Appendix_E_-_Monthly_Medical_Claims_Information_and_Enrollment.pdf
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- Attached to
- RFP for Claims Administration for the Self-Insured Preferred Provider Organization (PPO) Health Plans
- Solicitation number
- 017-202403-MC
- Issued by
- Orange County, San Francisco City, California
About this file
This is an Appendix containing monthly medical claims information and enrollment data for the County of Orange's self-insured Preferred Provider Organization (PPO) health plans, comprising Wellwise and Sharewell plans across active, pre-65, and post-65 member categories. The data covers the 12-month period from January 2023 through December 2023 and provides comprehensive enrollment metrics, member counts, and medical claims by plan and month. The appendix documents employee counts ranging from 5,245 to 5,357 per month across all plans, with total annual employee count of 63,567. Member enrollment data shows total monthly members ranging from 8,652 to 8,761, with annual total membership of 104,497. Medical claims data demonstrates significant monthly variation, ranging from approximately $2.97 million to $4.96 million monthly, with total annual medical claims of $48,850,706.
The claims data reveals notable monthly fluctuations in medical expenditures across plan types, with March 2023 representing a significant outlier due to claim credits of approximately $322,000 that offset paid claims of approximately $316,000. Wellwise Active consistently represents the largest claims volume, followed by Sharewell Active and Wellwise Post-65 plans. The enrollment and claims information contained in this appendix directly supports the County's RFP for claims administration services, providing prospective vendors with baseline operational metrics and historical claims patterns necessary to understand the scope and complexity of the administration contract commencing January 1, 2025.
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Employee Count Per Month Plan/Month Wellwise Active Wellwise Pre-65 Wellwise Post-65 Sharewell Active Sharewell Pre-65 Sharewell Post-65 Grand Total 202301 2,249 29 1,114 967 467 486 5,312 202302 2,246 25 1,101 957 456 487 5,272 202303 2,273 25 1,092 958 447 487 5,282 202304 2,270 25 1,095 944 449 493 5,276 202305 2,268 23 1,091 942 438 494 5,256 202306 2,282 22 1,087 937 427 490 5,245 202307 2,324 19 1,089 942 417 496 5,287 202308 2,339 21 1,083 941 415 494 5,293 202309 2,363 20 1,081 941 407 496 5,308 202310 2,394 22 1,075 935 405 499 5,330 202311 2,403 23 1,076 948 398 501 5,349 202312 2,426 21 1,071 945 393 501 5,357 Grand Total 27,837 275 13,055 11,357 5,119 5,924 63,567
Member Count Per Month Plan/Month Wellwise Active Wellwise Pre-65 Wellwise Post-65 Sharewell Active Sharewell Pre-65 Sharewell Post-65 Grand Total 202301 4,100 33 1,352 1,792 707 777 8,761 202302 4,104 29 1,331 1,789 689 780 8,722 202303 4,126 29 1,319 1,788 675 781 8,718 202304 4,104 33 1,319 1,775 682 788 8,701 202305 4,105 31 1,313 1,770 668 788 8,675 202306 4,123 26 1,307 1,761 654 781 8,652 202307 4,163 22 1,307 1,764 640 786 8,682 202308 4,183 24 1,301 1,768 631 782 8,689 202309 4,200 23 1,298 1,773 614 786 8,694 202310 4,229 25 1,291 1,769 610 791 8,715 202311 4,240 26 1,291 1,792 602 793 8,744 202312 4,263 24 1,286 1,783 593 795 8,744 Grand Total 49,940 325 15,715 21,324 7,765 9,428 104,497
Med Claims by Plan by Month Plan/Month Wellwise Active Wellwise Pre-65 Wellwise Post-65 Sharewell Active Sharewell Pre-65 Sharewell Post-65 Grand Total 202301 $2,139,906 $101,541 $434,093 $660,716 $495,756 $124,435 $3,956,447 202302 $1,980,348 $6,335 $269,915 $230,798 $284,579 $198,808 $2,970,784 202303 $2,275,814 $7,352 $435,749 $305,227 ($5,803) $293,750 $3,312,088 202304 $2,103,808 $66,340 $345,056 $375,081 $376,261 $159,869 $3,426,414 202305 $2,353,590 $5,990 $416,212 $425,264 $673,367 $200,368 $4,074,792 202306 $2,984,725 $4,280 $388,622 $282,803 $448,560 $683,872 $4,792,862 202307 $2,398,898 $5,131 $424,379 $714,019 $587,729 $121,462 $4,251,618 202308 $3,069,013 $6,297 $511,150 $370,233 $613,862 $189,411 $4,759,966 202309 $2,652,046 $8,477 $455,304 $389,158 $295,418 $145,003 $3,945,407 202310 $2,335,425 $23,795 $320,501 $531,728 $441,808 $272,230 $3,925,486 202311 $2,761,567 $19,922 $498,203 $677,882 $763,010 $235,767 $4,956,351 202312 $2,843,661 $13,079 $386,364 $494,428 $449,324 $291,634 $4,478,490 Grand Total $29,898,801 $268,541 $4,885,548 $5,457,336 $5,423,870 $2,916,611 $48,850,706
The month of March 2023 had significant claim credits (-$322K) that outweighed the paid claims (+$316K) in that respective month
File details come from the government source that posted it. Updated .