Iowa Bankers Benefit Plan

April 2011 Update

Iowa Bankers Benefit Plan1

Iowa Bankers Benefit Plan Update 2011

IBBP Demographic Update

Financials and Year End Numbers

Analysis of the Plan

2

Iowa Bankers Benefit Plan Health and Dental Employee Numbers3

2008 2009 2010 20110

2,000

4,000

6,000

8,000

10,000

12,00011,146 11,121 11,123 11,012

9,4699,005

8,3357,831

Number of Employees Health including Retirees Number of Employees Dental

4

IBBP Employee Demographics

Single Employee & Spouse

Employee plus Child(ren)

Family0

1,000

2,000

3,000

4,000

5,000

6,000

5

$250 deductible $500 deductible $1,000 deductible

$1,500 deductible

$2,000 deductible

$2,000 HDHP 0

5001,0001,5002,0002,5003,0003,5004,0004,500

469

1012

2866

3630

2330

739

Number of Employees at Renewal by Plan

Choice

2009 2010 2011 2012

6

$250 deductible $500 deductible $1,000 deductible

$1,500 deductible

$2,000 deductible

$2,000 HDHP 0

20

40

60

80

100

120

140

35

65

128 126

84

43

Number of Employers at Renewal by Plan

Choice

7

IBBP Demographic Detail

Health membership has declined 4% - 26,004 (2007) to 24,947(2011) in the past 4 years.

The workforce is primarily female (67%). Overall the gender is female (55%). The greatest concentration of members is between

the ages of 5 – 34(42%) and accounted for 24% of health claims paid.

Members over 45 account for 41% of membership and 60% of health claims paid.


IBBP Update



8

9

IBBP Health Cost Summary

Prior Year Current Year

Percent Change

COVERED CHARGES

$131,624,577

$136,971,858

4.1%

Inpatient $36,773,991

$35,981,525

(2.2%)

Outpatient $54,197,442

$58,608,631

8.1%

Office $35,824,651

$37,166,289

3.7%

Other $4,828,493 $5,215,413 8.0%CLAIMS PAID $67,285,63

7$68,635,008

2%

PharmacyCovered Charges

$27,937,391

$28,419,188

1.7%

Pharmacy Paid

$13,653,625

$13,589,957

(0.5)

2010 Administrative Expense Ratio10

2010 Total Premiums: $99,382,931

Wellmark Administrative Fees: $5,054,467

IBIS Administrative Expense: $4,469,936

Other Expense: Audit Expense $25,000 Legal Expense $47,452 Misc. Expense $489

Total Administrative Expense : $9,597,344

9.6% Administrative Expense Ratio

2010 Claims Wellmark Admin Fees

IBIS Admin. Expense Other Expense

Iowa IBBP

11

Health Claims86.5%

Adm.Exp13.8%

Operating Margin

.7%

Health Claims

90.35%

Wellmark Adm Fees

5.1%

IBIS Adm.

Expense4.5%

Other Expense.05%

Comparison of Administrative Expense

$0 $5,000,000

$10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000

Dec-07

Dec-08

Dec-09

Dec-10

Aug-11

August 2011 $27,794,822

December 2010 $20,629,7312010 Actuarial Certification Amount $9,698,548

December 2009 $18,210,897 2009 Actuarial Certification Amount

$8,739,928


$8,050,445


$6,835,781


$7,419,510

Iowa Bankers Benefit Plan Trust Reserve12


•IBBP Update



13

Total IBBP Claims by Month14

January February March April May June July August September October November December

2008 $5,538,729 $6,312,230 $5,472,395 $6,018,769 $6,633,649 $5,696,861 $5,684,415 $6,805,533 $5,464,621 $7,603,092 $5,836,552 $6,119,0142009 $6,767,899 $6,309,826 $5,590,944 $6,583,907 $7,461,058 $6,191,504 $7,857,762 $5,697,910 $5,905,447 $8,023,630 $6,259,775 $6,774,9312010 $7,223,080 $5,583,319 $6,634,185 $7,295,334 $6,092,703 $5,948,072 $7,290,348 $6,410,847 $6,961,272 $7,868,679 $6,665,801 $8,769,6902011 $6,158,473 $6,215,570 $6,322,191 $7,716,965 $6,580,135 $6,408,026 $7,217,173 $6,475,406

$0$2,000,000$4,000,000$6,000,000$8,000,000

$10,000,000

15

Inpatient Services Summary

Financial and Utilization Metrics

2009 2010 2011

Percent Change Wellmark Book

Admissions/1,000 56 52 52 0.0% 62

Average Length of Stay 3.7 3.9 3.5 (10.3%) 3.9

Covered Charge/Admission $26,345 $28,441 $27,979 (1.6%) $30,474

Claims Paid/Admission $13,641 $14,390 $13,759 (4.4%) $13,585

Claims Paid Per Member $759 $753 $709 (5.8%) n/a

Top Diagnostic Categories by Claims Paid

2010 2011 Difference % Change

Obstetrical $3,206,638 $3,785,357 $805,825 25.1%

Bones/Muscle/Ligaments $2,992,549 $3,138,993 $334,771 11.2%

Heart/Vessel $2,324,220 $2,106,973 ($90,838) (3.9%)

Digestive $1,567,514 $1,497,310 $19,628 1.3%

Injuries/Poisonings $1,480,777 $1,431,582 $36,694 2.5%

Top Diagnoses Categories by covered charges were: Bone/muscle/ligament conditions

accounted for 19% of covered charges. Covered charges per member were 2% less than the Wellmark average, but 11% more than the prior year level. Admissions also increased 14%. The primary diagnoses were osteoarthrosis, intervertebral disc disorders and curvature of the spine.

Obstetrical conditions also accounted for 19% of covered charges, which on a per member basis were 8% above the Wellmark book of business. The primary diagnoses were single live-born, normal delivery and abnormality of pelvic organs and soft tissue.

Heart/vessel followed with 13% of covered charges. Covered charges per member were 37% less than the Wellmark average. Top diagnoses included acute myocardial infarction, chronic ischemic heart disease and cardiac dysrhythmias.

16

Outpatient Services Summary


2009 2010 2011

Percent Change

Wellmark Book

Claims/1,000 Members 1,229 1,255 1,244 (0.9%) 1,267 Covered Charge/Member $1,937 $2,193 $2,349 7.1% $2,613 Claims Paid/Visit $676 $761 $818 7.5% n/a Claims Paid/Member $831 $955 $1,017 6.5% n/a


Prior Current Difference % Change

Bones/Muscles/Ligaments $3,220,686 $3,321,551 $300,144 9.3%

Benign/Cancerous Tumors $2,224,838 $2,763,116 $704,054 31.7%

Digestive $2,548,233 $2,329,857 ($78,594) (3.1%)

Genital/Urinary $2,055,549 $1,975,630 $38,610 1.9%

Nerves/Eyes/Ears $1,729,054 $1,873,626 $256,981 14.9%

Top Diagnoses Categories by covered charges were: Muscular/skeletal accounted for 14%

of covered charges. Covered charge per member was 2% more than the Wellmark average. Top diagnoses included intervertebral disc disease and other disorders of the back and joints.

Benign/cancerous tumors On a per member basis, covered charges were 15% more than last year, but 3% less than the Wellmark average. Top diagnoses included breast cancer, benign tumor of the digestive system and cancer of the trachea/bronchus/ lung.

Digestive Covered charges per member were 11% below the Wellmark average. The top diagnoses were gall bladder disease, diseases of the esophagus and abdominal hernia.

17

Office Visit Services Summary


2009 2010 2011

Percent Change

Wellmark Book

Office Visits/1,000 6,011 6,381 6,459 1.2% 6,782

Covered Charge/Member $1,330 $1,450 $1,490 2.8% $1,510

Claims Paid/Visit $139 $142 $141 (0.7%) n/a

Claims Paid/Member $833 $904 $913 1.0% n/a


Prior Current Difference % Change

Routine/Diagnostic $3,223,470 $3,306,947 $281,880 8.7%

Bones/Muscles/Ligaments $2,929,884 $3,056,262 $309,742 10.6%

Benign/Cancerous Tumors $2,757,090 $2,691,823 $96,231 3.5%

Nerves/Eyes/Ears $1,645,592 $1,756,939 $216,756 13.2%

Nose/Throat/Lungs $1,521,189 $1,653,822 $231,855 15.2%

Top Diagnoses Categories by covered charges were: Bone/muscles/ligaments accounted

for 14% of covered charges. This was 17% below the Wellmark average in covered charges per member. Primary diagnoses included unspecified disorders of the joints and back and non-allopathic lesions – chiropractic (16% of claims paid) and physical therapy (19% of claims paid).

Routine/diagnostic The number of office visits was down 8%, while covered charge per member was steady, but 21% above the Wellmark average. Primary diagnoses included special investigations/examinations, well-child exams and general medical examinations.

Benign/cancerous tumors Per member charges were 6% below the Wellmark average. Primary diagnoses included cancers of the breast and prostate and tumors or growths of other unspecified sites.

IBBP Drug Claims by Month

18

Janu

ary

Febru

ary

March Apr

ilMay

June Ju

ly

Augus

t

Septem

ber

Octobe

r

Novem

ber

Decem

ber

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,143,943

2008200920102011 th

ousa

nds

19

Prescription Drugs

Generic utilization increased 13%, but remained slightly below the Wellmark book of business.

Prescription claims paid per member decreased nearly a percent, well above expected trend.

A number of specialty medications including Humira, Copaxone, Avonex and Enbrel noted at left contributed to the pharmacy costs, but were off-set by decreased utilization and increased generic utilization.

Nearly 25% of members obtained no prescriptions and another 41% had claims paid of $100 or less. Just over 11% of members filled prescriptions in excess of $1,000, accounting for 42% of prescriptions and 81% of prescription dollars paid.

Biologic response modifiers accounted for the most claims paid (9.4%). These include several specialty meds used to treat multiple sclerosis. Antidepressants and disease modifying anti-heumatics (used to treat rheumatoid arthritis and other autoimmune conditions) followed, each with 6.2% of claims paid.


2009 2010 2011Percent Change

Wellmark Book

Generic Fill 63.7% 67.1% 75.5% 12.5% 76.1%

Covered Charge/Rx $94.22$106.6

5$109.6

1 2.8% $98.07

Claims Paid/Rx $46.26 $51.69 $51.87 0.3% n/a

Claims paid/Member $492.00$563.6

1$559.0

8 (0.8%) n/a

Member Liability/Rx $18.49 $20.11 $19.51 (3.0%) n/a

Member Liability % 28.6% 28.0% 27.3% (0.3%) n/a

Prescriptions/Member/Year 10.64 10.90 10.78 (1.1%) 12.20

Top Drugs by Claims Paid

Drug Name Primary Use Claims PaidHumira Rheumatoid Arthritis $520,870

Lipitor Cholesterol $394,851

Copaxone Multiple Sclerosis $391,158

Avonex Multiple Sclerosis $354,799Enbrel Rheumatoid Arthritis $324,908

20 Wellmark Blue Cross and Blue Shield

Generic Pipeline

2010 2011 2012 2013 2014$0

$5

$10

$15

$20

$25

$30

$35

$40

$45

$17.3 M $21.2 M

$41.1 M

$9.4 M

$19.2 M

Generic Pipeline - Pharmacy Benefit Cost Efficiencies$107.4 M in

Benefit Savings by 2014*

CozaarEffexor XR

ConcertaLevaquinXalatanZyprexa

ActosAvandiaDiovanLipitorLexaproPlavixSeroquelSingulair

AciphexCymbalta

CelebrexLunestaNexium

*Generic market entrance is estimated based on existing patent expiration dates. Patent litigation may alter these projections and actual savings may vary.

IBBP Total Health and Pharmacy Claims Paid Per Member

The Average Increase over the Past Five Years was 5.1%

Year 2007 2008 2009 2010 2011

Paid perMember

$2574 $2,806 $3,049 $3,276 $3,296

Percent ofChange

(.04%) 9% 8.7% 7.4% .6%

21

22

Most Costly Diagnosis Categories

The following graph represents the “top” diagnoses categories using claims paid for services obtained through all places of service, excluding pharmacy, comparing the current benefit period data to the prior benefit period dat

Bones

/Mus

cles/L

igamen

ts

Benign

/Can

cero

us T

umor

s

Routin

e/Diag

nosti

c

Obstet

rical

Heart/

Vesse

l

Digesti

ve

Nerve

s/Eye

s/Ear

s

Injur

ies/P

oison

ings

Genita

l/Urin

ary

Nose/T

hroa

t/Lun

gs0%2%4%6%8%

10%12%14%16%

14%

10%

7%6%

7% 7%6% 6% 6%

4%

14%

10%

7% 7% 7% 7% 6% 6% 5% 5%

Top 10 Diagnosis Categories by Claims Paid

% of Prior % of Current

23

Health Status Distribution

The above graph notes the current distribution of Iowa Bankers’ members along the health risk continuum. Compared to the prior period, the health risk of members remained relatively steady. However looking at members continuously enrolled in the plan throughout the two year period, there was a slightly greater move of members to a higher (less healthy) risk category. Of continuously enrolled members:

Over 77% (18,633 members) remained unchanged within the same risk category Nearly 11% (2,552 members) moved to healthier risk category Just over 12% of members (2,959) moved to a higher risk category

59% 15% 25% 2%

Low - Healthy / Non-User Elevated - Chronic Conditions

0.2% Extreme - Severe Illness Complex DiseaseModerate - Minor Chronic

High - Disease Progression

12 Month Ending 12/31/2010

58% 15% 25% 2%




12 Month Ending 12/31/2009

63% 12% 23% 2%




Wellmark Book of Business

24

IBBP Over All

Including all members, enrollment has increased 1%. Health claims paid per member increased less than

1% due to a 6% decrease in inpatient claims. Outpatient claims paid were 7% higher than last year.

Pharmacy claims paid per member decreased 1%,compared to 22% increase in 2010.

165 members account for 23% of total claims paid. Over all, health and pharmacy claims paid

increased .06%, compared to 7.4% last year

IBBP Dental Highlights

47.9% of paid claims are for check-ups Average claim cost is $142.67 94.8% of members receive service in-network Provider savings averages 12.5% of billed charge 84.4% of covered members visited a dentist at least

once in the past 12 months 2% of our members met or exceeded the annual

benefit maximum(all plan options combined)

25

Documents

Iowa Bankers Benefit Plan