8-Attachment C Sample Financial Medical Report.pdf
PDF 20 KB Posted
- Attached to
- Benefits Consulting and Actuarial Services
- Solicitation number
- RFP-27-00026
- Issued by
- Hillsborough County, Florida
About this file
This is a sample financial medical report prepared for illustrative purposes to support a benefits consulting and actuarial services contract opportunity with Hillsborough County Board of County Commissioners in Florida. The document demonstrates the type of financial analysis and reporting that a contractor would provide as part of comprehensive employee benefits consulting services. The contract opportunity is for a five-year period with an estimated value of $1,208,376.34, and the county seeks experienced and well-qualified contractors to provide actuarial services in support of employee benefits and wellness programs.
The sample report presents synthetic data illustrating the structure and format of financial medical reports, including plan cost summaries, per-employee-per-month (PEPM) metrics, monthly enrollment and cost tracking, and aggregate claims experience analysis. The illustrative example shows a total plan cost of $47.9 million with net employer costs of $38.4 million across 6,002 average subscribers, with medical and pharmacy claims analysis, rebates, stop-loss reimbursements, and high-cost claim activity monitoring. The report demonstrates the contractor's capability to provide detailed financial oversight, budget variance analysis, enrollment trend tracking, and cost management strategies, with privacy protections limiting reporting to aggregate counts and financial totals without individual member details.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
SAMPLE - S
YNTHETIC DATA
Illustrative reference only. No actual employer, member, or carrier data. Page 2
Executive Plan Summary Current period compared with budget and prior-year PEPM results
TOTAL PLAN COST
$47.9M 98.6% of budget
NET EMPLOYER COST
$38.4M $6,400 per subscriber
AVERAGE SUBSCRIBERS
6,002 1.5% year-over-year
HIGH-COST CLAIM SHARE
5.8% Aggregate only
Medical and pharmacy summary
Metric Current YTD Budget YTD Current PEPM Prior PEPM YoY change
Fixed costs $4,860,000 $4,920,000 $135 $132 2.3%
Gross medical claims $37,440,000 $38,150,000 $1,040 $1,075 (3.3%)
Gross pharmacy claims $12,420,000 $12,780,000 $345 $331 4.2%
Pharmacy rebates ($4,320,000) ($4,100,000) ($120) ($112) 7.1%
Stop-loss reimbursements ($2,520,000) ($2,120,000) ($70) ($58) 20.7%
Total plan cost $47,880,000 $48,550,000 $1,330 $1,368 (2.8%)
Employee contributions ($9,480,000) ($9,500,000) ($263) ($260) 1.2%
Net employer cost $38,400,000 $39,050,000 $1,067 $1,108 (3.7%)
Management observations
Plan cost is below budget by $670,000. Medical PEPM decreased versus the prior year, while pharmacy PEPM increased.
Aggregate high-cost activity remains within the expected stop-loss range.
Illustrative reference only. No actual employer, member, or carrier data. Page 3
Monthly Cost and Enrollment Budget and actual plan cost per employee per month (PEPM)
Month Jan Feb Mar Apr May Jun
Budget PEPM $1,342 $1,345 $1,347 $1,350 $1,352 $1,355
Actual PEPM $1,288 $1,379 $1,296 $1,328 $1,344 $1,345
Variance $54 ($34) $51 $22 $8 $10
Enrollment 5,960 5,982 6,001 6,018 6,026 6,027
Actual cost remained close to budget across the six-month period. Enrollment increased by 67 subscribers from January to June.
Illustrative reference only. No actual employer, member, or carrier data. Page 4
Aggregate Claims Experience Monthly financial detail with member-level information excluded
Month Enrollment Fixed cost Medical Pharmacy Rebates Stop-loss Total cost Budget Variance
Jan 5,960 $805,000 $5,850,000 $1,980,000 ($720,000) ($180,000) $7,735,000 $8,000,000 $265,000
Feb 5,982 $808,000 $6,320,000 $2,050,000 ($720,000) ($250,000) $8,208,000 $8,040,000 ($168,000)
Mar 6,001 $811,000 $5,940,000 $1,990,000 ($720,000) ($410,000) $7,611,000 $8,080,000 $469,000
Apr 6,018 $812,000 $6,170,000 $2,110,000 ($720,000) ($390,000) $7,982,000 $8,110,000 $128,000
May 6,026 $811,000 $6,480,000 $2,160,000 ($720,000) ($620,000) $8,111,000 $8,140,000 $29,000
Jun 6,027 $813,000 $6,680,000 $2,130,000 ($720,000) ($670,000) $8,233,000 $8,180,000 ($53,000)
YTD 6,002 avg $4,860,000 $37,440,000 $12,420,000 ($4,320,000) ($2,520,000) $47,880,000 $48,550,000 $670,000
High-cost claim activity
High-cost claimant indicator Illustrative aggregate result
Threshold $300,000
Claimants above threshold 7
Aggregate claimant cost $2,780,000
Share of gross claims 5.8%
Estimated stop-loss recovery $1,120,000
Privacy approach: report only aggregate counts and financial totals. Do not include member IDs, diagnoses, age bands, service dates, relationships, or claim-level detail in a public sample.
File details come from the government source that posted it. Updated .