Claims History Summary

This file is a claims history spreadsheet detailing the State of Tennessee's self-insured supplemental medical insurance plan (The Tennessee Plan) administered through the Department of Finance and Administration's Division of Benefits Administration. The spreadsheet provides month-by-month claims data, enrollment figures, and cost metrics spanning from January 2018 through December 2024, with partial data available for the first and second quarters of 2025. The document tracks total paid amounts, number of claims processed, paid per claim amounts, enrollment levels, and paid per enrolled member figures across a seven-year period, establishing baseline performance metrics and cost trends critical to evaluating administrative services for the upcoming third-party administrator contract.

The claims history demonstrates consistent growth in plan costs and utilization over the six-year period from 2018 to 2024, with total annual paid amounts increasing from $63.0 million in 2018 to $89.0 million in 2024, representing a 41% cumulative increase. Annual plan costs have grown by an average of 4% year-over-year, while claims volume increased an average of 4.24% annually and enrollment grew at an average of 2.20% per year. The cost per claim increased an average of 2.45% annually, reaching approximately $59.05 in 2024. Enrollment levels grew from 41,809 members in 2018 to 47,727 members in 2024, with growth continuing into 2025 to approximately 48,011 members by December 2024. This historical data serves as the foundation for projecting future claims volumes, administrative costs, and performance expectations for the incoming third-party administrator effective January 1, 2027.