9.Att I-Yearly Claims Exp Table 2019-2021_FINAL 4.25.22.pdf
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- Attached to
- Group Dental Insurance
- Solicitation number
- RFP-00747
- Issued by
- Leon County, Florida
About this file
This document is a Request for Proposals (RFP) issued by the State of Florida, Department of Management Services' Division of State Group Insurance, for Group Dental Insurance. The RFP seeks proposals for dental insurance plans, including indemnity plans with PPO networks, standard PPO plans, and preventative PPO plans. The claims experience data for the past three years (2019-2021) is provided for various dental insurance providers currently serving the state, including Ameritas, Cigna, Humana, Sun Life, and MetLife. The contract term is not specified, but the RFP indicates that the department is seeking to establish a new contract for these services. The RFP provides details on the monthly paid claims for each provider and plan type over the three-year period.
The document does not include specific pricing terms, set-asides, or funding information. However, it provides comprehensive historical claims data that respondents can use to develop their proposals. The RFP appears to be open to all qualified vendors, as no incumbent information is provided. Respondents will need to review the detailed claims experience to understand the current utilization and plan design requirements for the state's dental insurance program.
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Request for Proposals (RFP) No.: DMS‐21/22‐027
GROUP DENTAL INSURANCE
Attachment I: Dental Claims Experience
Plan Name 2019 2020 2021
Ameritas Indemnity w PPO 7,491,930$ 7,254,666$ 8,529,226$
Ameritas Standard PPO 5,889,325$ 5,320,021$ 6,144,006$
Ameritas Preventative PPO 819,210$ 711,779$ 884,358$
Cigna Prepaid 2,130,969$ 1,881,172$ 2,238,640$
Humana Prepaid 664,145$ 881,857$ 1,171,573$
Humana Indemnity w PPO 146,429$ 118,876$ 116,334$
Sun Life Prepaid 297,266$ 268,327$ 308,148$
Sun Life Indemnity w PPO 2,958,122$ 2,709,339$ 3,082,082$
MetLife Indemnity w PPO 9,804,883$ 8,851,953$ 9,950,688$
MetLife Standard PPO 18,079,925$ 17,033,478$ 19,854,383$
MetLife Preventative PPO 2,116,209$ 2,099,108$ 2,493,403$
Available Yearly Claims Experience
THIS SPACE INTENTIONALLY LEFT BLANK
RFP No.: DMS-21/22-027 Attachment I: Dental Claims Experience Page 1 of 6
Year/Month Indemnity w/ PPO Standard PPO Preventive PPO Total Paid Claims Jan-19 697,887$ 487,601$ 64,002$ $1,249,490 Feb-19 620,681$ 473,687$ 76,251$ $1,170,619 Mar-19 700,334$ 544,780$ 70,504$ $1,315,618 Apr-19 711,332$ 538,735$ 67,170$ $1,317,237
May-19 637,663$ 523,190$ 69,864$ $1,230,717 Jun-19 549,987$ 450,773$ 57,747$ $1,058,507 Jul-19 679,042$ 527,980$ 72,495$ $1,279,517
Aug-19 645,572$ 551,458$ 82,352$ $1,279,382 Sep-19 505,595$ 407,171$ 58,338$ $971,104 Oct-19 667,624$ 524,863$ 74,811$ $1,267,298 Nov-19 524,820$ 408,752$ 63,690$ $997,262 Dec-19 551,393$ 450,335$ 61,986$ $1,063,714 Jan-20 662,395$ 509,861$ 73,701$ $1,245,957 Feb-20 702,580$ 529,329$ 68,051$ $1,299,960 Mar-20 685,115$ 467,449$ 59,538$ $1,212,102 Apr-20 261,911$ 119,142$ 7,246$ $388,299
May-20 400,932$ 250,024$ 36,626$ $687,582 Jun-20 634,153$ 536,760$ 63,257$ $1,234,170 Jul-20 607,129$ 487,245$ 62,878$ $1,157,252
Aug-20 683,879$ 487,580$ 66,989$ $1,238,448 Sep-20 642,042$ 502,517$ 73,404$ $1,217,963 Oct-20 647,961$ 488,115$ 66,188$ $1,202,264 Nov-20 590,901$ 419,087$ 54,039$ $1,064,027 Dec-20 735,668$ 522,912$ 79,862$ $1,338,442 Jan-21 690,518$ 493,230$ 67,472$ $1,251,220 Feb-21 719,428$ 506,680$ 65,712$ $1,291,820 Mar-21 830,836$ 599,394$ 87,065$ $1,517,295 Apr-21 811,667$ 551,022$ 73,403$ $1,436,092
May-21 733,632$ 472,874$ 68,643$ $1,275,149 Jun-21 705,229$ 539,374$ 93,388$ $1,337,991 Jul-21 675,687$ 536,973$ 76,414$ $1,289,074
Aug-21 729,745$ 500,030$ 65,163$ $1,294,938 Sep-21 629,991$ 461,058$ 72,675$ $1,163,724 Oct-21 685,193$ 517,035$ 67,805$ $1,270,033 Nov-21 626,221$ 479,212$ 70,418$ $1,175,851 Dec-21 691,079$ 487,124$ 76,200$ $1,254,403
Monthly Paid Claims Data
Ameritas Paid Claims 2019 - 2021
RFP No.: DMS-21/22-027 Attachment I: Dental Claims Experience Page 2 of 6
Cigna Paid Claims 2019 - 2021
Year/Month Total Paid Claims Jan-19 $157,704.38 Feb-19 $170,290.29 Mar-19 $195,175.93 Apr-19 $195,191.93
May-19 $164,161.54 Jun-19 $208,262.18 Jul-19 $145,914.43
Aug-19 $223,331.41 Sep-19 $179,959.26 Oct-19 $190,997.34 Nov-19 $146,484.61 Dec-19 $153,495.56 Jan-20 $158,413.69 Feb-20 $146,149.34 Mar-20 $194,265.54 Apr-20 $55,198.24
May-20 $81,062.82 Jun-20 $155,560.01 Jul-20 $225,363.11
Aug-20 $158,025.17 Sep-20 $151,892.72 Oct-20 $160,448.95 Nov-20 $164,157.52 Dec-20 $230,634.96 Jan-21 $154,086.25 Feb-21 $201,933.34 Mar-21 $198,789.39 Apr-21 $208,514.75
May-21 $195,940.96 Jun-21 $174,172.97 Jul-21 $191,081.29
Aug-21 $187,927.22 Sep-21 $160,987.11 Oct-21 $197,601.97 Nov-21 $173,160.17 Dec-21 $194,444.53
179,959$ 190,997$
Monthly Paid Claims Data Prepaid Plan
157,704$ 170,290$ 195,176$
146,485$ 153,496$ 158,414$
195,192$ 164,162$ 208,262$ 145,914$ 223,331$
146,149$ 194,266$
55,198$ 81,063$
155,560$ 225,363$ 158,025$ 151,893$ 160,449$ 164,158$ 230,635$ 154,086$ 201,933$ 198,789$ 208,515$
*Total reimbursements do not include monthly capitation paid to providers, special agreement payments paid to certain key providers to retain their network participation and other costs associated with plan administration.
197,602$ 173,160$ 194,445$
195,941$ 174,173$ 191,081$ 187,927$ 160,987$
RFP No.: DMS-21/22-027 Attachment I: Dental Claims Experience Page 3 of 6
Humana Paid Claims 2019 - 2021
Year/Month Indemnity w/ PPO Total Paid Claims Jan-19 14,408.17$ $68,709.00 Feb-19 12,650.90$ $62,871.07 Mar-19 11,874.23$ $67,272.31 Apr-19 12,556.62$ $67,287.46
May-19 11,873.07$ $68,967.71 Jun-19 13,405.11$ $68,564.36 Jul-19 12,226.37$ $72,339.78
Aug-19 13,723.45$ $79,103.78 Sep-19 11,151.62$ $62,685.94 Oct-19 13,221.63$ $61,569.28 Nov-19 9,310.25$ $62,458.47 Dec-19 10,027.86$ $68,745.48 Jan-20 11,892.86$ $60,702.63 Feb-20 10,016.66$ $69,818.78 Mar-20 9,647.37$ $52,780.08 Apr-20 3,194.35$ $16,163.43
May-20 5,722.29$ $42,624.92 Jun-20 12,295.26$ $103,510.81 Jul-20 11,047.62$ $93,123.69
Aug-20 12,077.11$ $107,694.01 Sep-20 10,841.78$ $113,706.67 Oct-20 10,228.78$ $116,066.42 Nov-20 8,677.17$ $98,087.16 Dec-20 13,234.74$ $126,454.81 Jan-21 10,108.58$ $107,891.69 Feb-21 8,386.92$ $93,921.71 Mar-21 11,304.68$ $127,594.82 Apr-21 11,640.62$ $117,462.12
May-21 10,695.04$ $102,063.30 Jun-21 13,620.14$ $118,376.60 Jul-21 7,919.55$ $87,674.50
Aug-21 9,945.94$ $103,257.10 Sep-21 5,896.37$ $97,786.57 Oct-21 8,465.60$ $104,819.81 Nov-21 8,724.04$ $113,335.08 Dec-21 9,626.57$ $113,724.00
*Total reimbursements for Prepaid do not include monthly capitation paid to providers, special agreement payments paid to certain key providers to retain their network participation and other costs associated with plan administration.
96,354.21$ 104,611.04$ 104,097.43$
58,717.62$ 48,809.77$ 59,802.12$ 43,132.71$ 12,969.08$
Prepaid 54,300.83$ 50,220.17$ 55,398.08$ 54,730.84$ 57,094.64$ 55,159.25$ 60,113.41$ 65,380.33$ 51,534.32$
102,864.89$ 105,837.64$
89,409.99$
36,902.63$ 91,215.55$
Monthly Paid Claims Data
93,311.16$ 91,890.20$
113,220.07$ 97,783.11$ 85,534.79$
116,290.14$ 105,821.50$
48,347.65$ 53,148.22$
91,368.26$ 104,756.46$
79,754.95$
82,076.07$ 95,616.90$
RFP No.: DMS-21/22-027 Attachment I: Dental Claims Experience Page 4 of 6
Sun Life Paid Claims 2019 - 2021
Year/Month Indemnity w/ PPO Total Paid Claims Jan-19 258,828$ $278,957.07 Feb-19 260,522$ $283,931.37 Mar-19 262,053$ $285,737.85 Apr-19 275,859$ $298,599.52
May-19 252,227$ $274,710.77 Jun-19 254,779$ $285,649.23 Jul-19 240,164$ $266,952.00
Aug-19 277,185$ $309,876.00 Sep-19 211,924$ $231,734.00 Oct-19 252,621$ $286,377.00 Nov-19 195,005$ $219,040.00 Dec-19 216,955$ $233,823.00 Jan-20 254,072$ $279,549.00 Feb-20 264,253$ $295,088.00 Mar-20 218,493$ $239,896.00 Apr-20 63,214$ $97,122.57
May-20 150,173$ $163,194.60 Jun-20 269,857$ $278,462.34 Jul-20 293,926$ $319,661.40
Aug-20 254,289$ $277,359.28 Sep-20 257,726$ $279,790.73 Oct-20 252,630$ $283,495.43 Nov-20 175,127$ $195,469.88 Dec-20 255,580$ $268,576.99 Jan-21 242,760$ $277,939.74 Feb-21 246,109$ $273,585.16 Mar-21 280,687$ $306,448.07 Apr-21 331,441$ $375,976.65
May-21 227,130$ $247,275.86 Jun-21 272,114$ $300,492.35 Jul-21 277,490$ $307,435.80
Aug-21 234,289$ $252,384.45 Sep-21 226,158$ $250,475.09 Oct-21 278,739$ $299,579.07 Nov-21 211,241$ $227,793.12 Dec-21 253,925$ $270,844.9116,920$
16,868$ 25,477$ 30,835$ 21,403$ 33,908$
30,866$ 20,343$
13,022$ 8,605$
18,095$ 24,318$
28,379$ 29,946$
25,736$ 23,070$
Monthly Paid Claims Data
33,756$ 24,035$
20,146$
16,552$
22,064$
25,761$ 44,535$
12,997$ 35,180$ 27,476$
*Total reimbursements for Prepaid do not include monthly capitation paid to providers, special agreement payments paid to certain key providers to retain their network participation and other costs associated with plan administration.
20,840$
Prepaid 20,129$ 23,409$ 23,685$ 22,740$ 22,484$ 30,870$ 26,788$ 32,691$ 19,810$
RFP No.: DMS-21/22-027 Attachment I: Dental Claims Experience Page 5 of 6
Year/Month Indemnity PPO Standard PPO Preventive PPO Total Paid Claims 2019/01 852,757 1,472,001 158,638 $2,483,396.19 2019/02 862,965 1,572,828 195,521 $2,631,314.66 2019/03 878,754 1,624,046 199,229 $2,702,028.90 2019/04 945,000 1,673,874 180,608 $2,799,482.76 2019/05 841,272 1,585,205 170,287 $2,596,764.17 2019/06 719,186 1,410,379 151,355 $2,280,920.13 2019/07 861,401 1,563,212 188,336 $2,612,949.08 2019/08 835,920 1,575,663 187,470 $2,599,052.76 2019/09 695,327 1,239,246 160,354 $2,094,927.18 2019/10 835,781 1,541,800 196,732 $2,574,313.09 2019/11 717,442 1,367,878 164,356 $2,249,675.87 2019/12 759,078 1,453,793 163,323 $2,376,193.43 2020/01 871,007 1,661,345 186,876 $2,719,228.11 2020/02 843,161 1,597,361 209,796 $2,650,318.26 2020/03 829,061 1,651,665 207,555 $2,688,281.00 2020/04 356,486 596,652 33,361 $986,499.21 2020/05 484,461 759,162 85,824 $1,329,446.02 2020/06 792,431 1,532,611 200,970 $2,526,012.21 2020/07 822,737 1,620,294 210,079 $2,653,110.85 2020/08 777,437 1,573,276 204,191 $2,554,903.46 2020/09 779,272 1,506,900 194,158 $2,480,330.54 2020/10 768,921 1,532,183 189,753 $2,490,856.46 2020/11 719,333 1,424,963 168,532 $2,312,828.27 2020/12 807,646 1,577,066 208,013 $2,592,724.12 2021/01 773,618 1,469,999 197,212 $2,440,828.64 2021/02 832,322 1,602,981 211,521 $2,646,824.53 2021/03 956,736 1,941,174 235,284 $3,133,194.21 2021/04 944,173 1,793,707 211,767 $2,949,647.54 2021/05 805,596 1,630,723 198,706 $2,635,023.91 2021/06 884,673 1,739,970 209,519 $2,834,161.85 2021/07 889,998 1,674,924 213,514 $2,778,436.21 2021/08 787,916 1,720,730 217,175 $2,725,821.58 2021/09 706,276 1,588,918 195,678 $2,490,871.80 2021/10 787,942 1,569,693 202,780 $2,560,414.64 2021/11 764,199 1,560,812 198,353 $2,523,364.38 2021/12 817,239 1,560,752 201,894 $2,579,885.39
Monthly Paid Claims Data
MetLife Paid Claims 2019-2021
RFP No.: DMS-21/22-027 Attachment I: Dental Claims Experience Page 6 of 6
| 9b.Att. I-Dental Claims Experience_2019-2021_DRAFT 2.11.22.pdf |
| Adjustment (2) |
| Ameritas State of Florida Paid Claims by Plan 2019_2021.pdf |
| Sheet1 |
| Cigna State of Florida Paid Claims by Plan 2019_2021.pdf |
| Sheet1 |
| Humana State of Florida Paid Claims by Plan 2019_2021.pdf |
| Sheet1 |
| Sun Life State of Florida Paid Claims by Plan 2019_2021.pdf |
| Sheet1 |
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