4-Exhibit C-2 - YTD UHC Medical Claim Analysis Sept 2023 - Aug 31 2024.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, 2023 - August 31, 2024

August 2024

Presented by

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

Reporting as of August 31, 2024

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

Paid Month Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Total PEPM

Enrollment

Subscribers 1,195 1,179 1,184 1,184 1,164 1,157 1,154 1,154 1,148 1,144 1,131 1,138 13,932 1,161

Members 1,871 1,845 1,835 1,838 1,811 1,795 1,788 1,791 1,779 1,782 1,768 1,771 21,674 1,806

Contract Size 1.57 1.56 1.55 1.55 1.56 1.55 1.55 1.55 1.55 1.56 1.56 1.56

Claim Payments

Medical Claims $415,021 $878,475 $660,849 $396,003 $755,613 $557,682 $523,136 $399,969 $499,958 $274,854 $402,049 $558,827 $6,322,436 $453.81

Pharmacy Claims $315,325 $297,895 $297,347 $251,421 $174,741 $297,088 $197,447 $261,096 $331,169 $320,217 $333,863 $397,200 $3,474,808 $249.41

Pharmacy Rebates $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Claims Over Specific $0 ($233,945) ($2,902) ($21,561) ($49,924) ($92,672) ($174,301) ($36,640) ($113,796) ($39,832) ($36,636) ($104,655) ($906,862) ($65.09)

Total Net Claim Payments $730,346 $942,425 $955,294 $625,863 $880,430 $762,098 $546,283 $624,425 $717,331 $555,240 $699,276 $851,372 $8,890,382 $638.13

Fixed Costs

Administrative Fees $6,985 $6,911 $6,965 $6,959 $6,856 $6,802 $6,793 $6,793 $6,742 $6,719 $6,648 $6,707 $81,881 $5.88

Stop Loss Premiums $121,042 $119,421 $119,927 $119,927 $117,902 $117,193 $116,889 $116,889 $116,281 $115,876 $114,559 $115,268 $1,411,172 $101.29

Total Fixed Costs $128,027 $126,332 $126,892 $126,887 $124,758 $123,995 $123,682 $123,682 $123,023 $122,595 $121,207 $121,975 $1,493,054 $107.17

Total Plan Cost $858,373 $1,068,757 $1,082,186 $752,749 $1,005,188 $886,092 $669,965 $748,107 $840,354 $677,835 $820,483 $973,347 $10,383,435 $745.29

Employee Contributions ¹ $257,920 $254,946 $251,960 $251,168 $247,413 $243,935 $242,869 $243,050 $241,234 $242,759 $241,833 $242,183 $2,961,272 $212.55

Employer Cost $600,453 $813,810 $830,225 $501,581 $757,775 $642,157 $427,095 $505,057 $599,120 $435,076 $578,649 $731,164 $7,422,164 $532.74

Budget Comparison

Budgeted Cost ¹ $820,503 $809,976 $808,795 $807,952 $794,962 $787,892 $785,333 $785,513 $780,803 $780,821 $774,058 $777,452 $9,514,059 $682.89

Actual Cost $858,373 $1,068,757 $1,082,186 $752,749 $1,005,188 $886,092 $669,965 $748,107 $840,354 $677,835 $820,483 $973,347 $10,383,435 $745.29

Surplus/(Deficit) ($37,870) ($258,781) ($273,391) $55,203 ($210,226) ($98,201) $115,368 $37,406 ($59,551) $102,986 ($46,425) ($195,895) ($869,377) ($62.40)

Variance from Projected (%) 104.6% 131.9% 133.8% 93.2% 126.4% 112.5% 85.3% 95.2% 107.6% 86.8% 106.0% 125.2%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.56

109.1%

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24

Actual Cost $718 $906 $914 $636 $864 $766 $581 $648 $732 $593 $725 $855

Budgeted Cost $687 $687 $683 $682 $683 $681 $681 $681 $680 $683 $684 $683

Surplus/(Deficit) ($32) ($219) ($231) $47 ($181) ($85) $100 $32 ($52) $90 ($41) ($172)

Budget Comparison PEPM

56%

31%

1%

12%

Combined Plan Expenses

Medical Claims Pharmacy Claims Administrative Fees Stop Loss Premiums

Medical Summary - Nexus ACO

Reporting as of August 31, 2024

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

Paid Month Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Total PEPM

Enrollment

Subscribers 624 619 626 625 617 611 611 611 605 603 597 604 7,353 613

Members 990 987 982 978 969 953 951 951 941 940 933 935 11,510 959

Contract Size 1.59 1.59 1.57 1.56 1.57 1.56 1.56 1.56 1.56 1.56 1.56 1.55

Claim Payments

Medical Claims $205,393 $189,159 $179,968 $207,908 $317,236 $189,671 $220,346 $236,686 $216,719 $154,984 $224,223 $359,006 $2,701,298 $367.37

Pharmacy Claims $109,977 $103,787 $123,511 $106,189 $75,196 $99,673 $121,809 $100,628 $124,231 $137,844 $171,757 $144,336 $1,418,941 $192.97

Pharmacy Rebates $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ($8,656) ($8,656) ($1.18)

Total Net Claim Payments $315,370 $292,946 $303,479 $314,097 $392,432 $289,344 $342,155 $337,314 $340,951 $292,828 $395,979 $494,686 $4,111,582 $559.17

Fixed Costs

Administrative Fees $5,335 $5,292 $5,352 $5,344 $5,275 $5,224 $5,224 $5,224 $5,173 $5,156 $5,104 $5,164 $62,868 $8.55

Stop Loss Premiums $63,205 $62,699 $63,408 $63,306 $62,496 $61,888 $61,888 $61,888 $61,280 $61,078 $60,470 $61,179 $744,785 $101.29

Total Fixed Costs $68,540 $67,991 $68,760 $68,650 $67,771 $67,112 $67,112 $67,112 $66,453 $66,234 $65,574 $66,343 $807,654 $109.84

Total Plan Cost $383,910 $360,937 $372,239 $382,747 $460,203 $356,456 $409,267 $404,426 $407,404 $359,062 $461,554 $561,030 $4,919,236 $669.01

Employee Contributions ¹ $107,851 $108,240 $106,111 $104,770 $104,075 $100,561 $100,269 $99,977 $98,821 $98,495 $98,127 $98,174 $1,225,470 $166.66

Employer Cost $276,059 $252,697 $266,128 $277,977 $356,129 $255,896 $308,998 $304,449 $308,582 $260,566 $363,427 $462,856 $3,693,766 $502.35

Budget Comparison

Budgeted Cost ¹ $401,902 $400,094 $400,717 $398,731 $394,465 $387,735 $387,369 $387,004 $383,027 $381,824 $378,761 $381,800 $4,683,429 $636.94

Actual Cost $383,910 $360,937 $372,239 $382,747 $460,203 $356,456 $409,267 $404,426 $407,404 $359,062 $461,554 $561,030 $4,919,236 $669.01

Surplus/(Deficit) $17,992 $39,157 $28,478 $15,984 ($65,738) $31,278 ($21,898) ($17,423) ($24,376) $22,762 ($82,793) ($179,230) ($235,807) ($32.07)

Variance from Projected (%) 95.5% 90.2% 92.9% 96.0% 116.7% 91.9% 105.7% 104.5% 106.4% 94.0% 121.9% 146.9%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.57

105.0%

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24

Actual Cost $615 $583 $595 $612 $746 $583 $670 $662 $673 $595 $773 $929

Budgeted Cost $644 $646 $640 $638 $639 $635 $634 $633 $633 $633 $634 $632

Surplus/(Deficit) $29 $63 $45 $26 ($107) $51 ($36) ($29) ($40) $38 ($139) ($297)

Budget Comparison PEPM

55%

29%

1%

15%

Combined Plan Expenses

Medical Summary - Plan A

Reporting as of August 31, 2024

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

Paid Month Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Total PEPM

Enrollment

Subscribers 149 148 145 145 146 146 145 145 145 143 138 140 1,735 145

Members 229 228 222 222 223 223 222 222 223 225 220 222 2,681 223

Contract Size 1.54 1.54 1.53 1.53 1.53 1.53 1.53 1.53 1.54 1.57 1.59 1.59

Claim Payments

Medical Claims $16,652 $56,133 $28,577 $11,434 $25,247 $6,540 $45,430 $14,873 $22,501 $20,633 $30,893 $51,832 $330,745 $190.63

Pharmacy Claims $1,429 $5,404 $2,564 $1,313 $2,732 $1,201 $1,158 $672 $2,310 $2,728 $2,016 $4,548 $28,075 $16.18

Pharmacy Rebates $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

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

Total Net Claim Payments $18,081 $61,537 $31,141 $12,747 $27,979 $7,740 $46,589 $15,545 $24,810 $23,361 $32,909 $56,380 $358,819 $206.81

Fixed Costs

Administrative Fees $431 $428 $419 $419 $422 $422 $419 $419 $419 $413 $399 $405 $5,014 $2.89

Stop Loss Premiums $15,092 $14,991 $14,687 $14,687 $14,788 $14,788 $14,687 $14,687 $14,687 $14,484 $13,978 $14,181 $175,738 $101.29

Total Fixed Costs $15,523 $15,419 $15,106 $15,106 $15,210 $15,210 $15,106 $15,106 $15,106 $14,898 $14,377 $14,585 $180,752 $104.18

Total Plan Cost $33,604 $76,956 $46,247 $27,853 $43,189 $22,951 $61,695 $30,651 $39,917 $38,259 $47,286 $70,965 $539,572 $310.99

Employee Contributions ¹ $28,524 $28,451 $27,931 $27,931 $28,004 $28,004 $27,931 $27,931 $27,931 $28,801 $28,437 $28,583 $338,460 $195.08

Employer Cost $5,080 $48,505 $18,316 ($78) $15,185 ($5,053) $33,764 $2,720 $11,985 $9,457 $18,848 $42,382 $201,112 $115.91

Budget Comparison

Budgeted Cost ¹ $98,596 $98,074 $96,134 $96,134 $96,656 $96,656 $96,134 $96,134 $96,134 $96,228 $93,619 $94,663 $1,155,163 $665.80

Actual Cost $33,604 $76,956 $46,247 $27,853 $43,189 $22,951 $61,695 $30,651 $39,917 $38,259 $47,286 $70,965 $539,572 $310.99

Surplus/(Deficit) $64,992 $21,118 $49,887 $68,281 $53,467 $73,705 $34,439 $65,483 $56,218 $57,970 $46,334 $23,698 $615,591 $354.81

Variance from Projected (%) 34.1% 78.5% 48.1% 29.0% 44.7% 23.7% 64.2% 31.9% 41.5% 39.8% 50.5% 75.0%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.55

46.7%

$0

$100

$200

$300

$400

$500

$600

$700

$800

Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24

Actual Cost $226 $520 $319 $192 $296 $157 $425 $211 $275 $268 $343 $507

Budgeted Cost $662 $663 $663 $663 $662 $662 $663 $663 $663 $673 $678 $676

Surplus/(Deficit) $436 $143 $344 $471 $366 $505 $238 $452 $388 $405 $336 $169

Budget Comparison PEPM

61%

5%

1%33%

Combined Plan Expenses

Medical Summary - Plan B Reporting as of August 31, 2024

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

Paid Month Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Total PEPM

Enrollment

Subscribers 286 277 278 280 269 269 268 268 269 268 266 265 3,263 272

Members 448 427 428 436 423 424 421 421 422 422 420 420 5,112 426

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

Claim Payments

Medical Claims $84,742 $108,047 $262,389 $86,508 $280,614 $333,438 $216,559 $73,208 $158,997 $38,003 $92,249 $101,932 $1,836,687 $562.88

Pharmacy Claims $77,166 $50,611 $48,439 $79,975 $22,714 $67,793 $22,692 $38,849 $79,867 $55,362 $74,111 $91,229 $708,808 $217.23

Pharmacy Rebates $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Claims Over Specific $0 $0 $0 $0 ($47,045) ($88,021) ($173,101) ($30,028) ($101,712) ($8,677) ($1,509) ($25,951) ($476,044) ($145.89)

Total Net Claim Payments $161,908 $158,658 $310,828 $166,483 $256,283 $313,209 $66,149 $82,030 $137,153 $84,688 $164,851 $167,210 $2,069,451 $634.22

Fixed Costs

Administrative Fees $827 $801 $803 $809 $777 $777 $775 $775 $777 $775 $769 $766 $9,430 $2.89

Stop Loss Premiums $28,969 $28,057 $28,159 $28,361 $27,247 $27,247 $27,146 $27,146 $27,247 $27,146 $26,943 $26,842 $330,509 $101.29

Total Fixed Costs $29,795 $28,858 $28,962 $29,170 $28,024 $28,024 $27,920 $27,920 $28,024 $27,920 $27,712 $27,608 $339,939 $104.18

Total Plan Cost $191,704 $187,516 $339,790 $195,654 $284,307 $341,234 $94,069 $109,950 $165,177 $112,608 $192,563 $194,818 $2,409,390 $738.40

Employee Contributions ¹ $63,612 $60,607 $60,270 $61,103 $59,186 $59,506 $59,089 $59,089 $59,186 $59,409 $59,217 $59,658 $719,931 $220.63

Employer Cost $128,091 $126,909 $279,520 $134,551 $225,122 $281,728 $34,980 $50,861 $105,991 $53,199 $133,346 $135,160 $1,689,459 $517.76

Budget Comparison

Budgeted Cost ¹ $198,395 $190,931 $191,067 $192,944 $185,962 $186,355 $185,416 $185,416 $185,962 $185,809 $184,719 $184,764 $2,257,739 $691.92

Actual Cost $191,704 $187,516 $339,790 $195,654 $284,307 $341,234 $94,069 $109,950 $165,177 $112,608 $192,563 $194,818 $2,409,390 $738.40

Surplus/(Deficit) $6,692 $3,415 ($148,723) ($2,710) ($98,346) ($154,879) $91,347 $75,466 $20,785 $73,201 ($7,844) ($10,054) ($151,651) ($46.48)

Variance from Projected (%) 96.6% 98.2% 177.8% 101.4% 152.9% 183.1% 50.7% 59.3% 88.8% 60.6% 104.2% 105.4%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.57

106.7%

($1,000)

($500)

$0

$500

$1,000

$1,500

Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24

Actual Cost $670 $677 $1,222 $699 $1,057 $1,269 $351 $410 $614 $420 $724 $735

Budgeted Cost $694 $689 $687 $689 $691 $693 $692 $692 $691 $693 $694 $697

Surplus/(Deficit) $23 $12 ($535) ($10) ($366) ($576) $341 $282 $77 $273 ($29) ($38)

Budget Comparison PEPM

64%

25%

0%

11%

Combined Plan Expenses

Medical Summary - Plan D Reporting as of August 31, 2024

Carrier: United Healthcare HCA

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

Paid Month Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Total PEPM

Enrollment

Subscribers 136 135 135 134 132 131 130 130 129 130 130 129 1,581 132

Members 204 203 203 202 196 195 194 197 193 195 195 194 2,371 198

Contract Size 1.50 1.50 1.50 1.51 1.48 1.49 1.49 1.52 1.50 1.50 1.50 1.50

Claim Payments

Medical Claims $108,234 $525,136 $189,915 $90,153 $132,516 $28,034 $40,801 $75,202 $101,740 $61,235 $54,684 $46,056 $1,453,707 $919.49

Pharmacy Claims $126,753 $138,092 $122,833 $63,944 $74,099 $128,421 $51,788 $120,946 $124,761 $124,283 $85,980 $157,086 $1,318,985 $834.27

Pharmacy Rebates $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Claims Over Specific $0 ($233,945) ($2,902) ($21,561) ($2,879) ($4,650) ($1,199) ($6,612) ($12,084) ($31,155) ($35,127) ($70,047) ($422,162) ($267.02)

Total Net Claim Payments $234,987 $429,283 $309,846 $132,535 $203,736 $151,804 $91,390 $189,536 $214,418 $154,363 $105,537 $133,095 $2,350,530 $1,486.74

Fixed Costs

Administrative Fees $393 $390 $390 $387 $381 $379 $376 $376 $373 $376 $376 $373 $4,569 $2.89

Stop Loss Premiums $13,775 $13,674 $13,674 $13,573 $13,370 $13,269 $13,168 $13,168 $13,066 $13,168 $13,168 $13,066 $160,139 $101.29

Total Fixed Costs $14,168 $14,064 $14,064 $13,960 $13,752 $13,648 $13,543 $13,543 $13,439 $13,543 $13,543 $13,439 $164,709 $104.18

Total Plan Cost $249,155 $443,347 $323,910 $146,495 $217,488 $165,452 $104,933 $203,080 $227,857 $167,907 $119,080 $146,534 $2,515,239 $1,590.92

Employee Contributions ¹ $57,933 $57,649 $57,649 $57,364 $56,149 $55,864 $55,580 $56,053 $55,296 $56,053 $56,053 $55,769 $677,411 $428.47

Employer Cost $191,222 $385,699 $266,261 $89,131 $161,339 $109,587 $49,353 $147,027 $172,561 $111,854 $63,027 $90,766 $1,837,828 $1,162.45

Budget Comparison

Budgeted Cost ¹ $121,610 $120,877 $120,877 $120,143 $117,880 $117,146 $116,413 $116,959 $115,680 $116,959 $116,959 $116,226 $1,417,728 $896.73

Actual Cost $249,155 $443,347 $323,910 $146,495 $217,488 $165,452 $104,933 $203,080 $227,857 $167,907 $119,080 $146,534 $2,515,239 $1,590.92

Surplus/(Deficit) ($127,545) ($322,471) ($203,033) ($26,352) ($99,608) ($48,305) $11,480 ($86,121) ($112,177) ($50,948) ($2,121) ($30,309) ($1,097,511) ($694.19)

Variance from Projected (%) 204.9% 366.8% 268.0% 121.9% 184.5% 141.2% 90.1% 173.6% 197.0% 143.6% 101.8% 126.1%

¹ Estimated based on enrollment and fully insured equivalent rates.

Year-to-Date

1.50

177.4%

($3,000)

($2,000)

($1,000)

$0

$1,000

$2,000

$3,000

$4,000

Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24

Actual Cost $1,832 $3,284 $2,399 $1,093 $1,648 $1,263 $807 $1,562 $1,766 $1,292 $916 $1,136

Budgeted Cost $894 $895 $895 $897 $893 $894 $895 $900 $897 $900 $900 $901

Surplus/(Deficit) ($938) ($2,389) ($1,504) ($197) ($755) ($369) $88 ($662) ($870) ($392) ($16) ($235)

Budget Comparison PEPM

50%

45% 0%

5%

Combined Plan Expenses

Aggregate Stop Loss Reporting as of August 31, 2024

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

Paid Month Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Total PEPM

Subscribers 1,195 1,179 1,184 1,184 1,164 1,157 1,154 1,154 1,148 1,144 1,131 1,138 13,932 1,161

Aggregate Stop Loss

Actual Net Paid Claims $730,346 $942,425 $955,294 $625,863 $880,430 $762,098 $546,283 $624,425 $717,331 $555,240 $699,276 $851,372 $8,890,382 $638.13

Maximum Claims $850,661 $839,271 $842,830 $842,830 $828,593 $823,610 $821,475 $821,475 $817,204 $814,356 $805,102 $810,085 $9,917,494 $711.85

Maximum vs. Actual 85.9% 112.3% 113.3% 74.3% 106.3% 92.5% 66.5% 76.0% 87.8% 68.2% 86.9% 105.1%

Year-to-Date

89.6%

$0

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24

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, 2024

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

Claimant Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Total

1 $10,459 $15,655 $96,379 $9,774 $49 $99,318 $134,422 $21,077 $98,710 $8,746 $517 $25,481 $520,585 $320,585

2 $11,641 $422,304 $2,902 $9,337 $1,798 $4,650 $958 $6,079 $10,562 $103 $0 $365 $470,701 $270,701

3 $2,796 $1,410 $102,643 $13,562 $30,163 $105,813 $38,679 $8,321 $3,002 -$170 $992 $470 $307,683 $107,683

4 $18,343 $17,833 $26,671 $19,539 $30,663 $17,199 $18,036 $17,936 $34,649 $17,522 $18,766 $18,284 $255,441 $55,441

5 $0 $36,481 $2,427 $868 $207,269 $0 $0 $630 $0 $101 $0 $0 $247,776 $47,776

6 $26,772 $47,653 $21,499 $18,684 $14,037 $6,842 $6,328 $25,233 $21,783 $15,832 $16,332 $22,583 $243,576 $43,576

7 $35,213 $32,089 $28,759 $4,138 $3,105 $37,229 $8,043 -$4,135 $35,342 $29,086 $29 $28,816 $237,713 $37,713

8 $39,558 $34,358 $117,842 $20,466 $1,081 $0 $241 $533 $653 $0 $0 $0 $214,731 $14,731

9 $27,652 $9,223 $1,007 $8,325 $11,893 $40,620 $30,145 $7,616 $9,816 $9,478 $9,218 $43,662 $208,656 $8,656

10 $8,589 $21,040 $21,210 $3,708 -$1,152 $23,340 $21,780 $20 $21,832 $2,010 $21,552 $21,398 $165,328 $0

11 $15,787 $19,305 $12,193 $5,861 $16,812 $7,344 $0 $32,694 $10,456 $15,514 $17,819 $9,831 $163,617 $0

12 $29,479 $49,306 $13,023 $4,284 $16,318 $8,057 $2,652 $7,644 $1,552 $6,982 $5,725 $7,932 $152,954 $0

13 $3,748 $420 $2,401 $583 $110 $116,823 $0 $0 $7,156 $0 $0 $128 $131,369 $0

14 $0 $0 $0 $0 $0 $22 $29 $27,518 $3,181 $4,108 $6,388 $77,682 $118,927 $0

15 $0 $25 $22,465 $0 $169 $23,780 $0 $21,456 $2,553 $21,393 $147 $23,553 $115,542 $0

16 $21,230 $169 $0 $19,952 $0 $16,327 $43 $109 $21,522 $303 $0 $21,408 $101,063 $0

Total $251,267 $707,269 $471,422 $139,081 $332,317 $507,365 $261,356 $172,729 $282,769 $131,009 $97,485 $301,592 $3,655,661 $906,862

% of Gross Claims 34.4% 60.1% 49.2% 21.5% 35.7% 59.4% 36.3% 26.1% 34.0% 22.0% 13.2% 31.5% 37.3%

Claimants above $100,000 0 1 4 6 9 10 11 12 13 13 13 16 16

Expected

Reimbursement

Large Claimants Over $100,000 Reporting as of August 31, 2024

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

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

(YTD)

Expected

Reimbursement

1 Plan B Subscriber Male OTH MALIGNANT NEUROENDOCRINE TUMORS $520,378 $207 $520,585 $320,585

2 Plan D Child Female CHR RESP FAIL UNS HYPOX/HYPERCAPNIA $469,091 $1,610 $470,701 $270,701

3 Plan B Subscriber Female INFCT FOL PRC SUPF INC SRG SIT INIT $303,851 $3,832 $307,683 $107,683

4 Plan D Subscriber Female PAROXYSMAL ATRIAL FIBRILLATION $25,953 $229,488 $255,441 $55,441

5 Plan B Child Male SINGLE LIVEBORN INFANT DELIV C-SECT $247,776 $0 $247,776 $47,776

6 Plan D Subscriber Female ACUTE MYELOBLASTIC LEUKEMIA REMISS $44,644 $198,931 $243,576 $43,576

7 Plan D Child Female ENC RTN CHLD HLTH EX W/O ABNRM FIND $2,264 $235,449 $237,713 $37,713

8 Plan D Subscriber Female NEOPLASM RELATED PAIN ACUTE CHRONIC $213,769 $962 $214,731 $14,731

9 Nexus ACO Subscriber Female INF INFLM RXN OTH INT PROS DEV INIT $145,843 $62,813 $208,656 $8,656

10 Nexus ACO Subscriber Female CROHNS DISEASE SM INTEST W/O COMP $11,439 $153,889 $165,328 $0

11 Nexus ACO Child Male OTHER DIAGNOSIS $163,581 $36 $163,617 $0

12 Plan A Subscriber Female ENCOUNTER FOR ANTINEOPLASTIC CHEMO $147,698 $5,256 $152,954 $0

13 Plan B Subscriber Female PRE-EXISTING HTN PRE-ECLAMP COMP CB $131,071 $298 $131,369 $0

14 Nexus ACO Subscriber Female ISCHEMIC CARDIOMYOPATHY $112,983 $5,944 $118,927 $0

15 Plan D Subscriber Female TYPE 2 DM W/HYPERGLYCEMIA $366 $115,176 $115,542 $0

16 Plan B Subscriber Male ACUTE TONSILLITIS UNSPECIFIED $587 $100,475 $101,063 $0

$2,541,294 $1,114,368 $3,655,661 $906,862

Top 10 Diagnoses by Amount Paid

Reporting as of August 31, 2024

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

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

1 NEOPLASMS 167 $1,021,023 16.1%

2 OTHER CONDITIONS 1,162 $571,849 9.0%

3 MENTAL DISORDERS 317 $489,486 7.7%

4 INJURY AND POISONING 214 $432,519 6.8%

5 MUSCULO CNCTV TISSUE 311 $401,960 6.4%

6 CIRCULATORY SYSTEM 353 $371,348 5.9%

7 PERINATAL PERIOD 22 $350,496 5.5%

8 DIGESTIVE SYSTEM 185 $329,800 5.2%

9 NERVOUS SYS SENSE ORGANS 364 $293,041 4.6%

10 PREGNANCY CHILDBIRTH PUERP 81 $248,070 3.9%

Total 3,176 $4,509,594 71.3%

16%

9%

8%

7%

6% 6%

5%

5%

5%

4%

29%

Top Diagnosis by Amount Paid

NEOPLASMS OTHER CONDITIONS

MENTAL DISORDERS INJURY AND POISONING

MUSCULO CNCTV TISSUE CIRCULATORY SYSTEM

PERINATAL PERIOD DIGESTIVE SYSTEM

NERVOUS SYS SENSE ORGANS PREGNANCY CHILDBIRTH PUERP

All Other

Top Drugs by Plan Paid and Utilization

Reporting as of August 31, 2024

Carrier: United Healthcare

Specific Deductible: $200,000

Contract Type: Paid

Plan Year: 9/1/2023 - 8/31/2024

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

1 MOUNJARO DIABETIC THERAPY 42 268 $289,731 $1,081 8.3%

2 OZEMPIC DIABETIC THERAPY 42 193 $257,782 $1,336 7.4%

3 SKYRIZI PEN ALL OTHER DERMATOLOGICALS 4 11 $228,859 $20,805 6.6%

4 REVLIMID ANTINEOPLASTICS 1 13 $225,396 $17,338 6.5%

5 TRIKAFTA MISCELLANEOUS 1 6 $152,212 $25,369 4.4%

6 HUMIRA(CF) PEN ANTIARTHRITICS 5 23 $150,265 $6,533 4.3%

7 SKYRIZI ON-BODY MISCELLANEOUS 1 7 $146,742 $20,963 4.2%

8 KESIMPTA PEN MISCELLANEOUS 1 12 $96,380 $8,032 2.8%

9 ENBREL MINI ANTIARTHRITICS 1 12 $86,552 $7,213 2.5%

10 ENBREL SURECLICK ANTIARTHRITICS 3 13 $80,895 $6,223 2.3%

Total 101 558 $1,714,813 $3,073 49.3%

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

1 LEVOTHYROXINE SODIUM THYROID PREPS 105 394 $2,010 $5.10 0.1%

2 ESCITALOPRAM OXALATE PSYCHOSTIMULANTS-ANTIDEPRESSANTS 94 321 $1,634 $5.09 0.0%

3 LOSARTAN POTASSIUM OTHER ANTIHYPERTENSIVES 96 309 $666 $2.15 0.0%

4 ATORVASTATIN CALCIUM LIPOTROPICS 104 296 $2,737 $9.25 0.1%

5 AMOXICILLIN PENICILLINS 231 282 $354 $1.26 0.0%

6 LISINOPRIL OTHER ANTIHYPERTENSIVES 94 277 $289 $1.04 0.0%

7 ALBUTEROL SULFATE HFA BRONCHIAL DILATORS 171 273 $12,499 $45.78 0.4%

8 MOUNJARO DIABETIC THERAPY 42 268 $289,731 $1,081.08 8.3%

9 AMLODIPINE BESYLATE OTHER CARDIOVASCULAR PREPS 76 254 $91 $0.36 0.0%

10 BUPROPION XL PSYCHOSTIMULANTS-ANTIDEPRESSANTS 61 248 $5,558 $22.41 0.2%

Total 1074 2,922 $315,570 $108.00 9.1%

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.