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<br />September 26, 2025 <br /> <br /> <br />Karissa Goers <br />City of Lake Elmo <br />3800 Laverne Avenue No <br />Lake Elmo, MN 55042 <br /> <br />RE: January 1, 2026 PEIP Renewal for City of Lake Elmo <br /> <br />Dear Karissa: <br /> <br />Thank you for your participation in the Public Employees Insurance Program (PEIP). We hope the program <br />continues to fulfill your insurance needs. <br /> <br />2025 vs 2026 MEDICAL RATES <br /> <br /> Current Rate 2026 Renewal Rate <br />Without Commission <br />2026 Renewal Rate <br />With Commission <br /> <br />Projected <br />Enrollment <br /> High Option Single <br />Family <br />$657.22 <br />$1,684.36 <br />$678.94 <br />$1,808.80 <br />$718.94 <br />$1,848.80 <br />5 <br />6 <br />HSA Option Single <br />Family <br />$465.94 <br />$1,172.78 <br />$468.54 <br />$1,246.06 <br />$508.54 <br />$1,286.06 <br />6 <br />8 <br />In accordance with MN Stat. 471.61, renewal rates for retirees who are under age 65 are blended with the rates for active <br />employees. Eligible retirees currently on continuation are included in the rate structure. <br /> <br />The below information is being provided to you in accordance with the 2024 Transparency <br />Amendment to the HITA legislation. <br /> <br />Summary <br />Agent Commissions Paid as Part of the Premium $40.00 PCPM / $16.67 PMPM <br />Total Premium Dollars in the First 12 Month Period of the Quote, <br />Not Including Commissions <br />$324,327.00 <br />Total Premium Dollars Per Member Per Month Not Including <br />Commissions <br />$450.00 <br />Number of Expected Members 60 <br />Type of Provider Network Broad Tiered Network HMO1 <br />1The PEIP network operates as an HMO within each cost level tier. <br /> <br />2026 Actuarial Value <br />Plan % of Total Allowed Costs <br />2026 Cost Sharing Projection <br />Plan % of Total Allowed Costs <br />High HSA HIGH HSA <br />89.8% 74.0% 93.6% 85.9% <br />*Please find additional commentary regarding the source of these actuarial values and their applicability on page 4. <br /> <br />