Appendix_G_-_Plan_Enrollment_and_Average_Age.pdf

Appendix G is a plan enrollment and demographic summary document supporting the County of Orange Human Resource Services' Request for Proposal for claims administration services for self-insured Preferred Provider Organization health plans. The document provides detailed enrollment data across four health plan tiers—Wellwise Choice PPO, Sharewell Choice PPO, Wellwise Retiree PPO, and Sharewell Retiree PPO—segmented by coverage categories including individual, spouse/domestic partner, and dependent coverage options. The RFP seeks proposals for comprehensive claims administration services for approximately 5,600 active employees and retirees, with the contract term commencing January 1, 2025, for an initial three-year period with potential renewal for up to two additional consecutive one-year terms. Proposals were due March 15, 2024, by 4:00 PM Pacific Time.

The enrollment data demonstrates significant plan distribution, with active employees totaling 3,277 members across both plan options and retirees totaling 2,292 members across non-Medicare and Medicare categories. Active employees have an average age of 45.3 years, while early retirees average 60.6 years and Medicare retirees average 78.3 years. The incumbent claims administrator is Blue Shield of California. Medical expenditures totaled approximately $52.7 million in 2022, and the county anticipates potential plan design expansions including coverage for hearing aids, foot orthotics, fertility services, and abortion services. Vendor proposals must demonstrate integration capability with the existing OptumRx pharmacy benefits management system, robust cybersecurity protocols, healthcare regulatory compliance, and experience serving public sector clients with broad provider networks in California and nationally.