471F0983-EB69-959C-3B62A289547CA11E.xlsx

This is a Paid & Incurred (P&I) Limited Dental Claims Exhibit for Franklin County Cooperative Health Improvement Program (plan number 157775) as of July 31, 2025. The document presents comprehensive claims experience data and individual claim listings spanning from January 1, 2020, through August 1, 2025. The exhibit covers six experience periods plus a claim lag period, tracking metrics across an average of 2,050 covered lives with monthly enrollment ranging from 1,779 to 2,460 participants. Key performance indicators include paid claims totaling $1,516,944, incurred claims of $2,693,725, case reserves of $1,331,916, and IBNR reserves of $15,294 across the entire experience period. The program reflects a claim incidence rate of 5.13 per 1,000 lives with an average cost per claim of $50,989 and an incurred loss ratio (adjusted) of 0.788.

The detailed claim listing includes 78 individual LTD claims with disability dates ranging from January 3, 2020, through January 17, 2025. Claims are categorized by Social Security status (SSA for approved benefits, SSP for pending status, and NED for those not eligible or denied), claim status (active, declined, waiting, ended, inactive, incomplete, or pending), and monthly gross benefits ranging from approximately $1,252 to $5,446. The exhibit demonstrates active claim management with 18 open claims, 51 total open/closed claims, 2 pending claims, and 34 denied claims across the experience period. Current monthly indemnity payments total $42,702, with reserves established for 18 active claims totaling $1,331,916, reflecting the program's ongoing liability and reserve adequacy for disability benefit administration.