Exhibit 18 (Revised) -Cal Yrs 2023-2024 CIGNA City of Miami CAP Report_Redacted.pdf

PDF 292 KB Posted

Attached to
RFP No. 2130386 - Employee Health Benefits Plan
Solicitation number
RFP No. 2130386 - Employee Health Benefits Plan
Issued by
Florida

About this file

Written by GovTribe AI ·

This document is a Monthly Healthcare Detail Experience Report from Cigna Healthcare for the City of Miami, covering healthcare claims and enrollment data for January 2023 through December 2023, and projecting data for January 2024 through December 2024. The report is a self-funded (ASO) retrospective experience-rated healthcare plan with detailed monthly breakdowns of in-network, out-of-network, and prescription drug claims across multiple benefit options including Network Open Access POS plans, Standalone Network POS plans, and Out of Area plans.

The report reveals total claims of $41,354,103 for 2023, with 26,641 subscribers and 52,681 total members, and projected total claims of $46,486,255 for 2024, with 26,776 subscribers and 53,080 total members. The primary benefit option is the NPOS-Network Open Access POS (All Employees) plan, which accounts for the majority of claims. The funding type is self-funded, meaning the City of Miami bears the financial risk for healthcare claims, with Cigna providing administrative services. The report includes detailed monthly breakdowns of claims by benefit option, showing variations in in-network, out-of-network, and prescription drug expenses, which can help the city track and manage healthcare costs.

View the file

Other files

File Type Posted
Exhibit 18b - Cal Yr 2025 City of Miami CIGNA ASO and Fixed Charges Monthly Healthcare Experience by Prod YTD.xlsx XLSX spreadsheet
Exhibit 15b - City of Miami Cal Yr 2025 CIGNA Medical - Comp EEs Plan 70 Percent Ded 300 Max Out of Pocket 1K ASO68.pdf PDF
Exhibit 50 - Cal Yr 2024 City of Miami CIGNA Vision Plans Claim Summary Report.pdf PDF
Questionnaire No. 4 (Revised) - Group Benefit Dental Plan.pdf PDF
Exhibit 74 - Cal Yr 2023 City of Miami ASO Fixed Charges and Fees Per Product Type Monthly Healthcare Detail Experience.xlsx XLSX spreadsheet
Exhibit 06d - Cal Yr 2025 City of Miami CIGNA Dental PPO Territorial Legislation - 23 States ETALLD25B.pdf PDF
Exhibit 22 - Cal Yr 2025 City of Miami CIGNA Sum Ben Cov Comp EEs No Rx- Out Of Area Plan - Plan 70 Pct Ded 300 Max Out of Pocket 1K ASO67.pdf PDF
Exhibit 30a - Cal Yr 2025 City of MIami CIGNA VIS Vision Benefit imbedded in Medical Plan Document ASO71.pdf PDF
Attachment A - City of Miami Living Wage Ordinance.pdf PDF
Exhibit 11a - Cal Yr 2022 City of Miami CIGNA Total Health Insight - Claims paid Feb 2023.pdf PDF
Exhibit 37 - Cal Yr 2022 City of Miami Stop Loss - Greater than 50K High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Exhibit 54a - Cal Yr 2025 City of Miami CIGNA Medical - Administrative Services Only ASO And Stop Loss Fees Schedule.pdf PDF
Exhibit 16b - Cal Yr 2025 City of Miami CIGNA Open Access Plan (OAP) Medicare No Rx - Comp EEs Plan 80 Percent Ded 500 Max Out of Pocket 2K ASO70.pdf PDF
Exhibit 03 - City of Miami AFSCME 1907 General Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
Exhibit 28 - Cal Yr 2025 City of Miami Comprehensive Buy UP Vision Benefit Summary Fully Insured (VISE) C1 PPO.pdf PDF
Exhibit 07 - Cal Yr 2024 City of Miami CIGNA EGWP Medicare - Evidence of Coverage Snapshot.pdf PDF
Exhibit 62 - Cal Yr 2025 City of Miami CIGNA FSA Healthcare - Summary Plan Document.pdf PDF
Exhibit 57a - Cal Yr 2025 City of Miami CIGNA Rx - Standard 3-Tier Prescription Drug List.pdf PDF
Exhibit 35 - Cal Yr 2024 City of Miami CIGNA Dental PPO Summary of Benefits Summary.pdf PDF
Exhibit 02 - City of Miami AFSCME 871 Sanitation Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
Exhibit 16 - Cal Yr 2024 City of Miami CIGNA Open Access Plan (OAP) Medicare No Rx - Comp EEs Plan 80 Percent Ded 500 Max Out of Pocket 2K ASO66.pdf PDF
Exhibit 26 - Cal Yr 2025 City of Miami Imputed Biweekly Income Table for Domestic Partner Medical Coverage.pdf PDF
Exhibit 69 - Cal Yr 2024 City of Miami RX CAP Report Plan Exec Summ and Top 20 Therapeutic Drugs.ppt PPT presentation
Exhibit 65 - Aug 2024 to Jul 2025 City of Miami CIGNA Lag Report Incurred Date included - Monthly Healthcare Experience by Acct Rlg 12-1.xlsx XLSX spreadsheet
Exhibit 24 - Cal Yr 2025 City of Miami Benefits Biweekly Premiums.pdf PDF
Exhibit 40 - 2025 City of Miami Medical Network Access Disruption Report.pdf PDF
Exhibit 11b - Cal Yr 2023 City of Miami CIGNA Total Health Insight - Claims paid Feb 2024.pdf PDF
Exhibit 09d - Cal Yr 2024 City of Miami CIGNA Vision - Monthly Healthcare Experience INN OON Total Claims Subs Mbrs.xlsx XLSX spreadsheet
Attachment B - Reference Submittal Form.pdf PDF
Questionnaire No. 2 - Stop Loss Insurance.pdf PDF
Exhibit 25 - Cal Yr 2025 City of Miami Cobra Monthly Premiums.pdf PDF
Questionnaire No. 3 (Revised) - Prescription Drugs (Rx).pdf PDF
Exhibit 51a - Cal Yr 2024 City of Miami CIGNA ASO Monthly Fees Healthcare Experience by Benefit Option Rolling 12 BenOpt-1.xlsx XLSX spreadsheet
Exhibit 21 - Cal Yr 2025 City of Miami CIGNA Summary Benefits Coverage OAP - Out Of Area - Ded 300 Maximum Out of Pocket 1K Comp EEs.pdf PDF
Exhibit 08a - Cal Yr 2025 City of Miami CIGNA Medicare EGWP Prescription Drug Plan.pdf PDF
Exhibit 07a - Cal Yr 2025 City of Miami CIGNA Healthcare EGWP Rx Prescription Drug Plan and Summary of Benefits.pdf PDF
Exhibit 57b - Cal Yr 2025 City of Miami YTD as of Apr Stats by Ther Class _ Brand - Healthcare Spend and Trend - Pharmacy - Paid.xlsx XLSX spreadsheet
Exhibit 09b - Cal Yr 2025 City of Miami CIGNA VISE Comprehensive BuyUp Vision Certificate HP-POL1053.pdf PDF
Exhibit 20 - Cal Yr 2025 City of Miami Medicare No Rx - SBC_OAP Plan Comp 300 Ded 300 Max Out of Pocket 1K.pdf PDF
Exhibit 23 - Cal Yr 2025 City of Miami CIGNA Summary Benefits Coverage Open Access Plan - All employees.pdf PDF
Exhibit 27. 2025 City of Miami Master CIGNA Census De-ID All Benefit Options.xlsx XLSX spreadsheet
Exhibit 32 - Cal Yr 2023 CIty of Miami CIGNA Lag Report Incurred Date included - Monthly Healthcare Experience Lag Report by Acct Rolling 12-1.xlsx XLSX spreadsheet
Exhibit 68 - Cal Yr 2024 City of Miami RX Stats by Ther Class _ Brand Healthcare Spend and Trend.xlsx XLSX spreadsheet
Exhibit 14 - Cal Yr 2024 City of Miami CIGNA Medicare Benefits - Comp EEs No Rx Plan 70 Percent Ded 300 Max Out Of Pocket 1K ASO65.pdf PDF
Questionnaire No. 6 - Employee Assistance Program.pdf PDF
Exhibit 48 - Cal Yr 2024 City of Miami CIGNA Dental Experience.xlsx XLSX spreadsheet
Exhibit 54b - Cal Yr 2025 City of Miami Stop CIGNA ISL and ASL Coverage Information Amendment Plan 3202272 CSL-SCH(10-15).pdf PDF
Exhibit 55 - Cal Yr 2025 as of Apr EAP Network Analysis Report Access 118974.pdf PDF
Exhibit 38 - Cal Yr 2023 City of Miami Stop Loss - Greater than 50K High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Exhibit 15 - City of Miami Cal Yr 2024 CIGNA Medical - Comp EEs Plan 70 Percent Ded 300 Max Out of Pocket 1K ASO64.pdf PDF
Show 40 more

Latest 50 of 115 listed here. See the rest on GovTribe.

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Date: 7/30/2025

ADVICE Reporting System

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT

January 2023 thru December 2023

Funding Type : SELF-FUNDED (ASO) Rating Type : RETROSPECTIVE EXPERIENCE RATED Reported Premium: ASO Fees Reported Claims: All Claims Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

YTD/MONTH BENEFIT OPTION IN NETWORK OUT OF NETWORK DRUG TOTAL CLAIMS TOTAL SUBS TOTAL MBRS Jan-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,316,536 $26,921 $652,034 $2,995,492 2,064 4,221

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $41,709 $4,357 $0 $46,066 176 205

OOA-OUT OF AREA PLAN ($15) $0 $0 ($15) 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $120 $0 $0 $120 5 5

Jan-2023 Total $2,358,349 $31,278 $652,034 $3,041,662 2,246 4,432

Feb-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,613,225 $14,619 $780,033 $3,407,877 2,048 4,182

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $57,967 $4,287 $0 $62,254 175 204

OOA-OUT OF AREA PLAN $0 $0 $0 $0 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $8 $0 $0 $8 5 5

Feb-2023 Total $2,671,200 $18,906 $780,033 $3,470,139 2,229 4,392

Mar-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,895,120 $30,662 $662,250 $3,588,033 2,048 4,177

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $91,136 $1,442 $0 $92,579 174 203

OOA-OUT OF AREA PLAN $0 $0 $0 $0 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $74 $0 $0 $74 5 5

Mar-2023 Total $2,986,331 $32,104 $662,250 $3,680,686 2,228 4,386

Apr-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,068,802 $26,179 $786,682 $2,881,663 2,043 4,172

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($2,638) $1,794 $0 ($845) 174 204

OOA-OUT OF AREA PLAN $0 $0 $0 $0 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $513 $0 $0 $513 5 5

Apr-2023 Total $2,066,677 $27,973 $786,682 $2,881,331 2,223 4,382

May-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,899,734 $29,629 $800,093 $3,729,456 2,032 4,154 NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($37,173) $2,494 $0 ($34,679) 174 204

OOA-OUT OF AREA PLAN $0 $0 $0 $0 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $901 $0 $0 $901 4 4

May-2023 Total $2,863,462 $32,122 $800,093 $3,695,678 2,211 4,363

Jun-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,480,289 $20,943 $636,562 $3,137,795 2,037 4,170

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $28,575 $7,959 $0 $36,534 171 200

OOA-OUT OF AREA PLAN $81 $0 $0 $81 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $391 $0 $0 $391 4 4

Jun-2023 Total $2,509,336 $28,903 $636,562 $3,174,801 2,213 4,375

Jul-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,417,860 $55,830 $994,699 $3,468,390 2,033 4,166

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $114,890 $2,768 $0 $117,658 170 199

OOA-OUT OF AREA PLAN $0 $0 $0 $0 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $222 $0 $0 $222 4 4

Revised Exhibit 18

ADVICE Reporting System

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT

January 2023 thru December 2023

Funding Type : SELF-FUNDED (ASO) Rating Type : RETROSPECTIVE EXPERIENCE RATED Reported Premium: ASO Fees Reported Claims: All Claims Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

YTD/MONTH BENEFIT OPTION IN NETWORK OUT OF NETWORK DRUG TOTAL CLAIMS TOTAL SUBS TOTAL MBRS Jul-2023 Total $2,532,972 $58,599 $994,699 $3,586,270 2,208 4,370

Aug-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,826,523 $34,299 $971,942 $3,832,763 2,039 4,182

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $55,249 $1,458 $86 $56,794 170 199

OOA-OUT OF AREA PLAN $0 $0 $0 $0 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $28 $0 $0 $28 4 4

Aug-2023 Total $2,881,800 $35,757 $972,028 $3,889,585 2,214 4,386

Sep-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,178,503 $19,657 $1,033,588 $3,231,748 2,040 4,193

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $63,009 $4,452 $0 $67,462 170 199

OOA-OUT OF AREA PLAN ($6) $0 $0 ($6) 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $233 $0 $0 $233 4 4

Sep-2023 Total $2,241,738 $24,110 $1,033,588 $3,299,436 2,215 4,397

Oct-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,556,654 $33,377 $1,034,432 $3,624,463 2,040 4,195 NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $66,717 $106,960 $0 $173,677 169 198

OOA-OUT OF AREA PLAN $129 $0 $99 $228 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $637 $0 $0 $637 4 4

Oct-2023 Total $2,624,137 $140,337 $1,034,531 $3,799,005 2,214 4,398

Nov-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,226,296 $9,562 $878,609 $3,114,468 2,045 4,195

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $58,254 $29,850 $0 $88,104 168 197

OOA-OUT OF AREA PLAN $61 $0 $9 $70 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $170 $0 $0 $170 4 4

Nov-2023 Total $2,284,781 $39,412 $878,618 $3,202,812 2,218 4,397

Dec-23 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,520,873 $27,263 $993,713 $3,541,849 2,049 4,201

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $80,105 $10,121 $0 $90,226 168 197

OOA-OUT OF AREA PLAN $50 $0 $0 $50 1 1

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $571 $0 $0 $571 4 4

Dec-2023 Total $2,601,600 $37,384 $993,713 $3,632,697 2,222 4,403

BENEFIT OPTION Totals NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $617,801 $177,942 $86 $795,830 2,059 2,409 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $30,000,414 $328,942 $10,224,639 $40,553,996 24,518 50,208

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $3,868 $0 $0 $3,868 52 52

OOA-OUT OF AREA PLAN $301 $0 $108 $409 12 12

Grand Total $30,622,385 $506,884 $10,224,834 $41,354,103 26,641 52,681

ADVICE Reporting System

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT

January 2024 thru December 2024

Funding Type : SELF-FUNDED (ASO) Rating Type : RETROSPECTIVE EXPERIENCE RATED Reported Premium: ASO Fees Reported Claims: All Claims Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

YTD/MONTH BENEFIT OPTION IN NETWORK OUT OF NETWORK DRUG TOTAL CLAIMS TOTAL SUBS TOTAL MBRS Jan-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $1,358,990 $36,684 $224,508 $1,620,182 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $26,003 $3,018 $0 $29,021 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $842,739 $120 $714,301 $1,557,160 2,072 4,236

OAPCE-OAP PLAN COMP EES $0 $0 $0 $0 1 1

OAPCX-OAP COMP EES NO RX $0 $0 $0 $0 4 4

OAPNX-OAP PLAN NO RX $5,679 $0 $0 $5,679 168 196

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $362 $0 $0 $362 0 0

Jan-2024 Total $2,233,772 $39,822 $938,809 $3,212,403 2,245 4,437

Feb-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $539,116 $8,058 ($679) $546,496 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($18,659) $336 $0 ($18,322) 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $2,534,636 $4,246 $740,653 $3,279,534 2,068 4,229

OAPCE-OAP PLAN COMP EES $35 $0 $0 $35 1 1

OAPCX-OAP COMP EES NO RX $733 $0 $0 $733 4 4

OAPNX-OAP PLAN NO RX $71,369 $3,137 $0 $74,506 167 195

OOA-OUT OF AREA PLAN $5 $0 $0 $5 0 0

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $1,686 $0 $0 $1,686 0 0

Feb-2024 Total $3,128,921 $15,778 $739,974 $3,884,673 2,240 4,429

Mar-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $383,142 $5,866 ($416) $388,593 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($31,892) $179 $0 ($31,713) 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $2,693,956 $23,064 $1,231,565 $3,948,586 2,072 4,238

OAPCE-OAP PLAN COMP EES $35 $0 $0 $35 1 1

OAPCX-OAP COMP EES NO RX $147 $0 $0 $147 4 4

OAPNX-OAP PLAN NO RX $44,409 $4,678 $0 $49,087 164 192

OOA-OUT OF AREA PLAN ($5) $0 $0 ($5) 0 0

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $32 $0 $0 $32 0 0

Mar-2024 Total $3,089,825 $33,787 $1,231,149 $4,354,762 2,241 4,435

Apr-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $297,284 $813 $49 $298,146 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $1,079 $400 $0 $1,479 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $2,959,101 $20,850 $1,057,420 $4,037,371 2,071 4,246

OAPCE-OAP PLAN COMP EES $35 $0 $0 $35 1 1

OAPCX-OAP COMP EES NO RX $192 $0 $0 $192 4 4

OAPNX-OAP PLAN NO RX $43,808 $11,494 $0 $55,302 163 191

Apr-2024 Total $3,301,499 $33,558 $1,057,469 $4,392,526 2,239 4,442

May-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $31,058 $368 $0 $31,427 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($661) $50 $0 ($611) 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $2,386,694 $26,101 $1,232,584 $3,645,379 2,075 4,247

ADVICE Reporting System

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT

January 2024 thru December 2024

Funding Type : SELF-FUNDED (ASO) Rating Type : RETROSPECTIVE EXPERIENCE RATED Reported Premium: ASO Fees Reported Claims: All Claims Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

YTD/MONTH BENEFIT OPTION IN NETWORK OUT OF NETWORK DRUG TOTAL CLAIMS TOTAL SUBS TOTAL MBRS

OAPCE-OAP PLAN COMP EES $422 $0 $38 $460 1 1

OAPCX-OAP COMP EES NO RX $478 $94 $0 $573 4 4

OAPNX-OAP PLAN NO RX $89,002 $8,825 $0 $97,827 163 191

May-2024 Total $2,506,994 $35,439 $1,232,623 $3,775,055 2,243 4,443

Jun-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $99,980 $17 $0 $99,997 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($189) $0 $0 ($189) 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $2,771,540 $47,694 $1,090,030 $3,909,264 2,063 4,225

OAPCE-OAP PLAN COMP EES $169 $0 $0 $169 1 1

OAPCX-OAP COMP EES NO RX $304 $0 $0 $304 4 4

OAPNX-OAP PLAN NO RX $86,451 $9,646 $0 $96,096 162 190

Jun-2024 Total $2,958,255 $57,356 $1,090,030 $4,105,641 2,230 4,420

Jul-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $50,032 ($7,555) $0 $42,477 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $290 ($9) $0 $282 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $3,168,043 $53,606 $1,004,643 $4,226,291 2,057 4,218

OAPCE-OAP PLAN COMP EES $682 $22 $0 $704 1 1

OAPCX-OAP COMP EES NO RX $666 $27 $0 $693 4 4

OAPNX-OAP PLAN NO RX $128,052 $2,131 $0 $130,183 161 188

Jul-2024 Total $3,347,766 $48,221 $1,004,643 $4,400,630 2,223 4,411

Aug-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $3,372 $58 $381 $3,811 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($950) $59 $0 ($891) 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $2,623,606 $45,698 $1,108,980 $3,778,285 2,059 4,224

OAPCE-OAP PLAN COMP EES $64 $0 $0 $64 1 1

OAPCX-OAP COMP EES NO RX $311 $38 $0 $349 4 4

OAPNX-OAP PLAN NO RX $190,529 $2,268 $0 $192,797 160 187

Aug-2024 Total $2,816,933 $48,122 $1,109,361 $3,974,416 2,224 4,416

Sep-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $39,434 $188 $2,514 $42,135 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $289 $24 $0 $313 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $2,118,686 $30,719 $1,105,990 $3,255,395 2,055 4,216

OAPCE-OAP PLAN COMP EES $84 $0 $0 $84 1 1

OAPCX-OAP COMP EES NO RX $310 $99 $0 $410 4 4

OAPNX-OAP PLAN NO RX $5,439 $1,797 $0 $7,236 159 186

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $31 $0 $0 $31 0 0

Sep-2024 Total $2,164,274 $32,827 $1,108,504 $3,305,605 2,219 4,407

Oct-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $154,640 ($39) $4,360 $158,961 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($29) $41 $0 $12 0 0

ADVICE Reporting System

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT

January 2024 thru December 2024

Funding Type : SELF-FUNDED (ASO) Rating Type : RETROSPECTIVE EXPERIENCE RATED Reported Premium: ASO Fees Reported Claims: All Claims Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

YTD/MONTH BENEFIT OPTION IN NETWORK OUT OF NETWORK DRUG TOTAL CLAIMS TOTAL SUBS TOTAL MBRS OAPAE-OAP PLAN ALL EMPLOYEES $2,121,299 $91,163 $1,207,024 $3,419,486 2,059 4,224

OAPCE-OAP PLAN COMP EES $177 $0 $26 $203 1 1

OAPCX-OAP COMP EES NO RX $1,823 $0 $0 $1,823 4 4

OAPNX-OAP PLAN NO RX $73,183 $2,884 $0 $76,067 159 186

Oct-2024 Total $2,351,093 $94,048 $1,211,410 $3,656,552 2,223 4,415

Nov-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) ($33,565) $205 $0 ($33,360) 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $38 $25 $0 $64 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $1,801,968 $13,443 $625,510 $2,440,922 2,062 4,225

OAPCE-OAP PLAN COMP EES $118 $0 $23 $141 1 1

OAPCX-OAP COMP EES NO RX $342 $2 $0 $344 4 4

OAPNX-OAP PLAN NO RX $50,754 $832 $0 $51,586 159 186

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $40 $0 $0 $40 0 0

Nov-2024 Total $1,819,696 $14,507 $625,533 $2,459,735 2,226 4,416

Dec-24 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) ($65) ($7,914) $0 ($7,980) 0 0

NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX $15 $1,484 $0 $1,499 0 0

OAPAE-OAP PLAN ALL EMPLOYEES $3,187,894 $52,433 $1,564,321 $4,804,648 2,059 4,218

OAPCE-OAP PLAN COMP EES $288 $0 $0 $288 1 1

OAPCX-OAP COMP EES NO RX $345 $24 $0 $369 4 4

OAPNX-OAP PLAN NO RX $161,285 $4,148 $0 $165,433 159 186

Dec-2024 Total $3,349,761 $50,175 $1,564,321 $4,964,257 2,223 4,409

BENEFIT OPTION Totals NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX ($24,664) $5,608 $0 ($19,056) 0 0 NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) $2,923,419 $36,749 $230,717 $3,190,885 0 0 OAPAE-OAP PLAN ALL EMPLOYEES $29,210,162 $409,137 $12,683,021 $42,302,321 24,772 50,746

OAPCE-OAP PLAN COMP EES $2,110 $22 $87 $2,218 12 12

OAPCX-OAP COMP EES NO RX $5,652 $284 $0 $5,936 48 48

OAPNX-OAP PLAN NO RX $949,960 $51,840 $0 $1,001,800 1,944 2,274

OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX $2,150 $0 $0 $2,150 0 0

OOA-OUT OF AREA PLAN $0 $0 $0 $0 0 0

Grand Total $33,068,789 $503,641 $12,913,825 $46,486,255 26,776 53,080

ADVICE Reporting System

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2023 thru December 2023

Reported Claims: FIXED CHARGES Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2023 thru December 2023

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2023 thru December 2023

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2023 thru December 2023

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2023 thru December 2023

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2024 thru December 2024

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2024 thru December 2024

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2024 thru December 2024

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2024 thru December 2024

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

Date: 7/30/2025

This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law.

CITY OF MIAMI

FIXED CHARGES - INTERNAL USE ONLY

January 2024 thru December 2024

Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.

2023
2024
Fixed Charges - INTERNAL-1
Fixed Charges - INTERNAL-1 (2)

File details come from the government source that posted it. Updated .