2-Exhibit C-1 - YTD UHC Medical Claims Analysis Sept 2022 - Aug 31 2023.pdf

This analysis is for illustrative purposes only, and is not a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts. Please see your policy or contact us for specific information or further details in this regard.

A Self-Funded

Evaluation

YTD CLAIM ANALYSIS

PREPARED EXCLUSIVELY FOR:

Schertz-Cibolo Universal City ISD

September 1, 2022 - August 31, 2023

August 2023

Presented by

Financial Monitoring Report - Schertz-Cibolo Universal City ISD Medical Summary - All Plans

Reporting as of August 31, 2023

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Paid Month Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Total PEPM

Enrollment

Subscribers 1,152 1,150 1,153 1,157 1,138 1,143 1,142 1,139 1,130 1,127 1,115 1,122 13,668 1,139

Members 1,820 1,819 1,830 1,829 1,802 1,815 1,811 1,806 1,790 1,786 1,769 1,782 21,659 1,805

Contract Size 1.58 1.58 1.59 1.58 1.58 1.59 1.59 1.59 1.58 1.58 1.59 1.59

Claim Payments

Medical Claims $415,349 $561,130 $406,619 $635,057 $364,490 $768,947 $1,040,863 $387,377 $926,381 $713,750 $595,360 $2,368,249 $9,183,570 $671.90

Pharmacy Claims $235,421 $131,286 $297,151 $337,804 $183,990 $203,058 $278,096 $245,888 $139,215 $309,551 $221,186 $279,798 $2,862,444 $209.43

Claims Over Specific $0 $0 $0 ($49,052) ($57,619) ($206,513) ($656,265) ($186,485) ($602,002) ($308,794) ($112,540) ($1,934,806) ($4,114,076) ($301.00)

Total Net Claim Payments $650,770 $692,416 $703,770 $923,809 $490,861 $765,492 $662,694 $446,780 $463,593 $714,507 $704,007 $713,241 $7,931,938 $580.33

Fixed Costs

Administrative Fees $8,033 $8,013 $8,037 $8,066 $7,956 $8,005 $8,018 $7,988 $7,921 $7,885 $7,794 $7,841 $95,558 $6.99

Stop Loss Premiums $101,157 $100,982 $101,245 $101,596 $99,928 $100,367 $100,279 $100,016 $99,225 $98,962 $97,908 $98,523 $1,200,187 $87.81

Total Fixed Costs $109,190 $108,995 $109,282 $109,662 $107,883 $108,372 $108,297 $108,004 $107,146 $106,847 $105,702 $106,364 $1,295,746 $94.80

Total Plan Cost $759,960 $801,410 $813,052 $1,033,472 $598,745 $873,864 $770,991 $554,783 $570,739 $821,354 $809,709 $819,605 $9,227,684 $675.13

Employee Contributions ¹ $234,018 $235,637 $238,227 $238,260 $234,609 $236,534 $237,120 $234,999 $231,632 $231,226 $229,403 $230,302 $2,811,968 $205.73

Employer Cost $525,942 $565,773 $574,825 $795,212 $364,135 $637,330 $533,871 $319,784 $339,107 $590,128 $580,306 $589,303 $6,415,716 $469.40

Budget Comparison

Budgeted Cost ¹ $669,474 $670,337 $674,061 $675,606 $664,773 $668,588 $668,796 $665,541 $658,772 $657,232 $650,873 $654,418 $7,978,472 $583.73

Actual Cost $759,960 $801,410 $813,052 $1,033,472 $598,745 $873,864 $770,991 $554,783 $570,739 $821,354 $809,709 $819,605 $9,227,684 $675.13

Surplus/(Deficit) ($90,486) ($131,073) ($138,991) ($357,866) $66,029 ($205,276) ($102,195) $110,758 $88,033 ($164,122) ($158,836) ($165,187) ($1,249,212) ($91.40)

Variance from Projected (%) 113.5% 119.6% 120.6% 153.0% 90.1% 130.7% 115.3% 83.4% 86.6% 125.0% 124.4% 125.2%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.58

115.7%

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23

Actual Cost $660 $697 $705 $893 $526 $765 $675 $487 $505 $729 $726 $730

Budgeted Cost $581 $583 $585 $584 $584 $585 $586 $584 $583 $583 $584 $583

Surplus/(Deficit) ($79) ($114) ($121) ($309) $58 ($180) ($89) $97 $78 ($146) ($142) ($147)

Budget Comparison PEPM

69%

21%1%

9%

Combined Plan Expenses

Medical Claims Pharmacy Claims Administrative Fees Stop Loss Premiums

Medical Summary - Nexus ACO

Reporting as of August 31, 2023

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Paid Month Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Total PEPM

Enrollment

Subscribers 540 538 540 542 537 542 545 542 537 533 526 529 6,451 538

Members 890 885 888 888 882 892 894 890 883 877 867 874 10,610 884

Contract Size 1.65 1.64 1.64 1.64 1.64 1.65 1.64 1.64 1.64 1.65 1.65 1.65

Claim Payments

Medical Claims $96,498 $225,213 $124,335 $198,178 $126,298 $287,231 $214,093 $92,914 $154,654 $183,513 $181,798 $274,248 $2,158,973 $334.67

Pharmacy Claims $57,359 $44,263 $114,383 $69,130 $71,205 $83,327 $113,665 $81,902 $76,698 $96,718 $82,587 $95,065 $986,302 $152.89

Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Net Claim Payments $153,857 $269,475 $238,718 $267,309 $197,503 $370,558 $327,758 $174,816 $231,352 $280,231 $264,385 $369,313 $3,145,276 $487.56

Fixed Costs

Administrative Fees $5,389 $5,369 $5,389 $5,409 $5,359 $5,409 $5,439 $5,409 $5,359 $5,319 $5,249 $5,279 $64,381 $9.98

Stop Loss Premiums $47,417 $47,242 $47,417 $47,593 $47,154 $47,593 $47,856 $47,593 $47,154 $46,803 $46,188 $46,451 $566,462 $87.81

Total Fixed Costs $52,807 $52,611 $52,807 $53,002 $52,513 $53,002 $53,296 $53,002 $52,513 $52,122 $51,438 $51,731 $630,843 $97.79

Total Plan Cost $206,663 $322,086 $291,525 $320,311 $250,016 $423,561 $381,054 $227,818 $283,865 $332,353 $315,822 $421,044 $3,776,119 $585.35

Employee Contributions ¹ $93,327 $94,132 $95,255 $95,047 $94,960 $96,714 $97,897 $96,409 $95,265 $94,306 $93,494 $93,652 $1,140,456 $176.79

Employer Cost $113,336 $227,954 $196,271 $225,264 $155,056 $326,847 $283,157 $131,410 $188,600 $238,048 $222,329 $327,393 $2,635,663 $408.57

Budget Comparison

Budgeted Cost ¹ $297,447 $297,496 $299,375 $299,923 $297,946 $301,590 $303,907 $301,285 $298,251 $295,780 $292,322 $293,614 $3,578,934 $554.79

Actual Cost $206,663 $322,086 $291,525 $320,311 $250,016 $423,561 $381,054 $227,818 $283,865 $332,353 $315,822 $421,044 $3,776,119 $585.35

Surplus/(Deficit) $90,784 ($24,590) $7,850 ($20,388) $47,930 ($121,971) ($77,147) $73,466 $14,386 ($36,574) ($23,501) ($127,431) ($197,185) ($30.57)

Variance from Projected (%) 69.5% 108.3% 97.4% 106.8% 83.9% 140.4% 125.4% 75.6% 95.2% 112.4% 108.0% 143.4%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.64

105.5%

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23

Actual Cost $383 $599 $540 $591 $466 $781 $699 $420 $529 $624 $600 $796

Budgeted Cost $551 $553 $554 $553 $555 $556 $558 $556 $555 $555 $556 $555

Surplus/(Deficit) $168 ($46) $15 ($38) $89 ($225) ($142) $136 $27 ($69) ($45) ($241)

Budget Comparison PEPM

57%

26%

2%

15%

Combined Plan Expenses

Medical Summary - Plan A

Reporting as of August 31, 2023

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Paid Month Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Total PEPM

Enrollment

Subscribers 130 130 131 134 130 130 130 131 130 130 129 131 1,566 131

Members 176 176 177 181 176 176 178 179 179 178 177 181 2,134 178

Contract Size 1.35 1.35 1.35 1.35 1.35 1.35 1.37 1.37 1.38 1.37 1.37 1.38

Claim Payments

Medical Claims $15,401 $15,590 $8,169 $25,111 $38,406 $14,596 $16,849 $26,506 $56,030 $78,675 $136,789 $58,201 $490,322 $313.11

Pharmacy Claims $1,352 $1,989 $2,943 $2,360 $1,401 $391 $141 $1,912 $1,582 $3,127 $2,469 $983 $20,649 $13.19

Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ($34,045) ($42,108) ($76,154) ($48.63)

Total Net Claim Payments $16,753 $17,579 $11,111 $27,470 $39,807 $14,987 $16,990 $28,418 $57,613 $81,802 $105,213 $17,075 $434,817 $277.66

Fixed Costs

Administrative Fees $562 $562 $566 $579 $562 $562 $562 $566 $562 $562 $557 $566 $6,765 $4.32

Stop Loss Premiums $11,415 $11,415 $11,503 $11,767 $11,415 $11,415 $11,415 $11,503 $11,415 $11,415 $11,327 $11,503 $137,510 $87.81

Total Fixed Costs $11,977 $11,977 $12,069 $12,345 $11,977 $11,977 $11,977 $12,069 $11,977 $11,977 $11,885 $12,069 $144,276 $92.13

Total Plan Cost $28,730 $29,556 $23,180 $39,816 $51,784 $26,964 $28,967 $40,487 $69,589 $93,779 $117,098 $29,144 $579,093 $369.79

Employee Contributions ¹ $17,288 $17,288 $17,345 $17,972 $17,427 $17,427 $18,352 $18,410 $18,352 $18,352 $18,294 $18,722 $215,229 $137.44

Employer Cost $11,442 $12,268 $5,835 $21,844 $34,356 $9,537 $10,615 $22,077 $51,238 $75,427 $98,804 $10,422 $363,864 $232.35

Budget Comparison

Budgeted Cost ¹ $66,428 $66,428 $66,863 $68,624 $66,567 $66,567 $67,492 $67,928 $67,492 $67,492 $67,056 $68,240 $807,177 $515.44

Actual Cost $28,730 $29,556 $23,180 $39,816 $51,784 $26,964 $28,967 $40,487 $69,589 $93,779 $117,098 $29,144 $579,093 $369.79

Surplus/(Deficit) $37,698 $36,872 $43,683 $28,808 $14,784 $39,603 $38,525 $27,441 ($2,098) ($26,287) ($50,042) $39,096 $228,084 $145.65

Variance from Projected (%) 43.2% 44.5% 34.7% 58.0% 77.8% 40.5% 42.9% 59.6% 103.1% 138.9% 174.6% 42.7%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.36

71.7%

($600)

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23

Actual Cost $221 $227 $177 $297 $398 $207 $223 $309 $535 $721 $908 $222

Budgeted Cost $511 $511 $510 $512 $512 $512 $519 $519 $519 $519 $520 $521

Surplus/(Deficit) $290 $284 $333 $215 $114 $305 $296 $209 ($16) ($202) ($388) $298

Budget Comparison PEPM

75%

3%1%

21%

Combined Plan Expenses

Medical Summary - Plan B Reporting as of August 31, 2023

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Paid Month Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Total PEPM

Enrollment

Subscribers 325 326 328 325 318 319 319 319 317 318 316 317 3,847 321

Members 509 514 522 516 506 509 510 510 502 504 500 501 6,103 509

Contract Size 1.57 1.58 1.59 1.59 1.59 1.60 1.60 1.60 1.58 1.58 1.58 1.58

Claim Payments

Medical Claims $127,593 $154,838 $90,399 $109,476 $64,187 $108,919 $94,970 $56,377 $70,667 $98,292 $143,667 $180,848 $1,300,233 $337.99

Pharmacy Claims $42,553 $37,468 $87,172 $132,513 $22,949 $27,171 $54,693 $28,154 $39,438 $88,618 $43,698 $36,409 $640,833 $166.58

Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Net Claim Payments $170,146 $192,306 $177,571 $241,989 $87,136 $136,091 $149,662 $84,531 $110,105 $186,910 $187,365 $217,257 $1,941,066 $504.57

Fixed Costs

Administrative Fees $1,404 $1,408 $1,417 $1,404 $1,374 $1,378 $1,378 $1,378 $1,369 $1,374 $1,365 $1,369 $16,619 $4.32

Stop Loss Premiums $28,538 $28,626 $28,802 $28,538 $27,924 $28,011 $28,011 $28,011 $27,836 $27,924 $27,748 $27,836 $337,805 $87.81

Total Fixed Costs $29,942 $30,034 $30,219 $29,942 $29,297 $29,389 $29,389 $29,389 $29,205 $29,297 $29,113 $29,205 $354,424 $92.13

Total Plan Cost $200,088 $222,340 $207,789 $271,931 $116,433 $165,480 $179,052 $113,920 $139,310 $216,207 $216,478 $246,462 $2,295,491 $596.70

Employee Contributions ¹ $64,104 $65,154 $67,266 $66,411 $65,211 $65,617 $65,945 $65,945 $64,015 $64,568 $64,084 $64,162 $782,480 $203.40

Employer Cost $135,983 $157,187 $140,523 $205,520 $51,222 $99,863 $113,106 $47,975 $75,295 $151,639 $152,394 $182,300 $1,513,011 $393.30

Budget Comparison

Budgeted Cost ¹ $186,954 $188,382 $191,250 $189,261 $185,415 $186,199 $186,527 $186,527 $183,841 $184,772 $183,532 $183,988 $2,236,646 $581.40

Actual Cost $200,088 $222,340 $207,789 $271,931 $116,433 $165,480 $179,052 $113,920 $139,310 $216,207 $216,478 $246,462 $2,295,491 $596.70

Surplus/(Deficit) ($13,133) ($33,959) ($16,539) ($82,670) $68,982 $20,719 $7,476 $72,607 $44,531 ($31,435) ($32,946) ($62,474) ($58,845) ($15.30)

Variance from Projected (%) 107.0% 118.0% 108.6% 143.7% 62.8% 88.9% 96.0% 61.1% 75.8% 117.0% 118.0% 134.0%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.59

102.6%

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23

Actual Cost $616 $682 $634 $837 $366 $519 $561 $357 $439 $680 $685 $777

Budgeted Cost $575 $578 $583 $582 $583 $584 $585 $585 $580 $581 $581 $580

Surplus/(Deficit) ($40) ($104) ($50) ($254) $217 $65 $23 $228 $140 ($99) ($104) ($197)

Budget Comparison PEPM

56%

28%

1%

15%

Combined Plan Expenses

Medical Summary - Plan D Reporting as of August 31, 2023

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Paid Month Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Total PEPM

Enrollment

Subscribers 157 156 154 156 153 152 148 147 146 146 144 145 1,804 150

Members 245 244 243 244 238 238 229 227 226 227 225 226 2,812 234

Contract Size 1.56 1.56 1.58 1.56 1.56 1.57 1.55 1.54 1.55 1.55 1.56 1.56

Claim Payments

Medical Claims $175,857 $165,489 $183,716 $302,292 $135,599 $358,200 $714,951 $211,580 $645,029 $353,270 $133,106 $1,854,952 $5,234,041 $2,901.35

Pharmacy Claims $134,157 $47,567 $92,653 $133,801 $88,435 $92,169 $109,597 $133,920 $21,497 $121,088 $92,432 $147,341 $1,214,660 $673.31

Claims Over Specific $0 $0 $0 ($49,052) ($57,619) ($206,513) ($656,265) ($186,485) ($602,002) ($308,794) ($78,494) ($1,892,697) ($4,037,922) ($2,238.32)

Total Net Claim Payments $310,015 $213,056 $276,370 $387,042 $166,416 $243,856 $168,283 $159,015 $64,524 $165,564 $147,044 $109,596 $2,410,779 $1,336.35

Fixed Costs

Administrative Fees $678 $674 $665 $674 $661 $657 $639 $635 $631 $631 $622 $626 $7,793 $4.32

Stop Loss Premiums $13,786 $13,698 $13,523 $13,698 $13,435 $13,347 $12,996 $12,908 $12,820 $12,820 $12,645 $12,732 $158,409 $87.81

Total Fixed Costs $14,464 $14,372 $14,188 $14,372 $14,096 $14,004 $13,635 $13,543 $13,451 $13,451 $13,267 $13,359 $166,203 $92.13

Total Plan Cost $324,479 $227,428 $290,558 $401,414 $180,512 $257,859 $181,918 $172,558 $77,975 $179,015 $160,311 $122,955 $2,576,981 $1,428.48

Employee Contributions ¹ $59,298 $59,064 $58,362 $58,831 $57,011 $56,776 $54,926 $54,235 $54,001 $54,001 $53,531 $53,766 $673,803 $373.50

Employer Cost $265,180 $168,364 $232,196 $342,583 $123,501 $201,083 $126,992 $118,323 $23,974 $125,014 $106,779 $69,189 $1,903,179 $1,054.98

Budget Comparison

Budgeted Cost ¹ $118,644 $118,032 $116,574 $117,799 $114,845 $114,232 $110,870 $109,801 $109,189 $109,189 $107,963 $108,576 $1,355,715 $751.50

Actual Cost $324,479 $227,428 $290,558 $401,414 $180,512 $257,859 $181,918 $172,558 $77,975 $179,015 $160,311 $122,955 $2,576,981 $1,428.48

Surplus/(Deficit) ($205,834) ($109,396) ($173,984) ($283,615) ($65,667) ($143,627) ($71,048) ($62,757) $31,214 ($69,826) ($52,347) ($14,379) ($1,221,267) ($676.98)

Variance from Projected (%) 273.5% 192.7% 249.2% 340.8% 157.2% 225.7% 164.1% 157.2% 71.4% 163.9% 148.5% 113.2%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.56

190.1%

($2,500)

($2,000)

($1,500)

($1,000)

($500)

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23

Actual Cost $2,067 $1,458 $1,887 $2,573 $1,180 $1,696 $1,229 $1,174 $534 $1,226 $1,113 $848

Budgeted Cost $756 $757 $757 $755 $751 $752 $749 $747 $748 $748 $750 $749

Surplus/(Deficit) ($1,311) ($701) ($1,130) ($1,818) ($429) ($945) ($480) ($427) $214 ($478) ($364) ($99)

Budget Comparison PEPM

79%

18%0%

3%

Combined Plan Expenses

Aggregate Stop Loss Reporting as of August 31, 2023

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Paid Month Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Total PEPM

Subscribers 1,152 1,150 1,153 1,157 1,138 1,143 1,142 1,139 1,130 1,127 1,115 1,122 13,668 1,139

Aggregate Stop Loss

Actual Net Paid Claims $650,770 $692,416 $703,770 $923,809 $490,861 $765,492 $662,694 $446,780 $463,593 $714,507 $704,007 $713,241 $7,931,938 $580.33

Maximum Claims $775,204 $773,858 $775,877 $778,568 $765,783 $769,148 $768,475 $766,456 $760,400 $758,381 $750,306 $755,016 $9,197,471 $672.92

Maximum vs. Actual 83.9% 89.5% 90.7% 118.7% 64.1% 99.5% 86.2% 58.3% 61.0% 94.2% 93.8% 94.5%

Year-to-Date

86.2%

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

$8,000,000

$9,000,000

$10,000,000

Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23

Maximum vs. Aggregate Claims (YTD)

Actual Net Paid Claims YTD Maximum Claims YTD Alternative Max Claims

Large Claimants Over $100,000 Reporting as of August 31, 2023

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Claimant Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Total

1 $0 $109,861 $822 $984 $34,950 $97,115 $90,317 $99,770 $80,059 $68,124 $13,146 $1,802,700 $2,397,848 $2,197,848

2 $0 $0 $88,251 $17,701 $7,768 $55,876 $513,912 $874 $420,445 $1,513 $2,865 $3,318 $1,112,523 $912,523

3 $876 $766 $25,558 $221,852 $57,619 $162,781 $82,441 $85,842 $101,499 $238,962 $38,478 $63,327 $1,079,999 $879,999

4 $0 $0 $0 $0 $0 $0 $0 $19,262 $36,957 $63,574 $114,252 $42,108 $276,154 $76,154

5 $19,476 $19,630 $17,919 $36,289 $25,474 $16,072 $13,541 $12,218 $13,372 $26,205 $12,955 $18,874 $232,023 $32,023

6 $58,343 -$22,033 $25,975 $28,704 $3,287 $11,109 $6,987 $63,229 -$29,909 $36,671 $28,690 $4,479 $215,530 $15,530

7 $21,734 $12,465 $11,044 $11,420 $4,886 $10,964 $23,117 $10,301 $16,114 $15,801 $10,845 $16,360 $165,052 $0

8 $0 $0 $0 $0 $0 $147,501 $747 $0 $0 $0 $0 $417 $148,665 $0

9 $96 $69 $61,065 $64,048 $220 $0 $321 $11 $0 $9 $0 $0 $125,838 $0

10 $8,786 $95,469 $255 $143 $0 $0 -$47 $0 $0 $0 $0 $0 $104,605 $0

11 $12,621 $22,543 $3,044 $11,575 $1,130 $7,608 $5,991 $14,519 $596 $10,540 $510 $13,688 $104,365 $0

Total $121,931 $238,770 $233,933 $392,716 $135,334 $509,024 $737,326 $306,025 $639,132 $461,400 $221,739 $1,965,270 $5,962,601 $4,114,076

% of Gross Claims 18.7% 34.5% 33.2% 40.4% 24.7% 52.4% 55.9% 48.3% 60.0% 45.1% 27.2% 74.2% 49.5%

Claimants above $100,000 0 2 2 5 6 8 8 9 9 10 10 11 11

Expected

Reimbursement

Large Claimants Over $100,000 Reporting as of August 31, 2023

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Claimant Plan Relationship Gender Diagnosis Medical Paid Pharmacy Paid Total Paid Claims

(YTD)

Expected

Reimbursement

1 Plan D Child Female ACUTE RESPIRATORY FAIL W/HYPOXIA $2,397,594 $254 $2,397,848 $2,197,848

2 Plan D Child Male OTH CONGEN MALFORMATIONS TRACHEA $1,112,072 $450 $1,112,523 $912,523

3 Plan D Subscriber Female ACUTE MYELOBLASTIC LEUK NOT REMISS $892,459 $187,540 $1,079,999 $879,999

4 Plan A Subscriber Female MAL NEOPLASM UP LOBE RT BRONCH/LUNG $274,108 $2,046 $276,154 $76,154

5 Plan D Subscriber Female OTHR PERSISTENT ATRIAL FIBRILLATION $48,341 $183,683 $232,023 $32,023

6 Plan D Child Female CONTACT W/AND (SUSP) EXPOS COVID-19 $2,206 $213,324 $215,530 $15,530

7 Plan B Subscriber Male MALIGNANT CARCINOID TUMOR UNS SITE $155,918 $9,134 $165,052 $0

8 Nexus ACO Child Male SINGLE LIVEBORN INFANT DELIV C-SECT $148,665 $0 $148,665 $0

9 Plan B Spouse Female ENC SCR MAMMO MALIG NEOPLASM BREAST $728 $125,110 $125,838 $0

10 Nexus ACO Subscriber Male CHRONIC/UNS DUODENAL ULCER W/PERF $104,527 $78 $104,605 $0

11 Plan B Subscriber Female RA W/O RHEUMATOID FACTOR MX SITES $101,694 $2,671 $104,365 $0

$5,238,311 $724,290 $5,962,601 $4,114,076

Top 10 Diagnoses by Amount Paid

Reporting as of August 31, 2023

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Rank Diagnostic Category Number of Claimants Amount Paid % of Total Paid Medical Claims

1 RESPIRATORY SYSTEM 698 $2,175,854 23.7%

2 NEOPLASMS 167 $1,622,107 17.7%

3 CONGENITAL ANOMALIES 21 $1,026,465 11.2%

4 PERINATAL PERIOD 35 $753,104 8.2%

5 OTHER CONDITIONS 1,246 $666,942 7.3%

6 DIGESTIVE SYSTEM 231 $557,344 6.1%

7 MUSCULO CNCTV TISSUE 349 $459,952 5.0%

8 PREGNANCY CHILDBIRTH PUERP 106 $323,541 3.5%

9 GENITOURINARY SYSTEM 414 $277,499 3.0%

10 CIRCULATORY SYSTEM 353 $262,038 2.9%

Total 3,620 $8,124,846 88.5%

24%

18%

11% 8%

7%

6%

5%

3%

3%

3% 12%

Top Diagnosis by Amount Paid

RESPIRATORY SYSTEM NEOPLASMS

CONGENITAL ANOMALIES PERINATAL PERIOD

OTHER CONDITIONS DIGESTIVE SYSTEM

MUSCULO CNCTV TISSUE PREGNANCY CHILDBIRTH PUERP

GENITOURINARY SYSTEM CIRCULATORY SYSTEM

All Other

Top Drugs by Plan Paid and Utilization

Reporting as of August 31, 2023

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2022 - 8/31/2023

Rank Drug Therapeutic Class # of Claimants # of Scripts Amount Paid Amount Paid / Rx % of Total Paid Rx

1 OZEMPIC DIABETIC THERAPY 47 216 $274,833 $1,272 9.6%

2 SKYRIZI PEN ALL OTHER DERMATOLOGICALS 3 10 $199,632 $19,963 7.0%

3 HUMIRA(CF) PEN ANTIARTHRITICS 4 28 $183,584 $6,557 6.4%

4 TRIKAFTA MISCELLANEOUS 1 6 $158,871 $26,478 5.6%

5 XOSPATA ANTINEOPLASTICS 1 6 $146,866 $24,478 5.1%

6 MAVENCLAD MISCELLANEOUS 1 2 $124,995 $62,498 4.4%

7 LENALIDOMIDE ANTINEOPLASTICS 1 9 $123,439 $13,715 4.3%

8 MOUNJARO DIABETIC THERAPY 29 120 $100,691 $839 3.5%

9 SKYRIZI ALL OTHER DERMATOLOGICALS 1 5 $95,314 $19,063 3.3%

10 ENBREL MINI ANTIARTHRITICS 1 13 $92,182 $7,091 3.2%

Total 89 415 $1,500,406 $3,615 52.4%

Rank Drug Therapeutic Class # of Claimants # of Scripts Amount Paid Amount Paid / Rx % of Total Paid Rx

1 LEVOTHYROXINE SODIUM THYROID PREPS 107 372 $1,451 $3.90 0.1%

2 ATORVASTATIN CALCIUM LIPOTROPICS 111 350 $2,390 $6.83 0.1%

3 ESCITALOPRAM OXALATE PSYCHOSTIMULANTS-ANTIDEPRESSANTS 86 332 $981 $2.95 0.0%

4 LOSARTAN POTASSIUM OTHER ANTIHYPERTENSIVES 89 326 $439 $1.35 0.0%

5 MONTELUKAST SODIUM BRONCHIAL DILATORS 96 324 $2,396 $7.39 0.1%

6 LISINOPRIL OTHER ANTIHYPERTENSIVES 93 320 $161 $0.50 0.0%

7 FLUCELVAX QUAD 2022-2023 BIOLOGICALS 284 284 $7,745 $27.27 0.3%

8 AMOXICILLIN PENICILLINS 235 267 $163 $0.61 0.0%

9 AMLODIPINE BESYLATE OTHER CARDIOVASCULAR PREPS 66 263 $82 $0.31 0.0%

10 PREDNISONE GLUCOCORTICOIDS 196 251 $59 $0.24 0.0%

Total 1363 3,089 $15,866 $5.14 0.6%

Top Drugs by Plan Paid

Top Drugs by Count

This analysis is for illustrative purposes only, and is not a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts.

Please see your policy or contact us for specific information or further details in this regard.