9-ATTACHMENT I - 2025 YTD Claim Analysis.pdf

January 1, 2025 - December 31, 2025

A Self-Funded Evaluation

YTD CLAIM ANALYSIS

PREPARED EXCLUSIVELY FOR:

Austin ISD

July 2025

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.

Financial Monitoring Report - Austin ISD Executive Analysis

Reporting as of July 31, 2025 Carrier: BCBS TX Plan Year: 1/1/2025 - 12/31/2025

1) The medical plan expense for the month of July is $8,278,653 or $842.18 per employee per month (PEPM)

2) The YTD medical plan expense through July is $46,984,105 or $680.47 PEPM

3) Actual results YTD are 4.5% above projected budget on a gross PEPM basis

4) The projected budget results yield a $2,002,234 deficit YTD , which equates to $29.00 PEPM

5) BCBS TX Large claims (individuals with claims > $100,000) represent 21.5% of total BCBS TX YTD medical/rx claim expense

1) The dental plan expense for the month of July is $501,334 or $0.00 per employee per month (PEPM)

2) The YTD dental plan expense through July is $2,521,164 or $0.00 PEPM

3) Actual results YTD are 31.7% projected budget on a gross PEPM basis

Executive Analysis

Austin ISD Financial Monitoring Report - Historical Summary

Total Medical/Rx Claims 4 3 2 1 0

Month 2021 2022 2023 2024 2025

January $5,261,024 $6,131,868 $4,615,974 $5,958,566 $5,789,083 1 February $4,046,106 $5,980,943 $4,104,008 $4,729,729 $7,265,018 2 March $5,269,515 $4,267,625 $4,313,559 $4,450,713 $4,918,742 3 April $5,075,660 $3,655,313 $4,315,301 $6,185,911 $7,106,352 4 May $5,079,639 $4,910,250 $4,444,301 $4,928,776 $7,805,640 5 June $5,266,193 $4,936,885 $5,143,789 $5,214,123 $8,852,536 6 July $5,011,368 $6,239,457 $5,770,615 $5,522,828 $8,272,555 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 $50,009,926 Rx Rebates -$3,219,120 -$6,327,243 -$7,685,502 -$8,734,227 -$2,149,454 Specific Recoveries $0 -$870,194 $0 $0 $0 Net Claims $59,407,048 $56,058,155 $53,829,391 $63,119,036 $47,860,473 Average Monthly Enrollment 10,001 9,253 9,115 9,617 9,864 Net Claims PEPM $495.03 $504.89 $492.13 $546.92 $693.16 % Increase/Decrease from Prior - 2.0% -2.5% 11.1% 26.7%

Admin Fees* $4,313,052 $4,110,331 $4,048,325 $4,445,555 -$8,492,821 Stop Loss Fees $897,652 $739,460 $783,720 $968,282 $0 Total Fixed Costs $5,210,704 $4,849,790 $4,832,045 $5,413,836 -$8,492,821 Total Fixed Costs PEPM $43.42 $43.68 $44.18 $46.91 -$123.00 % Increase/Decrease from Prior - 0.6% 1.1% 6.2% -362.2%

*2025 Admin Fees include Rx Rebate Credits and One-time Administrative Fee Credits

2021 2022 2023 2024 2025

Net Claims $59,407,048 $56,058,155 $53,829,391 $63,119,036 $47,860,473

$0

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

Paid Claims by Plan Year

2021 2022 2023 2024 2025

Net Claims PEPM $495.03 $504.89 $492.13 $546.92 $693.16

$0

$100

$200

$300

$400

$500

$600

$700

$800

Net Paid Claims PEPM

Medical Summary - All Plans

Reporting as of July 31, 2025 Carrier: BCBS TX Plan Year: 1/1/2025 - 12/31/2025

Paid Month Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Year-to-Date

Total PEPM Rolling 12

Total PEPM

Enrollment Subscribers 9,867 9,889 9,886 9,877 9,860 9,838 9,830 69,047 117,168 Members 13,679 13,723 13,737 13,716 13,701 13,678 13,665 95,899 162,327 Contract Size 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39

Claim Payments BCBS Medical Claims $1,168,373 $3,512,927 $3,369,598 $4,359,404 $4,488,652 $5,514,565 $5,580,385 $27,993,903 $405.43 $27,993,903 $238.92 BCBS Pharmacy Claims $969,763 $1,538,229 $1,665,912 $1,794,226 $2,574,268 $2,319,850 $2,171,489 $13,033,737 $188.77 $13,033,737 $111.24 APR Savings Program Fees $2,487 $5,811 $17,560 $8,474 $11,266 $10,994 $11,228 $67,820 $0.98 $67,820 $0.58 Aenta Medical Runout Claims $2,285,031 $2,255,866 $2,015,032 $942,074 $728,857 $1,071,765 $520,575 $9,819,199 $142.21 $32,675,305 $278.88 CVS Runout Claims $1,363,207 ($48,560) ($3,004) $561 $1,171 ($66,397) ($17,724) $1,229,254 $17.80 $13,235,766 $112.96 Rx Rebates $0 $0 ($2,149,454) $0 $0 $0 $0 ($2,149,454) ($31.13) ($7,284,534) ($63.12) Access Fees $221 $746 $3,098 $1,613 $1,427 $1,759 $6,602 $15,466 $0.22 $15,466 $0.13 Total Claim Payments $5,789,083 $7,265,018 $4,918,742 $7,106,352 $7,805,640 $8,852,536 $8,272,555 $50,009,926 $724.29 $79,737,463 $680.54 Total Claim Payments PEPM $586.71 $734.66 $497.55 $719.48 $791.65 $899.83 $841.56

Prior PY Net Claims* $5,958,566 $4,729,729 $4,450,713 $6,185,911 $4,928,776 $5,214,123 $5,522,828 $36,990,646 $549.74 Prior PY Claims PEPM $622.69 $491.86 $461.60 $640.16 $509.54 $542.69 $580.31 *Excludes Rx Rebates

Fixed Costs Administrative Fees ($774,263) ($775,990) ($775,754) ($775,048) ($773,714) ($771,988) ($771,360) ($5,418,118) ($78.47) ($3,564,497) ($30.42) Stop Loss Premiums $0 $0 $0 $0 $0 $0 $0 $0 $0.00 $403,735 $3.45 Administrative Fees Credits ($3,074,703) $0 $0 $0 $0 $0 $0 ($3,074,703) ($44.53) ($3,074,703) ($26.24) Employer HSA Contributions $783,400 $784,267 $781,900 $781,908 $780,350 $777,717 $777,458 $5,467,000 $79.18 $8,724,333 $74.46 Total Fixed Costs ($3,065,566) $8,277 $6,146 $6,860 $6,636 $5,729 $6,098 ($3,025,821) ($43.82) $2,488,868 $21.24

Total Plan Cost $2,723,516 $7,273,295 $4,924,888 $7,113,213 $7,812,275 $8,858,265 $8,278,653 $46,984,105 $680.47 $82,226,331 $701.78 Employee Contributions (1)

$706,748 $712,297 $715,449 $714,546 $715,410 $713,318 $713,603 $4,991,371 $72.29 $9,386,148 $80.11 Employer Cost $2,016,768 $6,560,998 $4,209,439 $6,398,667 $7,096,866 $8,144,947 $7,565,051 $41,992,734 $608.18 $72,840,183 $621.67

Budget Comparison Budgeted Cost (1)

$6,423,648 $6,441,064 $6,440,349 $6,434,954 $6,425,760 $6,410,035 $6,406,061 $44,981,871 $651.47 $76,694,481 $654.57 Actual Cost $2,723,516 $7,273,295 $4,924,888 $7,113,213 $7,812,275 $8,858,265 $8,278,653 $46,984,105 $680.47 $82,226,331 $701.78 Surplus/(Deficit) $3,700,132 ($832,231) $1,515,461 ($678,259) ($1,386,516) ($2,448,230) ($1,872,592) ($2,002,234) ($29.00) ($5,531,850) ($47.21)

Plan Metrics Medical FFS Discount(2)

68.3% 61.9% 69.3% 65.1% 63.0% 67.6% 65.6% 65.8% 65.8% Network Penetration 98.4% 98.3% 97.5% 94.7% 90.1% 89.9% 87.4% 92.5% 92.5%

(1) Estimated based on enrollment and monthly employee contributions and fully insured equivalent rates. Employee contributions assume all employees contribute at the wellness rate.

(2) Based on carrier reported Allowed vs. Covered claims.

($400)

($200)

$0

$200

$400

$600

$800

$1,000

Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Actual Cost $276 $735 $498 $720 $792 $900 $842 $0 $0 $0 $0 $0

Budgeted Cost $651 $651 $651 $652 $652 $652 $652 $0 $0 $0 $0 $0

Surplus/(Deficit) $375 ($84) $153 ($69) ($141) ($249) ($190)

Budget Comparison PEPM

60%

28%0%

-12%

0%

Combined Plan Expenses

BCBS Medical Claims

BCBS Pharmacy Claims

Access Fees

Administrative Fees

Stop Loss Premiums

Medical Summary - HMO PLAN

Reporting as of July 31, 2025 Carrier: BCBS TX HCA Plan Year: 1/1/2025 - 12/31/2025

Paid Month Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Year-to-Date

Total PEPM

Enrollment Subscribers 2,806 2,813 2,818 2,815 2,806 2,803 2,799 19,660 Members 3,734 3,748 3,747 3,750 3,738 3,735 3,730 26,182 Contract Size 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33

Claim Payments BCBS Medical Claims $364,924 $664,862 $1,080,790 $1,237,398 $1,550,479 $1,830,166 $1,569,105 $8,297,724 $422.06 BCBS Pharmacy Claims $707,756 $876,593 $891,930 $1,032,153 $1,344,473 $1,107,763 $1,121,906 $7,082,573 $360.25 APR Savings Program Fees $375 $1,243 $4,281 ($2,384) $4,470 $2,883 $2,944 $13,812 $0.70 Access Fees $26 $23 $1 $38 $162 $205 $3,731 $4,186 $0.21 Total Claim Payments $1,073,081 $1,542,720 $1,977,001 $2,267,205 $2,899,585 $2,941,017 $2,697,686 $15,398,294 $783.23 Total Claim Payments PEPM $382.42 $548.43 $701.56 $805.40 $1,033.35 $1,049.24 $963.80

Fixed Costs Administrative Fees ($220,187) ($220,736) ($221,128) ($220,893) ($220,187) ($219,951) ($219,638) ($1,542,720) ($78.47) Total Fixed Costs ($220,187) ($220,736) ($221,128) ($220,893) ($220,187) ($219,951) ($219,638) ($1,542,720) ($78.47)

Total Plan Cost $852,894 $1,321,984 $1,755,872 $2,046,312 $2,679,398 $2,721,065 $2,478,048 $13,855,574 $704.76 Employee Contributions (1) $341,889 $345,097 $343,846 $345,858 $345,079 $343,775 $344,425 $2,409,969 $122.58 Employer Cost $511,005 $976,887 $1,412,026 $1,700,454 $2,334,319 $2,377,291 $2,133,624 $11,445,605 $582.18

Budget Comparison Budgeted Cost (1) $1,744,889 $1,751,597 $1,752,846 $1,753,358 $1,748,079 $1,745,275 $1,743,925 $12,239,969 $622.58 Actual Cost $852,894 $1,321,984 $1,755,872 $2,046,312 $2,679,398 $2,721,065 $2,478,048 $13,855,574 $704.76 Surplus/(Deficit) $891,995 $429,613 ($3,026) ($292,954) ($931,319) ($975,791) ($734,124) ($1,615,605) ($82.18)

Plan Metrics Medical FFS Discount(2) 68.5% 70.9% 70.0% 65.3% 60.8% 68.9% 68.9% 67.2% Network Penetration 100.0% 98.5% 97.8% 96.1% 93.3% 91.9% 93.5% 94.7%

(1) Estimated based on enrollment and monthly employee contributions and fully insured equivalent rates. Employee contributions assume all employees contribute at the wellness rate.

(2) Based on carrier reported Allowed vs. Covered claims.

($600)

($400)

($200)

$0

$200

$400

$600

$800

$1,000

$1,200

Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Actual Cost $304 $470 $623 $727 $955 $971 $885 $0 $0 $0 $0 $0

Budgeted Cost $622 $623 $622 $623 $623 $623 $623 $0 $0 $0 $0 $0

Surplus/(Deficit) $318 $153 ($1) ($104) ($332) ($348) ($262)

Budget Comparison PEPM

49%

42%0%

-9%

Combined Plan Expenses

BCBS Medical Claims BCBS Pharmacy Claims Access Fees

Administrative Fees

Medical Summary - HDHP PLAN

Reporting as of July 31, 2025 Carrier: BCBS TX HCA Plan Year: 1/1/2025 - 12/31/2025

Paid Month Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Year-to-Date

Total PEPM

Enrollment Subscribers 7,061 7,076 7,068 7,062 7,054 7,035 7,031 49,387 Members 9,945 9,975 9,990 9,966 9,963 9,943 9,935 69,717 Contract Size 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41

Claim Payments BCBS Medical Claims $803,449 $2,848,065 $2,288,809 $3,122,006 $2,938,172 $3,684,399 $4,011,280 $19,696,179 $398.81 BCBS Pharmacy Claims $262,007 $661,636 $773,982 $762,073 $1,229,795 $1,212,087 $1,049,584 $5,951,165 $120.50 APR Savings Program Fees $2,112 $4,568 $13,279 $10,858 $6,796 $8,111 $8,284 $54,008 $1.09 Access Fees $195 $724 $3,097 $1,575 $1,264 $1,554 $2,871 $11,280 $0.23 Total Claim Payments $1,067,763 $3,514,992 $3,079,167 $3,896,512 $4,176,028 $4,906,152 $5,072,018 $25,712,632 $520.64 Total Claim Payments PEPM $151.22 $496.75 $435.65 $551.76 $592.01 $697.39 $721.38

Fixed Costs Administrative Fees ($554,077) ($555,254) ($554,626) ($554,155) ($553,527) ($552,036) ($551,723) ($3,875,398) ($78.47) Employer HSA Contributions $783,400 $784,267 $781,900 $781,908 $780,350 $777,717 $777,458 $5,467,000 $110.70 Total Fixed Costs $229,323 $229,013 $227,274 $227,753 $226,823 $225,680 $225,736 $1,591,602 $32.23

Total Plan Cost $1,297,087 $3,744,005 $3,306,441 $4,124,265 $4,402,850 $5,131,832 $5,297,754 $27,304,234 $552.86 Employee Contributions (1) $364,859 $367,200 $371,603 $368,687 $370,331 $369,543 $369,178 $2,581,402 $52.27 Employer Cost $932,227 $3,376,805 $2,934,838 $3,755,578 $4,032,519 $4,762,289 $4,928,576 $24,722,833 $500.59

Budget Comparison Budgeted Cost (1) $4,678,759 $4,689,467 $4,687,503 $4,681,596 $4,677,681 $4,664,760 $4,662,136 $32,741,902 $662.97 Actual Cost $1,297,087 $3,744,005 $3,306,441 $4,124,265 $4,402,850 $5,131,832 $5,297,754 $27,304,234 $552.86 Surplus/(Deficit) $3,381,673 $945,461 $1,381,062 $557,330 $274,831 ($467,072) ($635,618) $5,437,667 $110.10

Plan Metrics Medical FFS Discount(2) 68.2% 59.0% 69.0% 65.0% 64.4% 66.8% 64.0% 65.1% Network Penetration 97.6% 98.2% 97.4% 94.1% 88.4% 89.0% 85.1% 91.6%

(1) Estimated based on enrollment and monthly employee contributions and fully insured equivalent rates. Employee contributions assume all employees contribute at the wellness rate.

(2) Based on carrier reported Allowed vs. Covered claims.

($200)

($100)

$0

$100

$200

$300

$400

$500

$600

$700

$800

Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Actual Cost $184 $529 $468 $584 $624 $729 $753 $0 $0 $0 $0 $0

Budgeted Cost $663 $663 $663 $663 $663 $663 $663 $0 $0 $0 $0 $0

Surplus/(Deficit) $479 $134 $195 $79 $39 ($66) ($90)

Budget Comparison PEPM

67%

20%0%

-13%

Combined Plan Expenses

BCBS Medical Claims BCBS Pharmacy Claims Access Fees

Administrative Fees

BCBS TX Large Claimants Over $100,000

Reporting as of July 31, 2025 Carrier: BCBS TX Plan Year: 1/1/2025 - 12/31/2025

Claimant Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Total(1)

1 $21,688 $1,484,514 $24,632 $50,097 $423,752 $5,797 $2,684 $2,013,164

2 $0 $517 $10 $0 $16 $404,501 $13,718 $418,762

3 $29,846 $35,507 $51,372 $63,214 $92,472 $48,159 $55,203 $375,773

4 $36 $22,093 $23,090 $25,075 $29,192 $27,858 $191,693 $319,036

5 $2,576 $73,429 $204,169 $24,950 $1,114 $550 $2,333 $309,121

6 $0 $46,086 $7,257 $237,146 $263 -$2,271 $230 $288,712

7 $0 $0 $11,822 $40,273 $64,654 $107,433 $53,452 $277,634

8 $416 $0 $0 $3,360 $39,004 $199,431 $13,693 $255,903

9 $0 $0 $17,918 $39,860 $115,197 $34,007 $47,375 $254,357

10 $9,304 $74,708 $45,093 $8,278 $79,928 $10,726 $19,686 $247,724

11 $22 $0 $8,748 $221,843 $5,321 $752 $0 $236,686

12 $1,068 $32,763 $32,453 $34,006 $43,176 $37,147 $28,887 $209,499

13 $28,302 $25,369 $23,203 $39,598 $4,007 $31,392 $28,834 $180,706

14 $95 $33,747 $27,718 $27,601 $24,388 $32,130 $34,257 $179,936

15 $407 $3,114 $38,305 $117,189 $8,374 $4,450 $1,527 $173,365

16 $0 $0 $0 $167,188 $15 $18 $0 $167,221

17 $0 $0 $78,812 $2,202 $0 $83,430 $0 $164,444

18 $0 $0 $52,602 $70 $53,758 $52,395 $410 $159,235

19 $0 $7,087 $1,311 $7,354 $3,274 $4,517 $131,833 $155,377

20 $23,947 $25,507 $1,098 $25,121 $25,021 $24,867 $25,625 $151,187

21 $79 $5 $59 $141,813 $5,759 $539 $929 $149,183

22 $15,423 $19,096 $19,852 $19,945 $21,708 $24,737 $22,768 $143,529

23 $21,504 $3,390 $24,750 $21,883 $23,739 $24,525 $21,604 $141,396

24 $8,462 $15,243 $15,392 $25,564 $31,748 $24,936 $5,238 $126,584

25 $0 $17,187 $21,394 $21,286 $22,757 $21,444 $21,983 $126,051

26 $724 $18,194 $17,994 $18,738 $33,646 $19,647 $15,911 $124,854

27 $486 $8,332 $59,323 $50,886 $2,675 $1,338 $866 $123,905

28 $1,539 $27,285 $0 $19,923 $45,016 $132 $28,169 $122,064

29 $0 $0 $68,265 $35,904 $3,929 $4,802 $8,613 $121,513

30 $0 $38,958 $1,262 $1,240 $1,745 $67,685 $8,768 $119,658

31 $21,989 $22,299 $778 $2,585 $21,293 $28,897 $21,629 $119,469

32 $0 $0 $0 $0 $276 $51,625 $65,854 $117,755

33 $1,182 $24,721 $25,685 $1,518 $30,827 $29,380 $2,538 $115,852

34 $15,838 $21,526 $17,461 $42 $43,624 $16,351 $809 $115,651

35 $0 $10 $4 $86,420 $7,838 $5,723 $10,144 $110,139

36 $4,025 $482 $23,431 $25,743 $17,914 $17,520 $17,600 $106,714

37 $128 $1,232 $1,560 $1,540 $1,541 $91,112 $7,083 $104,197

38 $15,293 $15,935 $15,925 $15,870 $8,287 $8,044 $23,729 $103,083

39 $0 $1,051 $1,107 $149 $5,716 $17,882 $76,557 $102,462

Total $224,380 $2,099,386 $963,857 $1,625,473 $1,342,964 $1,563,609 $1,012,232 $8,831,901 % of Gross Claims 10.5% 41.6% 19.1% 26.4% 19.0% 20.0% 13.0% 21.5%

Claimants above $100,000 0 1 4 13 18 30 39 39 Totals do not include HCA draft amount.

Aggregating Specific Erosion Total

Claims applied toward Aggregating Specific $0 $0 $0 $0 $0 $0 $0 $0

BCBS TX Large Claimants Over $100,000

Reporting as of July 31, 2025 Carrier: BCBS TX Plan Year: 1/1/2025 - 12/31/2025

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

(YTD)(1)

1 Subscriber HDHP PLAN Male 50-59 I21 - Acute myocardial infarction $2,012,700 $464 $2,013,164

2 Subscriber HDHP PLAN Female 50-59 M51 - Other intervertebral disc disorders $418,187 $575 $418,762

3 Subscriber HDHP PLAN Male 50-59 C84 - Peripheral and cutaneous T-cell lymphomas $375,731 $42 $375,773

4 Dependent Child HDHP PLAN Female <1-19 E84 - Cystic fibrosis $155,948 $163,088 $319,036

5 Dependent Child HDHP PLAN Male <1-19 P70 - Transitory disorders of carbohydrate metabolism specific to fetus and newborn $309,021 $100 $309,121

6 Subscriber HDHP PLAN Female 65+ M46 - Other inflammatory spondylopathies $288,562 $150 $288,712

7 Subscriber HDHP PLAN Male 65+ Z51 - Other medical care $277,140 $494 $277,634

8 Subscriber HMO PLAN Male 50-59 I60 - Subarachnoid haemorrhage $255,848 $55 $255,903

9 Subscriber HDHP PLAN Male 50-59 I69 - Sequelae of cerebrovascular disease $252,150 $2,207 $254,357

10 Spouse HDHP PLAN Female 50-59 C22 - Malignant neoplasm of liver and intrahepatic bile ducts $115,951 $131,773 $247,724

11 Subscriber HDHP PLAN Male 50-59 J98 - Other respiratory disorders $235,107 $1,579 $236,686

12 Spouse HMO PLAN Female 60-64 C50 - Malignant neoplasm of breast $50,571 $158,928 $209,499

13 Subscriber HMO PLAN Female 40-49 Z12 - Special screening examination for neoplasms $3,086 $177,621 $180,706

14 Subscriber HMO PLAN Female 60-64 C43 - Malignant melanoma of skin $5,204 $174,731 $179,936

15 Dependent Child HDHP PLAN Female <1-19 R00 - Abnormalities of heart beat $173,365 $0 $173,365

16 Subscriber HMO PLAN Male 30-39 Z45 - Adjustment and management of implanted device $167,188 $33 $167,221

17 Subscriber HDHP PLAN Female 30-39 G35 - Multiple sclerosis $2,202 $162,242 $164,444

18 Subscriber HMO PLAN Female 40-49 G70 - Myasthenia gravis and other myoneural disorders $159,235 $0 $159,235

19 Subscriber HDHP PLAN Female 30-39 T51 - Toxic effect of alcohol $148,138 $7,239 $155,377

20 Subscriber HMO PLAN Female 40-49 I30 - Acute pericarditis $2,067 $149,120 $151,187

21 Subscriber HDHP PLAN Female 50-59 I48 - Atrial fibrillation and flutter $145,186 $3,997 $149,183

22 Subscriber HDHP PLAN Female 40-49 C50 - Malignant neoplasm of breast $8,959 $134,570 $143,529

23 Subscriber HMO PLAN Female 40-49 N84 - Polyp of female genital tract $5,027 $136,369 $141,396

24 Subscriber HDHP PLAN Male 60-64 C34 - Malignant neoplasm of bronchus and lung $114,379 $12,206 $126,584

25 Subscriber HDHP PLAN Female 50-59 L63 - Alopecia areata $1,460 $124,590 $126,051

26 Subscriber HDHP PLAN Female 50-59 C50 - Malignant neoplasm of breast $19,114 $105,740 $124,854

27 Subscriber HMO PLAN Female 50-59 G06 - Intracranial and intraspinal abscess and granuloma $122,271 $1,634 $123,905

28 Dependent Child HMO PLAN Male 20-29 K51 - Ulcerative colitis $25,932 $96,133 $122,064

29 Subscriber HDHP PLAN Male 40-49 I48 - Atrial fibrillation and flutter $112,888 $8,625 $121,513

30 Dependent Child HDHP PLAN Male <1-19 K50 - Crohn's disease [regional enteritis] $93,261 $26,397 $119,658

31 Subscriber HDHP PLAN Female 40-49 I10 - Essential (primary) hypertension $17,463 $102,006 $119,469

32 Subscriber HDHP PLAN Female 30-39 C81 - Hodgkin's disease $117,648 $107 $117,755

33 Subscriber HDHP PLAN Female 50-59 M75 - Shoulder lesions $3,863 $111,988 $115,852

34 Spouse HDHP PLAN Male 60-64 C64 - Malignant neoplasm of kidney, except renal pelvis $1,454 $114,197 $115,651

35 Subscriber HDHP PLAN Male 30-39 K70 - Alcoholic liver disease $109,563 $577 $110,139

36 Subscriber HDHP PLAN Female 60-64 Z51 - Other medical care $106,536 $178 $106,714

37 Subscriber HMO PLAN Female 65+ M17 - Gonarthrosis [arthrosis of knee] $95,333 $8,864 $104,197

38 Subscriber HMO PLAN Female 50-59 C50 - Malignant neoplasm of breast $649 $102,434 $103,083

39 Subscriber HMO PLAN Female 50-59 C90 - Multiple myeloma and malignant plasma cell neoplasms $80,215 $22,247 $102,462

Total: $6,588,600 $2,243,301 $8,831,901

(1)Totals do not include HCA draft amount.

Run Out Large Claimants Over $75,000

Reporting as of July 31, 2025 Carrier: Aetna/CVS Plan Year: 1/1/2025 - 12/31/2025

1 $0 $0 $466,824 $1,320 $2,240 $1,223 $12 $471,619

2 $0 $329,812 $29 $40,395 $0 $0 $0 $370,236

3 $0 $310,636 $1,134 $892 $37 $10,882 $0 $323,581

4 $0 $0 $312,541 $1,520 $1,897 $0 $0 $315,958

5 $0 $197,853 $68,694 $1,283 $0 $0 $0 $267,830

6 $0 $194,524 $4 $0 $3,128 $0 $0 $197,655

7 $0 $0 $135,136 $60,624 $4,054 $15,280 -$49,834 $165,259

8 $0 $0 $0 $0 $0 $138,586 $91 $138,678

9 $130,520 $3,596 -$2,092 $2,327 $550 $0 $0 $134,901

10 $0 $0 $0 $117,402 $470 $0 $0 $117,872

11 $0 $0 $0 $0 $0 $88,922 $0 $88,922

12 $0 $0 $86,101 $915 $21 $0 $0 $87,037

13 $0 $0 $0 $0 $0 $82,560 $0 $82,560

14 $0 $0 $0 $0 $75,653 $1,026 $0 $76,679

Total $130,520 $1,036,421 $1,068,371 $226,678 $88,049 $338,479 -$49,731 $2,838,788

% of Aetna Run Out Claims 3.6% 47.0% 53.1% 24.0% 12.1% 33.7% -9.9% 25.7% Claimants above $75,000 1 5 9 10 11 14 14 14

PlanClaimant TotalDec-25Nov-25Oct-25Sep-25Aug-25Jul-25Jun-25May-25Apr-25Mar-25Feb-25Jan-25

Run Out Large Claimants Over $75,000

Reporting as of July 31, 2025 Carrier: Aetna/CVS Plan Year: 1/1/2025 - 12/31/2025

1 EE Other Encephalitis And Encephalomyelitis $471,508 $111 $471,619

2 EE Cardiomyopathy, Unspecified $367,125 $3,111 $370,236

3 EE Aortic Aneurysm Of Unspecified Site, Without Rupture $323,581 $0 $323,581

4 CH Enterocolitis Due To Clostridium Difficile, Not Specified As Recurrent $315,918 $40 $315,958

5 EE Chronic Hepatic Failure Without Coma $262,628 $5,202 $267,830

6 EE Unspecified Severe Protein-calorie Malnutrition $197,655 $0 $197,655

7 CH Alcoholic Cirrhosis Of Liver With Ascites $165,259 $0 $165,259

8 EE Nonrheumatic Aortic (valve) Stenosis $138,678 $0 $138,678

9 CH Sepsis, Unspecified Organism $134,878 $23 $134,901

10 EE Injury Of Other Cranial Nerves, Unspecified Side, Initial Encounter $117,483 $389 $117,872

11 CH Single Liveborn Infant, Delivered Vaginally $88,922 $0 $88,922

12 EE Encounter For Breast Reconstruction Following Mastectomy $87,036 $1 $87,037

13 EE Unilateral Primary Osteoarthritis, Left Knee $82,560 $1 $82,560

14 EE Radiculopathy, Cervical Region $77,209 -$530 $76,679

TotalDiagnosis

Total $2,838,788

Medical Pharmacy

$8,349$2,830,439

RelationshipClaimant

Top 10 Diagnoses by Amount Paid

Reporting as of July 31, 2025 Carrier: BCBS TX Plan Year: 1/1/2025 - 12/31/2025

Rank Diagnostic Category Number of Claimants Services Amount Paid(1) % of Total Paid Medical Claims

1 Diseases of the Circulatory System 1,609 4,592 $3,878,506 13.8%

2 Factors Influencing Health Status and Contact with Health Services 6,790 16,003 $3,697,903 13.2%

3 Diseases of the Musculoskeletal System and Connective Tissue 2,427 9,409 $3,123,132 11.2%

4 Neoplasms 967 2,519 $2,419,810 8.6%

5 Diseases of the Digestive System 962 2,545 $1,638,997 5.9%

6 Mental, Behavioral and Neurodevelopmental Disorders 1,993 11,854 $1,512,442 5.4%

7 Diseases of the Genitourinary System 1,898 4,881 $1,456,426 5.2%

8 Injury, Poisoning and Certain Other Consequences of External Causes 1,598 4,235 $1,447,892 5.2%

Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not

Elsewhere Classified 4,076 8,576 $1,414,313 5.0%

10 Diseases of the Respiratory System 2,537 4,280 $1,369,144 4.9%

Total: 24,857 68,894 $21,958,564 78.4%

(1) Amount Paid includes Blue Access Fees and excludes HCA drafts.

14%

13%

11%

9% 6%

5%

5%

5%

5%

5%

22%

Top 10 Diagnoses by Amount Paid

Diseases of the Circulatory System

Factors Influencing Health Status and Contact with Health Services

Diseases of the Musculoskeletal System and Connective Tissue

Neoplasms

Diseases of the Digestive System

Mental, Behavioral and Neurodevelopmental Disorders

Diseases of the Genitourinary System

Injury, Poisoning and Certain Other Consequences of External Causes

Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified Diseases of the Respiratory System

All Other

Top Drugs by Amount Paid

Reporting as of July 31, 2025 Carrier: BCBS TX Plan Year: 1/1/2025 - 12/31/2025

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

1 Not Available 0000 - Not Available Source Brand 122 415 $1,083,783 $2,612 8.3%

2 Mounjaro Incretin Mimetic Agents (Glp-1

Receptor Agonists) Source Brand 356 1154 $929,182 $805 7.1%

3 Zepbound Anti-Obesity Agents Source Brand 252 881 $679,473 $771 5.2%

4 Ozempic Incretin Mimetic Agents (Glp-1

Receptor Agonists) Source Brand 276 703 $571,933 $814 4.4%

5 Wegovy Anti-Obesity Agents Source Brand 184 500 $540,437 $1,081 4.1%

6 Skyrizi Pen Antipsoriatics Source Brand 14 22 $424,684 $19,304 3.3%

7 Taltz Antipsoriatics Source Brand 10 52 $326,226 $6,274 2.5%

8 Dupixent Eczema Agents Source Brand 27 114 $316,738 $2,778 2.4%

9 Trikafta Cystic Fibrosis Agents Source Brand 2 12 $289,779 $24,148 2.2%

10 Enbrel Sureclick Soluble Tumor Necrosis Factor

Receptor Agents Source Brand 10 45 $287,220 $6,383 2.2%

Total 3,898 $5,449,456 $1,398 41.8%

Dental Summary

Reporting as of July 31, 2025 Carrier: Cigna HCA Plan Year: 1/1/2025 - 12/31/2025

Paid Month Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Year-to-Date

Total PEPM Rolling 12

Total PEPM

Enrollment Subscribers 5,953 5,964 5,963 5,955 5,948 5,926 5,921 Members 9,029 9,046 9,040 9,023 9,022 8,992 8,976 Contract Size 1.52 1.52 1.52 1.52 1.52 1.52 1.52

Claim Payments Cigna Dental Claims $182,593 $88,000 $573,912 $350,545 $253,870 $379,299 $485,475 $2,313,694 $55.58 $3,366,469 $47.92 Delta Dental Claims $76,786 $14,994 $6,685 $6,191 $2,419 $2,049 $2,181 Total Dental Claims $259,379 $102,994 $580,597 $356,736 $256,289 $381,348 $487,656 $2,424,999 $58.25 $3,366,469 $47.92 Dental Claims PEPM $43.57 $17.27 $97.37 $59.91 $43.09 $64.35 $82.36

Prior PY Net Claims $323,141 $191,418 $251,429 $193,727 $216,374 $264,381 $395,896 $1,836,367 $45.45 Prior PY Claims PEPM $56.21 $33.17 $43.51 $33.49 $37.34 $45.65 $69.00

Fixed Costs Administrative Fees $13,751 $13,777 $13,775 $13,756 $13,740 $13,689 $13,678 $96,165 $2.31 $176,860 $2.52

Total Plan Cost $273,130 $116,770 $594,371 $370,492 $270,029 $395,037 $501,334 $2,521,164 $60.56 $3,654,634 $52.03 Employee Contributions (1)

$273,824 $274,156 $274,111 $273,657 $273,852 $272,958 $272,432 $1,914,990 $46.00 $3,219,625 $45.83 Employer Cost ($694) ($157,385) $320,260 $96,835 ($3,822) $122,078 $228,902 $606,174 $14.56 $435,009 $6.19

Budget Comparison Budgeted Cost (1)

$273,824 $274,156 $274,111 $273,657 $273,852 $272,958 $272,432 $1,914,990 $46.00 $3,219,638 $45.83 Actual Cost $273,130 $116,770 $594,371 $370,492 $270,029 $395,037 $501,334 $2,521,164 $60.56 $3,654,634 $52.03 Surplus/(Deficit) $694 $157,385 ($320,260) ($96,835) $3,822 ($122,078) ($228,902) ($606,174) ($14.56) ($434,996) ($6.19)

(1) Estimated based on enrollment and monthly employee contributions and fully insured equivalent rates.

63,128 41,630

1.51 105,863 70,245

1.52

Actual Cost $46 $20 $100 $62 $45 $67 $85 $0 $0 $0 $0 $0

Budgeted Cost $46 $46 $46 $46 $46 $46 $46 $0 $0 $0 $0 $0

Surplus/(Deficit) $0 $26 ($54) ($16) $1 ($21) ($39) $0 $0 $0 $0 $0

($80)

($60)

($40)

($20)

$0

$20

$40

$60

$80

$100

$120

Budget Comparison PEPM

96%

4%

Combined Plan Expenses

Cigna 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.