Attachment U - Supplemental Plan Claims Utilization.pdf

This is a Supplemental Plan Claims Utilization report for Gloucester County Public covering supplemental insurance products for the period spanning 2024 to 2025 under Group Contract 172963. The report details claims experience across three product categories: Accident, Critical Illness, and Hospital Indemnity insurance. The data encompasses 931 total year-end member lives and includes both member and dependent claims. Claims are segmented into Non-Wellness and Wellness claim categories, with comprehensive tracking of claim counts and corresponding benefits paid for each product line and reporting year.

The report documents total claims activity of 86 claims across all products, generating $37,010 in total benefits paid during the reporting period. Accident coverage recorded 38 claims with $4,460 in benefits paid across 434 member lives; Critical Illness recorded 24 claims with $12,300 in benefits paid across 284 member lives; and Hospital Indemnity recorded 24 claims with $20,250 in benefits paid across 213 member lives. Wellness claims comprised 70 of the total 86 claims, with $4,600 paid in wellness benefits, while Non-Wellness claims totaled 16 with $32,410 paid. Year-over-year comparison shows variation in claim activity and benefit utilization across both product categories and wellness classifications.