8-ATTACHMENT H - 2024 YTD Claim Analysis.pdf

December 2024

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.

January 1, 2024 - December 31, 2024

A Self-Funded Evaluation

YTD CLAIM ANALYSIS

PREPARED EXCLUSIVELY FOR:

Austin ISD

Financial Monitoring Report - Austin ISD Executive Analysis

Reporting as of December 31, 2024 Carrier: Aetna/CVS Specific Deductible: $1,000,000 Contract Type: Paid Plan Year: 1/1/2024 - 12/31/2024

1) The medical plan expense for the month of December is $5,175,475 or $534.71 per employee per month (PEPM)

2) The YTD medical plan expense through December is $76,238,605 or $660.59 PEPM

3) Actual results YTD are 0.2% above projected budget on a gross PEPM basis

4) The projected budget results yield a $132,511 deficit YTD , which equates to $1.15 PEPM

5) Large claims (individuals with claims > $200,000) represent 14.1% of total YTD medical/rx claim expense

6) The dental plan expense for the month of December is $219,606 or $38.35 per employee per month (PEPM)

7) The YTD dental plan expense through December is $2,954,237 or $42.80 PEPM

8) Actual results YTD are -6.1% below projected budget on a gross PEPM basis

Executive Analysis

Financial Monitoring Report - Historical Summary

Total Medical/Rx Claims 3 2 1 0

Month 2021 2022 2023 2024

January $5,261,024 $6,131,868 $4,615,974 $5,958,566 1 February $4,046,106 $5,980,943 $4,104,008 $4,729,729 2 March $5,269,515 $4,267,625 $4,313,559 $4,450,713 3 April $5,075,660 $3,655,313 $4,315,301 $6,185,911 4 May $5,079,639 $4,910,250 $4,444,301 $4,928,776 5 June $5,266,193 $4,936,885 $5,143,789 $5,214,123 6 July $5,011,368 $6,239,457 $5,770,615 $5,522,828 7 August $6,070,900 $5,736,979 $5,130,969 $6,819,448 8 September $5,501,561 $4,978,543 $5,609,641 $8,560,812 9 October $4,860,391 $5,295,783 $6,311,387 $5,869,570

10 November $5,100,427 $4,618,376 $5,607,721 $6,247,668 11 December $6,083,383 $6,503,572 $6,147,628 $7,365,119

Gross Claims $62,626,168 $63,255,593 $61,514,892 $71,853,263 Rx Rebates -$3,219,120 -$6,327,243 -$7,685,502 -$8,734,227 Specific Recoveries $0 -$870,194 $0 $0 Net Claims $59,407,048 $56,058,155 $53,829,391 $63,119,036 Average Monthly Enrollment 10,001 9,253 9,115 9,617 Net Claims PEPM $495.03 $504.89 $492.13 $546.92 % Increase/Decrease from Prior -0.6% 2.0% -2.5% 11.1%

Admin Fees $4,313,052 $4,110,331 $4,048,325 $4,445,555 Stop Loss Fees $897,652 $739,460 $783,720 $968,282 Total Fixed Costs $5,210,704 $4,849,790 $4,832,045 $5,413,836 Total Fixed Costs PEPM $43.42 $43.68 $44.18 $46.91 % Increase/Decrease from Prior -0.7% 0.6% 1.1% 6.2%

2021 2022 2023 2024

Net Claims $59,407,048 $56,058,155 $53,829,391 $63,119,036

$48,000,000

$50,000,000

$52,000,000

$54,000,000

$56,000,000

$58,000,000

$60,000,000

$62,000,000

$64,000,000

Paid Claims by Plan Year

2021 2022 2023 2024

Net Claims PEPM $495.03 $504.89 $492.13 $546.92

$250

$300

$350

$400

$450

$500

$550

$600

Net Paid Claims PEPM

Financial Monitoring Report - Medical Budget Summary (All Plans)

Reporting as of December 31, 2024

Carrier: Aetna/CVS Specific Deductible: $1,000,000 Contract Type: Paid Plan Year: 1/1/2024 - 12/31/2024

Total PEPM Total PEPM

Enrollment Subscribers 9,569 9,616 9,642 9,663 9,673 9,608 9,517 9,389 9,668 9,695 9,690 9,679 Members 13,201 13,272 13,309 13,333 13,346 13,261 13,147 13,025 13,330 13,360 13,366 13,347 Contract Size 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4

Claim Payments Medical Claims $4,036,629 $2,960,233 $2,597,959 $4,435,013 $2,919,249 $3,049,763 $3,473,662 $4,439,864 $6,170,927 $3,466,057 $3,812,319 $4,966,938 $46,328,614 $401.43 $46,328,614 $401.43 Pharmacy Claims $1,921,937 $1,769,496 $1,852,754 $1,750,898 $2,009,527 $2,164,360 $2,049,166 $2,379,584 $2,389,885 $2,403,513 $2,435,349 $2,398,181 $25,524,649 $221.17 $25,524,649 $221.17 Pharmacy Rebates $0 $0 ($1,819,484) $0 $0 ($1,779,663) $0 $0 ($1,830,594) $0 $0 ($3,304,486) ($8,734,227) ($75.68) ($8,734,227) ($75.68) Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00 $0 $0.00 Total Net Claim Payments $5,958,566 $4,729,729 $2,631,230 $6,185,911 $4,928,776 $3,434,460 $5,522,828 $6,819,448 $6,730,217 $5,869,570 $6,247,668 $4,060,633 $63,119,036 $546.92 $63,119,036 $546.92 Total Net Claim Payments PEPM $622.69 $491.86 $272.89 $640.16 $509.54 $357.46 $580.31 $726.32 $696.13 $605.42 $644.75 $419.53

Fixed Costs Administrative Fees $368,598 $370,408 $371,410 $372,219 $372,604 $370,100 $366,595 $361,664 $372,411 $373,451 $373,259 $372,835 $4,445,555 $38.52 $4,445,555 $38.52 Stop Loss Premiums $80,284 $80,678 $80,896 $81,073 $81,156 $80,611 $79,848 $78,774 $81,115 $81,341 $81,299 $81,207 $968,282 $8.39 $968,282 $8.39 HSA Employer Contributions $632,800 $635,333 $636,933 $638,533 $640,000 $635,200 $629,600 $620,000 $656,800 $659,333 $660,400 $660,800 $7,705,733 $66.77 $7,705,733 $66.77 Total Fixed Costs $1,081,682 $1,086,420 $1,089,240 $1,091,825 $1,093,760 $1,085,911 $1,076,042 $1,060,438 $1,110,326 $1,114,126 $1,114,958 $1,114,842 $13,119,570 $113.68 $13,119,570 $113.68

Total Plan Cost $7,040,248 $5,816,149 $3,720,469 $7,277,735 $6,022,537 $4,520,371 $6,598,870 $7,879,886 $7,840,543 $6,983,696 $7,362,626 $5,175,475 $76,238,605 $660.59 $76,238,605 $660.59 Employee Contributions $897,705 $903,207 $903,328 $903,463 $903,672 $898,865 $890,844 $878,654 $876,690 $879,521 $881,517 $878,396 $10,695,861 $92.68 $10,695,861 $92.68 Employer Cost $6,142,543 $4,912,942 $2,817,141 $6,374,273 $5,118,865 $3,621,506 $5,708,026 $7,001,232 $6,963,853 $6,104,175 $6,481,110 $4,297,079 $65,542,744 $567.92 $65,542,744 $567.92

Budget Comparison Budgeted Cost $6,315,005 $6,346,541 $6,361,262 $6,373,496 $6,380,172 $6,338,065 $6,278,944 $6,193,154 $6,367,490 $6,386,354 $6,386,917 $6,378,696 $76,106,094 $659.45 $76,106,094 $659.45 Actual Cost $7,040,248 $5,816,149 $3,720,469 $7,277,735 $6,022,537 $4,520,371 $6,598,870 $7,879,886 $7,840,543 $6,983,696 $7,362,626 $5,175,475 $76,238,605 $660.59 $76,238,605 $660.59 Surplus/(Deficit) ($725,243) $530,391 $2,640,793 ($904,239) $357,635 $1,817,694 ($319,926) ($1,686,732) ($1,473,053) ($597,342) ($975,710) $1,203,221 ($132,511) ($1.15) ($132,511) ($1.15)

Jan-24Paid Month Jun-24May-24Apr-24Mar-24Feb-24 Nov-24Oct-24Sep-24Aug-24Jul-24 Rolling 12

115,409 159,297

1.4

Dec-24 Year-to-Date

1.4 159,297 115,409

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Actual Cost $736 $605 $386 $753 $623 $470 $693 $839 $811 $720 $760 $535

Budgeted Cost $660 $660 $660 $660 $660 $660 $660 $660 $659 $659 $659 $659

Variance ($76) $55 $274 ($94) $37 $189 ($34) ($180) ($152) ($62) ($101) $124

Budget Comparison PEPM

55%

30%

5% 1%

9%

Combined Plan Expenses

Medical Claims

Pharmacy Claims

Administrative Fees

Stop Loss Premiums

HSA Employer Contributions

Financial Monitoring Report - Medical Budget Summary (HSA Seton)

Reporting as of December 31, 2024

Carrier: Aetna/CVS Specific Deductible: $1,000,000 Contract Type: Paid Plan Year: 1/1/2024 - 12/31/2024

Total PEPM Total PEPM

Enrollment Subscribers 5,997 6,026 6,044 6,060 6,070 6,030 5,976 5,913 6,200 6,222 6,234 6,238 Members 8,362 8,407 8,436 8,459 8,467 8,420 8,353 8,310 8,626 8,649 8,671 8,673 Contract Size 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4

Claim Payments Medical Claims $1,975,412 $1,423,209 $1,224,611 $2,371,992 $1,781,597 $1,829,812 $1,776,391 $2,675,188 $3,328,976 $1,988,800 $2,163,066 $2,684,674 $25,223,729 $345.48 $25,223,729 $345.48 Pharmacy Claims $703,953 $615,439 $759,793 $736,535 $823,238 $912,804 $801,664 $952,321 $984,617 $1,102,243 $1,145,205 $1,102,687 $10,640,500 $145.74 $10,640,500 $145.74 Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00 $0 $0.00 Total Net Claim Payments $2,679,365 $2,038,648 $1,984,405 $3,108,526 $2,604,835 $2,742,617 $2,578,055 $3,627,509 $4,313,593 $3,091,043 $3,308,271 $3,787,361 $35,864,229 $491.22 $35,864,229 $491.22 Total Net Claim Payments PEPM $447 $338 $328 $513 $429 $455 $431 $613 $696 $497 $531 $607

Fixed Costs Administrative Fees $231,004 $232,122 $232,815 $233,431 $233,816 $232,276 $230,196 $227,769 $238,824 $239,671 $240,134 $240,288 $2,812,345 $38.52 $2,812,345 $38.52 Stop Loss Premiums $50,315 $50,558 $50,709 $50,843 $50,927 $50,592 $50,139 $49,610 $52,018 $52,203 $52,303 $52,337 $612,554 $8.39 $612,554 $8.39 HSA Employer Contributions $632,800 $635,333 $636,933 $638,533 $640,000 $635,200 $629,600 $620,000 $656,800 $659,333 $660,400 $660,800 $7,705,733 $105.54 $7,705,733 $105.54 Total Fixed Costs $914,119 $918,013 $920,457 $922,808 $924,744 $918,067 $909,934 $897,379 $947,642 $951,207 $952,837 $953,425 $11,130,632 $152.45 $11,130,632 $152.45

Total Plan Cost $3,593,484 $2,956,661 $2,904,862 $4,031,334 $3,529,579 $3,660,684 $3,487,989 $4,524,888 $5,261,235 $4,042,251 $4,261,108 $4,740,786 $46,994,861 $643.68 $46,994,861 $643.68 Employee Contributions $309,159 $311,815 $312,546 $313,784 $312,631 $311,425 $309,712 $312,591 $316,432 $317,953 $319,878 $319,687 $3,767,613 $51.60 $3,767,613 $51.60 Employer Cost $3,284,325 $2,644,846 $2,592,316 $3,717,550 $3,216,948 $3,349,259 $3,178,276 $4,212,297 $4,944,804 $3,724,297 $3,941,230 $4,421,098 $43,227,248 $592.07 $43,227,248 $592.07

Budget Comparison Budgeted Cost $3,940,459 $3,960,148 $3,971,480 $3,982,317 $3,987,631 $3,961,625 $3,927,312 $3,889,091 $4,073,232 $4,088,287 $4,097,278 $4,099,487 $47,978,347 $657.15 $47,978,347 $657.15 Actual Cost $3,593,484 $2,956,661 $2,904,862 $4,031,334 $3,529,579 $3,660,684 $3,487,989 $4,524,888 $5,261,235 $4,042,251 $4,261,108 $4,740,786 $46,994,861 $643.68 $46,994,861 $643.68 Surplus/(Deficit) $346,975 $1,003,487 $1,066,618 ($49,017) $458,052 $300,941 $439,324 ($635,797) ($1,188,004) $46,036 ($163,830) ($641,298) $983,485 $13.47 ($983,485) ($13.47)

Feb-24Jan-24Paid Month Jul-24Jun-24May-24Apr-24Mar-24 Dec-24Nov-24Oct-24Sep-24Aug-24 Year-to-Date

73,010 101,833

1.4

Rolling 12

73,010 101,833

1.4

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Actual Cost $599 $491 $481 $665 $581 $607 $584 $765 $849 $650 $684 $760

Budgeted Cost $657 $657 $657 $657 $657 $657 $657 $658 $657 $657 $657 $657

Variance $58 $167 $176 ($8) $75 $50 $74 ($108) ($192) $7 ($26) ($103)

Budget Comparison PEPM

54%

23%

6%

1%

16%

Combined Plan Expenses

Medical Claims

Pharmacy Claims

Administrative Fees

Financial Monitoring Report - Medical Budget Summary (Seton Only)

Reporting as of December 31, 2024

Carrier: Aetna/CVS Specific Deductible: $1,000,000 Contract Type: Paid Plan Year: 1/1/2024 - 12/31/2024

Total PEPM Total PEPM

Enrollment Subscribers 3,418 3,438 3,448 3,453 3,454 3,431 3,395 3,336 3,335 3,340 3,323 3,309 Members 4,638 4,666 4,676 4,681 4,686 4,650 4,604 4,535 4,529 4,536 4,520 4,501 Contract Size 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4

Claim Payments Medical Claims $1,971,680 $1,468,654 $1,330,619 $1,814,783 $913,959 $1,001,823 $1,589,219 $1,655,700 $2,517,842 $1,419,161 $1,389,401 $2,157,622 $19,230,464 $472.73 $19,230,464 $472.73 Pharmacy Claims $1,123,821 $1,107,844 $1,053,988 $1,115,758 $1,122,553 $1,206,016 $1,204,440 $1,355,941 $1,345,747 $1,237,772 $1,308,398 $1,246,084 $14,428,362 $354.68 $14,428,362 $354.68 Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00 $0 $0.00 Total Net Claim Payments $3,095,501 $2,576,498 $2,384,607 $2,930,541 $2,036,512 $2,207,839 $2,793,660 $3,011,640 $3,863,589 $2,656,933 $2,697,799 $3,403,706 $33,658,826 $827.40 $33,658,826 $827.40 Total Net Claim Payments PEPM $906 $749 $692 $849 $590 $643 $823 $903 $1,158 $795 $812 $1,029

Fixed Costs Administrative Fees $131,661 $132,432 $132,817 $133,010 $133,048 $132,162 $130,775 $128,503 $128,464 $128,657 $128,002 $127,463 $1,566,994 $38.52 $1,566,994 $38.52 Stop Loss Premiums $28,677 $28,845 $28,929 $28,971 $28,979 $28,786 $28,484 $27,989 $27,981 $28,023 $27,880 $27,763 $341,305 $8.39 $341,305 $8.39 HSA Employer Contributions $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00 $0 $0.00 Total Fixed Costs $160,338 $161,277 $161,746 $161,980 $162,027 $160,948 $159,259 $156,492 $156,445 $156,679 $155,882 $155,225 $1,908,299 $46.91 $1,908,299 $46.91

Total Plan Cost $3,255,840 $2,737,775 $2,546,353 $3,092,521 $2,198,539 $2,368,787 $2,952,919 $3,168,132 $4,020,034 $2,813,612 $2,853,681 $3,558,932 $35,567,124 $874.31 $35,567,124 $874.31 Employee Contributions $523,027 $526,469 $526,453 $526,752 $527,350 $524,345 $518,895 $508,077 $503,793 $505,102 $505,173 $503,380 $6,198,816 $152.38 $6,198,816 $152.38 Employer Cost $2,732,812 $2,211,306 $2,019,899 $2,565,769 $1,671,189 $1,844,442 $2,434,024 $2,660,055 $3,516,241 $2,308,511 $2,348,508 $3,055,551 $29,368,308 $721.93 $29,368,308 $721.93

Budget Comparison Budgeted Cost $2,232,027 $2,245,469 $2,250,453 $2,253,252 $2,254,350 $2,239,845 $2,216,395 $2,176,077 $2,171,293 $2,175,102 $2,166,673 $2,157,880 $26,538,816 $652.38 $26,538,816 $652.38 Actual Cost $3,255,840 $2,737,775 $2,546,353 $3,092,521 $2,198,539 $2,368,787 $2,952,919 $3,168,132 $4,020,034 $2,813,612 $2,853,681 $3,558,932 $35,567,124 $874.31 $35,567,124 $874.31 Surplus/(Deficit) ($1,023,812) ($492,306) ($295,899) ($839,269) $55,811 ($128,942) ($736,524) ($992,055) ($1,848,741) ($638,511) ($687,008) ($1,401,051) ($9,028,308) ($221.93) $9,028,308 $221.93

Nov-24Paid Month Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24

1.4 1.4

Dec-24 Year-to-Date Rolling 12

40,680 40,680 55,222 55,222

($1,000)

($500)

$0

$500

$1,000

$1,500

Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Actual Cost $953 $796 $739 $896 $637 $690 $870 $950 $1,205 $842 $859 $1,076

Budgeted Cost $653 $653 $653 $653 $653 $653 $653 $652 $651 $651 $652 $652

Variance ($300) ($143) ($86) ($243) $16 ($38) ($217) ($297) ($554) ($191) ($207) ($423)

Budget Comparison PEPM

54% 41%

4%1%0%

Combined Plan Expenses

Medical Claims

Pharmacy Claims

Administrative Fees

Financial Monitoring Report - Medical Budget Summary (Nationwide HDHP)

Reporting as of December 31, 2024

Carrier: Aetna/CVS Specific Deductible: $1,000,000 Contract Type: Paid Plan Year: 1/1/2024 - 12/31/2024

Total PEPM Total PEPM

Enrollment Subscribers 154 152 150 150 149 147 146 140 133 133 133 132 Members 201 199 197 193 193 191 190 180 175 175 175 173 Contract Size 1.3 1.3 1.3 1.3 1.3 1.3 1.3 1.3 1.3 1.3 1.3 1.3

Claim Payments Medical Claims $89,244 $65,052 $45,086 $230,264 $125,644 $110,973 $104,598 $101,097 $324,794 $58,119 $210,264 $102,412 $1,567,547 $911.89 $1,567,547 $911.89 Pharmacy Claims $51,905 $46,221 $38,972 $28,311 $63,736 $45,540 $43,062 $71,322 $59,521 $63,498 $53,584 $49,410 $615,080 $357.81 $615,080 $357.81 Claims Over Specific $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00 $0 $0.00 Total Net Claim Payments $141,149 $111,273 $84,058 $258,575 $189,380 $156,513 $147,660 $172,419 $384,315 $121,617 $263,848 $151,821 $2,182,628 $1,269.71 $2,182,628 $1,269.71 Total Net Claim Payments PEPM $917 $732 $560 $1,724 $1,271 $1,065 $1,011 $1,232 $2,890 $914 $1,984 $1,150

Fixed Costs Administrative Fees $5,932 $5,855 $5,778 $5,778 $5,739 $5,662 $5,624 $5,393 $5,123 $5,123 $5,123 $5,085 $66,216 $38.52 $66,216 $38.52 Stop Loss Premiums $1,292 $1,275 $1,259 $1,259 $1,250 $1,233 $1,225 $1,175 $1,116 $1,116 $1,116 $1,107 $14,422 $8.39 $14,422 $8.39 HSA Employer Contributions $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00 $0 $0.00 Total Fixed Costs $7,224 $7,130 $7,037 $7,037 $6,990 $6,896 $6,849 $6,567 $6,239 $6,239 $6,239 $6,192 $80,638 $46.91 $80,638 $46.91

Total Plan Cost $148,373 $118,403 $91,095 $265,612 $196,370 $163,409 $154,509 $178,986 $390,554 $127,856 $270,087 $158,014 $2,263,266 $1,316.62 $2,263,266 $1,316.62 Employee Contributions $65,519 $64,924 $64,329 $62,926 $63,691 $63,096 $62,236 $57,986 $56,466 $56,466 $56,466 $55,328 $729,432 $424.33 $729,432 $424.33 Employer Cost $82,854 $53,480 $26,766 $202,685 $132,679 $100,313 $92,273 $121,000 $334,088 $71,391 $213,621 $102,686 $1,533,834 $892.28 $1,533,834 $892.28

Budget Comparison Budgeted Cost $142,519 $140,924 $139,329 $137,926 $138,191 $136,596 $135,236 $127,986 $122,966 $122,966 $122,966 $121,328 $1,588,932 $924.33 $1,588,932 $924.33 Actual Cost $148,373 $118,403 $91,095 $265,612 $196,370 $163,409 $154,509 $178,986 $390,554 $127,856 $270,087 $158,014 $2,263,266 $1,316.62 $2,263,266 $1,316.62 Surplus/(Deficit) ($5,854) $22,520 $48,234 ($127,685) ($58,179) ($26,813) ($19,273) ($51,000) ($267,588) ($4,891) ($147,121) ($36,686) ($674,334) ($392.28) $674,334 $392.28

Nov-24Paid Month Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24

1.3 1.3

Dec-24 Year-to-Date Rolling 12

1,719 1,719 2,242 2,242

($3,000)

($2,000)

($1,000)

$0

$1,000

$2,000

$3,000

$4,000

Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Actual Cost $963 $779 $607 $1,771 $1,318 $1,112 $1,058 $1,278 $2,936 $961 $2,031 $1,197

Budgeted Cost $925 $927 $929 $920 $927 $929 $926 $914 $925 $925 $925 $919

Variance ($38) $148 $322 ($851) ($390) ($182) ($132) ($364) ($2,012) ($37) ($1,106) ($278)

Budget Comparison PEPM

69%

27%

3%1%0%

Combined Plan Expenses

Medical Claims

Pharmacy Claims

Administrative Fees

Financial Monitoring Report - Large Claimants over $200,000

Reporting as of December 31, 2024 Carrier: Aetna/CVS Specific Deductible: $1,000,000 Contract Type: Paid Plan Year: 1/1/2024 - 12/31/2024

1 HSA Seton $0 $0 $0 $0 $83,022 $113,861 $27,337 $129,179 $19,651 $11,620 $28,305 $255,323 $668,298 $0

2 HSA Seton $0 $0 $0 $0 $0 $0 $0 $404,707 $167,610 $10,396 $8,581 $2,425 $593,720 $0

3 Seton Only $0 $0 $0 $0 $0 $0 $0 $0 $554,799 $21,701 $2,535 $3,861 $582,895 $0

Nationwide

HDHP

$0 $86,842 $667 $84,577 $61,512 $18,641 $27,924 $29,651 $266,008 -$9,075 -$2,864 $16,632 $580,514 $0

5 HSA Seton $0 $0 $0 $0 $0 $591,065 $2,148 -$1,120 -$55,628 $5,392 $2,096 $0 $543,952 $0

6 Seton Only $0 $106,057 $40,419 $41,286 $28,864 $53,057 $41,985 $52,226 $41,334 $37,481 $39,137 $41,923 $523,769 $0

7 HSA Seton $0 $95,959 $6,069 $338,264 $0 $0 $853 $295 $0 $232 $0 $0 $441,670 $0

8 HSA Seton $0 $0 $0 $0 $0 $0 $0 $266,290 $23,885 $9,564 $118,073 $1,683 $419,495 $0

9 Seton Only $0 $0 $0 $0 $0 $0 $0 $0 $379,081 $5,970 $11,828 $16,959 $413,838 $0

10 HSA Seton $0 $0 $0 $0 $0 $146,628 $3,329 $2,361 $1,906 $3,320 $8,018 $233,986 $399,548 $0

11 Seton Only $0 $0 $78,643 $32,769 $31,711 $32,843 $34,457 $32,747 $32,763 $34,513 $32,922 $32,763 $376,131 $0

12 HSA Seton $0 $0 $0 $0 $0 $0 $0 $0 $362,627 $287 $733 $196 $363,843 $0

13 Seton Only $0 $0 $93,598 $28,135 $23,409 $25,567 $24,792 $25,794 $35,939 $29,829 $28,835 $30,311 $346,207 $0

14 Seton Only $0 $0 $0 $0 $85,930 $61,683 $89,518 $89,768 $3,650 $294 $0 $0 $330,842 $0

15 HSA Seton $0 $0 $0 $0 $113,776 $23,127 $20,322 $268 $45,649 $9,635 $46,811 $28,918 $288,506 $0

16 HSA Seton $0 $0 $0 $79,220 $1,045 $4,993 $47,934 $26,259 $28,331 $19,878 $42,881 $22,862 $273,403 $0

17 HSA Seton $0 $0 $77,585 $1,043 $1,920 $28,739 $28,495 $29,398 $31,311 $5,457 $30,085 $34,877 $268,911 $0

18 Seton Only $0 $0 $0 $0 $0 $0 $0 $0 $235,831 $8,641 $18,460 $995 $263,927 $0

19 Seton Only $0 $0 $0 $237,924 $6,064 $2,977 $523 $1,018 -$3,373 $0 $0 $9,935 $255,068 $0

20 HSA Seton $0 $0 $0 $0 $172,596 $10,309 $3,091 -$185,995 $249,550 $513 $186 $882 $251,130 $0

21 HSA Seton $0 $0 $0 $0 $0 $96,059 $4,495 $50,161 $12,619 $27,801 $20,058 $27,384 $238,578 $0

22 HSA Seton $0 $0 $0 $0 $88,643 $19,535 $10,845 $36,333 $20,769 $18,963 $18,622 $19,036 $232,746 $0

23 Seton Only $0 $0 $0 $0 $79,174 $19,915 $23,609 $20,152 $23,723 $19,782 $20,366 $22,394 $229,116 $0

24 HSA Seton $0 $0 $0 $0 $75,458 $16,979 $41,831 $14,080 $26,823 $20,890 $18,617 $14,193 $228,871 $0

25 Seton Only $0 $0 $0 $0 $89,045 $24,174 $24,691 $24,915 $25,844 $245 $2,210 $24,674 $215,799 $0

26 Seton Only $180,274 $3,764 $8,180 $5,427 $7,137 $346 $0 $4,292 $340 $0 $2,428 $442 $212,630 $0

27 Seton Only $0 $0 $116,470 $87,948 $4,328 -$291 $1,433 $533 $189 $0 -$886 $0 $209,725 $0

28 Seton Only $0 $0 $0 $0 $77,970 $23,275 $20,279 $20,291 $20,999 $823 $22,431 $20,877 $206,946 $0

29 HSA Seton $0 $0 $0 $90,116 $22,931 $9,502 $9,251 $12,974 $11,812 $23,891 $8,948 $11,068 $200,494 $0

Total $180,274 $292,622 $421,632 $1,026,707 $1,054,533 $1,322,987 $489,140 $1,086,577 $2,564,044 $318,045 $529,415 $874,599 $10,160,573 $0

% of Gross Claims 0.3% 0.4% 0.6% 1.4% 1.5% 1.8% 0.7% 1.5% 3.6% 0.4% 0.7% 1.2% 14.1% Claimants above $200,000 0 0 0 3 6 7 10 13 19 21 25 29 29

Expected Reimbursement

Claimant TotalDec-24Nov-24Oct-24Sep-24Aug-24Jul-24Jun-24May-24Apr-24Mar-24Feb-24Jan-24Plan

Financial Monitoring Report - Large Claimants over $200,000-Diagnosis

Reporting as of December 31, 2024 Carrier: Aetna/CVS Specific Deductible: $1,000,000 Contract Type: Paid Plan Year: 1/1/2024 - 12/31/2024

1 CH HSA Seton Restricted Diagnosis $661,156 $7,142 $0 $668,298

2 EE HSA Seton Spondylolisthesis, Lumbosacral Region $593,483 $237 $0 $593,720

3 CH Seton Only Neuromuscular Scoliosis, Thoracolumbar Region $582,543 $352 $0 $582,895

4 EE Nationwide HDHP Ventricular Fibrillation $569,493 $11,021 $0 $580,514

5 EE HSA Seton Sepsis, Unspecified Organism $543,830 $122 $0 $543,952

6 EE Seton Only Adult Osteomalacia, Unspecified $125,840 $397,929 $0 $523,769

7 EE HSA Seton Sepsis Due To Escherichia Coli (e. Coli) $451,615 -$9,946 $0 $441,670

8 EE HSA Seton Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Right Dominant

Side $419,358 $137 $0 $419,495

9 EE Seton Only Cerebral Infarction Due To Unspecified Occlusion Or Stenosis Of Left Middle

Cerebral Artery $412,436 $1,402 $0 $413,838

10 EE HSA Seton Unstable Burst Fracture Of T11-t12 Vertebra, Initial Encounter For Closed Fracture $397,303 $2,245 $0 $399,548

11 EE Seton Only Malignant Melanoma Of Right Lower Limb, Including Hip $7,861 $368,270 $0 $376,131

12 EE HSA Seton Unspecified Severe Protein-calorie Malnutrition $363,841 $2 $0 $363,843

13 SP Seton Only Malignant Neoplasm Of Lower-inner Quadrant Of Left Female Breast $49,449 $296,758 $0 $346,207

14 EE Seton Only Malignant Neoplasm Of Unspecified Choroid $326,134 $4,708 $0 $330,842

15 EE HSA Seton Bronchiectasis, Uncomplicated $3,191 $285,315 $0 $288,506

16 EE HSA Seton Malignant Neoplasm Of Left Kidney, Except Renal Pelvis $173,649 $99,754 $0 $273,403

17 EE HSA Seton Other Specified Diseases Of Intestine $17,831 $251,080 $0 $268,911

18 EE Seton Only Disruption Of Wound, Unspecified, Initial Encounter $248,993 $14,935 $0 $263,927

19 CH Seton Only Sepsis, Unspecified Organism $252,107 $2,961 $0 $255,068

20 CH HSA Seton Malignant Neoplasm Of Cerebellum $251,088 $42 $0 $251,130

21 EE HSA Seton Malignant Neoplasm Of Lower Lobe, Left Bronchus Or Lung $209,100 $29,478 $0 $238,578

22 EE HSA Seton Malignant Neoplasm Of Lower-inner Quadrant Of Left Female Breast $26,349 $206,397 $0 $232,746

23 EE Seton Only Restricted Diagnosis $1,203 $227,913 $0 $229,116

24 CH HSA Seton Dental Caries On Smooth Surface Penetrating Into Dentin $228,871 $0 $0 $228,871

25 EE Seton Only Chronic Sinusitis, Unspecified $3,701 $212,098 $0 $215,799

26 EE Seton Only St Elevation (stemi) Myocardial Infarction Involving Other Coronary Artery Of Anterior

Wall $200,096 $12,534 $0 $212,630

27 EE Seton Only Spinal Stenosis, Lumbar Region Without Neurogenic Claudication $209,265 $460 $0 $209,725

28 EE Seton Only Dietary Counseling And Surveillance $2,174 $204,773 $0 $206,946

29 EE HSA Seton Multiple Myeloma Not Having Achieved Remission $3,538 $196,956 $0 $200,494

TotalDiagnosis

Total $10,160,573

Medical Pharmacy Pooled Claim

Amount

$0$2,825,074$7,335,499

PlanRelationshipClaimant

Financial Monitoring Report - Dental Budget Summary

Reporting as of December 31, 2024

Carrier: Delta Dental Plan Year: 1/1/2024 - 12/31/2024

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

Enrollment Subscribers 5,749 5,770 5,779 5,785 5,795 5,792 5,738 5,670 5,729 5,745 5,744 5,727 Members 8,575 8,619 8,629 8,644 8,660 8,654 8,561 8,496 8,556 8,566 8,571 8,546 Contract Size 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5

Plan Costs Dental Claims $323,141 $191,418 $251,429 $193,727 $216,374 $264,381 $395,896 $283,239 $167,351 $208,872 $173,708 $219,606 $2,889,143 $41.86 $2,889,143 $41.86 Total Claim Payments $323,141 $191,418 $251,429 $193,727 $216,374 $264,381 $395,896 $283,239 $167,351 $208,872 $173,708 $219,606 $2,889,143 $41.86 $2,889,143 $41.86 Total Claim Payments PEPM $56.21 $33.17 $43.51 $33.49 $37.34 $45.65 $69.00 $49.95 $29.21 $36.36 $30.24 $38.35

Administrative Fees $16,212 $16,271 $16,297 $16,314 $16,342 $16,333 $16,181 $15,989 $16,156 $16,201 $16,198 $16,150 $194,645 $2.82 $194,645 $2.82

Total Plan Cost $339,353 $207,690 $267,726 $210,041 $216,374 $264,381 $395,896 $283,239 $167,351 $208,872 $173,708 $219,606 $2,954,237 $42.80 $3,083,788 $44.68 Employee Contributions $261,757 $263,030 $263,476 $264,106 $264,650 $264,577 $261,444 $259,732 $260,915 $261,383 $261,664 $260,940 $3,147,674 $45.60 $3,147,674 $45.60 Employer Cost $77,596 ($55,340) $4,250 ($54,065) ($48,276) ($195) $134,453 $23,507 ($93,564) ($52,511) ($87,956) ($41,334) ($193,437) ($2.80) ($63,886) ($0.93)

Budget Comparison Budgeted Cost $261,760 $263,033 $263,479 $264,109 $264,653 $264,579 $261,447 $259,735 $260,918 $261,385 $261,667 $260,943 $3,147,707 $45.60 $3,147,707 $45.60 Actual Cost $339,353 $207,690 $267,726 $210,041 $216,374 $264,381 $395,896 $283,239 $167,351 $208,872 $173,708 $219,606 $2,954,237 $42.80 $3,083,788 $44.68 Surplus/(Deficit) ($77,593) $55,343 ($4,248) $54,068 $48,279 $198 ($134,450) ($23,504) $93,567 $52,513 $87,959 $41,337 $193,470 $2.80 $63,919 $0.93

Year-to-Date

69,023 103,077

1.5

Rolling 12

69,023 103,077

1.5

($40)

($20)

$0

$20

$40

$60

$80

Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Actual Cost $59 $36 $46 $36 $37 $46 $69 $50 $29 $36 $30 $38

Budgeted Cost $46 $46 $46 $46 $46 $46 $46 $46 $46 $45 $46 $46

Variance ($13) $10 ($1) $9 $8 $0 ($23) ($4) $16 $9 $15 $7

Budget Comparison PEPM

94%

6%

Combined Plan Expenses

Dental Claims

Administrative Fees

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.