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City Of Lake Elmo <br />Stember 20, 2024 <br />Page 4 <br /> <br /> <br /> <br />If you have any questions, please call 952-746-3101 or 1-800-829-5601 or email shawn@innovomn.com. We <br />look forward to another year of serving you. <br /> <br />Sincerely, <br /> <br />Shawn Byrne <br />Manager <br /> <br />CC: Agent (if applicable) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />2025 Actuarial Value3 <br />Plan % of Total Allowed Costs <br />2025 Cost Sharing Projection4 <br />Plan % of Total Allowed Costs <br />High HSA HIGH HSA <br />89.8% 74.0% 91.1% 82.2% <br /> <br />3This minimum value calculator was released by the Department of Health and Human Services in conjunction with the final rule for <br />determining minimum value, finalized as 45 CFR 156.145. This tool is being used to calculate actuarial value as required by Minnesota <br />Statute 2023, section 471.6161, subdivision 8 as amended by Chapter 114, Article 1, Section 15. <br /> <br />The HHS minimum value calculator utilizes 2009 data trended to 2014 to determine each plan’s actuarial value <br />and relies solely on the Single coverage plan design. No employer premium or HRA/HAS contributions are <br />included in these actuarial value calculations <br /> <br />4Using recent, actual claims data, as well as projected benefit changes, this represents PEIP’s estimated member cost sharing associated <br />with the HIGH and HSA plans. This estimate is calculated using actual PEIP membership and claim experience for both Single and Family <br />coverages, trended forward to 2025 and using 2025 plan designs. No employer premium or HRA/HSA contributions are included in these <br />actuarial value calculations. <br />