U.S. Office of Personnel Management www.opm.gov - Recruiting, Retaining and Honoring a World-Class Workforce to Serve the American People

Federal Employees Health Benefits Program

ANNUAL REPORTING INSTRUCTIONS

FOR EXPERIENCE-RATED CARRIERS

For the period January 1, 2003 - December 31, 2003

 

Instructions for the FEHBP Automated Accounting Spreadsheet

Introduction

The Automated Accounting Spreadsheet (AAS) is a Microsoft Excel-based solicitation of the annual financial information that is requested of the benefit plans by OPM. AAS is intended to provide several benefits to both the plans and OPM, including:

1. easier and faster completion resulting from an electronic document that automatically calculates totals, transfers values between pages where appropriate, cross-checks other calculations and entries, etc.
2. greater accuracy resulting from a highly structured, non-editable template that ties entries and calculations from multiple sheets together to help highlight incomplete and/or incompatible data
3. easier review and maintenance of the historical record as compared to the current paper-based submissions

This document presents basic instructions for filling out the AAS.

The AAS Structure

The AAS is comprised of a single Excel workbook that contains multiple spreadsheets. The name/content of each spreadsheet is shown by the name on the tab at the bottom. Clicking on the respective tabs causes the associated spreadsheet to become visible for review and editing.

1. The spreadsheets are ordered so that the sheets at the beginning, once filled out, can automatically populate cells in the subsequent sheets. For this reason, it is recommended if not mandatory that each user begin with the first sheet (the far left), finish that one, and then continue with the one to its immediate right, etc., until finished. For those not familiar with Excel, note that all of the tabs will not be visible at once, so the leftmost visible tab may or may not be that from the leftmost spreadsheet. The arrows at the far left can be used to "slide" the visible tabs all the way to the left, one to the left, one to the right, and all the way to the right. Note that these arrows only affect the tabs that are visible - it is still necessary to click on a tab to make its associated spreadsheet appear.

   AAS Workbook and Worksheet Protection

   The AAS utilizes the Excel protection features to "lock' the individual spreadsheets as well as the overall workbook. This locking prevents the user from editing any of the overall worksheet design (particularly inserting or deleting cells/rows/columns), and also prohibits the user from entering data in any but the appropriate unlocked fields. These unlocked fields are color-coded, to help indicate what kind of data is expected. This is discussed in the next section.

The AAS Color-coded Entry Fields

Yellow	User Numeric Entry
Yellow	User Currency Entry
Green	User Text Entry
Orange	Calculated Field (non-editable)
	Worksheet boundary

There are three basic colors used in the AAS to indicate which fields are intended for user-entry and which are automatically filled in by the document. The first worksheet shows this color legend:

As shown, the yellow and green cells are for user entry and are unlocked. Cells that are yellow indicate that the user is to enter a numeric value. Depending on the data type, the cell is formatted to show currency (integer dollars) or units (integers). Because no cents are displayed, it is requested that the AAS be filled out in whole dollars.

The green fields are intended for text entry. These fields are used to capture basic plan information like name and code, and also detail on several of the forms that allow for things like 'Other Expenses' but request that individual components of this 'Other' be listed in a separate section comprised of green and yellow boxes (i.e. for the name and amount). There is also a Notes section at the bottom of each worksheet, where plans can enter explanatory text (if desired).

The orange fields are locked, and indicate that the AAS has or will automatically fill them in. Some of these cells are calculated from values entered on the same page (e.g. the sum of a column of numbers). Others are transferred from other ('upstream', and thus presumably filled out earlier) worksheets. Even though these cells are locked, it is possible to highlight them and see where the calculations come from. Note that the presence of a name followed by an exclamation point (e.g. 'Health Benefits Charges Paid'!C349) indicates that the entry comes from the separate spreadsheet with that name.

Entering Options Detail

Several of the worksheets require that detail be provided for individual plan options, and this detail is automatically summed to provide the consolidated data. If your plan only offers one option, please fill out the 'High Option' section.

Also, those plans that have data from DOD projects during 2003 should provide those details as well. Again, if there is only one DOD option please fill in the areas marked 'DOD High'.

Embedded Comments

Some of the cells in the AAS have instructions or other information contained in comments. The presence of a comment is indicated by a red triangle in top-right corner of the cell. When the cell is highlighted, the comment is shown.

Printing the AAS

Each spreadsheet in the AAS has been pre-formatted to print in a concise way. It is possible to change the print page settings if the user desires, but the original settings will then be lost. Note that the default setting assumes a printer that can handle margins of .5" on all 4 sides.

The 'Calculation Checks' Worksheet

The 'Calculation Checks' worksheet contains several checks that indicate whether the data entered by the user has resulted in results that match where expected. Due to possible rounding error, the check gives a 'PASS' result if the compared totals are both within $10 and within .1%. If you get an 'EXPLAIN' result, please use the green comments fields to explain the reasons. It has been pointed out that some plans may get an EXPLAIN because of the difference between actual and accrued cash flows; if this is the cause of a flagged difference, just note that in the Explain section.

The 'User Worksheet' Worksheet

The 'User Worksheet' worksheet is a completely unlocked spreadsheet for interim calculations, additional footnotes (which can be referenced in the Notes sections on the individual spreadsheets). It is possible to cut and paste sections from the locked sheets into the User Worksheet, and vice-versa. However, it is recommended that pasting into locked sheets be done carefully. This can only be done when the target cells are unlocked (yellow and/or green). Also note that cutting unshaded cells from the User Worksheet or another spreadsheet onto shaded cells in the locked spreadsheets will result in the color being lost. This is not a problem, but it could lead to user confusion.

2003 ANNUAL REPORTING INSTRUCTIONS

This section contains the guidelines for your ANNUAL ACCOUNTING STATEMENT REPORTING, which is due no later than March 31, 2004. As in prior periods, the accounting reports and supporting schedules must be prepared using the accrual basis of accounting. The information provided in Enclosure A must be used in the preparation of your financial reports and its accuracy is essential. Please review this information and contact the Trust Funds Branch if you feel it is inaccurate.

REPORTING REQUIREMENTS

 

All the 2002 financial reporting requirements are required for 2003. You should ensure that all required statements and supporting schedules are included before submitting your completed 2003 annual accounting statement package. The last page of these instructions is a checklist of required documents.

In addition, please remember that all administrative expenses and other expenses and retentions shown on your report must be allowable under (1) The Federal Employees Health Benefit Regulation, Part 890, Title 5, Code of Federal Regulations; and (2) The Federal Acquisition Regulation, Chapters 1 and 16 of Title 48, Code of Federal Regulations.

 

MAINTENANCE OF HEALTH BENEFITS CLAIMS INFORMATION

Each carrier must prepare computer tape(s) with back-up of the paid claims history for each contract year. This tape(s) must support the claims paid amount shown on your Supplemental Schedule of Health Benefits Charges Paid, Part A before the reconciliation performed in Part D. These tapes must be maintained as a part of each carrier's financial records. The Office of the Inspector General (OIG) will request this information as a part of their periodic audit.

 

CONFIDENTIALITY

It is OPM's policy to disclose the Summary Statement of FEHBP Operations of participating carriers upon request, provided: (1) the carrier's accounting statement is accepted by OPM for use in administering the contract; and (2) the rate-negotiation process for the contract year in which the accounting statements are due has been completed for all participating carriers.

Consistent with Executive Order 12600, each carrier must designate, when the financial information is submitted, whether any other information submitted with the annual accounting statement is considered confidential commercial information.

COMPLIANCE WITH THE FEHBP AUDIT GUIDE

If your carrier activity consists of claims expense greater than $90 million and you have chosen either Option 3 or Option 4 of the Guide with a December 31 accounting period, you must have your Independent Public Accountant prepare the reports outlined in the "FEHBP Experience-Rated Carrier and Service Organization Audit Guide". A recent edition of the Audit Guide is available on http://www.opm.gov/carrier/carrier_letters/2002/2002-25.htm for your information and reference.

If your carrier activity consists of claims expense less than $90 million and you have chosen either Option 3 or 4 of the Guide with a December 31 accounting period, you must have your Independent Public Accountant follow the instructions outlined at the top of Page I-4 of the Audit Guide.

DOD PROJECT

 

If your Plan is participating in the Department of Defense Demonstration Project, the financial activity pertaining to this should be reported separately from other FEHBP operations on the Summary Statement, Supplemental Schedule of Administrative Expenses and the Supplemental Schedule of Health Benefits Charges Paid. Beginning balances for DOD reporting should be consistent with the prior year's submission. Calendar year 2002 is the final year of the DOD Project. Your calendar year 2003 financial statements must included the final expenses for the DOD Project.

DUE DATE

 

The completed Calendar Year Automated Accounting Statement should be e-mailed to Melanese.matthews@opm.gov or Laxman.pai@opm.gov no later than March 31, 2004.

In accordance with the Audit Guide, you are required to submit 4 copies of the completed Audited Accounting Statement and all Supplementary Schedules no later than March 31, 2004 to:

U.S. Office of Personnel Management
Business Units & Financial Services Group
Trust Funds Branch
Attention: Melanese Matthews/Laxman Pai
1900 E Street, NW, Room 3H25
Washington, D.C.20415-0001

If you have any questions regarding the preparation of your accounting statement or the Enclosure A for your plan, please contact Melanese Matthews at (202) 606-4498 or Laxman Pai at (202) 606-4492.

Questions and requests for the Audit Guide may be faxed to the Office of the Inspector General at (202)606-4823 or emailed to dlfletch@opm.gov.

FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
ANNUAL ACCOUNTING STATEMENTS
FOR THE YEAR ENDING DECEMBER 31, 2003

TABLE OF CONTENTS

1. Financial statements and required supplementary schedules of the FEHBP as of and for the years ended December 31, 2003 and 2002 and independent auditors' report.

   • INDEPENDENT ACCOUNTANT'S REPORT (If applicable)

   • SUMMARY STATEMENT OF FINANCIAL OPERATIONS

   • FEHBP BALANCE SHEET

   • STATEMENT OF CONSOLIDATED CASH FLOWS

   • NOTES TO FINANCIAL STATEMENTS

   Required supplementary schedules include:

   • Supplemental Schedule of Administrative Expenses

   • Supplemental Schedule of Status of Reserves

   • Supplemental Schedule of Health Charges Paid

   • Supplemental Schedule of Monthly Cash Flows

   • Supplemental Schedule of Audit Findings

2. Supplemental Data

   • Vendor Cost Containment Expenses

   • Other Expenses

3. Checklist of documents to be submitted

Instructions for Preparing 2003
FEHBP SUPPLEMENTAL SCHEDULE OF MONTHLY CASH FLOWS

This schedule must be prepared on a monthly basis for the period January 1, 2003 through December 31, 2003.

Cash Balance:

 

Beginning of year Balance: The total of ending cash balance and total value of investments held by carrier as shown on your 2002 annual accounting statement.

Net Inflow (Outflow): The net of total Sources of Cash minus total Applications of Cash.

Cash and Cash Equivalents Monthly Balance: Previous month's balance of cash, cash equivalents, and investments plus the month's net inflow (outflow).

End of Year Balance: The total of ending cash balance and total value of investments held by carriers at the end of each month through December 31, 2003.

 

Sources of Cash (all by month received):

LOC Drawdowns: Withdrawals made from your Letter of Credit (LOC) account as shown on line 4b. of Enclosure A.

Non-LOC Investment Income: Interest earned on funds held during the contract year, other than the LOC account.

Non-LOC Investment Sales: Provide an explanation.

Other Sources: Explain and provide a breakdown of all entries shown on this line.

Uses of Cash (all by month incurred): Included checks issued but not presented for payment at the bank as of 12/31/03.

Claims Paid: The total health benefits charges paid during the period January 1, 2003, through December 31, 2003.

Administrative Expenses Paid: The amount of cash paid for allowable administrative expenses during 2003.

Non-LOC Investment Purchases: Provide an explanation.

Other Uses: Explain and provide a breakdown of all entries shown on this line.

Instructions for Preparing 2003
FEHBP SUPPLEMENTAL SCHEDULE OF ADMINISTRATIVE EXPENSES

Show your Plan's total expenses, by object class. A separate column should be submitted for each entity of your plan; i.e., Organization and/or Underwriter, where applicable. The total charged must not exceed the contract limitation.

If your plan has two options, on a separate column show the basis and statistical data used for prorating administrative expenses between options, e.g. number of claims paid, or other units of work performed.

Carriers that are participating in the Department of Defense Demonstration Project must report the administrative expenses incurred for that project on a separate column. This should agree with administrative expenses reported in the DOD column of your Summary Statement.

NOTE:

A detailed breakdown is required for "Other Expenses."

A detailed breakdown is also required for the item "Vendor Cost Containment Expenses." PPO expenses should be shown as an administrative expense, not an addition to benefit expenses. Also, administrative expenses for vendor processing network drug and mental health/substance abuse claims should be shown as separate line items. Costs for processing non-network claims should be shown as a regular administrative expense (subject to the administrative expense ceiling) where feasible and material. Variations to these instructions should be fully explained in footnotes to the statements. This item only applies to FEE FOR SERVICE PLANS that have a provision for this expense in their contract.

Instructions for Preparing 2003
FEHBP SUPPLEMENTAL SCHEDULE OF HEALTH BENEFITS CHARGES PAID

 

A separate schedule should be submitted for each option and for the DOD Project.

Part A:

Health Benefits Charges Accrued but Unpaid BOY

The ending Health Benefits Accrual reported on your December 31, 2002 annual accounting statement.

Health Benefits Charges Accrued but Unpaid EOY

Charges incurred but unpaid as of December 31, 2003.

Balance or Prior Year Accrued Charges

This column will calculate, automatically, the prior years' paid amounts.

Amount Paid

This column will calculate, automatically, the amounts paid for the month.

Monthly Claims Paid

Report the amount of health benefits charges paid in each month, providing a breakdown by the year incurred.

Part B: Number of Claims Paid

Separate number of claims paid into hospitalization, physicians, drugs, and other claims.

Part C: Types of Claims Paid

Separate claims paid into hospitalization, physicians, drugs, and other claims.

Part D: Reconciliation of Health Benefit Charges Paid

Total Health Benefit Charges Paid must agree with the Summary Statement.

Instructions for Preparing 2003
FEHBP SUPPLEMENTAL SCHEDULE OF PRIOR PERIOD ADJUSTMENTS

Show adjustments made to the current year's report as a result of OPM audits and adjustments made from carrier financial records. All OPM-related prior period adjustments should show the amount of adjustment by year and identify the OPM audit report number. Also reference the date of the adjustment and the audit finding.

Instructions for Preparing 2003
FEHBP FINANCIAL OPERATIONS SUMMARY STATEMENT

Round all amounts to the nearest whole dollar. Carriers participating in the Department of Defense (DOD) Project should state this activity separately on the Summary Statement and related schedules.

Enclosure A shows the Letter-of-Credit (LOC) authorizations and reductions recorded by OPM for your plan during 2003 This information must be used to prepare your report. Please compare this information with your records and notify Melanese Matthews at (202) 606-4498 or Laxman Pai at (202) 606-4492 of any differences.

1. PROGRAM INCOME:

   1. Letter-of-Credit Authorizations:

      1. Semi-monthly Premiums: Show the total 2003 semi-monthly premium authorizations to your LOC account as stated on Enclosure A.

      2. Interest: Show the 2003 interest credited to your LOC account as stated on Enclosure A.

   2. Accrued Income BOY:

      1. Semi-monthly Premiums: Show the accrued premium income as of December 31, 2002 as stated on Enclosure A.

      2. Interest: Show the accrued interest on your LOC account as of December 31, 2002 as stated on Enclosure A.

   3. Accrued Income EOY:

      1. Semi-monthly Premiums: Show the accrued premium income as of December 31, 2003 as stated on Enclosure A.

      2. Interest: Show the accrued interest on your LOC account as of December 31, 2003 as stated on Enclosure A.

   4. Total Program Income: The total of lines 1a, 1b, and 1c. Automatically calculated.

   5. Carrier Interest Income: Your contract states that all funds in excess of those needed to properly discharge the obligations of the contract should be invested. Report on line 1e the amount of interest earned with FEHBP funds held other than in the LOC account during 2003. Attach a detailed schedule showing the development of interest earned on funds held by the Plan and/or Underwriter.

   6. Total Carrier Income: Line 1d plus line 1e. Automatically calculated.

2. HEALTH BENEFITS CHARGES: This entire section is automatically filled in and calculated from the Supplemental Schedule of Health Benefit Charges Paid.

3. ADMINISTRATIVE EXPENSES: If your plan has high and standard options, show the basis and amounts used for prorating administrative expenses between the two options. Carriers can choose to treat the cost of internally developed software in accordance with the AICPA Statement of Position (SOP) 98-1, which requires that the cost be capitalized and amortized over the useful life of the software. If a carrier chooses, instead, to expense the cost of internally developed software, the amount expensed must be reported as a separate line item on the Supplemental Schedule of Other Administrative Expenses.

   1. Paid: Should agree with the amount stated on the Monthly Cash Flows.

   2. Clearinghouse: This row is automatically entered from the Schedule of Administrative Expenses.

   3. Accrued but Unpaid:

      1. Beginning: Show on Line 3c(1) the amount of the accrued administrative expenses as shown on your prior year's annual accounting statement.

      2. Ending: Show on line 3c(2) the amount of accrued administrative expenses as of December 31, 2003.

   4. Total: Line 3a minus line 3b(1) plus line 3b(2). Automatically calculated.

4. OTHER EXPENSES AND RETENTIONS:

   1. State Statutory Reserve: Report the amount necessary to satisfy state requirements for mandatory statutory reserves if your contract provides for such a charge. Attach a supporting schedule showing in detail the calculation of the required reserve amount and citation to specific state statutes. If there is no requirement, enter zero.

   2. Reinsurance Expenses: Report the amount of reinsurance expenses (if applicable) incurred in contract year 2003. Attach a supporting schedule showing the development of your reinsurance expenses and the basis for this charge.

   3. Service Charge: Report the amount of service charge allowed under the provisions of your 2003 contract.

   4. Other Expenses not Listed Above: List the breakdown on the worksheet at the bottom of the statement and it will feed into this section.

   5. Total: The sum of Lines 4a through 4d. Automatically calculated.

5. CHANGES TO SPECIAL RESERVE:

   1. Special Reserve, Beginning: The amount of the prior year accounting statement ending Special Reserve balance. This must also be in agreement with the amount reported on your Enclosure A.

   2. Gain (Loss) on Operations: The sum of Total Carrier Income (line 1f), less Health Benefits Charges (line 2c), less Administrative Expenses (line 3d), less Other Expenses and Retentions (line 4e). Automatically calculated.

   3. Prior Period Adjustments: This section is automatically filled in and calculated from the Supplemental Schedule of Prior Period Adjustments.

   4. Contingency Reserve Transfers: Show on line 5d the amount transferred from the contingency reserve to your LOC account during 2003 as shown on Enclosure A.

   5. Return of Excess Reserves: Show on line 5e the amount of excess reserves withdrawn from your LOC account and transferred to the contingency reserve during 2003 as shown on Enclosure A.

   6. Other: List the breakdown on the worksheet at the bottom of the statement and it will feed into this section. Show any transfers or other additions or subtractions to the special reserve during 2003.

   7. Special Reserve, Ending: The total of lines 5a, 5b, 5c, 5d, 5e, and 5f. Automatically calculated.

   All reports and schedules must be supported by your
   Plan's accounting and statistical records.

Instructions for Preparing 2003
SUPPLEMENTAL SCHEDULE OF STATUS OF RESERVES

This entire section is automatically filled in and calculated using data from the Supplemental Schedule of Health Benefits Charges Paid and the Summary Statement.

Definitions (per 5 CFR 890)

1. Target Level of Carrier-Held Reserves - 3.5 times an amount equal to the sum of an average month's paid claims plus an average month's administrative expenses and retentions.

2. Average Month's Paid Claims - 1/6 of the total claims paid during the last 6 months of the most recent contract period.

3. Average Month's Administrative Expenses and Retentions - 1/12 of the total administrative expenses and retentions paid during the last twelve months ((Summary Statement lines 3d + 4e) times 1/12).

4. Excess Reserves - The amount by which the total of all reserves held by a plan as of the end of a contract period exceed the plan's target level (line 1c - line 3).

5. Deficiency of Reserves - The amount by which the plan's target level of reserves exceeds the reserves held at the end of a contract period (line 3 - line 1c).

Line 1a. Ending Special Reserve Balance: The ending Special Reserve as shown on line 5g of the Summary Statement.

Line 1b. Ending Accrued but Unpaid Health Benefits Charges: The ending accrued claims reserve as shown on line 2b(2) of the Summary Statement.

Line 1c. Total: Line 1a plus line 1b.

Line 2a. One month's average claims paid: One sixth of the total claims paid in the last six months of 2003. The monthly totals of claims paid must agree with the amounts shown on the Supplemental Schedule of Health Benefits Charges Paid.

Line 2b. One month's average administrative expenses and retentions: The total administrative expenses and retentions as shown on the Summary Statement (line 3d + Line 4e) divided by 12.

Line 2c. Total: Line 2a plus line 2b.

Line 3. Target Level of Carrier-Held Reserves: Line 2c multiplied by three and one-half).

Line 4. Status of Reserves:

1. Enter the amount by which line 1c exceeds line 3. This is the amount of "excess reserves" that will be withdrawn from your Letter-of-Credit (LOC) account and transferred to your Contingency Reserve. If your annual accounting statement is not filed by March 31, 2004, OPM may estimate the amount of excess reserves and transfer this amount from the LOC account to the contingency reserve.

2. Enter the amount by which line 3 exceeds line 1c. This is the amount of your "deficiency of reserves". If the balance in your contingency reserve is above the preferred minimum amount, transfers may be made available to your LOC account based on a preliminary review of your 2003 annual accounting statement.

Instructions for Preparing 2003
FEHBP PRIOR YEAR BALANCE SHEET

ASSETS

 

Cash and Cash Equivalents. The ending cash and cash equivalents balance as shown on the Consolidated Statement of FEHBP Cash Flows BOY. Automatically entered.

Balance in Letter of Credit Account. The balance in the LOC account as of December 31, 2002. This should agree with line 4a of Enclosure A.

Interest Income Receivable. The amount should agree with the balance sheet as of December 31, 2002.

Program Income Receivable. The amount should agree with the balance sheet as of December 31, 2002.

Prepaid Expenses. The amount should agree with the balance sheet as of December 31, 2002.

Due to Treasury Offsets. The amount due the Program as of December 31, 2002, as a result of actions by the U.S. Treasury to reduce or "offset" drawdowns from your LOCA account. Automatically entered.

Other Assets. Provide detailed description of the assets in the space provided.

LIABILITIES

Health Benefits Accrued but Unpaid. The beginning health benefits charges accrued but unpaid as of December 31, 2002. Automatically entered.

Accrued Administrative Expenses and Retentions. The total accrued administrative expenses and retentions as of December 31, 2002. Automatically entered.

Special Reserve. The ending Special Reserve as of December 31, 2002. Automatically entered.

Other Accrued Liabilities. The total other accrued administrative expenses and retentions as of December 31, 2002. Provide detailed breakdown in the space provided.

Total Liabilities with Special Reserve. Sum of Liabilities and Special Reserve; should also agree with total assets.

Note: The Balance Sheet should be prepared in accordance with the special purpose financial statements required by the U.S. Office of Personnel Management. This is a comprehensive basis of accounting other than generally accepted accounting principles.

Instructions for Preparing 2003
FEHBP CURRENT YEAR BALANCE SHEET

If your plan has an underwriter, please provide a consolidated balance sheet incorporating the financial activity of the underwriter, organization and former underwriter(s), if applicable. Please provide separate balance sheets for each entity if they are available.

In addition, if your plan has high and standard options, please provide a separate balance sheet for each option.

ASSETS

Cash and Cash Equivalents. The ending cash and cash equivalents balance as shown on the Schedule of Monthly Cash Flows.

Balance in Letter of Credit Account. The balance in the LOC account as of December 31, 2003. This should agree with line 4e of Enclosure A.

Interest Income Receivable. All accrued interest income from bank accounts or short-term investments maintained for payment of FEHBP expenses as the end of the reporting period. Do not include accrued interest from the Letter of Credit (LOC) account.

Program Income Receivable. The ending accrued semimonthly premiums and (LOC) account interest from line 1c (1) and 1c(2) of the Summary Statement.

Prepaid Expenses. The prepaid expenses as of December 31, 2003.

Other Assets. Provide detailed description of the assets in the space provided.

LIABILITIES

Health Benefits Accrued but Unpaid. The ending health benefits charges accrued but unpaid from line 2b(2) of the Summary Statement. Automatically entered.

Accrued Administrative Expenses and Retentions. The total accrued administrative expenses and retentions as of the end of the reporting period. Automatically entered.

Special Reserve. The ending Special Reserve from line 5g of the Summary Statement. Automatically entered.

Other Accrued Liabilities. Provide detailed description of the liability in the space provided.

Total Liabilities with Special Reserve. Sum of Liabilities and Special Reserve; should also agree with total assets.

Note: The Balance Sheet should be prepared in accordance with the special purpose financial statements required by the U.S. Office of Personnel Management. This is a comprehensive basis of accounting other than generally accepted accounting principles.

Instructions for Preparing 2003
FEHBP STATEMENT OF CASH FLOWS

This entire schedule is automatically filled in and calculated from the Balance Sheet, Summary Statement and the Monthly Cash Flows.

CASH FLOWS FROM OPERATING ACTIVITIES:
Net Gain (Loss): Show the net gain or (loss) from the Statement of operations.

Adjustments to Reconcile Net Gain (Loss) to Net Cash
Provided by (used in) Operating Activities:

Prior Period adjustments and other adjustments as shown on the -Statement of Operations
Contingency Reserve Payments
Return of Excess Reserves
Other - Note
Non-LOC Investment Income
Net Purchase of Investments

Change in Assets (show increase as positive)

Letter of Credit Account
Interest Income Receivable
Program Income Receivable
Prepaid Expenses
Due to Treasury Offset
Other Assets - Note

Change in Liabilities (show increase as positive)

Health Benefits Charges Accrued but Unpaid
Accrued Administrative Expenses
Other Accrued Liabilities - Note

Total Adjustments: The sum of Adjustments, (Increase) Decrease in assets and Increase (Decrease) in Liabilities.

Net Cash Provided by Operating Activities: The total net gain or (loss) plus total adjustments.

CASH FLOWS FROM INVESTMENT ACTIVITIES:
Proceeds from Sale of Investments: Present the sum of proceeds received from the sale of FEHBP investments.

Purchase of Investments: Present the sum paid to acquire FEHBP investments.

Investment Income Received: Non-LOC investment income.

Net Cash Provided by Investing Activities:Proceeds from the sale of investments plus non-LOC interest income minus payments for purchase of investments.

NET INCREASE IN CASH AND CASH EQUIVALENTS:Net Cash Provided by Operating Activities plus or minus Net Cash Provided by Investing Activities.

Cash and Cash Equivalents at Beginning of Year: From the 2002 FEHBP Balance Sheet.

Cash and Cash Equivalents at End of Year: From the 2003 Balance Sheet.

Instructions for Preparing 2003
NOTES TO THE FEHBP FINANCIAL STATEMSNTS

 

Carrier Name ___________________________ Code _______________

Additional Required Financial and Statistical Information:

1. The detailed method for developing the estimate of the accrued but unpaid Health Benefits Charges.

2. Statistical data used for allocating administrative expenses by line item.

3. Statistical data used for prorating expenses between options (high/standard option plans only).

4. Development of the investment income earned and credited to the FEHBP including an explanation of the allocation method used.

5. Calculation of the State Statutory Reserve payment.

6. Development of the reinsurance expenses factor.

ALL FINANCIAL REPORTS MUST BE SUPPORTED BY YOUR PLAN'S ACCOUNTING RECORDS

FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM

 

Carrier Name ___________________________ Code _______________

CHECKLIST OF DOCUMENTS TO BE SUBMITTED

 

BY EXPERIENCE RATED CARRIERS

 

FOR THE 2003 ANNUAL ACCOUNTING STATEMENT REPORT

(due no later than March 31, 2004)

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