Appendix_I_-_Monthly_Medical_Claims_Information_and_Enrollment_Final.xlsx

This is a monthly medical claims information and enrollment spreadsheet for the County of Orange's self-insured Preferred Provider Organization (PPO) health plans covering 2023. The document provides comprehensive enrollment and claims data for four health plans: Wellwise Active, Wellwise Pre-65, Wellwise Post-65, Sharewell Active, Sharewell Pre-65, and Sharewell Post-65. Throughout 2023, the plans maintained relatively stable enrollment, with total employee counts ranging from 5,245 to 5,357 per month and total member counts ranging from 8,652 to 8,744 per month. The Wellwise Active plan consistently represented the largest enrollment segment with approximately 2,200 to 2,426 employee count per month, while the member count for the same plan ranged from 4,100 to 4,263 monthly. Sharewell Active and Wellwise Post-65 also maintained substantial enrollment bases, with combined member counts representing significant portions of the total covered population throughout the year.

The annual medical claims for 2023 totaled $48,850,706 across all plans, with monthly claims ranging from approximately $2.97 million in February to $4.96 million in November. Wellwise Active generated the highest claims volume at $29.9 million annually, followed by Sharewell Active at $5.46 million and Wellwise Post-65 at $4.89 million. The data identifies top large claims by plan, highlighting significant individual claims for conditions including acute myocardial infarction ($688,613), encounter for antineoplastic therapies (multiple claims exceeding $536,000), and various serious health conditions across all plan segments. March 2023 contained claim credits of $322,000 that offset paid claims of $316,000 for that month. This claims and enrollment data serves as baseline information for the County's RFP for new claims administration services, with the contract commencing January 1, 2025.