Exhibit_C3-Dental_Utilization_Report_2023_2024.pdf

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Attached to
Brevard County Group Dental Plan State and local contract opportunity
Solicitation number
RFP-1-25-18
Issued by
Brevard County, Florida

About this file

This document is a Cigna healthcare dental utilization report for Brevard County Board of County Commissioners (BOCC) in Florida, comparing dental service usage between 2023 and 2024. The report covers two dental product lines: DPPO (Dental Preferred Provider Organization) and Dental Care, analyzing membership demographics, service utilization trends, and key performance metrics. The current period reflects claims incurred from January 2024 to December 2024, with a claims payment runout through February 2025, and is compared against a base period from January 2023 to December 2023.

Key insights include an average membership of 7,663 in the current period (a 0.2% increase), with employees representing 54.3% of the population, spouses 18.9%, and dependents 26.7%. The dental utilization trends show an overall 0.0% change, with notable variations across service categories: Periodontics saw a 29.7% increase in gross services, while Major Restorative services decreased by 45.8%. The report highlights high utilization of Diagnostic/Preventive services, which can potentially lead to lower usage in other service categories. Network performance remained stable, with total network charges at 84.0% and achieved discounts at 37.2%, slightly below the normative benchmark of 38.0%.

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Other files for this state and local contract opportunity

Other files attached to Brevard County Group Dental Plan, newest first.
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Public_Meeting_Notice.pdf PDF
Public_Meeting_Notice.pdf PDF
RFP_Tabulation_-_Names_Only.pdf PDF
RFP_Tabulation_-_Names_Only.pdf PDF
RFP_Tabulation_-_Names_Only.pdf PDF
Addendum_4.pdf PDF
Attachment_B_WORD_-_Proposal_Worksheet.docx DOCX document
Attachment_B_WORD_-_Proposal_Worksheet.docx DOCX document
Addendum_3.pdf PDF
Addendum_2.pdf PDF
Addendum_2.pdf PDF
Addendum_1.pdf PDF
Revised_Exhibit_A_-_Census.xlsx XLSX spreadsheet
Revised_Exhibit_A_-_Census.xlsx XLSX spreadsheet
Revised_Exhibit_A_-_Census.xlsx XLSX spreadsheet
Exhibit_A_-_Census.pdf PDF
Exhibit_C3-Dental_Utilization_Report_2023_2024.pdf PDF
Attachment_A_-_Mandatory_Features_Checklist.pdf PDF
Attachment_C_-_Network_and_Procedure_Compare.xlsx XLSX spreadsheet
Exhibit_A_-_Census.pdf PDF
Exhibit_B1-Ben_Sum_DPPOH_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
Exhibit_B5-DPPO_High_Plan_Certificate_of_Coverage.pdf PDF
Exhibit_B6-DPPO_Low_Plan_Certificate_of_Coverage.pdf PDF
Attachment_A_-_Mandatory_Features_Checklist.pdf PDF
Exhibit_B1-Ben_Sum_DPPOH_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
Exhibit_C2-BREVARD_COUNTY_BOCC_FL_exp_pkg.xls XLS spreadsheet
Exhibit_C3-Dental_Utilization_Report_2023_2024.pdf PDF
Exhibit_D_-_Draft_Contract.pdf PDF
Exhibit_B2-Ben_Sum_DPPOL_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
RFP12518_INV_&_SPEC.pdf PDF
Exhibit_B1-Ben_Sum_DPPOH_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
Exhibit_C1-Brevard_BOCC_2024_DPPO_DHMO_Cigna.xls XLS spreadsheet
Exhibit_C1-Brevard_BOCC_2024_DPPO_DHMO_Cigna.xls XLS spreadsheet
Exhibit_B2-Ben_Sum_DPPOL_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
Exhibit_B5-DPPO_High_Plan_Certificate_of_Coverage.pdf PDF
RFP12518_INV_&_SPEC.pdf PDF
Exhibit_B1-Ben_Sum_DPPOH_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
Exhibit_B2-Ben_Sum_DPPOL_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
Exhibit_B4-DHMO_Schedule_of_Benefits.pdf PDF
Exhibit_B5-DPPO_High_Plan_Certificate_of_Coverage.pdf PDF
Exhibit_C2-BREVARD_COUNTY_BOCC_FL_exp_pkg.xls XLS spreadsheet
Exhibit_B4-DHMO_Schedule_of_Benefits.pdf PDF
Exhibit_C2-BREVARD_COUNTY_BOCC_FL_exp_pkg.xls XLS spreadsheet
Attachment_B_-_Proposal_Worksheet.pdf PDF
Exhibit_C2-BREVARD_COUNTY_BOCC_FL_exp_pkg.xls XLS spreadsheet
RFP12518_INV_&_SPEC.pdf PDF
Exhibit_B2-Ben_Sum_DPPOL_01.01.2025_Brevard_County_Board_of_County_Commissioners_3308988.pdf PDF
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Exhibit_B5-DPPO_High_Plan_Certificate_of_Coverage.pdf PDF
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Text version

Dental Utilization 2023 vs. 2024

Table of Contents

• Dental

Dental Care - Utilization by Type of Service Dental Utilization 2023 vs. 2024

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

BREVARD COUNTY BOCC, FL-Request 1528082-View 1904475-RPT_ID 277_BCN-Tier 4

Comments

• There is an increase in utilization per thousand in 2 categories and a decrease in utilization per thousand in 6 categories for an overall utilization trend of 0.0%

• High utilization for Diagnostic/Preventive services can lead to lower usage of other service categories

Gross Services by Type Base Current Trend Norm

Count Percent of

Total Count Percent of

Total Percent of

Total Diagnostic/Preventive 1,528 56.8% 1,454 58.0% -4.8% 72.0% Basic Restorative 101 3.8% 68 2.7% -32.7% 6.1% Major Restorative 166 6.2% 90 3.6% -45.8% 3.6% Endodontics 29 1.1% 24 1.0% -17.2% 0.9% Periodontics 408 15.2% 529 21.1% 29.7% 8.5% Oral Surgery 94 3.5% 52 2.1% -44.7% 3.1% Orthodontics 108 4.0% 99 3.9% -8.3% 3.4% Other Services 254 9.4% 192 7.7% -24.4% 2.4% Total 2,688 100.0% 2,508 100.0% -6.7% 100.0%

Services per 1,000 Members by Type Base Current Trend Norm

Count Percent of

Total Count Percent of

Total Count Percent of

Total Diagnostic/Preventive 1,203.1 56.8% 1,227.0 58.0% 2.0% 2,281.3 72.0% Basic Restorative 79.5 3.8% 57.4 2.7% -27.8% 193.4 6.1% Major Restorative 130.7 6.2% 75.9 3.6% -41.9% 114.7 3.6% Endodontics 22.8 1.1% 20.3 1.0% -11.3% 28.8 0.9% Periodontics 321.2 15.2% 446.4 21.1% 39.0% 269.4 8.5% Oral Surgery 74.0 3.5% 43.9 2.1% -40.7% 99.7 3.1% Orthodontics 85.0 4.0% 83.5 3.9% -1.8% 107.6 3.4% Other Services 200.0 9.4% 162.0 7.7% -19.0% 75.3 2.4% Total 2,116.4 100.0% 2,116.5 100.0% 0.0% 3,170.1 100.0%

Percent of membership by age band and product

Percent of spend by age band and product

Dental - Membership Summary Dental Utilization 2023 vs. 2024

Comments

• Average membership in the current period was 7,663, an increase of 0.2%

• Average family size decreased from 1.88 to 1.84, a decrease of 2.1%. Average family size measures the ratio of members to employees

• Employees represented 54.3% of the population in the current period, spouses 18.9% and dependents 26.7%

Summary of membership Base

Average Populations Employees Spouses &

Dependents Members Average

Family Size Percent Female

Percent Male

Dental Care 746 524 1,270 1.70 44.5% 55.5%

DPPO 3,329 3,048 6,377 1.92 50.3% 49.7%

Total 4,074 3,573 7,647 1.88 49.3% 50.7%

20%

15%

10%

5%

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

28%

21%

14%

7%

0%

BREVARD COUNTY BOCC, FL-Request 1528082-View 1904475-RPT_ID 371_BCN-Tier 4

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

Current

Average Populations Employees Spouses &

Dependents Members Average

Family Size Percent Female

Percent Male

Dental Care 712 473 1,185 1.67 44.2% 55.8%

DPPO 3,451 3,027 6,478 1.88 49.9% 50.1%

Total 4,163 3,501 7,663 1.84 49.1% 50.9% <1 1-17 18-29 30-39 40-49 50-59 60-64 65+

DPPO Demographic Summary Base Current Trend Norm

Average Number of Employees 3,329 3,451 3.7% Average Number of Members 6,377 6,478 1.6% Average Member Age 41.4 41.6 0.5% 36.5 Services per Claimant 7.3 7.4 1.4% 7.6 % of Members Using Plan 65.0% 65.0% 0.0% 68.5% % of Unique Members Receiving a Cleaning

57.8% 57.9% 0.1% 60.7%

DPPO Dental Care

DPPO Dental Care

Average plan members

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

BREVARD COUNTY BOCC, FL-Request 1528082-View 1904475-RPT_ID 370_BCN-Tier 4

Dental Dashboard Dental Utilization 2023 vs. 2024

Base Current

DPPO Oral Health Behavior SavingsMember population

DPPO

Dental Care

Network performance Base Current Trend Norm

Total network charges 84.2% 84.0% -0.2% 70.6% Achieved discounts 35.8% 37.2% 1.4% 38.0%

Healthy behaviors Base Current Trend Norm

Exams 53.3% 53.7% 0.5% 58.5%

Cleanings 53.0% 52.5% -0.5% 57.1%

Fluoride 19.6% 19.3% -0.3% 20.9%

Periodontal cleanings 5.8% 6.0% 0.2% 4.4%

Treatment

Fillings 13.0% 13.6% 0.6% 14.1%

Crowns 7.2% 7.2% 0.0% 6.8%

Root canals 1.8% 1.8% -0.0% 1.7%

Extractions - all 4.1% 3.7% -0.4% 3.8%

Gum disease

Non surg perio 2.6% 3.0% 0.4% 2.2%

Current Period Members with 1 or More Cleanings

Total Plan Members

Norm

Current Period

Total Network Charges

Total Submitted Charges

Norm

Current Period

Family Size

Total Group

Norm Employees & dependents all products

Base Current Trend Norm Employees 4,074 4,163 2.2% Dependents 3,573 3,501 -2.0% Family Size 1.88 1.84 -1.9% 1.95 Total Members 7,647 7,663 0.2%

DPPO Dental Care Base 6,377 1,270 Current 6,478 1,185 Trend 1.6% -6.7%

8,000

6,000

4,000

2,000

% of Unique members by service type

% of Unique members receiving cleaning Base Current Trend Norm 57.8% 57.9% 0.1% 60.7%

Month with greatest overall change:

Base : April -0.6% Current : November -0.5%

DPPO

Base Current Trend Norm

Net effective discount

30.1% 31.2% 1.1% 26.8%

Plan design savings

21.4% 22.1% 0.7% 19.8%

Utilization management & review

14.3% 13.3% -1.0% 13.9%

Total savings

65.9% 66.7% 0.9% 60.6%

Plan paid claims PMPM

$21.00 $21.74 3.6% $29.56

Dental Care Member savings on services provided

82.3% 82.6% 0.4% 85.0%

Glossary

Additional Plan Design Savings Savings generated from contractual limitations and benefits exclusions.

Adjunctive General Services Palliative treatments, consultations, emergency care, second opinions and anesthesia.

Age Maximum Savings due to age limits on fluoride treatments, sealants, orthodontic services and other services.

Alternate Benefit Provision This provision includes a three-tier claim review process monitored by Dental Claim Analysts, Dental Reviewers and Dental Consultants. Under this process, proposed treatment plans are examined by Dental Reviewers and approved, denied, or referred to Dental Consultants for alternate treatment decisions.

Where appropriate, the Dental Consultant will recommend alternate treatments considered to be less costly and consistent with professional dental standards.

Annual Maximum Savings due to a patient reaching the maximum payment under the plan, often per calendar year.

Average Area Charge Average charge based on the number of dentist in the geographical area pertaining to your membership.

Basic Restorative Dental treatments or procedures performed to repair and restore individual teeth due to decay, erosion, trauma or improper function. Basic services may include fillings, oral surgery, endodontics (root canals) and periodontics (tissue/bone treatment).

Benefit Option This code is used to identify different Cigna product lines purchased by a customer.

Charges The amount charged by a dentist for dental services rendered.

Children Children are defined as child, step-child, handicapped child, eligible students and adult dependent.

Claim Branch This term describes the different ways an account can be sub-divided into groups for reporting purposes based on the account structure.

Coinsurance The percentage of covered expenses paid by the member when costs are being shared by both the plan and the individual member.

Coordination of Benefits (COB) The amount saved when Cigna is the secondary insurer. It represents the difference between what Cigna pays and (COB) what it would have paid if it were primary.

Covered Employees The number of Covered Employees for the reporting period equals the number of active employees in the first reporting period month and includes any active employee additions made in the following months within the reporting period.

To be counted as a covered employee addition the employee must have had atone day of coverage.

Deductible An amount specified in plan design that must be paid by member for covered expenses in a benefit period before the plan will pay benefits.

Dental care The term utilized to represent the Cigna Dental Care product (formerly represented as DHMO). In most states, the Cigna Dental Care plan requires the selection of a general dentist for routine, preventive, diagnostic and emergency care. Referrals to specialists are provided, as needed. Data for this product can be found in the sections labeled Dental Care.

DHMO

Dental Health Maintenance Organization. Cigna's DHMO product is called Cigna Dental Care. In most states, the Cigna Dental Care plan requires the selection of a general dentist for routine, preventive, diagnostic and emergency care. Referrals to specialists are provided, as needed. Data for this product can be found in the sections labeled Dental Care.

Diagnostic/Preventive Dental treatments or procedures focused on the prevention and diagnosis of dental diseases. These services may include oral examinations, cleanings, X-rays, sealants and fluoride treatments.

DPPO

Cigna Dental Preferred Provider Organization. With the Dental Preferred Provider Organization plan (DPPO), customers can see any licensed dentist or specialist, but may pay less for covered services when utilizing in-network dentists for care. Data for this product can be found in the sections labeled

DPPO.

Endodontics The dental specialty that concentrates on the treatment of root canals or other injuries/diseases of the pulp, or nerve, of the tooth.

Frequency Maximum Savings due to frequency limits on examinations, cleanings, radiographs, crowns and other services.

Ineligible Charges Ineligible Charges include savings attributable to limitations of the plan (Missing Tooth Limitation, Age/Frequency, Annual/Lifetime Maximums); charges submitted for ineligible participants; application of Alternate Benefit Provisions which may be a result of the Pre-Determination of Benefits (PDB) process;

services that exceed the maximum reimbursable charge limits per service, or the Scheduled Plan benefits, if applicable; and Utilization Management Services.

In-Network Services rendered by providers who are part of a network and with whom Cigna has a contractual relationship.

Major Restorative Dental treatments or procedures targeting the restoration of teeth using services such as crowns, inlays, or onlays. Major services also may include prosthodontics (i.e. dentures).

Member An individual who is eligible for coverage and enrolled under a dental plan.

Includes employee and any covered dependents.

Missing Tooth Limitation A contractual provision which limits or excludes payment for the replacement of teeth that are missing prior to the patient's effective date of plan coverage.

Norm Norm refers to the comparison group based on book of business or industry experience for the defined parameters. Norms are annualized unless otherwise stated.

Oral Surgery Non-surgical and surgical extractions, and other surgical procedures.

Orthodontics Dental treatments or procedures performed to correct misalignments of the teeth and restore the teeth to their proper alignment and bite function. Services may include braces or retainers.

Other Savings Other Savings is a category in which savings is captured when a claim has multiple plan design savings reasons.

Out-of-Network Services rendered by providers who are not part of the Cigna network based on your benefit plan design.

Paid Claims That portion of the dentist's charges paid by Cigna to a patient or provider for dental services covered under the benefit plan.

Patient A unique individual participant (employee or dependent) who received one or more dental services during the reporting period in-network and/or out-of-network.

Periodontics Scaling and root planing, surgical procedures of the gingiva/bone, and other gum-related treatment.

Pre-Determination of Benefits (PDB) A process that allows the patient and dentist learn what benefits are provided by the dental plan in advance of treatment. The PDB process provides the dentist and participant with a detailed explanation of what specific benefits are available at the time the claim is reviewed so that the dentist may discuss the information with the patient before treatment is rendered and expenses are incurred. Savings from this process are also realized through the avoidance of more costly dental treatments where a less costly alternative is recommended.

Provider Discounts The difference between the contracted payment amount and the average area charge for a procedure.

Scheduled Plan Savings Savings due to the application of set scheduled dollar payment amounts for dental services set forth in a scheduled benefit plan.

Services The number of individual dental procedures rendered by dental care providers.

Utlization Management The set of administrative practices used on behalf of purchasers of dental benefits to manage the necessity, appropriateness, frequency and mix of dental services. It entails practices used in claims review for predetermination or payment of benefits, statistical review of individual provider utilization profiles and appropriate follow-up procedures.

Report Parameters

Global Parameters

Overall Dates Current Base

Incurred 01/2024 to 12/2024 01/2023 to 12/2023

Incurred Runout 01/2024 to 02/2025 01/2023 to 02/2024

Catastrophic Threshold $50,000

Exclude Pharmacy Yes

Package :1904475

Package Name: Dental Utilization 2023 vs. 2024 Structure: Status = *, Division = *, Product Codes = DHMO,DPPO

Package Parameters PMPM,BCN,Override:No

Normative Values DPPO ,DHMO ,202408

BREVARD COUNTY BOCC, FL:3308988

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