Appendix_I_-_Monthly_Medical_Claims_Information_and_Enrollment_Final.xlsx

This is a comprehensive medical claims and enrollment spreadsheet for the County of Orange Human Resource Services, Employee Benefits Department, covering the entire calendar year 2023. The document details monthly enrollment and medical claims data for two health plan options: Wellwise and Sharewell, with subcategories for active, pre-65, and post-65 members. The County is seeking a Claims Administration provider for its Self-Insured Preferred Provider Organization (PPO) Health Plans, with potential expansion to include High Performance Network (HPN) self-insured PPO health plans for both active and retired members.

The spreadsheet reveals significant medical claims data, with total annual enrollment fluctuating between 5,245 and 5,357 employees and 8,652 to 8,744 total members per month. Total medical claims for 2023 reached $48,850,706, with notable large claims across different plan categories. The most expensive claims include acute myocardial infarction ($688,613), coagulation disorders ($697,361), and various cancer and treatment-related claims. The data also highlights a unique situation in March 2023, where claim credits (-$322,000) outweighed paid claims (+$316,000), indicating potential complex claims management considerations for the prospective claims administrator.