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In the way of explanation, two types of stop loss reinsurance are typically used. Specific Stop Loss coverage protects the City for plan year claims on an individual which exceed a ceRain limit. In this case that limit is $75,000. If claims exceed this amount on any individual, the reinsurance company reimburses the City for those claims. Aggregate Stop Loss coverage puts a limit on the City's liability for all eligible claims in a plan year. If that limit is exceeded, the reinsurance company reimburses the City for those claims. Under a self funded arrangement, the City would hold in reserve the funds it has budgeted for its shaze of insurance costs ($2,116,800) as well as City employee contributions for dependent coverage ($456,855). Over the course of the plan yeaz, the City would pay TML $101,630 for administration (processing claims, billing, Cobra administration, etc.) and pay the reinsurance company $309,181 for both types of stop loss coverage. As TML approves and processes claims, the City pays them. In this case there would be $2,162,844 available to pay claims. Because ofthe aggregate stop loss coverage, the maximum liability For claims would be $2,689,912. This leaves the City with a potential additional liability of $527,068 in a worse case scenario. TML used an expected claims amount of $2,151,930 in calculating its rates. Claims paid through the first 8 months of the current plan yeaz are $996,512. Annualized this number would be $1,494,783. If City claims next yeaz equaled that same $1,494,783, the City would profit by $668,061. The advantages of a self funded plan are (1) The City controls its own reserves. Any reserves not used represent savings to the City. This number will be $2,162,8441ess actual claims paid. (2) Claims aze paid only as they aze presented rather than as part of fully funded premiums. (3) City retains control over benefits, appeals, and the network. (4) The City's plan is not an ERISA plan which results in some claims cost savings. (5) Employees know that their current providers are in the network. Not all local providers aze in the Humana network. Capps Insurance has indicated that Humana will attempt to recruit local providers requested by the City but there is no obligation of the provider to join the network.