Free Motion for Leave to File - District Court of Federal Claims - federal

Case 1:01-cv-00517-MBH
BLUELINCS OPERFITIONS

Document 44-2

Filed 12/06/2005

Page 1 of 4

ID:9185619966

P.02 DEC 02'05 ia:57No.O01

FIL~ COPY

April 26, 2OOO

Dir~tor, Offic~of 1900E St*t~t, NW Room 43{)7 Wa~hingto~ DC2O415 i~: 2000Rate R~or~ilialion - BlucLin~sHMO

F~lot~l is te 2000rat~ rtoonclliatio~ for BlucLi~HMO. major differences included ~mlmr~l Tho to 1. Actual 1'~ Quarter2000at~rov~rat~ now Plan) 2. We havea Plan 3Awhlchi~ the Plan 3 (CommurdtF with I0(~/o ho~ital b~ne~fitfiled withtim Okhlhoma HealthI~lmrtm~t, Thisrate wasu.~din lieu of e, Piatt 3 plu~ a supplem~tal bet~fit load for ~ 100% haspital 3. The actualSSSG di~ount calc~tlat~d utilized. was and If you lmwany que.~iom, pl~ f~l f~ to contact meat 915-%1-9905.

At~achraent~

Case 1:01-cv-00517-MBH
BLUELINCS OPERRTIONS

Document 44-2

Filed 12/06/2005
DEC 02'05

Page 2 of 4
No.O01P.03

ID:9185619966

14:58

RECONCIL]AIqON
CARRIER NAME : BluaLfncs~M0 STATE; " OK CODE : N5

BIWEEKLY NET-TO-CAR~ER RATES 2~000 CONTRACT YEAR

Actual FERSP Rates -2000 2, Special Benefit Loadings (a) Prescription Dru~ (b) 8uppleme.tal Mental Health/Therapy (c) Vision ~)P~escriptionDrug Supplement PremiumTax AdJu§~me~t" FEHBP Rates Plu9 SpecialLoadings Standard Loadings (a) Extension ~Coverage [.004x(3)]

$73.50

$163.88

( 4.68) (~o~___.__) $91,63 .37 N/A N/A $92,00

i.17

2.83

3. ~.

$207.99 .83

(b)~ Children's Loading (c) Medicare Loading subtotal Enrollment Discrepancies Loading

$208.82 2.09

[,Olx(4d)]
5, Total FEHBP Rates - 2000" Contract Rate - 2000* S~nmll Carriers Use Line C, Attacb~nent ~ Here 7.Difference ((5) - (6)) + = Underpayment to Carrier - = Overpayment to Carrier 8. March 3!, 2000 Enrollment 9. Payment Due Carrier/(FEHBP) i0. Brochure Printing Cost~ ll. Outstanding Amount Due Carrier/(FEHBP) $2,841.80 $92.92 $210.91

12. Total Amount Due Carrier/(FEHBP) * These ra~es are subject to audit in accordance carrier's contract wi~h OPM. with the

10

Case 1:01-cv-00517-MBH

Document 44-2

Filed 12/06/2005

Page 3 of 4

May2. 2000

AIRBORNE~XPRES$-202~0~-0722 Ms. Nancy KJchak ~cL Dircctot,O£fic~ Actuarie~ of Ofli~ ofPer~ormelMm'mgement 1900 Sttczt, - Room E NW 4307 Washington, DC 20415

Dear Ms.Kichak:

If youhavemyquestions,pleas~feel fre~ to contactme 918-561-9905. al Sincen;ly,

Silvan Ftttgersol, CPA Vi~ Prcsi~nt, Financ~

SO, 0£ AON

996619S816:~I

Case 1:01-cv-00517-MBH

Document 44-2

Filed 12/06/2005

Page 4 of 4

RECONCILIATION
BlueLincs HM0 STATE : ' OK 'CODE

~I~[EEKLY NET-TO-CARRiER RATES ----"~"000 CONTRACT YEAR

i. Actual 2.

FEHBP

Rates

-2000

$73,50

$163.88

3, 4.

Special Benefi~ Loadin~s (a) Presc.rip~ionDru~ (b) ~uppl~m~ntal. Men~a H2al~h/Thera~ I Y (c) Vision Prescription Drug Supplement Pr (d2) smium Yax FEHBP Rates Plus SPecial Loadin~s S=andard Loadin~s {a) Extension ~-Coverage s Loading Loading

1.17 (~,06) $91.63 ¯ 37 N/A N/A

2,83 ( ~.68) $207,99 .83 N/A N/A

(b) Children' (c) Medicare 4d. Subtotal Enrollment [.01x(~d) ] 5. Total FEH~

$92.00
Discrepancies Loading .92

$208.~2
2.09

Rates

- 2000*

$92.92 C,

~210.91

Contrac~ Kate - 2000" Small Cazrier~ Use LAne Attachment ~ Here 7,Difference ((5) ÷ = Underpayment - = Overpayment 8. March 9. 9ayment i0, Brochure 31, 2000

to Carrier to Carrier

Enrollment

Due Carrier/(FEHBP) Prin~ing Amount Costs Due Carrier/(FEHBP) $2,84i.80

ii. Ou%s~anding 12. To~al Amount

Due Carrier/(FEHBP) to audi~ in accordance with

These rates are subject carrier's contrac~ with

£0"d £O0"ON 5~:~

~0,0£ AON

99661998~6:~I

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