Exhibit_E_St_Cloud_BCBS_MUE_1019_to_0920.pdf
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- Solicitation number
- 2024-007
- Issued by
- Polk County, Florida
About this file
This document is a Florida Blue insurance utilization and enrollment monitoring report for the City of St. Cloud, covering the period from October 2019 to September 2020. The report provides a detailed breakdown of healthcare enrollment, premiums, capitation, and fee-for-service claims for city employees across different coverage tiers (employee only, employee & spouse, employee & children, and family). Throughout the 12-month period, the total number of contracts ranged from 480 to 490, with total membership between 971 and 1,001 individuals.
The financial summary reveals total premiums of $962,768.93, with monthly averages of $80,230.74. The report shows total medical claims of $3,936,592.03 and pharmacy claims of $806,986.58, with varying monthly fluctuations in inpatient, outpatient, physician, and other medical expenses. Value-based programs and capitation fees are also tracked, with total capitation at $93,863.45 and value-based programs totaling $3,754.23. The enrollment breakdown consistently shows the majority of employees choosing employee-only coverage, with family plans being the second most common option, and no enrollment in spouse-only or spouse & children categories.
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Paid Year Month
Contracts Members ASO/MPP Fee Stoploss Premium
Total Premium PCP Specialty Total Capitation
Value Based Programs
Inpatient Outpatient Physician Other Total Medical Pharmacy
201910 484 985 $35,198.00 $44,360.73 $79,558.73 $0.00 $7,745.61 $7,745.61 $0.00 $246,278.36 $106,311.76 $45,098.33 $38,626.34 $436,314.79 $84,284.72
201911 483 977 $35,556.10 $44,777.11 $80,333.21 $0.00 $1,465.10 $1,465.10 $1,054.81 $101,398.64 $62,196.72 $59,287.19 $39,741.63 $262,624.18 $64,394.71
201912 490 990 $35,781.60 $44,884.81 $80,666.41 $0.00 $7,753.24 $7,753.24 $535.83 $29,403.35 $131,694.45 $55,276.34 $45,586.89 $261,961.03 $67,505.58
202001 490 990 $36,063.60 $45,243.71 $81,307.31 $0.00 $14,075.58 $14,075.58 $251.20 $13,968.27 $47,388.80 $45,744.34 $36,558.36 $143,659.77 $58,842.55
202002 481 971 $35,210.46 $44,438.04 $79,648.50 $0.00 $7,819.96 $7,819.96 $249.60 ($253.68) $185,716.43 $45,166.00 $49,324.24 $279,952.99 $58,106.59
202003 480 973 $34,890.80 $43,763.82 $78,654.62 $0.00 $7,673.80 $7,673.80 $241.60 $89,992.23 $124,350.10 $34,749.88 $34,601.17 $283,693.38 $57,399.35
202004 485 987 $35,257.30 $44,480.72 $79,738.02 $0.00 $7,856.52 $7,856.52 $236.80 $67,974.87 $155,703.36 $30,867.76 $17,944.22 $272,490.21 $55,534.30
202005 488 997 $35,917.00 $45,234.41 $81,151.41 $0.00 $7,942.49 $7,942.49 $247.34 $142,986.98 $80,020.13 $40,773.22 $49,626.05 $313,406.38 $56,615.35
202006 487 993 $35,770.40 $45,367.24 $81,137.64 $0.00 $7,886.75 $7,886.75 $247.34 $36,919.99 $167,620.68 $66,803.80 $48,894.98 $320,239.45 $63,831.68
202007 482 988 $35,697.10 $44,932.88 $80,629.98 $0.00 $7,883.60 $7,883.60 $185.90 $155,376.57 $120,159.72 $62,807.67 $33,535.41 $371,879.37 $94,399.66
202008 484 992 $35,037.40 $44,798.16 $79,835.56 $0.00 $7,854.93 $7,854.93 $184.60 $135,354.47 $118,439.47 $166,372.11 $63,302.05 $483,468.10 $72,839.10
202009 488 1,001 $35,330.60 $44,776.94 $80,107.54 $0.00 $7,905.87 $7,905.87 $319.21 $247,229.99 $154,027.76 $53,610.91 $52,033.72 $506,902.38 $73,232.99
Total 5,822 11,844 $425,710.36 $537,058.57 $962,768.93 $0.00 $93,863.45 $93,863.45 $3,754.23 $1,266,630.04 $1,453,629.38 $706,557.55 $509,775.06 $3,936,592.03 $806,986.58
Grouping Avg 485 987 $35,475.86 $44,754.88 $80,230.74 $0.00 $7,821.95 $7,821.95 $312.85 $105,552.50 $121,135.78 $58,879.80 $42,481.26 $328,049.34 $67,248.88
Monthly Avg 485 987 $35,475.86 $44,754.88 $80,230.74 $0.00 $7,821.95 $7,821.95 $312.85 $105,552.50 $121,135.78 $58,879.80 $42,481.26 $328,049.34 $67,248.88 $403,433.02
Notes:
- Grand Total includes Medical FFS, Pharmacy FFS, Incentives and Capitation.
- Grouping Avg – Average of the distinct groupings chosen by the user.
- Monthly Avg – Average of a measure over Service/Paid time period.
- Enrollment is recast to reflect retroactive adjustments.
- FFS = Fee For Service.
- MLR = Medical Loss Ratio.
$474,348.53
$564,346.73
$588,360.45
$4,841,196.29
$403,433.02
$346,129.14
$349,008.13
$336,117.83
$378,211.56
$392,205.22
Grand Total
$528,345.12
$329,538.80
$337,755.68
$216,829.10
Monitoring by Utilization and Enrollment Company: CITY OF ST CLOUD Group: 33709 Current Paid Period: From 10/2019 to 09/2020
Enrollment Premium Capitation Fee for Service Claims
This Florida Blue report is proprietary and confidential. Report Run: 02/10/2021 9:48 AM Page 1 of 2
Paid Year Month Employee Only
Employee & Spouse
Employee & Children
Family Spouse Only Spouse & Children
Children Only Total Contracts
Total Members
201910 251 62 59 112 0 0 0 484 985
201911 251 64 58 110 0 0 0 483 977
201912 254 66 59 111 0 0 0 490 990
202001 253 68 59 110 0 0 0 490 990
202002 249 67 56 109 0 0 0 481 971
202003 247 67 56 110 0 0 0 480 973
202004 249 68 56 112 0 0 0 485 987
202005 249 68 58 113 0 0 0 488 997
202006 250 67 57 113 0 0 0 487 993
202007 245 67 57 113 0 0 0 482 988
202008 246 67 57 114 0 0 0 484 992
202009 248 69 56 115 0 0 0 488 1,001
Total 2,992 800 688 1,342 0 0 0 5,822 11,844
Grouping Avg 249 67 57 112 0 0 0 485 987
Monthly Avg 249 67 57 112 0 0 0 485 987
Monitoring by Utilization and Enrollment
Notes:
- Enrollment is recast to reflect retroactive adjustments.
- Grouping Avg – Average of the distinct groupings chosen by the user.
- Monthly Avg – Average of a measure over Service/Paid time period.
This Florida Blue report is proprietary and confidential. Report Run: 02/10/2021 9:48 AM Page 2 of 2
| S1 Monitoring by Utiliza Page1 |
| S2 Monitoring by Utiliza Page2 |
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