Monthly package
Amera, Inc. plan
May 2026 carrier package. Monthly reporting starts at the group level and includes aggregate/spec summary, monthly experience, 50% specific detail, triggered diagnoses, specialty Rx, census, pended claims, and outstanding specific claims.
Status
Needs review
Due
Jun 5, 2026
Loss ratio
127.5%
Attachment used
102.0%
Open items
5
Aggregate contract
ClientAmera, Inc. plan
Report periodJanuary 2026 - May 2026
Policy effective01/01/2026
Policy expiration12/31/2026
MGUAmwins Group Benefits
CarrierTokio Marine HCC
Contract12/12
CoveragesMedical & Rx
Min. annual attachment point$4,968,000
EE factor$368
ES factor$690
EC factor$690
FAM factor$1,100
Specific contract
Policy effective01/01/2026
Policy expiration12/31/2026
Paid run-outthrough 03/31/2027
Contract12/12
CoveragesMedical & Rx
Specific deductible$150,000
50% spec threshold$75,000
Specific laserMember 35 / $225,000
Agg spec deductibleN/A
Agg max reimbursementUnlimited
50% specific reinsurance summary
| Member ID | Claims amount | Filed / to be filed | Spec advance | Ineligible | Reimbursement |
|---|---|---|---|---|---|
| HCC-008 | $335,000 | $185,000 | $74,000 | - | $111,000 |
| HCC-012 | $298,000 | $148,000 | $59,200 | - | $88,800 |
| HCC-019 | $267,000 | $117,000 | - | - | $117,000 |
| HCC-001 | $245,000 | $95,000 | - | - | $95,000 |
| HCC-031 | $228,000 | $78,000 | - | - | $78,000 |
| HCC-041 | $215,000 | $65,000 | - | $8,500 | $56,500 |
| HCC-047 | $189,500 | $39,500 | - | - | $39,500 |
| HCC-052 | $183,000 | $33,000 | - | - | $33,000 |
| HCC-063 | $142,000 | - | - | - | - |
| HCC-071 | $138,000 | - | - | - | - |
| HCC-023 | $125,000 | - | - | - | - |
| Total | $2,365,500 | $760,500 | $133,200 | $8,500 | $618,800 |
Aggregate reinsurance position
Contracted claims$7,650,000
Estimated advance funding$133,200
Total contracted claims$7,783,200
Less reimbursed dollars$0
Less filed / to be filed$760,500
Less spec advance dollars$133,200
Less laser difference$12,000
Less aggregating specific$0
Less monthly accommodations$0
Less ineligible dollars$8,500
Aggregate claims$7,526,500
Aggregate claims PEPM$2,737
Aggregate claims as % of expected160.8%
Aggregate claims as % of attachment102.0%
*Minimum attachment point$4,968,000