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 36 94
30007-BMWE (RRD) $0 22 49
30008-BLE (RRD) $0 31 85
30009-POLICE FOTP (HDQT) $0 9 25
Page 15 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 37 83
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 39
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 23 60
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 1 2
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,266 263 604
May-2014 Total $17,266 263 604
Jun-14 DHMO ALL-ALL COVERED MEMBERS $17,266 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 60
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 36 94
30007-BMWE (RRD) $0 22 47
30008-BLE (RRD) $0 31 86
30009-POLICE FOTP (HDQT) $0 9 25
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 37 83
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 39
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 22 55
Page 16 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30024-UTU 1594 (VICTORY) $0 5 9
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 1 2
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,266 262 602
Jun-2014 Total $17,266 262 602
Jul-14 DHMO ALL-ALL COVERED MEMBERS $17,200 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 61
30001-MGMT (HDQT) $0 21 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 36 94
30007-BMWE (RRD) $0 22 47
30008-BLE (RRD) $0 31 86
30009-POLICE FOTP (HDQT) $0 9 25
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 37 83
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 39
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 22 55
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,200 261 602
Jul-2014 Total $17,200 261 602
Aug-14 DHMO ALL-ALL COVERED MEMBERS $17,134 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 61
30001-MGMT (HDQT) $0 21 36
Page 17 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 36 93
30007-BMWE (RRD) $0 22 47
30008-BLE (RRD) $0 31 86
30009-POLICE FOTP (HDQT) $0 9 25
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 37 84
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 39
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 2
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 21 53
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,134 260 600
Aug-2014 Total $17,134 260 600
Sep-14 DHMO ALL-ALL COVERED MEMBERS $17,200 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 60
30001-MGMT (HDQT) $0 21 34
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 36 92
30007-BMWE (RRD) $0 22 46
30008-BLE (RRD) $0 31 85
30009-POLICE FOTP (HDQT) $0 10 26
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 36 82
30013-BRC (RRD) $0 3 7
Page 18 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30014-MGMT (CTD) $0 18 37
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 1
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 21 51
30021-SAM, POLICE, IBT 500, IBEW BMWE,(COBRA) $0 1 1
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 1
PRODUCT TYPE Total $17,200 261 588
Sep-2014 Total $17,200 261 588
Oct-14 DHMO ALL-ALL COVERED MEMBERS $17,134 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 60
30001-MGMT (HDQT) $0 21 34
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 35 89
30007-BMWE (RRD) $0 22 46
30008-BLE (RRD) $0 31 85
30009-POLICE FOTP (HDQT) $0 10 26
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 36 82
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 18 37
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 1
30017-BRS (RRD) $0 6 12
30018-IBEW (RRD) $0 21 51
30024-UTU 1594 (VICTORY) $0 5 9
81021-SAM, POLICE, IBT 500, IBEW, BMWE (COBRA) $0 1 1
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,134 260 586
Page 19 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
Oct-2014 Total $17,134 260 586
Nov-14 DHMO ALL-ALL COVERED MEMBERS $17,002 0 0
30000-MGMT-FREQ = 2 (RRD) $0 25 60
30001-MGMT (HDQT) $0 23 39
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 35 88
30007-BMWE (RRD) $0 22 47
30008-BLE (RRD) $0 31 85
30009-POLICE FOTP (HDQT) $0 9 24
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 36 82
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 17 35
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 1
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 21 51
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $17,002 258 584
Nov-2014 Total $17,002 258 584
Dec-14 DHMO ALL-ALL COVERED MEMBERS $16,739 0 0
30000-MGMT-FREQ = 2 (RRD) $0 26 62
30001-MGMT (HDQT) $0 22 37
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 35 87
30007-BMWE (RRD) $0 21 44
Page 20 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30008-BLE (RRD) $0 30 79
30009-POLICE FOTP (HDQT) $0 9 25
30010-IAMAW (RRD) $0 7 16
30011-SMWIA (RRD) $0 2 3
30012-TWU 2013 (RRD) $0 35 80
30013-BRC (RRD) $0 3 7
30014-MGMT (CTD) $0 17 36
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 1
30017-BRS (RRD) $0 5 10
30018-IBEW (RRD) $0 20 49
30024-UTU 1594 (VICTORY) $0 5 9
81024-UTU 1594 (VICTORY) $0 1 2
PRODUCT TYPE Total $16,739 254 572
Dec-2014 Total $16,739 254 572
Jan-15 DHMO ALL-ALL COVERED MEMBERS $16,975 0 0
30000-MGMT-FREQ = 2 (RRD) $0 26 62
30001-MGMT (HDQT) $0 22 37
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 35 90
30007-BMWE (RRD) $0 21 45
30008-BLE (RRD) $0 30 79
30009-POLICE FOTP (HDQT) $0 9 24
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 3 7
30012-TWU 2013 (RRD) $0 36 80
30013-BRC (RRD) $0 3 8
30014-MGMT (CTD) $0 17 36
30015-IBT 500 (CTD) $0 1 2
30016-MGMT (FRONTIER) $0 1 1
30017-BRS (RRD) $0 5 10
Page 21 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30018-IBEW (RRD) $0 19 47
30024-UTU 1594 (VICTORY) $0 5 9
PRODUCT TYPE Total $16,975 254 575
Jan-2015 Total $16,975 254 575
Feb-15 DHMO ALL-ALL COVERED MEMBERS $16,841 0 0
30000-MGMT-FREQ = 2 (RRD) $0 28 65
30001-MGMT (HDQT) $0 22 37
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
30006-UTU (RRD) $0 34 88
30007-BMWE (RRD) $0 21 45
30008-BLE (RRD) $0 29 76
30009-POLICE FOTP (HDQT) $0 9 24
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 3 7
30012-TWU 2013 (RRD) $0 36 80
30013-BRC (RRD) $0 3 8
30014-MGMT (CTD) $0 17 36
30015-IBT 500 (CTD) $0 2 4
30016-MGMT (FRONTIER) $0 1 1
30017-BRS (RRD) $0 4 8
30018-IBEW (RRD) $0 17 44
30024-UTU 1594 (VICTORY) $0 5 9
PRODUCT TYPE Total $16,841 252 570
Feb-2015 Total $16,841 252 570
Mar-15 DHMO ALL-ALL COVERED MEMBERS $16,774 0 0
30000-MGMT-FREQ = 2 (RRD) $0 28 65
30001-MGMT (HDQT) $0 22 36
30002-IBT 500 (HDQT) $0 5 8
30005-TCU (RRD) $0 9 15
Page 22 of 22
Date: 5/4/2015ADVICE Reporting System
This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.
SEPTA
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
December 2012 thru March 2015
FAT : TRADITIONAL
RAT : FULLY INSURED NON-PARTICPATING
Reported Premium: Billed Premium without fees
YTD/MONTH PRODUCT TYPE BRANCH BILLED PREMIUM TOTAL SUBS TOTAL MBRS
30006-UTU (RRD) $0 34 88
30007-BMWE (RRD) $0 21 44
30008-BLE (RRD) $0 28 74
30009-POLICE FOTP (HDQT) $0 9 24
30010-IAMAW (RRD) $0 7 15
30011-SMWIA (RRD) $0 3 7
30012-TWU 2013 (RRD) $0 36 80
30013-BRC (RRD) $0 3 8
30014-MGMT (CTD) $0 17 36
30015-IBT 500 (CTD) $0 2 3
30016-MGMT (FRONTIER) $0 1 1
30017-BRS (RRD) $0 4 8
30018-IBEW (RRD) $0 17 44
30024-UTU 1594 (VICTORY) $0 5 9
PRODUCT TYPE Total $16,774 251 565
Mar-2015 Total $16,774 251 565
Grand Total $491,338 7,657 17,644
