Addendum_1_Monthly_Med_and_Pharmacy_claims.pdf
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- Solicitation number
- 26-23HR
- Issued by
- Sarasota County, Siesta Key CDP, Florida
About this file
This is an Addendum containing the City of Sarasota's Medical/Rx Plan Cost Report for the prior period covering January through December 2025, detailing monthly claims data and enrollment metrics across the city's self-funded medical and pharmacy plans. The report documents monthly employee and member counts averaging 1,034 employees and 1,874 members, with fixed costs totaling $1,080,386 for the full year and net paid claims of $15,707,498. Medical claims for the 12-month period totaled $11,026,257, while pharmacy drug claims reached $5,603,974, resulting in a combined total plan cost of $16,787,884 against a premium equivalent of $17,233,194, representing 97.4% of the premium equivalent. Monthly plan costs ranged from a low of $880,163 in March 2025 to a high of $2,045,865 in May 2025, with employer costs totaling $11,975,243 after deducting employee contributions of $4,812,641. The report includes detailed breakdowns of fixed costs including consulting fees, PCORI taxes, pharmacy rebates, administrative costs, stop loss coverage, and wellness programs.
The cost report identifies high-cost claimants and their associated claims under the specific stop loss coverage, with the listed claimant incurring $670,037 in plan costs for complications of transplanted organs and tissue. Average monthly plan costs per member ranged from $539 to $1,089, reflecting seasonal and claims-related variations. Fixed costs encompassed base administrative fees of $379,126, consulting fees of $163,192, specific stop loss coverage of $872,275, aggregate stop loss of $40,534, HSA funding of $150,000, budgeted clinic costs of $992,800, and wellness credits totaling $75,000. The report demonstrates plan performance trending slightly below premium equivalent costs, indicating favorable claims experience relative to projected expenses for the measurement period.
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CITY OF SARASOTA
Medical/Rx Plan Cost Report - Prior Period 1 Paid January 2025 - December 2025
Month Employees Members Fixed Costs Medical Claims Rx Drug Claims Claims Over Specific
(current) Net Paid Claims Total Plan Cost Premium Equivalent
% of Premium
Equivalent
Employee
Contributions Employer Cost
Jan-25 1,024 1,858 $223,031 $811,253 $391,327 $0 $1,202,580 $1,425,610 $1,421,683 100.3% ($405,728) $1,019,883
Feb-25 1,034 1,877 $225,493 $1,037,176 $404,031 ($276,711) $1,164,496 $1,389,988 $1,435,004 96.9% ($403,750) $986,238
Mar-25 1,027 1,865 ($116,973) $592,671 $409,977 ($5,512) $997,136 $880,163 $1,427,057 61.7% ($401,844) $478,320
Apr-25 1,025 1,864 $223,550 $949,937 $417,078 ($90,272) $1,276,744 $1,500,294 $1,426,842 105.1% ($403,217) $1,097,076
May-25 1,037 1,878 $226,105 $1,298,729 $474,498 $46,533 $1,819,760 $2,045,865 $1,440,065 142.1% ($404,837) $1,641,028
Jun-25 1,042 1,884 ($167,636) $1,169,597 $455,836 ($226,203) $1,399,230 $1,231,594 $1,443,077 85.3% ($404,994) $826,600
Jul-25 1,036 1,878 $226,105 $927,468 $459,346 ($15,272) $1,371,542 $1,597,647 $1,440,488 110.9% ($402,316) $1,195,331
Aug-25 1,034 1,875 $225,762 $675,207 $499,298 ($56,953) $1,117,552 $1,343,314 $1,438,010 93.4% ($400,158) $943,156
Sep-25 1,036 1,880 ($214,070) $739,741 $472,628 $14,473 $1,226,842 $1,012,771 $1,441,620 70.3% ($400,613) $612,159
Oct-25 1,040 1,882 $227,415 $951,150 $615,187 ($90,473) $1,475,863 $1,703,279 $1,444,519 117.9% ($397,578) $1,305,701
Nov-25 1,036 1,876 $226,610 $667,518 $482,438 ($99,774) $1,050,181 $1,276,792 $1,437,005 88.9% ($394,092) $882,700
Dec-25 1,039 1,876 ($225,005) $1,205,810 $522,330 ($122,569) $1,605,571 $1,380,566 $1,437,825 96.0% ($393,515) $987,051
Total 12,410 22,493 $1,080,386 $11,026,257 $5,603,974 ($922,733) $15,707,498 $16,787,884 $17,233,194 97.4% ($4,812,641) $11,975,243
Fixed Costs Total Paid Claims Net Paid Claims % of Premium Equivalent
Avg. 1,034 1,874 $1,080,386 $16,630,231 $15,707,498 97.4%
Average Enrollment by Tier
EE Only 623
EE + 1 190
Family 222
Total Employees 1,035
$379,126
$163,192
$872,275
$40,534
$38,974
$4,538
$90,000
$7,198
($1,628,350)
$45,100
Wellness Credit ($75,000)
Budgeted Clinic Costs $992,800
HRA Contributions $150,000
Total $1,080,386
Notes
Fixed Costs include Rx rebates
Monthly Plan Cost Per Member
Consulting Fee
PCORI
Rx Rebates
HSA Funding
Administrative Costs by Category
Base Admin
Other Admin
Specific Stop Loss
Aggregate Stop Loss
HSA Fee
HRA Fee
Enrollment Plan Costs Cost vs. Premium Equivalent Employer Cost
$767 $741
$472
$805
$1,089
$654
$851
$716
$539
$905
$681 $736
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Fixed Costs Rx Claims Net Medical Claims Premium Equivalent
BROWN & BROWN | 9
High Cost Claimants - Prior Stop Loss Period 1 Incurred January 2024 - December 2025; Paid January 2025 - December 2025
Claimant Plan Employee Status Relatiopnship / Age Band Primary Dignosis Amount Paid Specific Deductible Over Specific
Claimant #1 HRA Actives Employee / 60 - 64 Complications Of Transplanted Organs And Tissue $670,037 $250,000 ($420,037)
Claimant #2 HRA Actives Dependent / <1 - 19 Lymphoid Leukemia $487,319 $250,000 ($237,319)
Claimant #3 HRA Actives Dependent / 20 - 29 Other Benign Neoplasms Of Skin. Drug Therapy: Alyftrek $349,806 $250,000 ($99,806)
Claimant #4 HRA Pre-65 Retirees Employee / 60 - 64 Dizziness And Giddiness. Drug Therapy: Stelara $340,646 $250,000 ($90,646)
Claimant #5 HRA Actives Employee / 50 - 59 Hypertensive Heart And Chronic Kidney Disease $311,057 $250,000 ($61,057)
Claimant #6 HRA Actives Employee / 40 - 49 Type 1 Diabetes Mellitus $263,867 $250,000 ($13,867)
Claimant #7 HDHP Actives Dependent / 20 - 29 Drug Therapy: Vykat Xr $218,702 $250,000 $0
Claimant #8 HRA Actives Employee / 40 - 49 Thyrotoxicosis [Hyperthyroidism] $215,305 $250,000 $0
Claimant #9 HRA Actives Spouse / 60 - 64 Other Spondylopathies $195,899 $250,000 $0
Claimant #10 HRA Pre-65 Retirees Employee / 60 - 64 Presence Of Other Functional Implants. Drug Therapy: Nuzyra $192,235 $250,000 $0
Claimant #11 HRA Actives Employee / 40 - 49 Paroxysmal Tachycardia $188,751 $250,000 $0
Claimant #12 HRA Pre-65 Retirees Employee / 60 - 64 Complications Of Procedures, Not Elsewhere Classified $172,682 $250,000 $0
Claimant #13 HRA Pre-65 Retirees Spouse / 60 - 64 Personal History Of Malignant Neoplasm. Drug Therapy: Verzenio $170,648 $250,000 $0
Claimant #14 HRA Actives Dependent / 20 - 29 Fracture Of Skull And Facial Bones $160,348 $250,000 $0
Claimant #15 HRA Post-65 Retirees Employee / 65+ Complications Of Artificial Openings Of The Digestive System $152,525 $0 $0
Claimant #16 HRA Actives Employee / 50 - 59 Other Inflammatory Spondylopathies $143,511 $250,000 $0
Claimant #17 HRA Actives Employee / 50 - 59 Crohn'S Disease [Regional Enteritis]. Drug Therapy: Skyrizi $142,142 $250,000 $0
Claimant #18 HRA Actives Employee / 50 - 59 Atrial Fibrillation And Flutter $137,687 $250,000 $0
Claimant #19 HDHP Actives Employee / 20 - 29 Hydrocephalus $134,990 $250,000 $0
Total $4,648,158 ($922,733)
Total Medical/Rx Claims Paid January 2025 - December 2025 $16,630,231
Large Claim % of Medical/Rx Claims Paid 28.0%
* No specific deductible listed for claimant #15 due to being a post-65 retiree. Post-65 retirees are not covered under the stop loss contract.
Claimants over $125,000
BROWN & BROWN | 10
Medical/Rx Plan Cost Report - Prior Period 2 Paid January 2024 - December 2024
Month Employees Members Fixed Costs Medical Claims Rx Drug Claims Claims Over Specific
(current) Net Paid Claims Total Plan Cost Premium Equivalent
% of Premium
Equivalent
Employee
Contributions Employer Cost
Jan-24 1,029 1,839 $204,752 $833,628 $360,276 $0 $1,193,904 $1,398,655 $1,300,895 107.5% ($396,264) $1,002,391
Feb-24 1,032 1,846 $205,517 $653,667 $312,057 $0 $965,724 $1,171,241 $1,305,679 89.7% ($394,752) $776,489
Mar-24 1,028 1,847 ($128,269) $469,656 $378,645 $0 $848,301 $720,032 $1,305,340 55.2% ($394,212) $325,820
Apr-24 1,028 1,850 $205,034 $1,203,039 $293,965 ($125,305) $1,371,698 $1,576,732 $1,308,105 120.5% ($391,885) $1,184,847
May-24 1,024 1,849 $204,373 $1,270,649 $341,611 ($386,347) $1,225,912 $1,430,285 $1,306,450 109.5% ($390,403) $1,039,882
Jun-24 1,030 1,873 ($125,976) $888,807 $311,371 ($14,259) $1,185,920 $1,059,943 $1,324,281 80.0% ($393,610) $666,333
Jul-24 1,027 1,870 $205,088 $1,290,565 $422,197 ($328,248) $1,384,514 $1,589,602 $1,323,434 120.1% ($393,920) $1,195,683
Aug-24 1,031 1,880 $206,010 $1,110,337 $364,236 ($33,192) $1,441,381 $1,647,391 $1,331,118 123.8% ($393,904) $1,253,487
Sep-24 1,031 1,879 ($83,950) $1,154,946 $442,807 ($306,679) $1,291,075 $1,207,125 $1,330,250 90.7% ($393,216) $813,909
Oct-24 1,026 1,869 $205,110 $1,208,444 $414,511 ($406,803) $1,216,151 $1,421,261 $1,323,208 107.4% ($389,217) $1,032,044
Nov-24 1,021 1,865 $204,102 $970,625 $434,808 ($115,109) $1,290,324 $1,494,426 $1,320,511 113.2% ($388,009) $1,106,417
Dec-24 1,022 1,868 ($105,279) $1,067,982 $438,982 ($256,968) $1,249,996 $1,144,717 $1,321,360 86.6% ($384,133) $760,584
Total 12,329 22,335 $1,196,512 $12,122,344 $4,515,465 ($1,972,911) $14,664,898 $15,861,410 $15,800,630 100.4% ($4,703,525) $11,157,885
Fixed Costs Total Paid Claims Net Paid Claims % of Premium Equivalent
Avg. 1,027 1,861 $1,196,512 $16,637,809 $14,664,898 100.4%
Average Enrollment by Tier
EE Only 617
EE + 1 200
Family 211
Total Employees 1,028
$474,050
$149,797
$612,350
$33,715
$36,544
$4,248
$90,000
$6,459
($1,264,437)
$42,467
($125,000)
$986,320
$150,000
$1,196,512
Notes
Fixed Costs include Rx rebates
Wellness Credit
Budgeted Clinic Costs
HRA Contributions
Total
Consulting Fee
PCORI
Rx Rebates
HSA Funding
Administrative Costs by Category
Base Admin
Other Admin
Specific Stop Loss
Aggregate Stop Loss
HSA Fee
HRA Fee
Monthly Plan Cost Per Member
Enrollment Plan Costs Cost vs. Premium Equivalent Employer Cost
$761
$634
$390
$852 $774
$566
$850 $876
$642
$760 $801
$613
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Fixed Costs Rx Claims Net Medical Claims Premium Equivalent
BROWN & BROWN | 11
High Cost Claimants - Prior Stop Loss Period 2 Incurred January 2023 - December 2024; Paid January 2024 - December 2024
Claimant Plan Employee Status Relatiopnship / Age Band Primary Dignosis Amount Paid Specific Deductible Over Specific
Claimant #1 HRA Actives Dependent / 10 - 14 Encounter For Antineoplastic Immunotherapy $1,245,885 $250,000 ($995,885)
Claimant #2 HRA Pre-65 Retirees Employee / 60 - 64 Myasthenia Gravis Without (Acute) Exacerbation $604,548 $250,000 ($354,548)
Claimant #3 HRA Actives Dependent / 20 - 24 Encounter For Insertion Of Intrauterine Contraceptive Device $507,890 $300,000 ($207,890)
Claimant #4 HRA Actives Dependent / <1 Single Liveborn Infant, Delivered By Cesarean $478,565 $250,000 ($228,565)
Claimant #5 HRA Actives Dependent / 20 - 24 Unsp Intracapsular Fracture Of Left Femur, Init For Clos Fx $405,900 $250,000 ($155,900)
Claimant #6 HRA Actives Spouse / 60 - 64 Age-Rel Osteopor W Current Path Fracture, Vertebra(E), Init $277,020 $250,000 ($27,020)
Claimant #7 HRA Pre-65 Retirees Employee / 60 - 64 Non-St Elevation (Nstemi) Myocardial Infarction $253,102 $250,000 ($3,102)
Claimant #8 HRA Pre-65 Retirees Employee / 60 - 64 Infect/Inflm Reaction Due To Internal Left Hip Prosth, Init $219,771 $250,000 $0
Claimant #9 HRA Pre-65 Retirees Employee / 60 - 64 Basal Cell Carcinoma Of Skin Of Nose $191,456 $250,000 $0
Claimant #10 HRA Actives Employee / 45 - 49 Multiple Sclerosis $178,260 $250,000 $0
Claimant #11 HDHP Actives Employee / 50 - 54 Malignant Neoplasm Of Vagina $171,356 $250,000 $0
Claimant #12 HRA Pre-65 Retirees Spouse / 60 - 64 Malignant Neoplasm Of Unsp Site Of Right Female Breast $158,926 $250,000 $0
Claimant #13 HRA Actives Dependent / 5 - 9 Congenital Insufficiency Of Aortic Valve $151,724 $250,000 $0
Claimant #14 HRA Actives Employee / 60 - 64 Athscl Heart Disease Of Native Cor Art W Unstable Ang Pctrs $149,526 $250,000 $0
Claimant #15 HRA Pre-65 Retirees Employee / 55 - 59 Other Persistent Atrial Fibrillation $141,972 $250,000 $0
Claimant #16 HRA Pre-65 Retirees Dependent / 20 - 24 Narcolepsy With Cataplexy $140,570 $250,000 $0
Claimant #17 HRA Pre-65 Retirees Employee / 55 - 59 Malignant Neoplasm Of Prostate $135,770 $250,000 $0
Claimant #18 HRA Pre-65 Retirees Employee / 60 - 64 End Stage Renal Disease $130,085 $250,000 $0
Claimant #19 HRA Actives Spouse / 60 - 64 Unilateral Primary Osteoarthritis, Right Knee $126,109 $250,000 $0
Total $5,668,436 ($1,972,911)
Total Medical/Rx Claims Paid January 2024 - December 2024 $16,637,809
Large Claim % of Medical/Rx Claims Paid 34.1%
Claimants over $125,000
BROWN & BROWN | 12
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