Exhibit 64 - Aug 2024 to Jul 2025 City of Miami CIGNA Claims by Products ASO Fees Charges Monthly Healthcare Experience by Acct No Rllg 12.xlsx

XLSX spreadsheet 24 KB Posted

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

About this file

Written by GovTribe AI ·

This document is a monthly healthcare experience report for the City of Miami's health insurance claims and Administrative Services Only (ASO) fees from August 2024 through July 2025, prepared by CIGNA. The report covers a 12-month period with retrospective experience rating and details monthly healthcare claims across multiple product types including COH, DPP4, OAP1, COMP, and VISP. The contract involves healthcare coverage for approximately 5,600-5,700 subscribers and 11,200-11,300 total members, with total annual claims reaching $48,583,443 and ASO fees of $820,446.

The healthcare experience report reveals consistent monthly variations in claims across different product lines, with significant fluctuations in in-network and out-of-network expenses. Total monthly claims range from approximately $2.5 million to $5 million, with fixed charges and drug expenses contributing to the overall healthcare costs. The City of Miami's healthcare plan demonstrates stability in subscriber numbers and demonstrates a comprehensive approach to managing healthcare expenses through detailed monthly tracking and analysis of claims, memberships, and associated fees.

View the file

Other files

File Type Posted
Exhibit 50 - Cal Yr 2024 City of Miami CIGNA Vision Plans Claim Summary Report.pdf PDF
Exhibit 39 - Cal Yr 2024 City of Miami Stop Loss - High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Exhibit 14b - Cal Yr 2025 City of Miami CIGNA Medicare Benefits - Comp EEs No Rx Plan 70 Percent Ded 300 Max Out Of Pocket 1K ASO69.pdf PDF
Questionnaire No. 2 - Stop Loss Insurance.pdf PDF
Exhibit 46 - Cal Yr 2025 City of Miami Benefit Eligible Employees as of Sep 2025.xlsx XLSX spreadsheet
Exhibit 69 - Cal Yr 2024 City of Miami RX CAP Report Plan Exec Summ and Top 20 Therapeutic Drugs.ppt PPT presentation
Exhibit 01a - Cal Yr 2025 YTD as of June City of Miami Monthly Healthcare Detail Experience - Stop Loss ALL claims.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 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 51 - Cal Yr 2023 City of Miami CIGNA Claims by Benefits and ASO Fees Monthly Healthcare Experience by Benefit Option Rolling 12 BenOpt-1.xlsx XLSX spreadsheet
Exhibit 52a - Cal Yr 2022 City of Miami CIGNA Pooled Stop Loss High Claims Greater than 50K Experience De-ID.xlsx XLSX spreadsheet
Questionnaire No. 7 - Flexible Spending Accounts.pdf PDF
Exhibit 06c - Cal Yr 2025 City of Miami CIGNA Dental PPO Certificate Riders and Coverage for other states ETALLD25B Plan 3202272 HC-IMP35.pdf PDF
Exhibit 47 - Cal Yr 2023 City of Miami CIGNA Dental Exp.xlsx XLSX spreadsheet
Questionnaire No. 5 - Group Benefit Vision Plan.pdf PDF
Exhibit 29 - Cal Yr 2025 City of Miami CIGNA OAP No Rx PlanMedical Benefits - Summary Benefits Coverage POST 65.pdf PDF
Exhibit 25 - Cal Yr 2025 City of Miami Cobra Monthly Premiums.pdf PDF
Exhibit 03 - City of Miami AFSCME 1907 General Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
Exhibit 45 - Cal Yr 2024 City of Miami EAP - EAP Utilization.pptx PPTX presentation
Exhibit 05 - Cal Yr 2024 City of Miami CIGNA Dental HMO Plan Document.pdf PDF
2130386 - Sample PSA.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 44 - Cal Yrs 2025 _ 2026 EAP Renewal Letter.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 37 - Cal Yr 2022 City of Miami Stop Loss - Greater than 50K High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Questionnaire No. 8 - COBRA.pdf PDF
Exhibit 55 - Cal Yr 2025 as of Apr EAP Network Analysis Report Access 118974.pdf PDF
Exhibit 57c - Cal Yr 2025 YTD as of Jul - City of Miami CIGNA Pharmacy RX Dispensed Report.xlsx XLSX spreadsheet
Exhibit 08 - Cal Yr 2024 City of Miami CIGNA EGWP Medicare Formulary.pdf PDF
Exhibit 62 - Cal Yr 2025 City of Miami CIGNA FSA Healthcare - Summary Plan Document.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 49 - Cal Yr 2023 City of Miami CIGNA Vision Plans Claim Summary Report.pdf PDF
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 34 - Cal Yr 2025 City of Miami CIGNA Dental HMO Summary with Patient Charge Schedule.pdf PDF
Exhibit 42 - Cal Yr 2025 City of Miami CIGNA TC19 Disruption Report - Total Records Total Claimants Total Eligible Charges Summary.xlsx XLSX spreadsheet
Exhibit 61 - Cal Yr 2025 City of Miami CIGNA FSA Dependent Care - Summary Plan Document.pdf PDF
Exhibit 41a - Cal Yr 2025 City of Miami CIGNA Medical - Disruption Detail with Provider TIN - Option 1 - OAP-OA001 RITM9284277_TC19.xlsx XLSX spreadsheet
Exhibit 59 - City of Miami CIGNA Medical - Professional Services Agreement AMENDMENT NO 1 May 6 2021 ASO Agreement with Fees.pdf PDF
Exhibit 02 - City of Miami AFSCME 871 Sanitation Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
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
Exhibit 30a - Cal Yr 2025 City of MIami CIGNA VIS Vision Benefit imbedded in Medical Plan Document ASO71.pdf PDF
Exhibit 18 - Cal Yrs 2023 _ 2024 City of Miami CIGNA FIXED Charges Report - PRR.xlsx XLSX spreadsheet
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
Attachment A - City of Miami Living Wage Ordinance.pdf PDF
Exhibit 19 - Cal Yr 2025 City of Miami CIGNA Medical - SBC Comp Ded 300 Max Out of Pocket 1K.pdf PDF
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
Exhibit 17c - Cal Yr 2025 City of Miami CIGNA Healthcare Massachusetts Rider for OAP Plans HC-RDR1.pdf PDF
Exhibit 54a - Cal Yr 2025 City of Miami CIGNA Medical - Administrative Services Only ASO And Stop Loss Fees Schedule.pdf PDF
Exhibit 05c - Cal Yr 2025 City of Miami CIGNA Dental HMO Certificate Riders and Coverage for 7 States ETALLD25A Plan 3202272 HC-ETRDR.pdf PDF
Exhibit 06d - Cal Yr 2025 City of Miami CIGNA Dental PPO Territorial Legislation - 23 States ETALLD25B.pdf PDF
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
Try for free Login

Text version

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

Rllg12 Acct Product-1

CITY OF MIAMI
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
August 2024 thru July 2025
EXHIBIT 64
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/MONTHACCOUNTPRODUCT TYPEFIXED CHARGESIN NETWORKOUT OF NETWORKDRUGTOTAL CLAIMSTOTAL ASO FEESTOTAL SUBSTOTAL MBRS
Aug-243202272COH$0$0$0$0$0$01,9614,093
DPP4$1,023$1,399$117$381$2,920$000
OAP1$214,004$2,600,506$48,005$1,108,980$3,971,496$81,0762,2244,416
VISP$0$21,937$0$0$21,937$4981,4122,719
ACCOUNT Total$215,028$2,623,842$48,122$1,109,361$3,996,353$81,5755,59711,228
Aug-2024 Total$215,028$2,623,842$48,122$1,109,361$3,996,353$81,5755,59711,228
Sep-243202272COH$0$0$0$0$0$01,9574,084
COMP$0$31$0$0$31$000
DPP4$36,096$3,647$211$2,514$42,468$000
OAP1$228,821$1,895,679$32,616$1,105,990$3,263,106$80,9312,2194,407
VISP$0$38,645$0$0$38,645$4961,4052,707
ACCOUNT Total$264,917$1,938,002$32,827$1,108,504$3,344,249$81,4285,58111,198
Sep-2024 Total$264,917$1,938,002$32,827$1,108,504$3,344,249$81,4285,58111,198
Oct-243202272COH$0$0$0$0$0$01,9614,094
DPP4$0$154,611$2$4,360$158,973$000
OAP1$196,888$1,999,595$94,046$1,207,050$3,497,579$80,6052,2234,415
VISP$0$30,279$0$0$30,279$4931,4072,715
ACCOUNT Total$196,888$2,184,484$94,048$1,211,410$3,686,831$81,0985,59111,224
Oct-2024 Total$196,888$2,184,484$94,048$1,211,410$3,686,831$81,0985,59111,224
Nov-243202272COH$0$0$0$0$0$01,9654,097
COMP$0$40$0$0$40$000
DPP4$0($33,527)$230$0($33,297)$000
OAP1$257,639$1,595,544$14,277$625,533$2,492,992$80,7142,2264,416
VISP$0$41,156$0$0$41,156$4921,4062,712
ACCOUNT Total$257,639$1,603,213$14,507$625,533$2,500,892$81,2065,59711,225
Nov-2024 Total$257,639$1,603,213$14,507$625,533$2,500,892$81,2065,59711,225
Dec-243202272COH$0$0$0$0$0$01,9614,087
DPP4$260($310)($6,430)$0($6,480)$000
OAP1$237,242$3,112,569$56,605$1,564,321$4,970,737$80,6772,2234,409
VISP$0$41,496$0$0$41,496$4911,4032,704
ACCOUNT Total$237,502$3,153,755$50,175$1,564,321$5,005,753$81,1695,58711,200
Dec-2024 Total$237,502$3,153,755$50,175$1,564,321$5,005,753$81,1695,58711,200
Jan-253202272COH$0$0$0$0$0$02,0074,172
DPP4$0$9,925$288($384)$9,829$000
OAP1$237,984$2,551,930$69,889$1,025,484$3,885,287$82,5632,2694,491
VISP$0$29,479$0$0$29,479$4861,3852,643
ACCOUNT Total$237,984$2,591,334$70,177$1,025,100$3,924,595$83,0495,66111,306
Jan-2025 Total$237,984$2,591,334$70,177$1,025,100$3,924,595$83,0495,66111,306
Feb-253202272COH$0$0$0$0$0$02,0004,157
DPP4$0$26,198$79$86$26,363$000
OAP1$246,791$2,630,985$46,702$1,226,464$4,150,941$81,9832,2634,477
VISP$0$27,080$0$0$27,080$4841,3832,635
ACCOUNT Total$246,791$2,684,262$46,781$1,226,551$4,204,384$82,4665,64611,269
Feb-2025 Total$246,791$2,684,262$46,781$1,226,551$4,204,384$82,4665,64611,269
Mar-253202272COH$0$0$0$0$0$02,0044,172
DPP4$921($3,924)$571$0($2,433)$000
OAP1$235,618$2,644,634$49,978$1,162,835$4,093,065$82,0552,2654,490
VISP$0$14,787$0$0$14,787$4841,3832,637
ACCOUNT Total$236,539$2,655,497$50,548$1,162,835$4,105,419$82,5395,65211,299
Mar-2025 Total$236,539$2,655,497$50,548$1,162,835$4,105,419$82,5395,65211,299
Apr-253202272COH$0$0$0$0$0$02,0014,166
DPP4$0($784)$1,212$65$493$000
OAP1$240,329$3,345,473$59,712$1,120,198$4,765,713$81,8742,2594,481
VISP$0$4,211$0$0$4,211$4831,3812,635
ACCOUNT Total$240,329$3,348,900$60,924$1,120,263$4,770,417$82,3575,64111,282
Apr-2025 Total$240,329$3,348,900$60,924$1,120,263$4,770,417$82,3575,64111,282
May-253202272COH$0$0$0$0$0$02,0034,173
DPP4$0$22,280$1,712$0$23,992$000
OAP1$249,842$3,320,172$40,509$1,067,820$4,678,342$81,8742,2594,486
VISP$0$2,095$0$0$2,095$4831,3812,638
ACCOUNT Total$249,842$3,344,547$42,220$1,067,820$4,704,429$82,3575,64311,297
May-2025 Total$249,842$3,344,547$42,220$1,067,820$4,704,429$82,3575,64311,297
Jun-253202272COH$0$0$0$0$0$01,9934,163
DPP4$0$167,298$998$80$168,376$000
OAP1$245,398$2,247,863$42,067$1,124,271$3,659,599($254)2,2504,477
VISP$0$4,464$0$0$4,464$4821,3782,639
ACCOUNT Total$245,398$2,419,625$43,066$1,124,351$3,832,440$2285,62111,279
Jun-2025 Total$245,398$2,419,625$43,066$1,124,351$3,832,440$2285,62111,279
Jul-253202272COH$0$0$0$0$0$01,9984,173
DPP4$0($2,193)$498$0($1,695)$000
OAP1$243,154$2,956,531$42,663$1,263,260$4,505,609$4942,2544,486
VISP$0$3,768$0$0$3,768$4811,3742,634
ACCOUNT Total$243,154$2,958,107$43,161$1,263,260$4,507,682$9755,62611,293
Jul-2025 Total$243,154$2,958,107$43,161$1,263,260$4,507,682$9755,62611,293

Grand Total $2,872,009 $31,505,569 $596,556 $13,609,309 $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 .