Exhibit 63 - Aug 2024 to Jul 2025 City of Miami CIGNA Claims by Benefits and ASO Fees Monthlty Healthcare Experience by Ben Option Rlg 12.xlsx
XLSX spreadsheet 21 KB Posted
- Attached to
- RFP No. 2130386 - Employee Health Benefits Plan
- Solicitation number
- RFP No. 2130386
- Issued by
- Florida
About this file
This document is a monthly healthcare experience report for the City of Miami's employee health benefits plan, covering the period from August 2024 through July 2025. The report, labeled as Exhibit 63, details a retrospective experience-rated contract with CIGNA for healthcare services, encompassing various benefit options including Network Open Access POS, Standalone Network POS, OAP Plans, Vision Services, and Out of Area Plans. The contract term spans 12 months, from August 2024 to July 2025, with comprehensive monthly breakdowns of claims, fees, subscribers, and members.
The financial details reveal total paid claims of $47,059,826 over the contract period, with ASO (Administrative Services Only) fees totaling $820,446. The City of Miami's health plan covers 5,626 to 5,661 subscribers and approximately 11,200 to 11,306 total members each month. The report shows fluctuating monthly claims and fees, with total paid claims ranging from $2,500,892 to $5,005,753 per month. The pricing structure is retrospective, meaning actual claims and administrative costs are calculated and billed after service delivery, providing flexibility in healthcare cost management for the municipal employer.
View the file
Other files
Show 40 more
Latest 50 of 114 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
Text version
Rllg12 Client BenOpt-1
| CITY OF MIAMI | |||||||||||||
| MONTHLY HEALTHCARE EXPERIENCE REPORT BY BENEFIT OPTION | |||||||||||||
| August 2024 thru July 2025 | |||||||||||||
| EXHIBIT 63 | |||||||||||||
| Rating Type : RETROSPECTIVE EXPERIENCE RATED | |||||||||||||
| Reported Premium: ASO Fees | |||||||||||||
| Reported Claims: All Claims | |||||||||||||
| YTD/MONTH | NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES) | NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX | OAPAE-OAP PLAN ALL EMPLOYEES | OAPCE-OAP PLAN COMP EES | OAPCX-OAP COMP EES NO RX | OAPNX-OAP PLAN NO RX | OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX | VIS-CIGNA VISION FOR NETWORK PARTICIPANTS (B | VIS-VISION FOR NETWORK PARTICIPANTS (BUNDLED | TOTAL PAID CLAIMS | TOTAL ASO FEES | TOTAL SUBS | TOTAL MBRS |
| Aug-24 | $3,811 | ($891) | $3,778,285 | $64 | $349 | $192,797 | $0 | $0 | $21,937 | $3,996,353 | $81,575 | 5,597 | 11,228 |
| Sep-24 | $42,135 | $313 | $3,255,395 | $84 | $410 | $7,236 | $31 | $0 | $38,645 | $3,344,249 | $81,428 | 5,581 | 11,198 |
| Oct-24 | $158,961 | $12 | $3,419,486 | $203 | $1,823 | $76,067 | $0 | $0 | $30,279 | $3,686,831 | $81,098 | 5,591 | 11,224 |
| Nov-24 | ($33,360) | $64 | $2,440,922 | $141 | $344 | $51,586 | $40 | $41,156 | $0 | $2,500,892 | $81,206 | 5,597 | 11,225 |
| Dec-24 | ($7,980) | $1,499 | $4,804,648 | $288 | $369 | $165,433 | $0 | $41,496 | $0 | $5,005,753 | $81,169 | 5,587 | 11,200 |
| Jan-25 | $9,829 | $0 | $3,849,947 | $39 | $546 | $34,755 | $0 | $29,479 | $0 | $3,924,595 | $83,049 | 5,661 | 11,306 |
| Feb-25 | $26,202 | $161 | $4,088,643 | $50 | $249 | $62,000 | $0 | $27,080 | $0 | $4,204,384 | $82,466 | 5,646 | 11,269 |
| Mar-25 | $17,911 | ($20,344) | $3,998,693 | $538 | $341 | $93,493 | $0 | $14,787 | $0 | $4,105,419 | $82,539 | 5,652 | 11,299 |
| Apr-25 | $451 | $42 | $4,670,219 | $1,792 | $701 | $93,000 | $0 | $4,211 | $0 | $4,770,417 | $82,357 | 5,641 | 11,282 |
| May-25 | $24,010 | ($18) | $4,679,892 | $365 | $513 | ($2,427) | $0 | $2,095 | $0 | $4,704,429 | $82,357 | 5,643 | 11,297 |
| Jun-25 | $161,032 | $7,345 | $3,612,357 | $136 | $1,195 | $45,911 | $0 | $4,464 | $0 | $3,832,440 | $228 | 5,621 | 11,279 |
| Jul-25 | ($1,712) | $17 | $4,461,340 | $89 | $509 | $43,670 | $0 | $3,768 | $0 | $4,507,682 | $975 | 5,626 | 11,293 |
| Grand Total | $401,291 | ($11,802) | $47,059,826 | $3,789 | $7,349 | $863,521 | $71 | $168,537 | $90,860 | $48,583,443 | $820,446 | 67,443 | 135,100 |
&G &7This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law. ADVICE Reporting System &8Page &P of &N Date: 8/6/2025 image1.png
File details come from the government source that posted it. Updated .