Appendix 5 Medical Claims.xlsx

This document is a medical claims data summary for the State of Illinois health insurance program covering the period from June 2023 through May 2025. The spreadsheet presents monthly claim data across multiple entities and accounts, including STATE (primary account), TRIP (tripled coverage account), LGHP (local government health plan), and CIP (cooperative insurance plan) divisions. The data reflects customer-funded claims under two primary plan types: QCHP (Qualified Consumer Health Plan) and HDHP (High Deductible Health Plan) with Point-of-Service (POS) access, representing a self-insured health benefits program for state employees and affiliated groups.

The claims data demonstrates significant monthly variation in both employee enrollment and funded claims amounts across 24 months of operation. The STATE account represents the largest portion of claims, ranging from approximately $6.8 million to $10.5 million per month for individual sub-accounts, with estimated enrolled employees fluctuating between 7,200 and 7,900 employees. The TRIP account shows monthly claims between $4.3 million and $6.8 million with 2,800 to 3,900 covered employees, while LGHP and CIP accounts represent smaller populations with correspondingly lower claim volumes. The aggregate data reveals total combined monthly claims ranging from approximately $31.7 million to $43.7 million, with cumulative claimed amounts exceeding $896 million across all accounts and plan types during the 24-month reporting period. Employee counts and claim amounts fluctuate seasonally, with notable increases occurring in months such as November and February, suggesting patterns consistent with typical healthcare utilization cycles and annual plan periods.