Exhibit 12 - Cal Yr 2024 City of Miami CIGNA Total Health Insight - Claims Paid Feb 2025.pdf

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2023 Cigna Healthcare.

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Total Health Insight

April 29, 2025

City of Miami

Powered by Consultative Analytics

EXHIBIT 12

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2023 Cigna Healthcare.

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute.

Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Agenda

Insights

1. Total Health Insight Overview

▪ Medical

▪ Pharmacy

2. High Cost Claimants

3. Specialty Pharmacy

4. Key Conditions

5. Prevention

6. Virtual Care

7. Appendix

Timeframes

• Current period reflects claims incurred between January 2024 and December 2024, paid through February 2025

• Base period reflects claims incurred between January 2023 and December 2023, paid through February 2024

• Norm represents Cigna Florida average for government and municipal employers

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2023 Cigna Healthcare.

Multi-Year Trend

2020: -6% medical trend, roughly $1.2m in initial Covid-19 costs

2021: +12% medical trend impact from returning utilization pattern, Covid-19 costs increase approximately $2.2m

2022: Medical utilization normalizes, $2.5m decrease in Covid-19 costs

2023: 4 individual claimants exceed $700k each in total cost, hypoglycemic medications account for more than half of total pharmacy trend

2024: Mounjaro and Ozempic spend increases to over $2.5m in total cost

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Total Health Insight Overview

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

What conditions contributed the most to trend? How much did we ask members of the plan to pay out of pocket?

Did members use the plan for appropriate services?

Medical Summary

• Network penetration remained at over 98% (no material change following move to OAP)

• Maternity remained the top driver of hospital admissions

• ER utilization increased 21% in total, with most of the increase related to non-steerable visits for dependent children. Employee ER utilization increased 16% for the year, with gastrointestinal and MSK visits higher (not specific to any single facility)

• $3.1m in 2024 in savings from Health Matters Care Management Preferred programs (case and utilization management)

2024 cost share rate is nearly identical to prior year following the change to OAP plan

Employee well visit rate increased further to now exceed norm by over 13 percentage points

Although not a driver of trend in 2024, Cancer spend remains well above norm rate

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Pharmacy Summary

Key Condition Medication Adherence Pharmacy program savings

• Utilization Management - Reviews access and safe use of medications.

Savings: $1.5M; Baseline in place today

• RationalMed - Sends alerts to providers to notify of potential gaps in care and medication-related issues. Savings: $60k

• Cigna 90Now - Drives lower network rates and conversion to 90-day supply.

Savings: $60k; 24% higher med adherence

• Patient Assurance Program - Lowers the customer cost of eligible diabetes medications to $25 per 30-day supply. Mbr Savings: $26,680; 332 mbrs

• Additional Savings Opportunities: consider Limited Protection UM ($1.07M); SaveOnSP for FL ($504k; ex 60+); 30-DS max for SRx members had interactions with the Accredo Therapeutic Resource Center to assist with management of their specialty medications

67 175

Hypertension

Diabetes

Depression

Cholesterol

Plan Compliance Rate

Norm Compliance Rate

79% 77%

72% 72%

73% 74%

76% 76%

Generic Dispensing Rate (GDR): 93.1% (+0.8%); $560k plan savings

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Specialty Pharmacy

Plan Spend

Summary

Medical Specialty – percent of current spend

Top drugs by spend

Pharmacy Specialty – percent of current spend

Base Current Trend Norm

Pharmacy Specialty Rx $111.25 $135.28 21.6% $104.11

Medical SRx HCP/Home Infusion $10.08 $13.73 36.2% $24.95

Medical SRx Outpatient/Inpatient $50.50 $50.33 (0.3%) $15.58

Total Specialty Rx $171.83 $199.34 16.0% $144.63

Rank Members Claims

Base Current Drug Name Condition Base Current Base Current

1 1 Stelara(SRx) RA/Psoriasis/Crohn's 6 5 65 58

6 2 Biktarvy(SRx) Antivirals, HIV Specific 10 11 85 103

0 3 Enhertu Cancer 0 2 0 12

3 4 Humira(Cf) Pen(SRx) RA/Psoriasis/Crohn's 6 6 52 51

0 5 Verzenio(SRx) Cancer 0 3 0 20

9 6 Rinvoq(SRx) RA/Psoriasis/Crohn's 4 4 37 42

21 7 Kisqali(SRx) Cancer 1 3 6 15

0 8 Phesgo Cancer 0 1 0 10

0 9 Opdivo Cancer 0 1 0 13

0 10 Ruxience Cancer 0 1 0 7

Top Drugs by Spend

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Rank Plan Spend PMPM Plan Spend Unique Members Scripts

· The top 20 drugs by plan spend PMPM accounted for 54.4% ($142.69) of all plan spend PMPM ($262.54) in the current period

Base Current Drug Name Condition Base Current Trend Norm Current Base Current Base Current

3 1 Mounjaro Diabetes $12.90 $33.00 155.9% $16.93 $1,660,194 115 219 658 1,645

1 2 Stelara (SRx) Psoriasis $24.74 $21.99 -11.1% $8.23 $1,106,355 6 5 65 58

2 3 Ozempic Diabetes $13.36 $17.81 33.3% $13.23 $896,013 129 160 827 1,048

6 4 Biktarvy (SRx) HIV $6.47 $8.05 24.4% $2.83 $405,074 10 11 85 103

4 5 Humira(Cf) Pen (SRx) Arthritis $7.26 $7.25 -0.2% $9.35 $364,663 6 6 52 51

- 6 Verzenio (SRx) Cancer $0.00 $5.88 0.0% $1.39 $295,650 0 3 0 20

8 7 Rinvoq (SRx) Arthritis $4.72 $5.56 17.9% $2.50 $279,928 4 4 37 42

18 8 Kisqali (SRx) Cancer $2.05 $5.25 155.7% $0.99 $264,272 1 3 6 15

39 9 Genotropin (SRx) Growth Hormone $1.13 $3.99 253.5% $1.61 $200,686 1 4 6 31

16 10 Dupixent Pen (SRx) Asthma $2.30 $3.85 67.4% $3.47 $193,943 3 7 31 49

13 11 Jardiance Diabetes $2.70 $3.80 40.8% $4.71 $191,050 41 48 253 349

11 12 Farxiga Diabetes $3.39 $3.55 4.7% $2.83 $178,800 43 46 324 335

10 13 Kesimpta Pen (SRx) Multiple Sclerosis $3.40 $3.26 -4.1% $0.67 $163,887 2 2 20 18

66 14 Venclexta (SRx) Cancer $0.61 $3.07 401.4% $0.16 $154,523 2 2 5 20

15 15 Brukinsa (SRx) Cancer $2.32 $2.94 26.8% $0.76 $147,795 1 1 8 10

40 16 Otezla (SRx) Psoriasis $1.13 $2.90 157.3% $1.71 $146,088 2 4 12 30

51 17 Enbrel Sureclick (SRx) Arthritis $0.87 $2.89 232.5% $2.63 $145,166 1 2 6 19

37 18 ambrisentan (SRx) Pulmonary Hypertension

$1.15 $2.64 129.5% $0.22 $132,629 1 2 12 17

- 19 Bimzelx Autoinjector (SRx) Seborrhea/Psoriasis $0.00 $2.51 0.0% $0.15 $126,492 0 1 0 12

20 20 Entresto Heart $1.97 $2.51 27.3% $1.19 $126,090 20 25 158 198

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

EnGuide Pharmacy

EnReachRx for Cigna

Healthcare®

EncircleRx for Cigna

Healthcare2

• Integrated weight management solution.

• GLP-1s for weight management.

• Required lifestyle modification.

• Enhanced FW&A

• Financial Guarantees

• Dedicated to GLP-1 fulfillment.

• Complements specialized

GLP-1 dispensing pharmacies anchored by Walgreens® and

Costco®

• High-touch, integrated

GLP-1 clinical support model.

• Optimized drug spend management.

• Reduced waste and abuse.

GLP-1 Innovation Now

Readying for the future

• More FDA approvals

• More conditions

• Widespread use

• Massive spend

• Supply chain

• Fewer pharmacies

• Alternative access

~$1,300/month1

~$1,000/month1

Recent Condition Approvals

Major adverse cardiovascular events, chronic kidney disease, stroke risk, sleep apnea3

GLP-1 Solutions

GLP-1 Challenges

1. Schimelpfening, Nancy. Healthline. “Could Zepbound’s Lower Cost Start a Weight Loss Drug Price War?” 12/23. Mounjaro: Lilly website – not part of EncircleRx 2. Available for self-funded clients only. 3. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight, March 08, 2024 Press Announcement.

~$1,000/month1 https://pricinginfo.lilly.com/mounjaro

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Interchangeable Humira® and Stelara® biosimilars at $0 out-of-pocket for eligible Accredo® patients

EvernorthSM – in partnership with Quallent PharmaceuticalsSM – takes the next step toward improving affordability and access to treatments for inflammatory conditions.

Humira biosimilars

• Currently available to eligible Accredo patients through Quallent Pharmaceuticals

• Estimated to save customers an average of $3,500 per year1

• Priced 85% lower than the Wholesale Acquisition Cost (WAC) of Humira1

• Estimated to save clients between

$4.50 PMPM - $10.00 PMPM2

Inflammatory conditions are the top pharmacy cost drivers3

In fact, Humira and Stelara are the #1 and #2 highest spend drugs for Cigna Healthcare clients3

Stelara biosimilar

• Available to eligible Accredo patients starting in early 2025 through Quallent Pharmaceuticals

• Estimated to save customers an average of $4,000 per year1

• Client savings estimates available early 2025

Accredo makes the switch to interchangeable biosimilars convenient and easy. No new prescription is needed.4

1. Accredo analysis 2024. Results may vary. 2. Cigna Healthcare National Book of Business analysis 2024. Savings are not guaranteed and your results may vary depending on various factors including patient drug mix and utilization patterns. PMPM = per member per month. 3. Internal analysis, 2024 year-to-date, Cigna Healthcare commercial book of business. 4. Applicable federal and state pharmacy regulations apply.

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Population Health

Top Chronic Medical Conditions by Prevalence

• Chronic risk percentage increased 2 points from 2023 to further exceed norm

• Preventive care and annual physical utilization improved 2-3 points, mostly due to better employee compliance

• Cervical and colon cancer screenings showed significant improvement from prior year. Mammography rates remained above norm

• Diabetes, depression, coronary artery disease and low back pain are the top projected chronic conditions by cost over the next 12 months

• Behavioral claimant prevalence increased 30% overall. 80% of diagnoses were related to depression, anxiety and stress

Health Risk Highlights

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Catastrophic Summary

Costs ConditionsOverview

72* individuals (56 in prior year)

• 42 over age 50, 13 over age 65

• 48 employees (up from 32 in prior year), 14 spouses, 10 dependents

• 3 were new enrollees on the plan (2 are newborns)

• Only 8 are no longer enrolled in the plan

• 28 of the individuals also reached the catastrophic level in the prior policy year

• Nearly 100% of medical spend was in-network

• 87% of those with a chronic condition had 2 or more

• Hypertension, obesity, diabetes and arthritis were the most prevalent chronic medical conditions

• 50% also have a co-morbid behavioral diagnosis

• 32% see a Cigna Collaborative Care Physician

• 87% medication adherence rate

• Top individual incurred $659k in total cost

• 30 individuals had over $100k in medication spend (8 more than 2023)

• Specialty medications accounted for 42% of total catastrophic costs

• Cancer accounted for the highest percentage of costs and number of claimants, 21 individuals

• 62% of individuals with current costs above $50,000 are projected to remain at or above that level over the next year

$222K average cost per individual

88% have a chronic condition

*catastrophic level of $100,000 per individual

Catastrophic claimants increased to 2% of the population and 35% of total costs, totaling $16.0m in combined medical and pharmacy costs

Employees with costs above $50,000 have on average 3.7 chronic conditions each

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Top 10 Catastrophic Detail

Out of Date of in Clinical

M/F Age Relshp ICD Major ICD Minor Medical Pharmacy Med Srx Pharm Srx Total ($) Net % Eligibility 2023? Programs

1 M 50-59 EE Circulatory Other Heart $605,907 $747 $693 $51,699 $659,047 0% 03/25 Y COM,WI

2 F 50-59 EE Neoplasms Female Breast $181,522 $268 $472,412 $0 $654,202 0% 11/24 Y ONC,WI

3 F 50-59 EE Neoplasms Care/Neoplas $161,396 $138 $491,367 $0 $652,901 0% 03/25 Y ONC,WI

4 M 65+ SP Infect/Parasit Bacterial $572,458 $2,319 $72,913 $0 $647,690 0% 06/24 Y COM,ONC

5 M 65+ EE Neoplasms Care/Neoplas $197,176 $2,357 $229,224 $176,042 $604,799 0% 03/25 N ONC,WI

6 F 50-59 EE Neoplasms Other Neopla $402,157 $1,554 $72,522 $89,909 $566,142 0% 03/25 N COM,ONC,WI

7 M 65+ EE Neoplasms Leukemia $293,867 $79,939 $102,722 $35,254 $511,782 0% 03/25 Y ONC,WI

8 F 60-64 EE Infect/Parasit Bacterial $373,812 $1,082 $0 $128 $375,022 0% 03/25 N WI

9 F 50-59 EE Neoplasms Female Breast $31,537 $266 $102,556 $220,731 $355,091 8% 03/25 Y MIR,WI

10 M 65+ EE Blood/Blood Org Blood $336,733 $65 $0 $0 $336,798 0% 02/24 Y

Latest Cat

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Cancer Summary

141. Cigna HealthCare 2023 Cancer Cases by Type

• 150 individuals with eligibility in the current period had a cancer episode, or 3.6% prevalence

• Average cost per patient for these episodes was $64,036 for a total of $9,605,444

• Employees represented 71% of cancer patients and 88% of cancer costs

• 40% of cancer patients also received behavioral care during the year

Prevalence and cost by condition

Condition

# of Members Prevalence

Cancer Cost Per Patient

Total Plan Spend

Male Rep. 35 0.8% $25,307 $885,733

Breast 32 0.8% $129,222 $4,135,109

Leukemia/Myeloma 24 0.6% $104,310 $2,503,450

Dermatology 21 0.5% $13,283 $278,943

Thyroid 19 0.5% $8,833 $167,829

Gastrointestinal 12 0.3% $52,061 $624,726

Female Rep. 9 0.2% $11,708 $105,374

CNS 4 0.1% $54,527 $218,108

Eye 3 0.1% $28,792 $86,377

Other 10 0.2% $59,980 $599,796

Total 150 3.6% $64,036 $9,605,444

Behavioral Health - Executive Summary

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Behavioral Health Claimants

Top Conditions by Prevalence Total Membership Base Current Trend Average Number of Employees 2,020 2,041 1.0%

Average Number of Members 4,150 4,195 1.1%

Behavioral Health Members

Average Number of Claimants 413 551 33.4%

Mental Health 407 541 33.0%

Substance Use Disorder 15 15 5.2%

Catastrophic Claimants(>$100k in BH) 1 1 0.0%

Average Age 36.1 35.4 -2.2%

Behavioral Virtual visits 1,983 3,949 99.1%

ABA Claimants 15 12 -20.0%

Happify Unique Users 7 7 0.0%

Happify Active Users 5 3 -40.0% iPrevail Unique Users 0 2 0.0%

Total iPrevail Activities 0 3 0.0%

Key Metrics

10%13%

52%50%

13%13%

35%37%

97%98%

Percent of Total

Membership

Employee Spouse Dependents Member Network

Utilization

100%

75%

50%

25%

0%

% of Behavioral Health Claimants

Base % Behavioral Health Members

Curr % of Behavioral Health

Members

3%

8%

22%

29%

29%

· 13% of the total membership had a claim with a behavioral health provider in the current period

· Average age of employees with behavioral health claims was 45.2 years

· 97.5% of members used an in-network behavioral health provider in the current period

· Virtual Care utilization with behavioral providers increased by 99.1% in the current period. There were 61 MD Live behavioral visits and 38 Talkspace visits during the current period

· 19 appointment searches were performed for members in the current period

Reactive Stress Disorders

Anxiety

Depression

ADD/ADHD

Autism

Base Current

29%

31%

22%

7%

3%

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Virtual Care

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2023 Cigna Healthcare.

Appendix

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Key Metrics by Group

Base Current Trend

Members

Average Number of Employees 1,878 1,896 0.9%

Average Number of Members 3,961 4,002 1.0%

Cost Trend

Plan Spend $40,831,178 $45,180,171 10.7%

Plan Spend PMPM $859 $941 9.5%

Performance Indicators

Cat Claimants in Excess Per K 13.6 17.7 30.1%

Network Penetration 98.6% 98.2% -0.4%

Network Discounts 68.3% 67.0% -1.3%

Generic Rx Utilization Rate 92.3% 93.1% 0.8%

Chronic Percent of Population 50.1% 55.0% 4.9%

Chronic Percent of Cost 79.9% 84.8% 4.9%

Health and Wellness

Total Health Engagement - % of pop 49.1% 49.4% 0.3%

Health Maintenance Engagement 45.9% 47.1% 1.2%

Health Improvement Engagement 8.2% 6.7% -1.5%

Preventive Care Utilization 56.5% 59.2% 2.7%

Health Assessment Penetration 0.4% 0.5% 0.1%

Gaps in Care Rule Compliance 83.0% 80.4% -2.6%

Actives Base Current Trend

142 145 2.3%

189 193 2.2%

$2,283,788 $2,546,871 11.5%

$1,007 $1,099 9.1%

10.6 15.5 46.8%

98.8% 98.8% 0.0%

72.1% 73.8% 1.7%

92.7% 93.5% 0.8%

76.2% 80.2% 4.0%

95.5% 97.1% 1.6%

51.9% 47.6% -4.3%

44.7% 43.9% -0.8%

16.8% 10.4% -6.4%

52.4% 55.4% 3.0%

0.0% 0.5% 0.5%

84.0% 82.8% -1.2%

Under 65 Rets Base Current Trend

200 190 -4.8%

240 229 -4.4%

$1,489,921 $1,670,255 12.1%

$518 $608 17.3%

8.3 8.7 4.6%

93.2% 94.5% 1.3%

56.9% 62.8% 5.9%

93.4% 91.4% -2.0%

88.6% 89.0% 0.4%

95.8% 96.0% 0.2%

27.2% 21.0% -6.2%

26.4% 20.2% -6.2%

4.1% 1.3% -2.8%

39.2% 32.7% -6.5%

0.0% 0.0% 0.0%

85.2% 84.2% -1.0%

Over 65 Rets

Executive Summary Total Excluding Over 65 Retirees

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members

Average Number of Employees 2,020 2,041 1.0%

Average Number of Members 4,150 4,195 1.1%

Average Employee Age 48.4 48.8 0.8%

Cost Trend

Plan Spend - Medical $32,557,201 $34,517,813 6.0%

Plan Spend - Pharmacy $10,557,765 $13,209,277 25.1%

Total Plan Spend $43,114,966 $47,727,090 10.7%

Medical Plan Spend PMPM $653.76 $685.65 4.9% $563.45

Pharmacy Plan Spend PMPM $212.01 $262.54 23.8% $226.35

Total Plan Spend PMPM $865.77 $948.19 9.5% $789.79

Performance Indicators

Cat Claimants in Excess Per K 13.5 17.2 27.2% 12.1

Cat Plan Spend PMPM(Med+Rx) $316.85 $332.79 5.0% $220.27

Non-Cat Plan Spend PMPM(Med + Rx) $548.92 $615.40 12.1% $569.52

Network Penetration 98.6% 98.3% -0.3% 98.7%

Current

PMPM Trend

Variance from Norm

$948.19 9.5% 20.1%

$903.57 10.0% 23.3%

$44.62 0.5% -21.7%

$685.65 4.9% 21.7%

$650.21 5.2% 25.5%

$262.54 23.8% 16.0%

$253.36 24.8% 18.0%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 50.9% 55.1% 4.2% 48.3%

Chronic Percent of Cost 80.8% 84.5% 3.7% 79.5%

Total Health Engagement - % of Pop 49.4% 49.4% 0.0% 45.6%

Preventive Care Utilization 56.3% 58.9% 2.6% 54.5%

Well Visit Completions 48.1% 51.4% 3.3% 44.4%

Health Assessment Completions 0.4% 0.6% 0.2% 16.0%

Gaps in Care Rule Compliance 83.0% 80.5% -2.5% 79.0%

Pharmacy Indicators

Generic Dispensing Rate 92.4% 93.1% 0.8% 92.9%

Generic Substitution Rate 98.5% 98.4% -0.1% 98.5%

Specialty Plan Spend PMPM (Rx Only) $111.25 $135.28 21.6% $104.11

Specialty Plan Spend PMPM (Med Only) $60.58 $64.06 5.7% $40.52

Non-Specialty Plan Spend PMPM (Rx only) $100.76 $127.26 26.3% $122.24

Prescriptions PMPY(Retail adjusted) 15.66 16.34 4.3% 16.35

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Total Including Over 65 Retirees

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members

Average Number of Employees 2,220 2,232 0.5%

Average Number of Members 4,390 4,425 0.8%

Average Employee Age 50.7 51.0 0.6%

Cost Trend

Plan Spend - Medical $33,851,390 $35,993,666 6.3%

Plan Spend - Pharmacy $10,753,497 $13,403,630 24.6%

Total Plan Spend $44,604,887 $49,397,297 10.7%

Medical Plan Spend PMPM $642.57 $677.90 5.5% $563.45

Pharmacy Plan Spend PMPM $204.26 $252.75 23.7% $226.35

Total Plan Spend PMPM $846.83 $930.65 9.9% $789.79

Performance Indicators

Cat Claimants in Excess Per K 13.2 16.7 26.6% 12.1

Cat Plan Spend PMPM(Med+Rx) $308.94 $322.17 4.3% $220.27

Non-Cat Plan Spend PMPM(Med + Rx) $537.89 $608.48 13.1% $569.52

Network Penetration 97.8% 98.1% 0.3% 98.7%

Current

PMPM Trend

Variance from Norm

$930.53 11.1% 17.8%

$882.55 10.9% 20.4%

$47.98 13.3% -15.8%

$677.90 5.5% 20.3%

$638.76 5.0% 23.3%

$252.64 29.3% 11.6%

$243.80 30.3% 13.6%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 53.0% 56.9% 3.9% 48.3%

Chronic Percent of Cost 81.3% 84.9% 3.6% 79.5%

Total Health Engagement - % of Pop 48.2% 48.0% -0.2% 45.6%

Preventive Care Utilization 55.3% 57.6% 2.3% 54.5%

Well Visit Completions 47.0% 50.0% 3.0% 44.4%

Health Assessment Completions 0.4% 0.5% 0.1% 16.0%

Gaps in Care Rule Compliance 83.1% 80.6% -2.5% 79.0%

Pharmacy Indicators

Generic Dispensing Rate 92.4% 93.1% 0.7% 92.9%

Generic Substitution Rate 98.5% 98.4% -0.1% 98.5%

Specialty Plan Spend PMPM (Rx Only) $106.96 $130.12 21.7% $104.11

Specialty Plan Spend PMPM (Med Only) $60.95 $66.88 9.7% $40.52

Non-Specialty Plan Spend PMPM (Rx only) $93.06 $122.58 31.7% $122.24

Prescriptions PMPY(Retail adjusted) 15.15 15.82 4.4% 16.35

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Actives

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members

Average Number of Employees 1,878 1,896 0.9%

Average Number of Members 3,961 4,002 1.0%

Average Employee Age 47.3 47.7 0.8%

Cost Trend

Plan Spend - Medical $30,893,615 $33,057,412 7.0%

Plan Spend - Pharmacy $9,937,563 $12,122,760 22.0%

Total Plan Spend $40,831,178 $45,180,171 10.7%

Medical Plan Spend PMPM $649.95 $688.32 5.9% $563.45

Pharmacy Plan Spend PMPM $209.08 $252.49 20.8% $226.35

Total Plan Spend PMPM $859.03 $940.82 9.5% $789.79

Performance Indicators

Cat Claimants in Excess Per K 13.6 17.7 30.1% 12.1

Cat Plan Spend PMPM(Med+Rx) $321.70 $336.73 4.7% $220.27

Non-Cat Plan Spend PMPM(Med + Rx) $537.33 $604.09 12.4% $569.52

Network Penetration 98.6% 98.2% -0.4% 98.7%

Current

PMPM Trend

Variance from Norm

$940.82 9.5% 19.1%

$897.41 10.0% 22.5%

$43.41 -0.2% -23.8%

$688.32 5.9% 22.2%

$653.61 6.3% 26.1%

$252.49 20.8% 11.6%

$243.80 21.6% 13.6%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 50.1% 55.0% 4.9% 48.3%

Chronic Percent of Cost 79.9% 84.8% 4.9% 79.5%

Total Health Engagement - % of Pop 49.1% 49.4% 0.3% 45.6%

Preventive Care Utilization 56.5% 59.2% 2.7% 54.5%

Well Visit Completions 48.5% 51.8% 3.3% 44.4%

Health Assessment Completions 0.4% 0.5% 0.1% 16.0%

Gaps in Care Rule Compliance 83.0% 80.4% -2.6% 79.0%

Pharmacy Indicators

Generic Dispensing Rate 92.3% 93.1% 0.8% 92.9%

Generic Substitution Rate 98.5% 98.4% -0.0% 98.5%

Specialty Plan Spend PMPM (Rx Only) $114.23 $132.20 15.7% $104.11

Specialty Plan Spend PMPM (Med Only) $62.96 $66.77 6.0% $40.52

Non-Specialty Plan Spend PMPM (Rx only) $94.84 $120.29 26.8% $122.24

Prescriptions PMPY(Retail adjusted) 14.65 15.20 3.8% 16.35

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Under 65 Retirees

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members

Average Number of Employees 142 145 2.3%

Average Number of Members 189 193 2.2%

Average Employee Age 62.9 63.2 0.4%

Cost Trend

Plan Spend - Medical $1,663,586 $1,460,353 -12.2%

Plan Spend - Pharmacy $620,202 $1,086,517 75.2%

Total Plan Spend $2,283,788 $2,546,871 11.5%

Medical Plan Spend PMPM $733.50 $630.28 -14.1% $563.45

Pharmacy Plan Spend PMPM $273.58 $468.93 71.4% $226.35

Total Plan Spend PMPM $1,007.08 $1,099.21 9.1% $789.79

Performance Indicators

Cat Claimants in Excess Per K 10.6 15.5 46.8% 12.1

Cat Plan Spend PMPM(Med+Rx) $215.27 $250.37 16.3% $220.27

Non-Cat Plan Spend PMPM(Med + Rx) $791.81 $848.84 7.2% $569.52

Network Penetration 98.8% 98.8% 0.0% 98.7%

Current

PMPM Trend

Variance from Norm

$1,099.21 9.1% 39.2%

$1,029.52 9.1% 40.5%

$69.69 10.6% 22.3%

$630.28 -14.1% 11.9%

$579.62 -15.7% 11.9%

$468.93 71.4% 107.2%

$449.90 75.6% 109.6%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 76.2% 80.2% 4.0% 48.3%

Chronic Percent of Cost 95.5% 97.1% 1.6% 79.5%

Total Health Engagement - % of Pop 51.9% 47.6% -4.3% 45.6%

Preventive Care Utilization 52.4% 55.4% 3.0% 54.5%

Well Visit Completions 40.2% 45.1% 4.9% 44.4%

Health Assessment Completions 0.0% 0.5% 0.5% 16.0%

Gaps in Care Rule Compliance 84.0% 82.8% -1.2% 79.0%

Pharmacy Indicators

Generic Dispensing Rate 92.7% 93.5% 0.9% 92.9%

Generic Substitution Rate 98.6% 98.0% -0.6% 98.5%

Specialty Plan Spend PMPM (Rx Only) $48.62 $198.16 307.6% $104.11

Specialty Plan Spend PMPM (Med Only) $10.70 $7.94 -25.8% $40.52

Non-Specialty Plan Spend PMPM (Rx only) $224.96 $270.77 20.4% $122.24

Prescriptions PMPY(Retail adjusted) 36.87 39.78 7.9% 16.35

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Over 65 Retirees

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members

Average Number of Employees 200 190 -4.8%

Average Number of Members 240 229 -4.4%

Average Employee Age 74.5 75.2 0.8%

Cost Trend

Plan Spend - Medical $1,294,189 $1,475,901 14.0%

Plan Spend - Pharmacy $195,732 $194,354 -0.7%

Total Plan Spend $1,489,921 $1,670,255 12.1%

Medical Plan Spend PMPM $449.22 $536.11 19.3% $563.45

Pharmacy Plan Spend PMPM $68.73 $71.53 4.1% $226.35

Total Plan Spend PMPM $517.94 $607.64 17.3% $789.79

Performance Indicators

Cat Claimants in Excess Per K 8.3 8.7 4.6% 12.1

Cat Plan Spend PMPM(Med+Rx) $171.40 $126.89 -26.0% $220.27

Non-Cat Plan Spend PMPM(Med + Rx) $346.54 $480.75 38.7% $569.52

Network Penetration 93.2% 94.5% 1.3% 98.7%

Current

PMPM Trend

Variance from Norm

$607.01 24.8% -23.1%

$497.69 5.1% -32.1%

$109.33 745.3% 91.8%

$536.11 19.3% -4.9%

$429.40 -1.9% -17.1%

$70.91 90.1% -68.7%

$68.29 90.6% -68.2%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 88.6% 89.0% 0.4% 48.3%

Chronic Percent of Cost 95.8% 96.0% 0.2% 79.5%

Total Health Engagement - % of Pop 27.2% 21.0% -6.2% 45.6%

Preventive Care Utilization 39.2% 32.7% -6.5% 54.5%

Well Visit Completions 27.9% 24.8% -3.1% 44.4%

Health Assessment Completions 0.0% 0.0% 0.0% 16.0%

Gaps in Care Rule Compliance 85.2% 84.2% -1.0% 79.0%

Pharmacy Indicators

Generic Dispensing Rate 93.4% 91.4% -2.0% 92.9%

Generic Substitution Rate 99.4% 97.2% -2.2% 98.5%

Specialty Plan Spend PMPM (Rx Only) $31.93 $34.56 8.2% $104.11

Specialty Plan Spend PMPM (Med Only) $67.35 $118.46 75.9% $40.52

Non-Specialty Plan Spend PMPM (Rx only) $19.97 $36.65 83.5% $122.24

Prescriptions PMPY(Retail adjusted) 6.21 6.11 -1.5% 16.35

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Preventive Care Summary

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Well visit completion rates

80%

60%

40%

20%

0%

Base

Current

Norm

Pediatric Adult

71.4% 43.7%

77.6% 46.5%

72.1% 37.7%

Current period OV & preventive utilization

100.0%

75.0%

50.0%

25.0%

0.0%

PCP/SPC OV Annual Physical

75.0% 51.4%

83.2% 75.6%

62.6% 40.9%

74.4% 47.6%

83.2% 50.8%

All Ages

<18

18-39

40-49

50+

Base

Current

Norm

60%

45%

30%

15%

0%

Well visit completion ratesPreventive care utilization (all services)

80%

60%

40%

20%

0%

Base

Current

Norm

Employee Spouse Dependent Total

57.8% 60.8% 52.0% 56.3%

59.9% 60.6% 56.9% 58.9%

50.8% 60.3% 57.4% 54.5%

Employee Spouse Dependent Total

46.4% 48.3% 50.3% 48.1%

49.1% 50.6% 55.0% 51.4%

36.5% 48.1% 55.5% 44.4%

Member Cost Share

• Medical cost share increased from $35.41 PMPM to $35.45 PMPM, and compares to a norm of $45.29 PMPM

• Medical cost share as a percent of total plan spend decreased from 5.4% to

5.2%, and compares to a norm of 8.0%

$60

$45

$30

$15

$0

Base

Current

Norm

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Deductible/Copay Coinsurance Total

$23 $13 $35

$23 $12 $35

$32 $13 $45

12%

9%

6%

3%

0%

Base

Current

Norm

Deductible/Copay Coinsurance Total

3.5% 1.9% 5.4%

3.4% 1.8% 5.2%

5.7% 2.3% 8.0%

Account summary (PMPM basis) Base Current Trend

Plan Costs

Total Plan Spend - Medical $653.76 $685.65 4.9%

Cost Share - Medical $35.41 $35.45 0.1%

Net Employer Paid - Medical $618.35 $650.21 5.2%

Cost sharing per member - medical only

Cost share as % of total plan spend - medical only o f

T o ta l S p en d

Total Plan Spend by Condition

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Base Current Norm 28.0%

21.0%

14.0%

7.0%

0.0%

Top conditions by plan spend

Top ICD conditions PMPM Claimants per 1k Spend per Claimant

Trend

ICD Category Base Current Contribution Norm Base Current Trend Base Current Trend

Neoplasms $124.86 $121.24 -0.6% $74.34 191.3 203.1 6.1% $7,831 $7,164 -8.5%

Musculoskeletal $69.71 $79.51 1.6% $72.19 295.9 299.1 1.1% $2,827 $3,189 12.8%

Circulatory $47.78 $55.28 1.3% $43.17 223.9 228.1 1.9% $2,561 $2,908 13.5%

Gastrointestinal $43.08 $54.06 1.8% $44.97 184.8 182.8 -1.1% $2,797 $3,548 26.9%

Gen Med Diag $49.12 $48.61 -0.1% $41.54 712.0 709.9 -0.3% $828 $822 -0.7%

Neurological $33.40 $34.09 0.1% $30.83 134.7 139.2 3.3% $2,975 $2,939 -1.2%

Pregnancy $20.70 $27.48 1.1% $23.06 22.9 22.9 -0.0% $10,851 $14,408 32.8%

End/Nutr/Metab $25.40 $25.21 -0.0% $20.10 339.5 360.4 6.2% $898 $839 -6.5%

Infect/Parasit $20.25 $23.90 0.6% $21.02 180.7 160.7 -11.1% $1,345 $1,785 32.7%

Reproductive $17.86 $22.16 0.7% $18.03 262.2 255.3 -2.6% $817 $1,042 27.5%

All Other $146.16 $147.65 0.2% $128.22 1192.5 1229.5 3.1% $1,471 $1,441 -2.0%

Total $598.33 $639.19 6.8% $517.49 910.6 902.9 -0.8% $7,885 $8,495 7.7%

Neoplasms Musculoskeletal Circulatory Gastrointestinal Gen Med Diag Neurological Pregnancy End/Nutr/Metab Infect/Parasit Reproductive All Other

Population Demographic Summary

Percent of membership by age band

• Average member age increased from 37.2 years to 37.6 years, an increase of

0.9%

• The percentage of members in the 40+ age range increased from 48.7% to

49.4%, and compares to a norm of 48.0%

Key metrics overview Base Current Trend Norm

Percent of Pop. Age 40+ 48.7% 49.4% 0.7% 48.0%

Average Member Age 37.2 37.6 0.9% 37.6

Average Employee Age 48.4 48.8 0.8% 48.1

Percent of Population Male 49.1% 49.1% 0.0% 52.4%

Percent of Population Female 50.9% 50.9% 0.0% 47.6%

Percent of plan spend by age band

Average spend by age band Base Current Trend Norm

All Members

40-49 $844 $942 11.5% $817

50-59 $1,196 $1,236 3.3% $1,177

60-64 $1,570 $1,674 6.6% $1,424

65+ $1,841 $2,362 28.3% $1,057

Excluding Catastrophic

40-49 $614 $625 1.7% $609

50-59 $702 $784 11.7% $814

60-64 $953 $1,029 8.0% $945

65+ $852 $1,077 26.4% $738

20%

15%

10%

5%

0% <1 1-17 18-29 30-39 40-49 50-59 60-64 65+

4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

Base Current Norm Demo Fact

28%

21%

14%

7%

0% <1 1-17 18-29 30-39 40-49 50-59 60-64 65+

Base Current Norm

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Population Demographics by Relationship

Percent of members by relationship

• Employees represented 48.7% of the population and 62.5% of spend for the current period, versus norms of 51.4% and 58.5%

• By relationship type, employees incurred higher per member costs than spouses, $1,218 PMPM for the current period

• Excluding Catastrophic Claimants, spouses incurred higher per member costs compared to employees, $774 PMPM for the current period

Percent of plan spend by relationship

Average spend by relationship Base Current Trend Norm

All Members

Employee $1,067 $1,218 14.1% $882

Spouse $1,076 $1,125 4.5% $1,106

Dependent $483 $484 0.2% $408

Excluding Catastrophic

Employee $676 $753 11.4% $642

Spouse $733 $774 5.7% $794

Dependent $325 $389 19.5% $310

60%

45%

30%

15%

0%

Base Current Norm

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Employee Spouse Dependent

Base Current Norm

80%

60%

40%

20%

0% Employee Spouse Dependent

Inpatient Summary

• Non-catastrophic inpatient costs decreased from $53.31 PMPM to $52.65

PMPM, contributing -0.1% of the overall 9.5% plan trend

• Utilization increased from 56.4 to 60.1 admits per thousand and increased from

284.3 to 329.4 bed days per thousand

• Cost per admit increased from $28,231 to $29,677 and decreased for bed days from $5,598 to $5,411

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Account summary (PMPM basis)

Base Current Trend

Trend

Contribution

Non-Catastrophic Inpatient $53.31 $52.65 -1.2% -0.1%

Catastrophic Inpatient $82.02 $95.94 17.0% 1.6%

Total Inpatient $135.33 $148.59 9.8% 1.5%

All Other Service Categories $730.45 $799.60 9.5% 8.0%

Total Plan Cost $865.77 $948.19 9.5%

Utilization metrics per 1,000 members

Average cost metrics

Base

Current

Norm

Admits Bed Days

56.4 284.3

60.1 329.4

62.9 316.5

$32,000

$24,000

$16,000

$8,000

$0

Base

Current

Norm

Per Admit Per Bed Day

$28,231 $5,598

$29,677 $5,411

$25,433 $5,053

Inpatient - Major Diagnostic Category Summary

• Pregnancies was the top category by plan cost in the current period. Pregnancies cost increased from $7.82 PMPM to $10.01 PMPM, an increase of 27.9%

• Cost per case for the Pregnancies category increased from $11,461 to $13,993, an increase of 22.1%

• Plan cost for non-catastrophic decreased from $53.31 PMPM to $52.65 PMPM, a decrease of 1.2%

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Cost & utilization trends (excluding catastrophic) $PMPM Admits Per 1,000 Days Per 1,000 Cost Per Case

Base Current Trend Base Current Trend Base Current Trend Base Current Trend

Pregnancies $7.82 $10.01 27.9% 8.2 8.6 4.7% 21.7 26.2 20.9% $11,461 $13,993 22.1%

Digestive $4.26 $5.41 27.1% 2.4 3.6 48.4% 9.4 9.8 4.0% $21,214 $18,171 -14.3%

Newborn $2.53 $4.33 70.8% 5.1 4.8 -5.8% 13.0 18.4 41.1% $6,010 $10,892 81.2%

Musculoskeletal $6.49 $3.76 -42.0% 3.1 3.1 -1.1% 21.2 18.4 -13.4% $24,870 $14,571 -41.4%

Nervous $5.32 $3.75 -29.5% 2.4 2.9 18.7% 8.0 16.0 100.8% $26,498 $15,736 -40.6%

Other $26.88 $25.39 -5.5% 15.2 15.7 3.6% 49.9 65.3 30.9% $20,542 $19,338 -5.9%

Total Non-Cat $53.31 $52.65 -1.2% 36.4 38.6 6.1% 123.1 154.0 25.1% $17,288 $16,350 -5.4%

Catastrophic $82.02 $95.94 17.0% 20.0 21.5 7.3% 161.2 175.4 8.8% $48,140 $53,665 11.5%

Total $135.33 $148.59 9.8% 56.4 60.1 6.5% 284.3 329.4 15.9% $28,231 $29,677 5.1%

Outpatient surgical details

Endoscopy procedures per 1,000

Top Outpatient Surgeries

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Plan Spend PMPM Visits per 1k Avg. Spend per Visit Average Age

Trend Type of Surgery Base Current Contribution Norm Base Current Base Current Base Current

Endoscopy $21.05 $25.99 12.9% $25.51 61.9 74.1 $4,080 $4,207 52.5 52.6

Cataract $4.43 $3.38 -2.7% $1.53 6.0 6.0 $8,826 $6,805 62.7 66.3

Upper GI $2.71 $3.05 0.9% $4.17 9.2 12.4 $3,557 $2,953 45.8 52.0

Cardiac Cath $3.26 $2.78 -1.3% $5.88 3.4 2.9 $11,602 $11,647 59.4 58.3

Hernia Repair $1.50 $1.59 0.2% $1.40 1.0 1.2 $18,732 $16,004 51.3 55.8

Ovary Removal $1.70 $1.34 -0.9% $2.52 1.0 1.2 $21,124 $13,521 46.3 45.4

Tonsils $0.65 $1.31 1.7% $1.30 1.2 1.7 $6,515 $9,417 17.4 18.4

Breast $0.47 $0.85 1.0% $0.32 0.7 0.2 $7,874 $42,700 41.3 69.0

Carpal Tunnel $1.41 $0.74 -1.8% $0.67 1.5 1.0 $11,740 $9,301 47.0 48.5

Skin $0.44 $0.73 0.8% $0.73 14.0 8.1 $378 $1,074 54.3 55.2

All Other $0.57 $0.26 -0.8% $1.32 1.7 1.2 $4,090 $2,582 24.4 26.0

Total $38.19 $42.02 10.0% $45.35 101.4 109.9 $4,521 $4,587 51.4 52.4

• The total cost of the surgeries, including facility and professional costs have been included in this exhibit

• Endoscopy was the top surgery by plan spend in the current period.

Endoscopy spend increased from $21.05 PMPM to $25.99 PMPM, an increase of 23.5%

• Endoscopy had the greatest impact on overall trend, contributing 12.9%

60.0

45.0

30.0

15.0

0.0

Base

Current

Norm

Colonoscopy Uterus Bladder Joint Gall Bladder

42.7 6.7 8.9 3.1 0.5

51.7 7.9 7.2 5.2 2.1

49.7 4.1 10.7 5.9 2.2

Facility outpatient utilization per 1,000 members

Facility outpatient cost per visit

Outpatient - Emergency Room and Urgent Care Detail

• Emergency room costs increased from $64.66 PMPM to $77.10 PMPM, contributing 1.4% of the overall 9.5% plan trend

• Urgent Care was the largest category of utilization. Utilization per thousand increased from 444.3 to 688.2, and compares to a norm of 328.5

• Emergency room was the largest average cost category. Cost per visit increased from $2,810 to $2,815, and compares to a norm of $3,041

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Base Current Trend

Trend

Contribution

Emergency Room $64.66 $77.10 19.2% 1.4%

Urgent Care $17.87 $17.95 0.5% 0.0%

Total Outpatient Facility $213.53 $232.79 9.0% 2.2%

Total Plan Cost $865.77 $948.19 9.5% 9.5%

Base

Current

Norm

ER Urgent Care

276.1 444.3

328.7 688.2

245.3 328.5

Base

Current

Norm

ER Urgent Care

$2,810 $482

$2,815 $313

$3,041 $208

Account summary (PMPM basis)

$3,200

$2,400

$1,600

$800

$0

Emergency Room/Urgent Care Opportunity

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Cost & utilization trends Visits Per 1000 Cost Per Visit PMPM Cost Share %

Base Current Trend Base Current Trend Base Current Trend Current

Emergency Room

Non-Steerable 226.7 268.2 18% $3,139 $3,156 1% $59 $71 19% 5.7%

Steerable 49.4 60.5 23% $1,299 $1,305 0% $5 $7 23% 14.8%

Urgent Care 444.3 688.2 55% $482 $313 -35% $18 $18 0% 5.2%

Office Visits 3,978.3 3,889.4 -2% $157 $163 3% $52 $53 1% 14.3%

Convenience Care 14.5 15.3 6% $27 $48 76% $0 $0 86% 17.7%

Virtual Care- Medical 76.4 87.2 14% $59 $63 7% $1 $0 -7% 1.6%

Total 4,789.6 5,008.8 5% $135 $148 10%

• Current period urgent care cost per visit was $313, compared to emergency room steerable cost per visit of $1,305

• In the current period, 254 emergency room visits were steerable representing potential redirect savings of up to $260,179

• Of the steerable emergency room visits, 99% had a contracted urgent care facility within 10 miles

• Steerable emergency room cost share percentage is 14.8%, compared to urgent care at 5.2%

0-5 miles 16+ miles

99%

1%

Urgent Care - nearest facility

Emergency Room Steerable Primary Opportunity for Urgent Care Plan Cost PMPM Total Visits Cost Per Visit

Musculoskeletal $76,198 $1.51 61 $1,249.15

Ear,Nose,Throat $70,727 $1.40 59 $1,198.75

Skin $30,806 $0.61 24 $1,283.59

Respiratory $30,078 $0.60 20 $1,503.88

Gastrointestinal $26,822 $0.53 10 $2,682.24

Renal/Urologic $23,493 $0.47 16 $1,468.32

Int/Ext Injury $20,390 $0.41 18 $1,132.80

Infect/Parasit $17,610 $0.35 16 $1,100.64

Eye $16,055 $0.32 17 $944.41

Other $19,332 $0.38 13 $1,487.11

Total $331,512 $6.59 254 $1,305.17

UC Average Cost Per Visit $280.84

Per Visit Redirect Savings $1,024.33

Opportunity Redirect Savings

10% Redirect to Urgent Care $26,018

25% Redirect to Urgent Care $65,045

*UC Average Cost per visit calculation for steerable opportunity excludes outliers > $1,500

Office Visits

• 80% of individuals ages 40 and above received care from a PCP and or

Specialist in the current period

• 50% of individuals ages 40 and above received an annual physical in the current period

• Plan spend for Specialists in the current period was $31 PMPM compared to

$22 PMPM for Primary Care Physicians

• Specialist Evaluation & Management cost decreased from $23 PMPM to $22

PMPM, a decrease of 4.0%

8,000

6,000

4,000

2,000

Base

Current

Norm

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Primary Care Specialist Total

1,866.7 2,111.3 3,978.3

1,891.2 1,998.0 3,889.4

2,054.6 2,021.5 4,077.7

$200

$150

$100

$50

$0

Base

Current

Norm

Primary Care Specialist Total

$136 $176 $157

$141 $184 $163

$138 $190 $164

Office visits per 1,000 members Average plan cost per office visit

% of individuals continuously enrolled for at least 12 months who did not see a PCP/SPC

80%

60%

40%

20%

0%

No OV

% Employee

% Female

All <18 18-39 40-49 50+

22% 13% 34% 22% 15%

43% 0% 27% 74% 71%

37% 51% 35% 32% 39%

Well Informed Gaps in Care - Summary

• 3,996 members qualified for a gap in care evaluation, with 976 compliant and

3,020 non-compliant with evidence-based medicine guidelines

• 80.5% of rules evaluated were compliant with evidence-based medicine guidelines, compared to a norm of 79.0%

• The greatest number of members with gaps was found in the 50-59 age band, with 648 total members

• The Diabetes category had the greatest rate of multiple gaps (2 or more), 69%

Current Period reflects Well Informed Gaps in Care program activity between Jan.2024 and Dec.2024

Rule compliance summary

100%

75%

50%

25%

0%

Current

Norm

Non-Compliant Compliant

19.5% 80.5%

21.0% 79.0%

Compliance by category

100%

75%

50%

25%

0%

Current

Norm

Achieve

Targets

Approp.

Monitor.

Approp.

Therapy

Med.

Adhere.

Patient

Safety 88.2% 90.9% 76.7% 84.1% 89.7%

89.7% 89.5% 69.5% 89.0% 92.0%

Compliance by condition

100%

75%

50%

25%

0%

Current

Norm

General

Imaging

Obesity HPL HTN Diabetes URI

98% 98% 94% 84% 84% 83%

99% 99% 92% 85% 85% 79%

Health Matters Care Management - Summary

Total savings from care management programs

• Inpatient pre-certification and utilization management generated $732,717 in savings in the Current Period, impacting 90 events primarily driven by admissions avoided at 80.8%.

• Case management generated $1,171,782 in savings, impacting 128 members in the Current Period; savings were primarily driven by medical injectable redirection at 51.0%.

• Outpatient utilization management generated $937,122 in savings from 120 events in the Current Period. Savings are derived from programs such as home health care, speech therapy and durable medical equipment.

• Outpatient Total Medical Cost Management (TMC) savings were primarily driven by oncology management that generated $90,574 in savings from 11 events in the Current Period.

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Total medical cost savings by program

IP utilization mgmt.

savings % by event

$92,000

$69,000

$46,000

$23,000

$0

Admissions avoided

Decertified days

Bed day intensity mgmt.

81%

14%

5%

Medical injectable redirection

Other care coordination

Oncology

NICU

All other

50%

23%

11%

5%

11%

Case mgmt.

savings % by program

Oncology mgmnt.

MSK/Pain mgmnt.

Radiation therapy

Physical therapy

All other

Savings($)

Current Current

IP utilization mgmt. (events) 90 $732,717

Case mgmt. (members) 128 $1,171,782

OP utilization mgmt. (events) 120 $937,122

Total medical cost (events) 352 $264,073

Total savings $3,105,694

Health Matters Care Management - Inpatient Utilization Management

Inpatient utilization management days/events summary

• Inpatient pre-certification and utilization management generated $822,543 in savings and touched 57 individuals in the Current Period

• Savings increased from the Base Period result of $0

• 35 admissions were avoided, resulting in $644,214 savings

• 48 days were decertified for $138,144 in savings and 23 days were stepped down for $40,185 savings

Reviewed admission by type

Base Current

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Emergency

Elective

Behavioral Health

Maternity/Newborn

74%

14%

9% 3%

Inpatient utilization management savings summary

Savings($)

Current

Pre-certification

Admissions avoided $644,214

Inpatient utilization mgmt.

Decertified days $138,144

Bed day intensity mgmt. $40,185

Total $822,543

Admissions avoided

Decertified days Bed day intensity mgmt.

Top categories for TMC savings

$100,000

$75,000

$50,000

$25,000

$0

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024

Outpatient utilization management

Health Matters Care Management - Outpatient Utilization Management

• Outpatient utilization management generated $1,245,222 in savings and avoided 19.67% of requests in the Current Period

• Savings increased from the Base Period result of $127,937

• 53 Other requests were avoided resulting in $430,302 savings in the Current

Period

• Total Medical Cost Management savings were $292,675 in the Current Period

Requests Avoided Savings($) % Avoided

Current Current Current Current

Behavioral Health 0 0 $0 0.00%

DME 9 2 $22,008 22.22%

Experimental, Investigational or Unproven 35 7 $0 20.00%

Gastroenterology 139 28 $81,004 20.14%

High Tech Radiology / Diagnostic Imaging 18 5 $5,575 27.78%

Home Health Care 48 0 $0 0.00%

Home Infusion Therapy 2 0 $0 0.00%

Medical Injectables 210 20 $366,360 9.52%

Potentially Cosmetic Procedures 31 6 $47,298 19.35%

Speech Therapy 0 0 $0 0.00%

Total Medical Cost Management (TMC) * * $292,675 *

Transplants 5 0 $0 0.00%

Other 118 53 $430,302 44.92%

Total 615 121 $1,245,222 19.67%

Oncology

Mgmnt.

Radiation

Therapy

MSK/Pain

Mgmnt.

Physical

Therapy

All Other

Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Feb. 2025

Total Medical Cost Management

Health Matters Care Management - Total Medical Cost Management

Management Program Description Avoided/Events

Savings Per

Avoidance/Event Total Savings

Radiation Therapy Through partnership with eviCore, Cigna customers receive end to end Episode of Care management for targeted cancer disease profiles, spanning from referral base (radiation oncologist) to treatment (therapy) to the final delivery of radiological dose.

20 $3,800 $76,000

Physical Therapy Cigna ensures appropriate customer access to outpatient physical therapy/occupational therapy (PT/OT) care by incorporating evidence-based clinical coverage standards; Medical Necessity Reviews (MNR) are conducted for both Participating and Non-Participating PT/OT practitioners.

416 $112 $46,688

Chiropractic Services Cigna ensures appropriate customer access to quality chiropractic care by incorporating evidence-based clinical coverage standards in reviews for both

Participating and Non-Participating providers. Reviews focus on chiropractic care that demonstrates inconsistencies with recommended clinical evidence.

9 $49 $441

Musculoskeletal/Pain

Management

Cigna works with eviCore healthcare, to provide quality, cost-effective services to customers for select inpatient and outpatient musculoskeletal and pain management services. This program helps eliminate excess utilization when services don't meet evidence-based guidelines to help improve clinical outcomes.

18 $3,930 $70,738

Oncology Management The savings from Medical Oncology prior authorization reviews performed by eviCore, based on ensuring that proposed treatments…