Monthly Plan Performance Report Sample Client – Medical Report Category Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Employee 12 15 18 20 22 25 27 30 32 35 37 40 Employee + Spouse 12 15 18 20 22 25 27 30 32 35 37 40 Family 12 15 18 20 22 25 27 30 32 35 37 40 Total Expenses ($) 12 15 18 20 22 25 27 30 32 35 37 40 Total Members 12 15 18 20 22 25 27 30 32 35 37 40

Monthly Plan Performance Report - Page 3 Monthly Plan Performance Report Page 2 Page 4