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Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. No. 34GL-18-2220.
Doc. N
o. 34GL-18-2220.
Doc. N
o. 34GL-18-2220.
Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 May-2018 Jun-2018
Network Expenses $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
FHP Expenses $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Network Expenses $1,389.36 $3,154.89 $5,213.14 $1,259.51 $2,860.97 $1,528.55 $1,674.74
FHP Expenses $0.00 $91.86 $0.00 $0.00 $0.00 $33.96 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$1,389.36 $3,246.75 $5,213.14 $1,259.51 $2,860.97 $1,562.51 $1,674.74
Network Expenses $0.00 $50.00 $275.42 $482.61 $1,046.77 $1,237.82 $562.84
FHP Expenses $0.00 $241.22 $70.59 $373.83 $664.45 $0.00 $0.00
$1,039.77 $1,884.64 $5,645.52 $1,729.20 $2,855.65 $2,531.63 $1,675.18
Formulary Brand $610.25 $861.90 $4,497.53 $1,222.21 $1,335.51 $1,886.81 $274.13
Formulary Generic $429.52 $296.03 $757.85 $506.99 $783.75 $644.82 $1,401.05
Non-Formulary $0.00 $0.00 $390.14 $0.00 $0.00 $0.00 $0.00
Specialty $0.00 $726.71 $0.00 $0.00 $736.39 $0.00 $0.00
$1,039.77 $2,175.86 $5,991.53 $2,585.64 $4,566.87 $3,769.45 $2,238.02
Network Expenses $41,640.43 $40,483.84 $22,942.88 $18,666.39 $56,200.98 $51,404.61 $40,122.32
FHP Expenses $14,743.59 $13,365.66 $12,981.18 $5,466.97 $53,173.83 $16,721.13 $10,653.18
$2,175.60 $1,822.09 $1,341.41 $596.10 $670.99 $451.13 $649.80
Formulary Brand $1,542.98 $962.02 $556.62 $402.94 $402.94 $152.08 $403.21
Formulary Generic $632.62 $813.19 $730.05 $141.79 $207.32 $248.89 $196.43
Non-Formulary $0.00 $46.88 $54.74 $51.37 $60.73 $50.16 $50.16
$58,559.62 $55,671.59 $37,265.47 $24,729.46 $110,045.80 $68,576.87 $51,425.30
Network Expenses $286,249.49 $146,874.99 $219,973.70 $273,999.03 $620,409.94 $387,939.00 $501,584.07
FHP Expenses $117,798.93 $75,699.84 $134,201.59 $130,388.07 $882,828.46 $293,228.98 $206,407.32
$96,417.28 $111,781.08 $101,721.99 $109,731.48 $160,318.86 $178,076.06 $121,597.42
Formulary Brand $61,962.08 $68,050.70 $58,938.75 $54,306.18 $94,015.70 $102,280.22 $82,589.28
Formulary Generic $29,103.66 $27,719.76 $31,007.97 $33,906.18 $38,562.65 $30,732.49 $30,981.71
Non-Formulary $2,002.52 $3,658.82 $6,016.27 $14,975.13 $16,962.68 $21,971.02 $2,961.59
Specialty $3,349.02 $12,351.80 $5,759.00 $6,543.99 $10,777.83 $23,092.33 $5,064.84
$500,465.70 $334,355.91 $455,897.28 $514,118.58 $1,663,557.26 $859,244.04 $829,588.81
Network Expenses $33,486.88 $31,632.30 $116,199.93 $60,174.15 $123,746.13 $127,158.96 $53,132.26
FHP Expenses $80,583.27 $43,679.17 $50,898.23 $35,260.76 $57,219.93 $36,513.40 $29,165.44
Formulary Generic $0.00 ($5.09) $8.49 $0.00 $0.00 $0.00 $0.00
$114,070.15 $75,311.47 $167,098.16 $95,434.91 $180,966.06 $163,672.36 $82,297.70Total Expenses $69,051.33 $118,676.36
$49,435.80 $65,710.83
$19,615.53 $52,965.53
$0.00 $0.00
DENTAL
Medical Expenses
$2,324.69 $3,147.85
$11,019.87 $6,539.31
Total Expenses $526,650.94 $939,227.94
RX Expenses $89,272.87 $104,058.81
$49,826.91 $65,631.70
$26,101.40 $28,739.95
Medical Expenses
$223,260.44 $530,524.52
$214,117.63 $304,644.61
Total Expenses $332,253.71 $31,855.92
PPO
$578.18 $389.10
$757.13 $212.18
$64.64 $796.69
$306,782.36 $15,346.74
$24,071.40 $15,111.21
RX Expenses $1,399.95 $1,397.97
HSA
Medical Expenses
$0.00 $0.00
$0.00 $736.39
Total Expenses $4,304.01 $4,561.37
RX Expenses $4,304.01 $3,712.92
$3,952.63 $1,331.25
$351.38 $1,645.28
Medical Expenses
$0.00 $470.59
$0.00 $377.86
Total Expenses $1,807.01 $9,746.75
GGRSUP03
$1,807.01 $9,684.99
$0.00 $61.76
RX Expenses $0.00 $0.00
GGRSUP02
Medical Expenses
RX Expenses $0.00 $0.00
Total Expenses $76.37 $0.00
Medical Expenses
$76.37 $0.00
$0.00 $0.00
TakeCare Insurance CompanyMed & RX Claims for GOVERNMENT OF GUAMPaid Date From: 10/1/2017 To 7/31/2018Print Date/Time:8/8/2018 2:34 PM
Oct-2017 Apr-2018
GGRSUP01
Copyright @ 2011 TakeCare. All rights reserved TC Confidential Page 1 of 29 Doc. No. 34GL-18-2220.*
Jul-2018 Total
$0.00 $76.37
$0.00 $0.00
$0.00 $0.00
$0.00 $76.37
$78.53 $28,651.69
$0.00 $187.57
$0.00 $0.00
$78.53 $28,839.26
$901.96 $5,028.01
$1,556.58 $3,284.53
$3,228.90 $28,607.42
$978.38 $16,950.60
$677.75 $7,494.42
$0.00 $390.14
$1,572.77 $3,772.26
$5,687.44 $36,919.96
$18,174.46 $611,765.01
$14,362.10 $180,650.24
$772.80 $11,277.84
$579.34 $5,969.41
$133.94 $4,073.54
$59.52 $1,234.89
$33,309.36 $803,693.09
$694,980.78 $3,885,795.96
$232,045.89 $2,591,361.31
$141,572.43 $1,214,548.28
$92,819.78 $730,421.30
$29,150.41 $306,006.18
$10,132.35 $84,152.92
$9,469.89 $93,967.88
$1,068,599.10 $7,691,705.55
$82,774.89 $743,452.13
$42,867.75 $448,769.03
$0.00 $3.40
$125,642.64 $1,192,221.16
Copyright @ 2011 TakeCare. All rights reserved TC Confidential Page 2 of 29 Doc. No. 34GL-18-2220.*
Total Claim Amount
$51.37
$25.00
$76.37
Total Claim Amount
$9,357.13
$5,164.05
$3,994.01
$1,361.63
$1,125.00
$1,084.88
$997.15
$767.53
$685.28
$597.61
$439.77
$419.63
$415.73
$410.91
$301.12
$265.92
$256.34
$175.00
$156.25
$140.92
$90.41
$80.72
$78.05
$74.85
$71.48
$54.29
$50.51
$39.00
$34.60
$28.70
$26.13
$20.04
$16.33
$14.68
$13.38
$11.10
$9.29
$7.96
$1.88
$28,839.26
Inpatient- EKG, X-Ray (Plain Film)
Anesthesia - Facility/OP Hosp Off-Island
ER, Injectables and other medications
Inpatient Diagnostic
Inpatient Ultrasound
Foot Care Services, Specialist
Mammogram, Diagnostic
Surgery
ER, Ambulance
GMH- URGENT CARE
Immunizations
Ultrasound, 26 Modifier
EKG, X-Ray (Plain Film)
Inpatient Surgery Physicians
Standard DME, Home Health
Injectables and other medications
Inpatient Hemodialysis - IP & OP Professional
ER Physicians
Anesthesia - OP Hospital
Surgery Facility, Hospital OP
Nuclear Medicine (radiology)
Routine Lab
Wellness Preventive Incentive
Preventive Care Services - Adult
ER Facility, Emergency
Prescriptions
Hemodialysis - Facility
Inpatient-Hospital Visit-Professional
Specialist, Diagnostic
Prosthetic Supplies/Devices/Implants, Outpatient Hospital
Facility Supplies, Hospital Outpatient
Inpatient-Hospital
Office Visit
GYM PARTNER PAYMENT (Invoice Payments)
Specialist Office Visit
Specialist, Surgery
Surgery Physicians - OP Hospital/Facility
Wellness Preventive Incentive
GGRSUP02
Service
Hemodialysis - OP Professional
Hemodialysis - IP & OP Professional
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
GGRSUP01
Service
Standard DME, Home Health
Page 3 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
Total Claim Amount
$2,229.27
$1,200.00
$785.54
$753.84
$534.26
$499.60
$406.09
$278.81
$263.81
$159.55
$152.26
$152.20
$135.89
$117.25
$113.59
$108.48
$93.91
$75.00
$69.64
$47.18
$33.71
$24.89
$22.57
$21.84
$15.86
$9.51
$4.58
$3.42
$8,312.54
Total Claim Amount
$106,073.62
$64,654.20
$56,412.12
$55,869.29
$47,954.32
$34,287.93
$34,152.96
$28,131.99
$24,627.06
$23,070.96
$21,942.74
$21,765.00
$21,381.77
$21,350.78Inpatient Routine Lab
Surgery Facility, Hospital OP
Inpatient-Maternity
Inpatient-Prescription Items
Inpatient-Hospital Visit-Professional
GYM PARTNER PAYMENT (Invoice Payments)
Inpatient Maternity-Professional
Inpatient Surgery Facility
Urgent Care, within normal business hours
Routine Lab
Preventive Care Services - Adult
Immunizations - Well Baby Care (up to 2 yrs. old)
Inpatient Diagnostic
EKG, X-Ray (Plain Film), ER, 26 Modifier
Mammogram, Diagnostic
HSA
Service
Inpatient-Hospital
Mental Health - Professional
ER Physicians
ER, Injectables and other medications
Routine Lab
Injectables and other medications
Office Visit, Inpatient
Specialist, Diagnostic
Refraction, Preventive
Lodging
Wellness Preventive Incentive
Inpatient Surgery Physicians
Foot Care Services, Specialist
Prescriptions
Hemodialysis - IP & OP Professional
Inpatient-Hospital Visit-Professional
Specialist, Surgery
Refraction
Preventive Care Services - Adult
Eye Glasses / Frames / Contact Lenses
Executive Check-Up
Specialist Office Visit
Immunizations
Airfare Travel
ER Facility, Emergency
GGRSUP03
Service
Office Visit
GYM PARTNER PAYMENT (Invoice Payments)
Page 4 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
$20,777.58
$19,835.52
$18,844.64
$13,561.66
$12,500.00
$12,252.32
$11,916.16
$11,731.36
$10,808.54
$9,722.92
$8,011.67
$7,264.30
$6,576.61
$4,463.48
$3,660.66
$3,597.09
$3,519.66
$3,478.53
$3,276.46
$3,069.89
$3,035.99
$2,881.05
$2,818.40
$2,817.51
$2,568.13
$2,083.89
$1,928.33
$1,816.34
$1,566.05
$1,562.40
$1,548.21
$1,474.17
$1,111.32
$1,003.60
$990.35
$905.00
$900.06
$841.12
$810.80
$808.18
$750.24
$696.23
$648.14
$478.56
$468.92
$467.75
$419.43
Inpatient Injectables and other medications
Inpatient Ultrasound
ER, Injectables and other medications
Refraction, Preventive
Prescription Items, Hospital OP
Inpatient Physical Therapy
Gym Membership
Inpatient Emergency Room, Admitted
Inpatient-Pacemaker
Surgery
Inpatient-Hospital, PA required
Injectables and other medications
Eye Glasses / Frames / Contact Lenses
Executive Check-Up
Mammogram, Diagnostic
Diagnostic, Hospital Outpatient
ER, CT Scan (radiology)
Well Baby Care (2 - 17 yrs old)
Treatment/Observation Room, Hospital Outpatient
Specialist, Diagnostic
Maternity - OP Professional
CT Scan (radiology)
EEG, Ultrasound
Inpatient Surgery Physicians
Inpatient- EKG, X-Ray (Plain Film)
Prosthetic Supplies/Devices/Implants, Outpatient Hospital
ER Facility, Emergency
MATERNITY PRENATAL VISITS
Specialist Office Visit
Anesthesia - IP
Anesthesia - OP Hospital
Office Visit
Contraceptive
ER Physicians
Surgery Physicians, Outpatient Hospital
Routine Lab, Hospital OP
Immunizations - Well Child Care (3 - 17yrs. old)
Well Child Care - Preventive (0 to 4 yrs old)
Facility Supplies, Hospital Outpatient
Specialist, Surgery
Well Child Care - Preventive (5 to 17 yrs old)
SCREENING MAMMOGRAM FOR WOMEN AGES 40 - 74 YEARS
Facility Supplies
Inpatient-Prosthetics Supplies/Devices/Implants/ (UB Codes only)
Surgery Physicians - OP Hospital/Facility
Immunizations
Wellness Preventive Incentive
Page 5 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
$372.68
$365.67
$351.00
$330.00
$295.80
$254.49
$202.88
$201.00
$169.72
$169.66
$165.00
$162.08
$136.29
$133.00
$131.50
$121.08
$115.38
$114.84
$113.49
$76.41
$75.72
$70.20
$56.14
$50.00
$49.49
$41.74
$39.05
$34.66
$21.34
$10.35
$9.51
$9.37
$9.21
$8.38
$3.00
$1.15
$792,415.25
Total Claim Amount
$1,340,753.11
$487,121.79
$453,264.01
$441,436.87
$321,743.91
$272,758.92
$227,510.81
$164,197.32
Urgent Care, within normal business hours
Preventive Care Services - Adult
Hemodialysis - IP & OP Professional
Hemodialysis - OP Professional
Specialist Office Visit
PPO
Service
Office Visit
Inpatient-Hospital
Routine Lab
Office Visit, Inpatient
Other Laboratory services
Inpatient Nuclear Medicine (radiology)
EKG, X-Ray (Plain Film), 26 Modifier, Hosp OP
Cardiac Therapy
Inhaled Medication and Administration
MRI (radiology), ER, 26 Modifier
Inpatient CT Scan (radiology)
ER Facility, OP Hospital
EKG, X-Ray (Plain Film), Hospital OP
Prescription Items - Emergency
Ultrasound, TC Modifier
Occupational Therapy, Hospital OP
Consult
Prescriptions
EKG, X-Ray (Plain Film), ER, 26 Modifier
Refraction
Wellness Outcome Based Bonuses
Hearing Screening
Specialty Lab
MRI, Hospital Outpatient
Chiropractic Care
Health Education / Wellness / Disease Management
Maternity, Office Visit
Birthing Center, Outpatient Hospital/Facility
EEG, Ultrasound, ER, 26 Modifier
EKG, X-Ray (Plain Film)
ER, Surgery
Intra-Ocular Lens, Outpatient Hospital/Facility
Inpatient Radiation Therapy
Labor and Delivery, Outpatient Hospital
GMH- URGENT CARE
ER, Ambulance
Anesthesia - Facility/OP Hosp Off-Island
Inpatient Cardiac Therapy
Inpatient, MRI (radiology)
Page 6 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
$148,450.30
$147,092.35
$117,111.27
$110,102.44
$109,770.00
$104,927.88
$94,059.47
$87,313.35
$86,681.94
$77,410.00
$77,033.50
$75,494.33
$75,050.09
$68,520.00
$66,877.88
$65,914.91
$60,293.93
$59,803.66
$59,634.27
$54,827.55
$53,381.59
$49,941.85
$43,730.18
$38,107.92
$37,814.36
$37,349.16
$36,943.84
$31,257.37
$31,146.12
$30,767.19
$30,359.12
$29,230.69
$28,628.40
$28,608.97
$24,629.41
$22,909.53
$22,330.51
$20,120.80
$19,772.33
$18,948.48
$18,773.91
$18,762.41
$16,418.38
$15,778.19
$15,657.20
$15,176.63
$15,095.90
EEG, Ultrasound
Refraction, Preventive
Surgery Physicians, Outpatient Hospital
Anesthesia - Facility/OP Hosp Off-Island
Routine Lab, Hospital OP
MRI (radiology)
Executive Check-Up
CT Scan (radiology)
Mental Health - Professional
Inpatient CT Scan (radiology)
Facility Supplies, Hospital Outpatient
Refraction
Surgery
Surgery Facility, Hospital OP
Inpatient-Prosthetics Supplies/Devices/Implants/ (UB Codes only)
Injectables and other medications
Airfare Travel
Inpatient Surgery Physicians
MATERNITY PRENATAL VISITS
Facility Supplies
Prescription Items, Hospital OP
Contraceptive
EKG, X-Ray (Plain Film)
ER Facility, Emergency
Inpatient Routine Lab
Chemotherapy
Anesthesia - IP
ER Physicians
Wellness Preventive Incentive
Nuclear Medicine (radiology)
Well Child Care - Preventive (0 to 4 yrs old)
Inpatient-Hospital Visit-Professional
SCREENING MAMMOGRAM FOR WOMEN AGES 40 - 74 YEARS
Inpatient Diagnostic
Specialist, Surgery
Immunizations
Inpatient Maternity-Professional
Well Child Care - Preventive (5 to 17 yrs old)
Radiation Therapy
Inpatient Surgery Facility
Immunizations - Well Baby Care (up to 2 yrs. old)
Inpatient-Maternity
Immunizations - Well Child Care (3 - 17yrs. old)
GYM PARTNER PAYMENT (Invoice Payments)
Inpatient-Prescription Items
Surgery Physicians - OP Hospital/Facility
Eye Glasses / Frames / Contact Lenses
Page 7 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
$13,964.38
$13,869.69
$13,707.24
$13,705.59
$13,151.23
$11,643.67
$11,636.65
$9,744.15
$9,451.17
$9,393.00
$8,765.97
$8,342.89
$7,111.67
$7,089.65
$7,079.79
$6,079.14
$5,269.58
$5,246.40
$5,242.13
$5,216.10
$5,147.32
$5,042.02
$5,003.73
$4,139.54
$4,106.46
$3,475.78
$3,287.13
$3,094.04
$2,836.16
$2,798.83
$2,676.60
$2,556.70
$2,520.00
$2,430.00
$2,078.70
$2,035.87
$2,025.29
$1,532.46
$1,374.04
$1,354.38
$1,277.70
$1,234.04
$1,128.95
$1,124.67
$1,108.83
$1,042.74
$995.22
EKG, X-Ray (Plain Film), 26 Modifier, Hosp OP
Specialist Periodic Exams
Chiropractic Care
Radiation Therapy, OP Hospital
EKG, X-Ray (Plain Film), Hospital OP
Inpatient Radiation Therapy
Cardiac Therapy, Hospital OP
Injectibles and other medications, Outpatient Hospital
EKG, X-Ray (Plain Film), 26 Modifier
Chemotherapy, Outpatient Hospital
Gym Membership
Standard DME, Home Health
Treatment/Observation Room, Hospital Outpatient
CT Scan 26 Modifier, Hosp OP
Consult
Inpatient-Pacemaker
Prescriptions
Inpatient Physical Therapy
Inpatient Ultrasound
Maternity, Diagnostic
EKG, X-Ray (Plain Film), TC Modifier
Diagnostic, Hospital Outpatient
ER Facility, OP Hospital
ER, CT Scan (radiology)
ER, Injectables and other medications
EKG, X-Ray (Plain Film), ER, 26 Modifier
Inpatient-Treatment/Observation Room
Inpatient-Hospital, PA required
Inpatient, MRI (radiology)
Hospital Visit - Professional, Outpatient Hospital
Maternity - OP Professional
Inpatient- EKG, X-Ray (Plain Film)
Inpatient Injectables and other medications
Physical Therapy
Inpatient-Labor and Delivery
Well Baby Care (2 - 17 yrs old)
Mammogram, Diagnostic
Anesthesia - OP Hospital
CT Scan, PA Required,Hospital OP
Home Health Services
Home Health, Physical Therapy
Inpatient Emergency Room, Admitted
Chemotherapy Agents
Specialist, Diagnostic
Lodging
MRI, Hospital Outpatient
Birthing Center, Outpatient Hospital/Facility
Page 8 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
$924.65
$861.54
$820.15
$808.56
$772.61
$760.39
$733.87
$687.80
$670.46
$659.97
$645.18
$632.71
$596.83
$578.90
$563.45
$560.75
$557.34
$550.15
$484.74
$464.06
$390.62
$356.07
$324.49
$284.02
$263.50
$222.72
$210.12
$197.64
$194.69
$191.97
$156.00
$153.60
$152.59
$140.00
$104.40
$88.82
$71.00
$60.23
$58.50
$57.30
$50.00
$39.52
$37.48
$21.83
$21.34
$19.21
$13.92
Hospital Visit - Professional, Outpatient Hospital/Facility
Ostomy/Colostomy/Urinary Supplies
Diagnostic, 26 Modifier, Hosp OP
Wellness Outcome Based Bonuses
Cast Supplies
Allergy Injectable
Diagnostic, Outpatient Hospital/Facility
Prescription Items - Emergency
Acupuncture
Foot Care Services
CT Scan (radiology), 26 Modifer
Mammogram, Diagnostic, 26 Modifer
Inhaled Medication and Administration
Office Visit, OP Hospital
Other Laboratory services
Inpatient Nuclear Medicine (radiology)
Hospital, Outpatient
Ambulance
Mammogram, Diagnostic, ER, 26 Modifier
MRI, 26 Modifier, Hosp OP
Miscellaneous, Facility - Hospital OP
Inpatient-Skilled Nursing Facility
Ultrasound, Hospital Outpatient
Inpatient Occupational Therapy
Inpatient, Hearing Screening
Office Visit, Inpatient
Inpatient Chemotherapy
Occupational Therapy, Hospital OP
Labor and Delivery, Outpatient Hospital
GMH- URGENT CARE
Hospital Visit - Professional
Mammogram, Diagnostic, TC Modifer
Specialty Lab
ER, Ambulance
Intra-Ocular Lens, Outpatient Hospital/Facility
Specialist Hearing Screening
EEG, Ultrasound, ER, 26 Modifier
Radiation Therapy, w/ Mod 26
Inpatient Hemodialysis - IP & OP Professional
Health Education / Wellness / Disease Management
Foot Care Services, Specialist
Physical Therapy, Hospital OP
Anesthesia
Hearing Screening
Maternity, Office Visit
Prosthetics
MRI (radiology), TC Modifier
Page 9 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
$8.00
$6,477,157.27
Ultrasound, TC Modifier
67%
33%
GGRSUP01
Standard DME, Home Health
Wellness Preventive Incentive
14%
8%
7%
7%
6%
58%
HSA
Inpatient‐HospitalInpatient Surgery FacilityUrgent Care, within normal business hoursRoutine LabPreventive Care Services ‐ AdultOthers
Page 10 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims By Type of Service - GOVERNMENT OF GUAMDate of Service From Oct 01, 2017 to Jul 31, 2018Printed Date/Time: 8/8/2018 1:29:51 PM
21%
7%
7%
7%5%
53%
PPO
Office VisitInpatient‐HospitalRoutine LabUrgent Care, within normal business hoursPreventive Care Services ‐ AdultOthers
32%
18%14%
5%
4%
27%
GGRSUP02
Hemodialysis ‐ OP ProfessionalHemodialysis ‐ IP & OP ProfessionalInpatient‐HospitalOffice VisitGYM PARTNER PAYMENT (Invoice Payments)Others
27%
14%
10%9%6%
34%
GGRSUP03
Office VisitGYM PARTNER PAYMENT (Invoice Payments)Eye Glasses / Frames / Contact LensesExecutive Check‐UpSpecialist Office VisitOthers
Page 11 of 29 TC Confidential
Copyright @ 2011 TakeCare. All rights reserved Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
DOA1 - GOVGUAM - DEPT. OF ADMINISTRATION (DOA)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 39 37 37 38 39 39 33 33 34 34 363
Subscriber + Spouse 26 28 28 26 28 28 26 26 24 22 262
Subs + Deps 39 41 41 41 41 41 43 43 43 53 426
Family 139 144 149 153 156 156 159 159 159 169 1,543
Total Members 243 250 255 258 264 264 261 261 260 278 2,594
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 196 181 179 180 178 181 178 179 179 181 1,812
Subscriber + Spouse 96 100 100 96 94 94 88 88 88 90 934
Subs + Deps 330 355 360 356 363 359 358 350 346 343 3,520
Family 674 710 717 724 738 743 747 764 765 757 7,339
Total Members 1,296 1,346 1,356 1,356 1,373 1,377 1,371 1,381 1,378 1,371 13,605
DOE1 - GOVGUAM - DEPT. OF EDUCATION (DOE)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 56 53 53 51 53 53 46 45 45 41 496
Subscriber + Spouse 32 32 32 30 30 30 26 24 24 22 282
Subs + Deps 61 63 63 63 63 56 62 60 56 53 600
Family 68 65 77 77 77 85 78 75 75 73 750
Total Members 217 213 225 221 223 224 212 204 200 189 2,128
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 223 209 207 201 202 199 180 178 176 170 1,945
Subscriber + Spouse 96 96 92 94 90 88 82 78 80 76 872
Subs + Deps 304 344 352 361 358 362 342 344 348 337 3,452
Family 453 492 498 485 497 494 476 480 485 480 4,840
Spouse + Deps 2 2
Total Members 1,078 1,141 1,149 1,141 1,147 1,143 1,080 1,080 1,089 1,063 11,111
GAA1 - GOVGUAM - GUAM INT'L AIRPORT AUTHORITY
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 3 3 3 3 3 3 3 3 3 3 30
Family 4 4 4 4 4 4 4 4 4 4 40
Total Members 7 7 7 7 7 7 7 7 7 7 70
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 1 2 2 3 3 4 4 4 4 29
Subscriber + Spouse 8 8 8 8 8 8 8 8 8 8 80
Subs + Deps 4 4 4 4 4 4 4 4 4 4 40
Family 30 37 37 37 37 37 37 37 36 36 361
Total Members 44 50 51 51 52 52 53 53 52 52 510
GCC1 - GOVGUAM - GUAM COMMUNITY COLLEGE (GCC)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 3 2 1 1 1 1 1 1 1 1 13
Subscriber + Spouse 2 2 2 2 2 2 2 2 2 2 20
Family 8 4 4 4 4 4 4 4 4 4 44
Total Members 13 8 7 7 7 7 7 7 7 7 77
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 14 15 15 15 15 15 15 15 15 15 149
Subscriber + Spouse 8 6 6 6 6 6 6 6 6 6 62
Subs + Deps 33 22 22 22 22 22 22 22 21 21 229
Family 36 53 52 53 53 53 53 53 53 53 512
Total Members 91 96 95 96 96 96 96 96 95 95 952
GHC1 - GOVGUAM - GUAM HOUSING CORPORATION (GHC)
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 1 1 1 1 1 1 1 1 1 1 10
Subs + Deps 7 6 6 6 6 6 6 6 6 6 61
Family 9 9 9 9 9 9 9 9 9 9 90
Total Members 17 16 16 16 16 16 16 16 16 16 161
GHU1 - GOVGUAM - GUAM HOUSING & URBAN RENEWAL
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 1 1 1 1 1 1 1 1 1 1 10
Family 4 4 4 4 4 4 4 4 4 4 40
Total Members 5 5 5 5 5 5 5 5 5 5 50
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 2 2 2 2 2 20
Subs + Deps 16 16 16 16 16 16 16 16 16 16 160
Family 7 7 7 7 7 7 7 7 7 7 70
Total Members 25 25 25 25 25 25 25 25 25 25 250
GMH1 - GOVGUAM - GUAM MEMORIAL HOSPITAL
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 6 6 6 6 6 6 5 5 6 6 58
Subscriber + Spouse 2 4 4 4 2 2 18
Subs + Deps 4 4 4 4 4 4 4 4 4 4 40
Family 14 14 14 14 14 14 14 14 14 14 140
Total Members 26 28 28 28 26 26 23 23 24 24 256
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 50 46 49 50 49 46 43 43 42 43 461
Subscriber + Spouse 42 40 40 44 44 42 40 40 40 40 412
Subs + Deps 90 93 100 100 100 100 100 100 101 101 985
Family 167 189 192 192 192 197 197 194 194 194 1,908
Total Members 349 368 381 386 385 385 380 377 377 378 3,766
GPA1 - GOVGUAM - GUAM POWER AUTHORITY (GPA)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 6 6 6 6 6 6 6 6 6 6 60
Subscriber + Spouse 4 2 2 2 2 2 2 2 2 2 22
Subs + Deps 6 10 10 10 10 10 10 10 10 10 96
Page 12 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Family 11 9 9 9 9 9 9 9 9 6 89
Total Members 27 27 27 27 27 27 27 27 27 24 267
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 25 25 24 24 24 25 25 25 25 26 248
Subscriber + Spouse 28 32 32 32 32 30 28 28 28 28 298
Subs + Deps 49 44 46 45 40 40 39 39 39 39 420
Family 120 144 145 145 151 151 150 150 147 157 1,460
Total Members 222 245 247 246 247 246 242 242 239 250 2,426
GVB1 - GOVGUAM - GUAM VISITORS BUREAU (GVB)
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 5 5 4 4 4 4 4 4 4 4 42
Subscriber + Spouse 2 2 2 2 2 2 2 2 2 2 20
Family 5 5 5 5 5 5 5 5 5 5 50
Total Members 12 12 11 11 11 11 11 11 11 11 112
GWA1 - GOVGUAM - GUAM WATERWORKS (GWA)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 4 4 5 5 5 5 5 5 5 4 47
Subs + Deps 7 7 7 7 7 7 7 7 7 7 70
Family 3 3 3 3 3 3 3 3 3 3 30
Total Members 14 14 15 15 15 15 15 15 15 14 147
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 16 16 17 17 17 17 20 20 20 19 179
Subscriber + Spouse 10 8 6 6 6 6 6 6 6 6 66
Subs + Deps 45 47 50 56 51 51 51 59 59 57 526
Family 67 81 87 89 97 101 102 102 106 106 938
Total Members 138 152 160 168 171 175 179 187 191 188 1,709
LEG1 - GOVGUAM - GUAM LEGISLATURE (LEG)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 4 4 4 4 3 3 2 2 2 2 30
Subscriber + Spouse 2 3 3 3 3 3 3 1 21
Subs + Deps 2 2 2 2 2 2 2 2 2 2 20
Family 3 3 3 3 3 3 3 3 24
Total Members 11 9 9 12 11 11 10 10 7 5 95
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 13 13 13 13 13 14 14 14 14 14 135
Subs + Deps 7 7 7 7 7 7 7 7 7 7 70
Family 22 18 18 18 18 18 18 18 18 18 184
Total Members 42 38 38 38 38 39 39 39 39 39 389
PAG1 - GOVGUAM - PORT AUTHORITY OF GUAM (PAG)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 4 3 3 3 3 3 3 3 3 3 31
Subscriber + Spouse 4 4 4 4 4 4 4 4 4 4 40
Subs + Deps 4 4 4 4 4 4 4 4 4 4 40
Family 13 13 13 17 17 17 17 17 17 17 158
Total Members 25 24 24 28 28 28 28 28 28 28 269
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 28 25 25 25 25 25 25 25 26 25 254
Subscriber + Spouse 24 22 22 20 20 20 20 20 20 20 208
Subs + Deps 32 40 43 43 43 45 47 47 47 47 434
Family 136 154 154 161 161 161 161 156 159 165 1,568
Total Members 220 241 244 249 249 251 253 248 252 257 2,464
PUB1 - GOVGUAM - PUBLIC DEFENDER (PUB)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 2 2 2 2 2 20
Total Members 2 2 2 2 2 2 2 2 2 2 20
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 1 1 1 1 1 15
Subscriber + Spouse 2 2 2 2 2 2 2 2 2 2 20
Subs + Deps 11 12 12 12 12 8 8 8 8 8 99
Family 15 17 17 17 16 16 16 16 16 16 162
Total Members 30 33 33 33 32 27 27 27 27 27 296
RAC1 - GOVGUAM - RETIREMENT FUND ACTIVE
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 2 2 2 2 2 20
Total Members 2 2 2 2 2 2 2 2 2 2 20
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 9 9 9 9 9 9 9 10 10 9 92
Subscriber + Spouse 2 2 2 2 2 2 2 2 2 2 20
Subs + Deps 12 12 12 12 12 12 12 12 12 11 119
Family 2 2 2 3 3 3 3 3 3 3 27
Total Members 25 25 25 26 26 26 26 27 27 25 258
RET1 - GOVGUAM - RETIREES
Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 33 33 35 35 35 35 36 38 37 35 352
Subscriber + Spouse 14 16 16 16 16 16 16 18 18 18 164
Total Members 47 49 51 51 51 51 52 56 55 53 516
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 20 20 19 19 19 20 19 19 18 16 189
Subscriber + Spouse 16 16 16 14 14 14 14 14 14 14 146
Subs + Deps 3 3 2 8
Family 23 23 23 23 23 23 23 19 19 19 218
Total Members 59 59 58 56 56 57 56 55 54 51 561
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Page 13 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Subs Only 117 113 117 118 118 119 120 116 115 109 1,162
Subscriber + Spouse 90 88 90 90 94 92 92 92 94 96 918
Subs + Deps 81 88 88 88 89 89 88 88 88 88 875
Family 78 94 98 94 98 98 98 95 92 93 938
Total Members 366 383 393 390 399 398 398 391 389 386 3,893
UOG1 - GOVGUAM - UNIVERSITY OF GUAM (UOG)
HSA Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 7 6 6 6 8 8 8 8 9 8 74
Subscriber + Spouse 2 2 2 2 2 2 2 14
Subs + Deps 5 2 2 2 2 2 2 2 2 2 23
Family 30 30 30 30 29 29 32 32 32 32 306
Total Members 42 40 40 40 41 41 44 44 43 42 417
PPO Plan
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 35 36 38 38 37 36 36 37 38 37 368
Subscriber + Spouse 14 16 16 16 16 16 16 18 16 18 162
Subs + Deps 41 38 38 38 38 38 38 36 36 36 377
Family 66 67 67 71 71 71 76 73 73 72 707
Total Members 156 157 159 163 162 161 166 164 163 163 1,614
Grand Total Members: 4,851 5,065 5,138 5,154 5,194 5,195 5,113 5,110 5,106 5,077 51,003
DOA1 - GOVGUAM - DEPT. OF ADMINISTRATION (DOA)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 43 42 42 42 44 44 39 38 39 39 412
Subscriber + Spouse 28 29 29 27 29 29 27 27 25 23 273
Subs + Deps 43 43 43 43 43 41 43 43 43 51 436
Family 155 160 158 159 162 162 165 165 168 178 1,632
Total Members for HSA DENTAL 269 274 272 271 278 276 274 273 275 291 2,753
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 182 170 168 169 168 171 167 169 168 170 1,702
Subscriber + Spouse 90 92 92 88 86 86 82 82 78 80 856
Subs + Deps 311 337 342 340 347 343 342 334 328 325 3,349
Family 654 690 697 704 718 723 728 742 746 739 7,141
Total Members for PPO DENTAL 1,237 1,289 1,299 1,301 1,319 1,323 1,319 1,327 1,320 1,314 13,048
Total Members for DOA1 1,506 1,563 1,571 1,572 1,597 1,599 1,593 1,600 1,595 1,605 15,801
DOE1 - GOVGUAM - DEPT. OF EDUCATION (DOE)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 65 61 61 60 60 60 52 54 53 48 574
Subscriber + Spouse 32 32 32 32 32 32 28 26 26 22 294
Subs + Deps 71 74 72 72 65 60 62 60 60 57 653
Family 67 64 76 76 83 91 84 81 86 84 792
Total Members for HSA DENTAL 235 231 241 240 240 243 226 221 225 211 2,313
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 206 195 192 186 189 188 168 167 165 160 1,816
Subscriber + Spouse 78 76 70 68 68 66 64 60 62 58 670
Subs + Deps 299 337 347 356 353 357 343 343 343 332 3,410
Family 418 453 462 449 461 461 437 441 446 441 4,469
Total Members for PPO DENTAL 1,001 1,061 1,071 1,059 1,071 1,072 1,012 1,011 1,016 991 10,365
Total Members for DOE1 1,236 1,292 1,312 1,299 1,311 1,315 1,238 1,232 1,241 1,202 12,678
GAA1 - GOVGUAM - GUAM INT'L AIRPORT AUTHORITY
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 2 2 2 2 2 20
Family 5 5 5 5 5 5 5 5 5 5 50
Total Members for HSA DENTAL 7 7 7 7 7 7 7 7 7 7 70
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 1 2 2 3 3 4 4 4 4 29
Subscriber + Spouse 8 8 8 8 8 8 8 8 8 8 80
Subs + Deps 4 4 4 4 4 4 4 4 4 4 40
Family 26 33 33 33 33 33 33 33 33 33 323
Total Members for PPO DENTAL 40 46 47 47 48 48 49 49 49 49 472
Total Members for GAA1 47 53 54 54 55 55 56 56 56 56 542
GCC1 - GOVGUAM - GUAM COMMUNITY COLLEGE (GCC)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 3 3 2 2 2 2 2 2 2 2 22
Subscriber + Spouse 4 4 4 4 4 4 4 4 4 4 40
Subs + Deps 5 5 5 5 5 5 5 5 5 5 50
Family 14 10 10 10 10 10 10 10 10 10 104
Total Members for HSA DENTAL 26 22 21 21 21 21 21 21 21 21 216
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 15 15 15 15 15 15 15 15 15 15 150
Subscriber + Spouse 8 6 6 6 6 6 6 6 6 6 62
Subs + Deps 26 22 22 22 22 22 22 22 21 21 222
Family 36 45 44 45 45 45 45 45 45 45 440
Total Members for PPO DENTAL 85 88 87 88 88 88 88 88 87 87 874
Total Members for GCC1 111 110 108 109 109 109 109 109 108 108 1,090
GHC1 - GOVGUAM - GUAM HOUSING CORPORATION (GHC)
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 1 1 1 1 1 1 1 1 1 1 10
Subs + Deps 7 6 6 6 6 6 6 6 6 6 61
Family 9 9 9 9 9 9 9 9 9 9 90
Total Members for PPO DENTAL 17 16 16 16 16 16 16 16 16 16 161
Total Members for GHC1 17 16 16 16 16 16 16 16 16 16 161
GHU1 - GOVGUAM - GUAM HOUSING & URBAN RENEWAL
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 2 2 2 2 2 20
Family 4 4 4 4 4 4 4 4 4 4 40
Page 14 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Total Members for HSA DENTAL 6 6 6 6 6 6 6 6 6 6 60
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 3 3 3 3 3 3 3 3 3 3 30
Subs + Deps 14 14 14 14 14 14 14 14 14 14 140
Family 3 3 3 3 3 3 3 3 3 3 30
Total Members for PPO DENTAL 20 20 20 20 20 20 20 20 20 20 200
Total Members for GHU1 26 26 26 26 26 26 26 26 26 26 260
GMH1 - GOVGUAM - GUAM MEMORIAL HOSPITAL
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 8 8 9 9 10 10 9 9 9 9 90
Subscriber + Spouse 6 8 8 8 6 6 4 4 4 4 58
Subs + Deps 4 4 4 4 4 4 4 4 4 4 40
Family 24 24 24 24 24 24 24 24 24 24 240
Total Members for HSA DENTAL 42 44 45 45 44 44 41 41 41 41 428
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 40 38 40 41 41 38 35 35 34 35 377
Subscriber + Spouse 32 28 24 28 28 26 26 26 26 26 270
Subs + Deps 88 91 98 98 98 98 98 98 99 99 965
Family 150 167 170 170 170 175 175 172 172 172 1,693
Total Members for PPO DENTAL 310 324 332 337 337 337 334 331 331 332 3,305
Total Members for GMH1 352 368 377 382 381 381 375 372 372 373 3,733
GPA1 - GOVGUAM - GUAM POWER AUTHORITY (GPA)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 7 7 7 7 7 7 7 7 7 7 70
Subscriber + Spouse 4 2 2 2 2 2 2 2 2 2 22
Subs + Deps 6 10 10 10 10 10 10 10 10 10 96
Family 11 9 9 9 9 9 9 9 9 6 89
Total Members for HSA DENTAL 28 28 28 28 28 28 28 28 28 25 277
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 24 24 23 23 24 25 25 25 25 27 245
Subscriber + Spouse 22 26 26 26 26 24 22 22 22 22 238
Subs + Deps 46 41 43 42 37 37 36 36 36 36 390
Family 126 150 151 151 157 157 156 156 153 160 1,517
Total Members for PPO DENTAL 218 241 243 242 244 243 239 239 236 245 2,390
Total Members for GPA1 246 269 271 270 272 271 267 267 264 270 2,667
GVB1 - GOVGUAM - GUAM VISITORS BUREAU (GVB)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Family 5 5 5 5 5 5 5 5 5 5 50
Total Members for HSA DENTAL 5 5 5 5 5 5 5 5 5 5 50
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 4 4 3 3 3 3 3 3 3 3 32
Subscriber + Spouse 2 2 2 2 2 2 2 2 2 2 20
Family 5 5 5 5 5 5 5 5 5 5 50
Total Members for PPO DENTAL 11 11 10 10 10 10 10 10 10 10 102
Total Members for GVB1 16 16 15 15 15 15 15 15 15 15 152
GWA1 - GOVGUAM - GUAM WATERWORKS (GWA)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 3 3 3 3 3 3 3 2 27
Subs + Deps 10 10 10 10 10 10 10 10 10 10 100
Family 3 3 3 3 3 3 3 3 3 3 30
Total Members for HSA DENTAL 15 15 16 16 16 16 16 16 16 15 157
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 16 16 17 17 17 17 20 20 20 19 179
Subscriber + Spouse 6 4 2 2 2 2 2 2 2 2 26
Subs + Deps 48 50 50 51 51 51 51 54 54 52 512
Family 59 73 83 85 86 90 91 91 91 91 840
Total Members for PPO DENTAL 129 143 152 155 156 160 164 167 167 164 1,557
Total Members for GWA1 144 158 168 171 172 176 180 183 183 179 1,714
LEG1 - GOVGUAM - GUAM LEGISLATURE (LEG)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 5 5 5 5 4 4 3 3 3 3 40
Subscriber + Spouse 2 3 3 3 3 3 3 1 21
Subs + Deps 3 3 3 3 3 3 3 3 3 3 30
Family 7 7 7 7 7 7 7 7 4 4 64
Total Members for HSA DENTAL 17 15 15 18 17 17 16 16 13 11 155
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 13 13 13 13 13 14 14 14 14 14 135
Subs + Deps 7 7 7 7 7 7 7 7 7 7 70
Family 18 14 14 14 14 14 14 14 14 14 144
Total Members for PPO DENTAL 38 34 34 34 34 35 35 35 35 35 349
Total Members for LEG1 55 49 49 52 51 52 51 51 48 46 504
PAG1 - GOVGUAM - PORT AUTHORITY OF GUAM (PAG)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 6 4 4 4 4 4 4 4 4 4 42
Subs + Deps 4 4 4 4 4 4 4 4 4 4 40
Family 9 14 14 22 22 22 22 22 22 22 191
Total Members for HSA DENTAL 19 22 22 30 30 30 30 30 30 30 273
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 28 25 25 25 25 25 25 25 26 25 254
Subscriber + Spouse 24 22 22 20 20 20 20 20 20 20 208
Subs + Deps 32 40 43 43 43 45 47 47 47 47 434
Family 125 142 142 153 153 153 153 153 156 162 1,492
Total Members for PPO DENTAL 209 229 232 241 241 243 245 245 249 254 2,388
Total Members for PAG1 228 251 254 271 271 273 275 275 279 284 2,661
PUB1 - GOVGUAM - PUBLIC DEFENDER (PUB)
Page 15 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
39 37 37 38 39 39 33 34 34 363
13 14 14 13 14 14 13 12 11 131
14 15 15 15 15 15 16 16 19 156
33 34 34 35 36 36 37 37 39 358
99 100 100 101 104 104 99 99 103 1,008
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
196 181 179 180 178 181 178 179 181 1,812
48 50 50 48 47 47 44 44 45 467
110 117 118 118 121 120 120 116 116 1,174
150 158 160 162 166 167 168 173 171 1,647
504 506 507 508 512 515 510 512 513 5,100
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
56 53 53 51 53 53 46 45 41 496
16 16 16 15 15 15 13 12 11 141
22 23 23 23 23 22 24 22 20 225
17 16 19 19 19 20 18 17 16 178
111 108 111 108 110 110 101 96 88 1,040
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
223 209 207 201 202 199 180 176 170 1,945
48 48 46 47 45 44 41 40 38 436
101 109 111 115 115 116 108 111 109 1,105
101 110 112 110 112 111 107 109 108 1,088
1 1
474 476 476 473 474 470 436 436 425 4,575
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 2 2 2 2 2 20
Subs + Deps 1 1 1 1 1 1 1 1 1 1 10
Family 4 4 4 4 4 4 4 4 4 4 40
Total Members for HSA DENTAL 7 7 7 7 7 7 7 7 7 7 70
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 1 1 1 1 1 15
Subscriber + Spouse 2 2 2 2 2 2 2 2 2 2 20
Subs + Deps 8 9 9 9 9 5 5 5 5 5 69
Family 15 17 17 17 16 16 16 16 16 16 162
Total Members for PPO DENTAL 27 30 30 30 29 24 24 24 24 24 266
Total Members for PUB1 34 37 37 37 36 31 31 31 31 31 336
RAC1 - GOVGUAM - RETIREMENT FUND ACTIVE
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 2 2 2 2 2 2 2 2 2 2 20
Subscriber + Spouse 1 1 1 1 1 1 1 1 1 1 10
Total Members for HSA DENTAL 3 3 3 3 3 3 3 3 3 3 30
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 9 9 9 9 9 9 9 10 10 9 92
Subscriber + Spouse 2 2 2 2 2 2 2 2 2 2 20
Subs + Deps 12 12 12 12 12 12 12 12 12 11 119
Family 2 2 2 3 3 3 3 3 3 3 27
Total Members for PPO DENTAL 25 25 25 26 26 26 26 27 27 25 258
Total Members for RAC1 28 28 28 29 29 29 29 30 30 28 288
RET1 - GOVGUAM - RETIREES
DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 14 14 15 15 15 15 15 16 15 15 149
Subscriber + Spouse 4 2 2 2 2 2 2 4 4 4 28
Total Members for DENTAL 18 16 17 17 17 17 17 20 19 19 177
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 20 18 18 18 18 18 18 18 18 16 180
Subscriber + Spouse 20 20 20 20 20 20 20 20 20 20 200
Subs + Deps 3 3 2 8
Family 22 22 22 22 22 22 22 18 18 18 208
Total Members for HSA DENTAL 62 60 60 60 60 60 60 59 59 56 596
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 92 91 94 94 90 90 92 90 89 83 905
Subscriber + Spouse 60 60 62 64 64 64 66 66 68 70 644
Subs + Deps 74 77 77 77 85 85 84 84 84 84 811
Family 77 93 97 97 97 97 97 94 91 92 932
Total Members for PPO DENTAL 303 321 330 332 336 336 339 334 332 329 3,292
Total Members for RET1 383 397 407 409 413 413 416 413 410 404 4,065
UOG1 - GOVGUAM - UNIVERSITY OF GUAM (UOG)
HSA DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 8 7 7 7 9 8 8 8 9 8 79
Subscriber + Spouse 2 2 2 2 2 2 12
Subs + Deps 2 2 2 2 2 2 2 2 2 2 20
Family 25 25 25 25 24 24 27 27 27 27 256
Total Members for HSA DENTAL 35 36 36 36 37 36 39 37 38 37 367
PPO DENTAL PLAN
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Total
Subs Only 28 27 29 29 28 28 28 29 30 29 285
Subscriber + Spouse 10 13 13 13 13 13 13 14 12 12 126
Subs + Deps 41 38 38 38 38 38 38 36 36 36 377
Family 66 67 67 71 71 71 76 73 73 72
186
707
Total Members for PPO DENTAL 145 145 147 151 150 150 155
Total Members for UOG1 180 181 183 187 187
151 149 1,495152
189 189 186
48,514
DOA1 - GOVGUAM - DEPT. OF ADMINISTRATION (DOA)
1,862
Grand Total Members 4,609 4,814 4,863 4,829
194
HSA Plan
May-2018
4,941 4,947 4,8714,876 4,899 4,865
Subs Only 33
Subscriber + Spouse 13
Subs + Deps 16
Family 37
Total Subscribers: 99
PPO Plan
May-2018
Subs Only 179
Subscriber + Spouse 44
Subs + Deps 118
Family 172
Total Subscribers: 513
DOE1 - GOVGUAM - DEPT. OF EDUCATION (DOE)
HSA Plan
May-2018
Subs Only 45
Subscriber + Spouse 12
Subs + Deps 23
Family 17
Total Subscribers: 97
PPO Plan
May-2018
Subs Only 178
Subscriber + Spouse 39
Subs + Deps 110
Family 108
Spouse + Deps
Total Subscribers: 435
Page 16 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
3 3 3 3 3 3 3 3 3 30
1 1 1 1 1 1 1 1 1 10
4 4 4 4 4 4 4 4 4 40
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 1 2 2 3 3 4 4 4 29
4 4 4 4 4 4 4 4 4 40
2 2 2 2 2 2 2 2 2 20
7 8 8 8 8 8 8 8 8 79
15 15 16 16 17 17 18 18 18 168
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
3 2 1 1 1 1 1 1 1 13
1 1 1 1 1 1 1 1 1 10
2 1 1 1 1 1 1 1 1 11
6 4 3 3 3 3 3 3 3 34
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
14 15 15 15 15 15 15 15 15 149
4 3 3 3 3 3 3 3 3 31
10 8 8 8 8 8 8 8 8 82
8 11 11 11 11 11 11 11 11 107
36 37 37 37 37 37 37 37 37 369
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 1 1 10
2 2 2 2 2 2 2 2 2 20
4 4 4 4 4 4 4 4 4 40
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 1 1 10
2 2 2 2 2 2 2 2 2 20
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 2 2 2 2 20
4 4 4 4 4 4 4 4 4 40
2 2 2 2 2 2 2 2 2 20
8 8 8 8 8 8 8 8 8 80
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
6 6 6 6 6 6 5 6 6 58
1 2 2 2 1 1 9
1 1 1 1 1 1 1 1 1 10
4 4 4 4 4 4 4 4 4 40
12 13 13 13 12 12 10 11 11 117
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
50 46 49 50 49 46 43 42 43 461
21 20 20 22 22 21 20 20 20 206
27 27 29 29 29 29 29 29 29 286
39 45 45 45 45 46 46 45 45 446
137 138 143 146 145 142 138 136 137 1,399
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
6 6 6 6 6 6 6 6 6 60
2 1 1 1 1 1 1 1 1 11
2 3 3 3 3 3 3 3 3 29
3 3 3 3 3 3 3 3 2 29
13 13 13 13 13 13 13 13 12 129
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
25 25 24 24 24 25 25 25 26 248
14 16 16 16 16 15 14 14 14 149
18 16 17 17 16 16 16 16 16 164
24 28 28 28 29 29 29 28 29 281
81 85 85 85 85 85 84 83 85 842
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
5 5 4 4 4 4 4 4 4 42
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 1 1 10
7 7 6 6 6 6 6 6 6 62
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
4 4 5 5 5 5 5 5 4 47
2 2 2 2 2 2 2 2 2 20
1 1 1 1 1 1 1 1 1 10
7 7 8 8 8 8 8 8 7 77
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
16 16 17 17 17 17 20 20 19 179
5 4 3 3 3 3 3 3 3 33
16 17 18 19 18 18 18 20 19 183
16 18 19 19 20 21 21 22 22 199
53 55 57 58 58 59 62 65 63 594
GAA1 - GOVGUAM - GUAM INT'L AIRPORT AUTHORITY
HSA Plan
May-2018
Subs Only 3
Family 1
Total Subscribers: 4
PPO Plan
May-2018
Subs Only 4
Subscriber + Spouse 4
Subs + Deps 2
Family 8
Total Subscribers: 18
GCC1 - GOVGUAM - GUAM COMMUNITY COLLEGE (GCC)
HSA Plan
May-2018
Subs Only 1
Subscriber + Spouse 1
Family 1
Total Subscribers: 3
PPO Plan
May-2018
Subs Only 15
Subscriber + Spouse 3
Subs + Deps 8
Family 11
Total Subscribers: 37
GHC1 - GOVGUAM - GUAM HOUSING CORPORATION (GHC)
PPO Plan
May-2018
Subs Only 1
Subs + Deps 1
Family 2
Total Subscribers: 4
GHU1 - GOVGUAM - GUAM HOUSING & URBAN RENEWAL
HSA Plan
May-2018
Subs Only 1
Family 1
Total Subscribers: 2
PPO Plan
May-2018
Subs Only 2
Subs + Deps 4
Family 2
Total Subscribers: 8
GMH1 - GOVGUAM - GUAM MEMORIAL HOSPITAL
HSA Plan
May-2018
Subs Only 5
Subscriber + Spouse
Subs + Deps 1
Family 4
Total Subscribers: 10
PPO Plan
May-2018
Subs Only 43
Subscriber + Spouse 20
Subs + Deps 29
Family 45
Total Subscribers: 137
GPA1 - GOVGUAM - GUAM POWER AUTHORITY (GPA)
HSA Plan
May-2018
Subs Only 6
Subscriber + Spouse 1
Subs + Deps 3
Family 3
Total Subscribers: 13
PPO Plan
May-2018
Subs Only 25
Subscriber + Spouse 14
Subs + Deps 16
Family 29
Total Subscribers: 84
GVB1 - GOVGUAM - GUAM VISITORS BUREAU (GVB)
PPO Plan
May-2018
Subs Only 4
Subscriber + Spouse 1
Family 1
Total Subscribers: 6
GWA1 - GOVGUAM - GUAM WATERWORKS (GWA)
HSA Plan
May-2018
Subs Only 5
Subs + Deps 2
Family 1
Total Subscribers: 8
PPO Plan
May-2018
Subs Only 20
Subscriber + Spouse 3
Subs + Deps 20
Family 21
Total Subscribers: 64
LEG1 - GOVGUAM - GUAM LEGISLATURE (LEG)
Page 17 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
4 4 4 4 3 3 2 2 2 30
1 2 2 2 2 2 1 14
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 8
7 6 6 8 7 7 6 5 4 62
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
13 13 13 13 13 14 14 14 14 135
2 2 2 2 2 2 2 2 2 20
6 5 5 5 5 5 5 5 5 51
21 20 20 20 20 21 21 21 21 206
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
4 3 3 3 3 3 3 3 3 31
2 2 2 2 2 2 2 2 2 20
1 1 1 1 1 1 1 1 1 10
3 3 3 4 4 4 4 4 4 37
10 9 9 10 10 10 10 10 10 98
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
28 25 25 25 25 25 25 26 25 254
12 11 11 10 10 10 10 10 10 104
9 11 11 11 11 12 13 13 13 117
31 34 34 35 35 35 35 35 36 344
80 81 81 81 81 82 83 84 84 819
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 2 2 2 2 20
2 2 2 2 2 2 2 2 2 20
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 1 1 1 1 15
1 1 1 1 1 1 1 1 1 10
3 3 3 3 3 2 2 2 2 25
4 4 4 4 4 4 4 4 4 40
10 10 10 10 10 8 8 8 8 90
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 2 2 2 2 20
2 2 2 2 2 2 2 2 2 20
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
9 9 9 9 9 9 9 10 9 92
1 1 1 1 1 1 1 1 1 10
4 4 4 4 4 4 4 4 4 40
1 1 1 1 1 1 1 1 1 10
15 15 15 15 15 15 15 16 15 152
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
33 33 35 35 35 35 36 37 35 352
7 8 8 8 8 8 8 9 9 82
40 41 43 43 43 43 44 46 44 434
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
20 20 19 19 19 20 19 18 16 189
8 8 8 7 7 7 7 7 7 73
1 1 3
6 6 6 6 6 6 6 5 5 57
34 34 33 32 32 33 32 31 29 322
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
117 113 117 118 118 119 120 115 109 1,162
45 44 45 45 47 46 46 47 48 459
28 29 29 29 30 30 30 30 30 295
22 27 28 27 28 28 28 26 26 267
212 213 219 219 223 223 224 218 213 2,183
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
7 6 6 6 8 8 8 9 8 74
1 1 1 1 1 1 7
2 1 1 1 1 1 1 1 1 11
7 7 7 7 7 7 8 8 8 74
16 15 15 15 17 17 18 18 17 166
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
35 36 38 38 37 36 36 38 37 368
7 8 8 8 8 8 8 8 9 81
13 12 12 12 12 12 12 12 12 121
14 14 14 15 15 15 16 15 15 148
69 70 72 73 72 71 72 73 73 718
2,091 2,100 2,120 2,123 2,136 2,133 2,080 2,075 2,048 20,984
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
43 42 42 42 44 44 39 39 39 412
14 15 15 14 15 15 14 13 12 141
16 16 16 16 16 15 16 16 18 161
36 37 36 36 37 37 38 39 41 375
109 110 109 108 112 111 107 107 110 1,089
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
HSA Plan
May-2018
Subs Only 2
Subscriber + Spouse 2
Subs + Deps 1
Family 1
Total Subscribers: 6
PPO Plan
May-2018
Subs Only 14
Subs + Deps 2
Family 5
Total Subscribers: 21
PAG1 - GOVGUAM - PORT AUTHORITY OF GUAM (PAG)
HSA Plan
May-2018
Subs Only 3
Subscriber + Spouse 2
Subs + Deps 1
Family 4
Total Subscribers: 10
PPO Plan
May-2018
Subs Only 25
Subscriber + Spouse 10
Subs + Deps 13
Family 34
Total Subscribers: 82
PUB1 - GOVGUAM - PUBLIC DEFENDER (PUB)
HSA Plan
May-2018
Subs Only 2
Total Subscribers: 2
PPO Plan
May-2018
Subs Only 1
Subscriber + Spouse 1
Subs + Deps 2
Family 4
Total Subscribers: 8
RAC1 - GOVGUAM - RETIREMENT FUND ACTIVE
HSA Plan
May-2018
Subs Only 2
Total Subscribers: 2
PPO Plan
May-2018
Subs Only 10
Subscriber + Spouse 1
Subs + Deps 4
Family 1
Total Subscribers: 16
RET1 - GOVGUAM - RETIREES
Plan
May-2018
Subs Only 38
Subscriber + Spouse 9
Total Subscribers: 47
HSA Plan
May-2018
Subs Only 19
Subscriber + Spouse 7
Subs + Deps 1
Family 5
Total Subscribers: 32
PPO Plan
May-2018
Subs Only 116
Subscriber + Spouse 46
Subs + Deps 30
Family 27
Total Subscribers: 219
UOG1 - GOVGUAM - UNIVERSITY OF GUAM (UOG)
HSA Plan
May-2018
Subs Only 8
Subscriber + Spouse 1
Subs + Deps 1
Family 8
Total Subscribers: 18
PPO Plan
May-2018
Subs Only 37
Subscriber + Spouse 9
Subs + Deps 12
Family 15
Total Subscribers: 73
Grand Total Subscribers: 2,078
DOA1 - GOVGUAM - DEPT. OF ADMINISTRATION (DOA)
HSA DENTAL PLAN
May-2018
Subs Only 38
Subscriber + Spouse 14
Subs + Deps 16
Family 38
Total Subscribers for HSA DENTAL 106
PPO DENTAL PLAN
May-2018
Page 18 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
182 170 168 169 168 171 167 168 170 1,702
45 46 46 44 43 43 41 39 40 428
102 109 111 112 115 114 114 109 109 1,107
146 154 156 158 162 163 164 169 167 1,606
475 479 481 483 488 491 486 485 486 4,843
584 589 590 591 600 602 593 592 596 5,932
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
65 61 61 60 60 60 52 53 48 574
16 16 16 16 16 16 14 13 11 147
25 27 26 26 25 25 26 25 23 253
18 17 20 20 21 22 20 20 19 196
124 121 123 122 122 123 112 111 101 1,170
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
206 195 192 186 189 188 168 165 160 1,816
39 38 35 34 34 33 32 31 29 335
98 105 108 112 112 113 107 108 106 1,077
93 101 104 102 104 104 98 100 99 1,004
436 439 439 434 439 438 405 404 394 4,232
560 560 562 556 561 561 517 515 495 5,402
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 2 2 2 2 20
2 2 2 2 2 2 2 2 2 20
4 4 4 4 4 4 4 4 4 40
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 1 2 2 3 3 4 4 4 29
4 4 4 4 4 4 4 4 4 40
2 2 2 2 2 2 2 2 2 20
6 7 7 7 7 7 7 7 7 69
14 14 15 15 16 16 17 17 17 158
18 18 19 19 20 20 21 21 21 198
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
3 3 2 2 2 2 2 2 2 22
2 2 2 2 2 2 2 2 2 20
2 2 2 2 2 2 2 2 2 20
3 2 2 2 2 2 2 2 2 21
10 9 8 8 8 8 8 8 8 83
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
15 15 15 15 15 15 15 15 15 150
4 3 3 3 3 3 3 3 3 31
9 8 8 8 8 8 8 8 8 81
8 10 10 10 10 10 10 10 10 98
36 36 36 36 36 36 36 36 36 360
46 45 44 44 44 44 44 44 44 443
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 1 1 10
2 2 2 2 2 2 2 2 2 20
4 4 4 4 4 4 4 4 4 40
4 4 4 4 4 4 4 4 4 40
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 2 2 2 2 20
1 1 1 1 1 1 1 1 1 10
3 3 3 3 3 3 3 3 3 30
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
3 3 3 3 3 3 3 3 3 30
3 3 3 3 3 3 3 3 3 30
1 1 1 1 1 1 1 1 1 10
7 7 7 7 7 7 7 7 7 70
10 10 10 10 10 10 10 10 10 100
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
8 8 9 9 10 10 9 9 9 90
3 4 4 4 3 3 2 2 2 29
1 1 1 1 1 1 1 1 1 10
7 7 7 7 7 7 7 7 7 70
19 20 21 21 21 21 19 19 19 199
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
40 38 40 41 41 38 35 34 35 377
16 14 12 14 14 13 13 13 13 135
26 26 28 28 28 28 28 28 28 276
34 39 39 39 39 40 40 39 39 387
116 117 119 122 122 119 116 114 115 1,175
135 137 140 143 143 140 135 133 134 1,374
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
7 7 7 7 7 7 7 7 7 70
2 1 1 1 1 1 1 1 1 11
2 3 3 3 3 3 3 3 3 29
3 3 3 3 3 3 3 3 2 29
14 14 14 14 14 14 14 14 13 139
Subs Only 169
Subscriber + Spouse 41
Subs + Deps 112
Family 167
Total Subscribers for PPO DENTAL 489
Total Subscriber for DOA1 595
DOE1 - GOVGUAM - DEPT. OF EDUCATION (DOE)
HSA DENTAL PLAN
May-2018
Subs Only 54
Subscriber + Spouse 13
Subs + Deps 25
Family 19
Total Subscribers for HSA DENTAL 111
PPO DENTAL PLAN
May-2018
Subs Only 167
Subscriber + Spouse 30
Subs + Deps 108
Family 99
Total Subscribers for PPO DENTAL 404
Total Subscriber for DOE1 515
GAA1 - GOVGUAM - GUAM INT'L AIRPORT AUTHORITY
HSA DENTAL PLAN
May-2018
Subs Only 2
Family 2
Total Subscribers for HSA DENTAL 4
PPO DENTAL PLAN
May-2018
Subs Only 4
Subscriber + Spouse 4
Subs + Deps 2
Family 7
Total Subscribers for PPO DENTAL 17
Total Subscriber for GAA1 21
GCC1 - GOVGUAM - GUAM COMMUNITY COLLEGE (GCC)
HSA DENTAL PLAN
May-2018
Subs Only 2
Subscriber + Spouse 2
Subs + Deps 2
Family 2
Total Subscribers for HSA DENTAL 8
PPO DENTAL PLAN
May-2018
Subs Only 15
Subscriber + Spouse 3
Subs + Deps 8
Family 10
Total Subscribers for PPO DENTAL 36
Total Subscriber for GCC1 44
GHC1 - GOVGUAM - GUAM HOUSING CORPORATION (GHC)
PPO DENTAL PLAN
May-2018
Subs Only 1
Subs + Deps 1
Family 2
Total Subscribers for PPO DENTAL 4
Total Subscriber for GHC1 4
GHU1 - GOVGUAM - GUAM HOUSING & URBAN RENEWAL
HSA DENTAL PLAN
May-2018
Subs Only 2
Family 1
Total Subscribers for HSA DENTAL 3
PPO DENTAL PLAN
May-2018
Subs Only 3
Subs + Deps 3
Family 1
Total Subscribers for PPO DENTAL 7
Total Subscriber for GHU1 10
GMH1 - GOVGUAM - GUAM MEMORIAL HOSPITAL
HSA DENTAL PLAN
May-2018
Subs Only 9
Subscriber + Spouse 2
Subs + Deps 1
Family 7
Total Subscribers for HSA DENTAL 19
PPO DENTAL PLAN
May-2018
Subs Only 35
Subscriber + Spouse 13
Subs + Deps 28
Family 39
Total Subscribers for PPO DENTAL 115
Total Subscriber for GMH1 134
GPA1 - GOVGUAM - GUAM POWER AUTHORITY (GPA)
HSA DENTAL PLAN
May-2018
Subs Only 7
Subscriber + Spouse 1
Subs + Deps 3
Family 3
Total Subscribers for HSA DENTAL 14
PPO DENTAL PLAN
Page 19 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
24 24 23 23 24 25 25 25 27 245
11 13 13 13 13 12 11 11 11 119
17 15 16 16 15 15 15 15 15 154
26 30 30 30 31 31 31 30 30 300
78 82 82 82 83 83 82 81 83 818
92 96 96 96 97 97 96 95 96 957
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 1 1 10
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
4 4 3 3 3 3 3 3 3 32
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 1 1 10
6 6 5 5 5 5 5 5 5 52
7 7 6 6 6 6 6 6 6 62
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 3 3 3 3 3 3 2 27
3 3 3 3 3 3 3 3 3 30
1 1 1 1 1 1 1 1 1 10
6 6 7 7 7 7 7 7 6 67
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
16 16 17 17 17 17 20 20 19 179
3 2 1 1 1 1 1 1 1 13
17 18 18 18 18 18 18 19 18 181
14 16 18 18 18 19 19 19 19 179
50 52 54 54 54 55 58 59 57 552
56 58 61 61 61 62 65 66 63 619
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
5 5 5 5 4 4 3 3 3 40
1 2 2 2 2 2 1 14
1 1 1 1 1 1 1 1 1 10
2 2 2 2 2 2 2 1 1 18
9 8 8 10 9 9 8 7 6 82
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
13 13 13 13 13 14 14 14 14 135
2 2 2 2 2 2 2 2 2 20
5 4 4 4 4 4 4 4 4 41
20 19 19 19 19 20 20 20 20 196
29 27 27 29 28 29 28 27 26 278
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
6 4 4 4 4 4 4 4 4 42
1 1 1 1 1 1 1 1 1 10
2 4 4 6 6 6 6 6 6 52
9 9 9 11 11 11 11 11 11 104
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
28 25 25 25 25 25 25 26 25 254
12 11 11 10 10 10 10 10 10 104
9 11 11 11 11 12 13 13 13 117
28 31 31 33 33 33 33 34 35 324
77 78 78 79 79 80 81 83 83 799
86 87 87 90 90 91 92 94 94 903
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 2 2 2 2 20
1 1 1 1 1 1 1 1 1 10
1 1 1 1 1 1 1 1 1 10
4 4 4 4 4 4 4 4 4 40
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 1 1 1 1 15
1 1 1 1 1 1 1 1 1 10
2 2 2 2 2 1 1 1 1 15
4 4 4 4 4 4 4 4 4 40
9 9 9 9 9 7 7 7 7 80
13 13 13 13 13 11 11 11 11 120
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
2 2 2 2 2 2 2 2 2 20
1 1 1 1 1 1 1 1 1 10
3 3 3 3 3 3 3 3 3 30
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
9 9 9 9 9 9 9 10 9 92
1 1 1 1 1 1 1 1 1 10
4 4 4 4 4 4 4 4 4 40
1 1 1 1 1 1 1 1 1 10
15 15 15 15 15 15 15 16 15 152
18 18 18 18 18 18 18 19 18 182
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
14 14 15 15 15 15 15 15 15 149
2 1 1 1 1 1 1 2 2 14
May-2018
Subs Only 25
Subscriber + Spouse 11
Subs + Deps 15
Family 31
Total Subscribers for PPO DENTAL 82
Total Subscriber for GPA1 96
GVB1 - GOVGUAM - GUAM VISITORS BUREAU (GVB)
HSA DENTAL PLAN
May-2018
Family 1
Total Subscribers for HSA DENTAL 1
PPO DENTAL PLAN
May-2018
Subs Only 3
Subscriber + Spouse 1
Family 1
Total Subscribers for PPO DENTAL 5
Total Subscriber for GVB1 6
GWA1 - GOVGUAM - GUAM WATERWORKS (GWA)
HSA DENTAL PLAN
May-2018
Subs Only 3
Subs + Deps 3
Family 1
Total Subscribers for HSA DENTAL 7
PPO DENTAL PLAN
May-2018
Subs Only 20
Subscriber + Spouse 1
Subs + Deps 19
Family 19
Total Subscribers for PPO DENTAL 59
Total Subscriber for GWA1 66
LEG1 - GOVGUAM - GUAM LEGISLATURE (LEG)
HSA DENTAL PLAN
May-2018
Subs Only 3
Subscriber + Spouse 2
Subs + Deps 1
Family 2
Total Subscribers for HSA DENTAL 8
PPO DENTAL PLAN
May-2018
Subs Only 14
Subs + Deps 2
Family 4
Total Subscribers for PPO DENTAL 20
Total Subscriber for LEG1 28
PAG1 - GOVGUAM - PORT AUTHORITY OF GUAM (PAG)
HSA DENTAL PLAN
May-2018
Subs Only 4
Subs + Deps 1
Family 6
Total Subscribers for HSA DENTAL 11
PPO DENTAL PLAN
May-2018
Subs Only 25
Subscriber + Spouse 10
Subs + Deps 13
Family 33
Total Subscribers for PPO DENTAL 81
Total Subscriber for PAG1 92
PUB1 - GOVGUAM - PUBLIC DEFENDER (PUB)
HSA DENTAL PLAN
May-2018
Subs Only 2
Subs + Deps 1
Family 1
Total Subscribers for HSA DENTAL 4
PPO DENTAL PLAN
May-2018
Subs Only 1
Subscriber + Spouse 1
Subs + Deps 1
Family 4
Total Subscribers for PPO DENTAL 7
Total Subscriber for PUB1 11
RAC1 - GOVGUAM - RETIREMENT FUND ACTIVE
HSA DENTAL PLAN
May-2018
Subs Only 2
Subscriber + Spouse 1
Total Subscribers for HSA DENTAL 3
PPO DENTAL PLAN
May-2018
Subs Only 10
Subscriber + Spouse 1
Subs + Deps 4
Family 1
Total Subscribers for PPO DENTAL 16
Total Subscriber for RAC1 19
RET1 - GOVGUAM - RETIREES
DENTAL PLAN
May-2018
Subs Only 16
Subscriber + Spouse 2
Page 20 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyMonthly Enrollment by Plan - GOVERNMENT OF GUAMExtraction Date From: 10/1/2017 to 7/31/2018Print Date/Time:8/8/2018 1:30 PM
16 15 16 16 16 16 16 17 17 163
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
20 18 18 18 18 18 18 18 16 180
10 10 10 10 10 10 10 10 10 100
1 1 3
6 6 6 6 6 6 6 5 5 57
36 34 34 34 34 34 34 34 32 340
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
92 91 94 94 90 90 92 89 83 905
30 30 31 32 32 32 33 34 35 322
25 25 25 25 28 28 28 28 28 268
22 27 28 28 28 28 28 26 26 268
169 173 178 179 178 178 181 177 172 1,763
221 222 228 229 228 228 231 228 221 2,266
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
8 7 7 7 9 8 8 9 8 79
1 1 1 1 1 1 6
1 1 1 1 1 1 1 1 1 10
6 6 6 6 6 6 7 7 7 64
15 15 15 15 17 16 17 17 16 159
Oct-2017 Nov-2017 Dec-2017 Jan-2018 Feb-2018 Mar-2018 Apr-2018 Jun-2018 Jul-2018 Total
28 27 29 29 28 28 28 30 29 285
5 7 7 7 7 7 7 6 6 66
13 12 12 12 12 12 12 12 12 121
14 14 14 15 15 15 16 15 15 148
60 60 62 63 62 62 63 63 62 620
75 75 77 78 79 78 80 80 78 779
1,954 1,966 1,982 1,987 2,002 2,001 1,951 1,945 1,917 19,655
Total Subscribers for DENTAL 18
HSA DENTAL PLAN
May-2018
Subs Only 18
Subscriber + Spouse 10
Subs + Deps 1
Family 5
Total Subscribers for HSA DENTAL 34
PPO DENTAL PLAN
May-2018
Subs Only 90
Subscriber + Spouse 33
Subs + Deps 28
Family 27
Total Subscribers for PPO DENTAL 178
Total Subscriber for RET1 230
UOG1 - GOVGUAM - UNIVERSITY OF GUAM (UOG)
HSA DENTAL PLAN
May-2018
Subs Only 8
Subscriber + Spouse
Subs + Deps 1
Family 7
Total Subscribers for HSA DENTAL 16
PPO DENTAL PLAN
May-2018
Subs Only 29
Subscriber + Spouse 7
Subs + Deps 12
Family 15
Total Subscribers for PPO DENTAL 63
Total Subscriber for UOG1 79
Grand Total Subscribers: 1,950
Page 21 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
Brand Name Total Claim Cost
ENBREL INJ 50MG/ML $139,515.20
JANUVIA TAB 100MG $109,015.20
LANTUS INJ SOLOSTAR $54,599.40
LEVEMIR INJ FLEXTOUC $39,277.40
IBRANCE CAP 100MG $38,444.28
NOVOLOG INJ FLEXPEN $35,151.35
ENBREL SRCLK INJ 50MG/ML $31,734.31
STELARA INJ 45MG/0.5 $29,365.64
VICTOZA INJ 18MG/3ML $28,521.45
ADVAIR DISKU AER 250/50 $21,992.39Fluticasone-Salmeterol Aer Powder BA 250-50 CG/ OS
Insulin Detemir Soln Pen-injector 100 Unit/ML
Palbociclib Cap 100 MG
Insulin Aspart Soln Pen-injector 100 Unit/ML
Etanercept Subcutaneous Solution Auto-injector 50 G/Ustekinumab Soln Prefilled Syringe 45 MG/0.5ML
Liraglutide Soln Pen-injector 18 MG/3ML (6 MG/ML)
TakeCare Insurance CompanyGOVERNMENT OF GUAM - Top 10 Drug UtilizationStart Date: 10/1/2017 ; End Date: 7/31/2018Print Date/Time:8/8/2018 1:30 PM
Generic Name
Etanercept Subcutaneous Soln Prefilled Syringe 50 G/Sitagliptin Phosphate Tab 100 MG (Base Equiv)
Insulin Glargine Soln Pen-Injector 100 Unit/ML
26%
21%
10%8%
7%
7%
6%
6%5% 4%
Top 10 Drug Utilization
ENBREL INJ 50MG/ML
JANUVIA TAB 100MG
LANTUS INJ SOLOSTAR
LEVEMIR INJ FLEXTOUC
IBRANCE CAP 100MG
NOVOLOG INJ FLEXPEN
ENBREL SRCLK INJ 50MG/ML
STELARA INJ 45MG/0.5
VICTOZA INJ 18MG/3ML
ADVAIR DISKU AER 250/50
Page 22 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
Secondary Diagnosis Total Claims
I5023 - Acute on chronic systolic (congestive) heart failure $225,789.68
I2582 - Chronic total occlusion of coronary artery $39,772.99
- Not Assigned $30,030.91
Secondary Diagnosis Total Claims
Z992 - Dependence on renal dialysis $219,937.82
Z992 - Dependence on renal dialysis $183,383.20
C61 - Malignant neoplasm of prostate $104,476.91
M726 - Necrotizing fasciitis $71,266.30
Z992 - Dependence on renal dialysis $71,259.89
- Not Assigned $56,869.32
- Not Assigned $54,200.00
R6521 - Severe sepsis with septic shock $52,791.48
- Not Assigned $52,375.00
- Not Assigned $48,986.51
C775 - Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes
$45,741.31
T7803XA - Anaphylactic reaction due to other fish, initial encounter
$42,592.55
- Not Assigned $39,060.07
N151 - Renal and perinephric abscess $38,987.09
78959 - Other ascites $32,192.36
I442 - Atrioventricular block, complete $29,405.40
- Not Assigned $27,554.07
I10 - Essential (primary) hypertension $27,190.42
- Not Assigned $26,510.45
Generic/Brand Name Total RX Amount
Etanercept Subcutaneous Soln Prefilled Syringe 50 MG/ML $139,515.20
Sitagliptin Phosphate Tab 100 MG (Base Equiv) $108,364.39
Insulin Glargine Soln Pen-Injector 100 Unit/ML $50,277.06
Palbociclib Cap 100 MG $38,444.28
Insulin Detemir Soln Pen-injector 100 Unit/ML $37,569.08
Insulin Aspart Soln Pen-injector 100 Unit/ML $34,543.91
Etanercept Subcutaneous Solution Auto-injector 50 MG/ML $31,734.31
Ustekinumab Soln Prefilled Syringe 45 MG/0.5ML $29,365.64
Liraglutide Soln Pen-injector 18 MG/3ML (6 MG/ML) $28,521.45VICTOZA INJ 18MG/3ML
LANTUS INJ SOLOSTAR
IBRANCE CAP 100MG
LEVEMIR INJ FLEXTOUC
NOVOLOG INJ FLEXPEN
ENBREL SRCLK INJ 50MG/ML
STELARA INJ 45MG/0.5
C541 - Malignant neoplasm of endometrium - ST. LUKE'S MEDICAL CENTER
PPO
Label Name
ENBREL INJ 50MG/ML
JANUVIA TAB 100MG
I2510 - Atherosclerotic heart disease of native coronary artery 1366519027 - GUAM MEMORIAL HOSPITAL
Z460 - Encounter for fitting and adjustment of spectacles and 1275911950 - HINES, MONICA K.
I6521 - Occlusion and stenosis of right carotid artery - UCLA MEDICAL CENTER
Z0000 - Encounter for general adult medical examination 1215930987 - DIAGNOSTIC LABORATORY SERVICES INC.
A419 - Sepsis, unspecified organism 1366519027 - GUAM MEMORIAL HOSPITAL
5724 - Hepatorenal Syndrome - THE QUEENS MEDICAL CENTER
C61 - Malignant neoplasm of prostate 1083946933 - ISLAND CANCER CENTER
C538 - Malignant neoplasm of overlapping sites of cervix uteri - UCLA MEDICAL CENTER
J869 - Pyothorax without fistula 1366519027 - GUAM MEMORIAL HOSPITAL
Y939 - Activity, unspecified - INTERNATIONAL SPORTS CENTER
A4102 - Sepsis due to Methicillin resistant Staphylococcus 1366519027 - GUAM MEMORIAL HOSPITAL
Z0000 - Encounter for general adult medical examination - WELLNESS INCENTIVES
T814XXA - Infection following a procedure, initial encounter 1366519027 - GUAM MEMORIAL HOSPITAL
N186 - End stage renal disease 1295910255 - U.S. RENAL CARE TAMUNING DIALYSIS
I2510 - Atherosclerotic heart disease of native coronary artery - ST. LUKE'S MEDICAL CENTER
N186 - End stage renal disease 1346436441 - U.S. RENAL CARE DEDEDO DIALYSIS
N186 - End stage renal disease 158849541 - U.S. RENAL CARE SINAJANA DIALYSIS
S22089A - Unspecified fracture of T11-T12 vertebra, initial - ST. LUKE'S MEDICAL CENTER
I25119 - Atherosclerotic heart disease of native coronary - THE QUEENS MEDICAL CENTER
I350 - Nonrheumatic aortic (valve) stenosis - ST. LUKE'S MEDICAL CENTER
PPO
Primary Diagnosis NPI + Service Provider
TakeCare Insurance CompanyLarge Claims Report (≥$25,000) - GOVERNMENT OF GUAMStart Date: 10/1/2017 ; End Date: 7/31/2018Print Date/Time:8/8/2018 1:30 PM
HSA
Primary Diagnosis NPI + Service Provider
I2510 - Atherosclerotic heart disease of native coronary artery without angina pectoris
1509959323 - GOOD SAMARITAN HOSPITAL
Page 23 of 29 TC Confidential Doc. No. 34GL-18-2220.*
Days % Cummulative Cum. %1 2.76% 350 2.76%2 1.21% 503 3.96%3 2.67% 842 6.63%4 5.27% 1511 11.90%5 6.51% 2337 18.41%6 2.78% 2690 21.19%7 13.45% 4398 34.64%8 2.64% 4733 37.28%9 2.22% 5015 39.50%
10 3.37% 5443 42.87%11 1.98% 5695 44.86%12 1.26% 5855 46.12%13 1.57% 6054 47.68%14 0.67% 6139 48.35%15 0.83% 6245 49.19%16 0.64% 6326 49.83%17 0.57% 6399 50.40%18 0.50% 6462 50.90%19 1.23% 6618 52.13%20 0.60% 6694 52.73%21 0.44% 6750 53.17%22 0.29% 6787 53.46%23 0.32% 6828 53.78%24 0.44% 6884 54.22%25 0.31% 6923 54.53%26 0.29% 6960 54.82%27 0.25% 6992 55.07%28 0.72% 7084 55.80%29 0.86% 7193 56.66%30 0.76% 7290 57.42%31 1.98% 7542 59.40%32 0.82% 7646 60.22%33 1.58% 7846 61.80%34 1.30% 8011 63.10%35 1.28% 8174 64.38%36 1.60% 8377 65.98%37 0.89% 8490 66.87%38 1.12% 8632 67.99%39 1.55% 8829 69.54%40 1.03% 8960 70.57%41 1.38% 9135 71.95%42 1.35% 9307 73.31%43 0.72% 9399 74.03%44 1.65% 9608 75.68%45 0.95% 9729 76.63% 45 days ~ 76.63%46 0.98% 9853 77.61%47 1.04% 9985 78.65%
124132
13117517292
209121
165163203113142197
9210997
252104200
374156393732
817363
1567656
42825216019985
106
669826353
1708335282
TakeCare Insurance CompanyClaims TAT for GOVGUAM3Parameters: Start Date: 10/1/2017, End Date: 7/31/2018Print Date/Time:8/8/2018 1:29 PM
Claim Count350153339
Page 24 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims TAT for GOVGUAM3Parameters: Start Date: 10/1/2017, End Date: 7/31/2018Print Date/Time:8/8/2018 1:29 PM
48 0.19% 10009 78.84%49 0.52% 10075 79.36%50 0.75% 10170 80.10%51 0.63% 10250 80.73%52 0.61% 10328 81.35%53 0.30% 10366 81.65%54 0.10% 10379 81.75%55 0.42% 10432 82.17%56 0.27% 10466 82.44%57 0.36% 10512 82.80%58 0.25% 10544 83.05%59 0.18% 10567 83.23%60 0.50% 10630 83.73%61 0.46% 10688 84.18%62 0.28% 10724 84.47%63 0.24% 10754 84.70%64 0.26% 10787 84.96%65 0.50% 10851 85.47%66 0.14% 10869 85.61%67 0.14% 10887 85.75%68 0.12% 10902 85.87%69 0.78% 11001 86.65%70 0.36% 11047 87.01%71 0.44% 11103 87.45%72 0.39% 11153 87.85%73 0.20% 11179 88.05%74 0.41% 11231 88.46%75 0.44% 11287 88.90%76 0.43% 11341 89.33%77 0.08% 11351 89.41%78 0.09% 11363 89.50%79 0.20% 11388 89.70%80 0.43% 11443 90.13%81 0.41% 11495 90.54%82 0.24% 11525 90.78%83 0.13% 11541 90.90%84 0.17% 11563 91.08%85 0.28% 11598 91.35%86 0.35% 11643 91.71%87 0.13% 11660 91.84%88 0.61% 11738 92.45%89 0.13% 11754 92.58%90 0.66% 11838 93.24%91 0.63% 11918 93.87%92 0.24% 11948 94.11%93 0.42% 12001 94.53%94 0.11% 12015 94.64%95 0.20% 12040 94.83%
1425
781684803053
301622354517
541012255552
465650265256
336418181599
322363583630
783813533446
24669580
Page 25 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims TAT for GOVGUAM3Parameters: Start Date: 10/1/2017, End Date: 7/31/2018Print Date/Time:8/8/2018 1:29 PM
96 0.03% 12044 94.86%97 0.03% 12048 94.90%98 0.08% 12058 94.97%99 0.15% 12077 95.12% 99 days ~ 95.12%100 0.09% 12089 95.22%101 0.20% 12114 95.42%102 0.14% 12132 95.56%103 0.20% 12157 95.75%104 0.23% 12186 95.98%105 0.29% 12223 96.27%106 0.21% 12250 96.49%107 0.06% 12257 96.54%108 0.36% 12303 96.90%109 0.23% 12332 97.13%110 0.08% 12342 97.21%111 0.12% 12357 97.33%112 0.06% 12364 97.39%113 0.17% 12386 97.56%114 0.28% 12421 97.83%115 0.03% 12425 97.87%116 0.06% 12432 97.92%117 0.14% 12450 98.06%118 0.02% 12453 98.09%119 0.03% 12457 98.12%120 0.06% 12464 98.17%121 0.05% 12470 98.22%122 0.17% 12491 98.39%123 0.17% 12513 98.56%124 0.09% 12524 98.65%125 0.15% 12543 98.79%132 0.01% 12544 98.80%134 0.01% 12545 98.81%140 0.01% 12546 98.82%142 0.09% 12557 98.91%143 0.01% 12558 98.91%147 0.06% 12565 98.97%148 0.06% 12572 99.02%152 0.02% 12575 99.05%153 0.02% 12577 99.06%154 0.02% 12580 99.09%156 0.03% 12584 99.12%157 0.01% 12585 99.13%159 0.17% 12607 99.30%160 0.13% 12624 99.43%163 0.13% 12641 99.57%165 0.01% 12642 99.57%166 0.01% 12643 99.58%167 0.08% 12653 99.66%
110
41
2217171
177323
1119111
11
3476
2122
7223547
18
277
46291015
122518252937
44
1019
Page 26 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
TakeCare Insurance CompanyClaims TAT for GOVGUAM3Parameters: Start Date: 10/1/2017, End Date: 7/31/2018Print Date/Time:8/8/2018 1:29 PM
168 0.12% 12668 99.78%170 0.04% 12673 99.82%173 0.01% 12674 99.83%174 0.01% 12675 99.83%175 0.01% 12676 99.84%177 0.02% 12678 99.86%179 0.09% 12689 99.94%180 0.06% 12696 100.00%
Totals:
12
117
12696
15511
Page 27 of 29 Copyright @ 2011 TakeCare. All rights reserved
TC Confidential Doc. No. 34GL-18-2220.*
Subgroup ID Oct-17 Nov-17 Dec -17 Jan -18 Feb -18 Mar - 18 Apr - 18 May -18 June-18 July- 18 TotalDOA1 334,480.81$ 272,424.56$ 272,542.53$ 271,894.07$ 272,642.51$ 419,797.67$ 281,998.56$ 282,517.99$ 282,667.77$ 283,973.54 $ 2,974,940.01 DOE1 198,898.43$ 228,937.30$ 227,307.54$ 215,400.51$ 225,617.74$ 338,554.86$ 232,107.51$ 115,450.23$ 339,840.63$ 198,467.32 $ 2,320,582.07 GAA1 10,660.68$ 12,495.00$ 12,495.00$ 18,877.68$ 12,765.36$ 11,142.74$ 13,576.67$ 12,765.36$ 19,148.04$ 12,765.36 $ 136,691.89 GCC1 16,316.74$ 19,024.32$ 18,959.67$ 18,895.02$ 18,895.02$ 28,342.53$ 18,895.02$ 18,895.02$ 18,895.02$ 18,895.02 $ 196,013.38 GHC1 2,310.45$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 2,317.10$ 3,475.65 $ 24,322.90 GHU1 4,444.66$ 4,373.22$ 6,559.83$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22$ 4,373.22 $ 45,990.25 GMH1 60,781.82$ 71,802.34$ -$ -$ - $109,506.04 148,844.29$ 145,674.27$ 70,585.52$ - $ 607,194.28 GPA1 48,230.13$ 49,835.56$ 71,874.11$ 23,548.33$ 47,262.32$ 57,513.52$ 46,064.94$ 45,437.03$ 71,706.46$ 46,197.95 $ 507,670.35 GVB1 3,871.95$ 2,405.70$ 2,405.70$ 2,405.70$ 2,405.70$ 2,405.70$ 3,608.55$ 2,405.70$ 2,405.70$ 2,405.70 $ 26,726.10 GWA1 25,425.60$ 37,342.62$ 31,334.26$ 30,657.44$ 31,898.02$ 35,311.78$ 33,625.74$ 34,079.64$ 51,202.99$ 40,347.72 $ 351,225.81 LEG1 9,841.73$ 9,242.34$ 9,242.34$ 9,182.11$ 4,693.91$ 14,081.73$ 9,387.82$ 9,008.44$ 8,615.52$ 12,874.62 $ 96,170.56 PAG1 36,455.63$ 47,292.14$ 47,292.14$ 71,587.95$ 47,941.88$ 48,254.81$ 48,132.18$ 48,327.28$ 49,641.22$ 75,154.99 $ 520,080.22 PUB1 4,571.46$ 5,838.90$ 8,067.23$ 3,932.00$ 5,567.91$ 5,331.38$ 5,331.38$ 5,633.56$ 604.36$ 2,109.23 $ 46,987.41 RAC1 5,570.58$ 9,324.48$ 3,108.16$ 9,324.48$ 6,216.32$ 6,404.54$ 6,216.32$ 6,216.32$ 9,324.48$ 5,945.96 $ 67,651.64 RET1 324,382.04$ 43,285.73$ 86,821.56$ 501,272.44$ 386,022.99$ 925,003.54$ 182,549.94$ 207,282.03$ 181,585.45$ 468,567.78 $ 3,306,773.50 UOG1 31,957.33$ 35,519.44$ 35,588.96$ 51,297.36$ 37,640.79$ 38,242.64$ 38,126.10$ 37,491.48$ 33,154.45$ 48,283.11 $ 387,301.66
$1,118,200.04 $ 851,460.75 $ 835,916.13 $1,234,965.41 $1,106,260.79 $2,046,583.80 $1,075,155.34 $ 977,874.67 $1,146,067.93 $1,223,837.17 $ 11,616,322.03
TakeCare Insurance CompanyTotal Monthly Premiums Paid - GOVERNMENT OF GUAMStart Date: 10/1/2017 ; End Date: 07/31/2018Print Date/Time:08/08/2018 10:00 AM
Subgroup NameGOVGUAM - DEPT. OF GOVGUAM - DEPT. OF GOVGUAM - GUAM INT'L GOVGUAM - GUAM GOVGUAM - GUAM HOUSING GOVGUAM - GUAM HOUSING & GOVGUAM - GUAM MEMORIAL GOVGUAM - GUAM POWER GOVGUAM - GUAM VISITORS
GOVGUAM - UNIVERSITY OF Total Premium Paid
GOVGUAM - GUAM GOVGUAM - GUAM GOVGUAM - PORT AUTHORITY GOVGUAM - PUBLIC GOVGUAM - RETIREMENT GOVGUAM - RETIREES
Doc. No. 34GL-18-2220.*
Group ID 17-Oct 17-Nov 17-Dec 18-Jan 18-Feb 18-Mar 18-Apr 18-May 18-Jun 18-Jul Total
GOVGUAM3 $ 16,300.00 $ 50.00 $ 1,025.00 $ 11,925.00 $ 400.00 $ 26,965.00 $ 2,850.00 $ 9,505.00 $ - $ 2,350.00 $ 71,370.00
$ 16,300.00 $ 50.00 $ 1,025.00 $ 11,925.00 $ 400.00 $ 26,965.00 $ 2,850.00 $ 9,505.00 $ - $ 2,350.00 $ 71,370.00
TakeCare Insurance CompanyGym Membership Expenses - GOVERNMENT OF GUAMStart Date: 10/1/2017 ; End Date: 07/31/2018Print Date/Time:08/08/2018 9:00 AM
Group Name
Government Of Guam
Total Premium Paid
Doc. No. 34GL-18-2220.*