Exhibit_E_St_Cloud_BCBS_MUE_1020_to_0921.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 2020 to September 2021. The report details monthly health insurance enrollment, premium, capitation, and claims information for the city's employee health insurance group (Group 33709). The enrollment remained relatively stable throughout the period, averaging 493 contracts and 1,038 total members, with coverage types including employee only, employee & spouse, employee & children, and family plans.
The financial breakdown shows total premiums of $1,124,332.94 for the year, with ASO/MPP fees of $433,955.55 and stoploss premiums of $690,377.39. Total medical claims reached $4,345,320.16, with pharmacy claims adding $805,494.41. The report provides a detailed monthly breakdown of enrollment, premiums, capitation, value-based programs, inpatient and outpatient services, physician claims, and other medical expenses. Notable variations exist month-to-month in claims and utilization, with some months showing significantly higher medical expenses than others, such as September 2021, which had the highest total medical claims at $618,063.66.
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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
202010 490 1,029 $36,210.20 $57,795.31 $94,005.51 $0.00 $8,262.48 $8,262.48 $316.88 $84,301.67 $128,354.40 $52,834.27 $52,903.45 $318,393.79 $62,714.70
202011 494 1,034 $36,136.90 $57,037.57 $93,174.47 $0.00 $8,230.64 $8,230.64 $314.55 $136,649.57 $110,639.11 $47,634.54 $35,835.76 $330,758.98 $58,082.58
202012 495 1,033 $36,650.00 $57,696.90 $94,346.90 $0.00 $8,270.43 $8,270.43 $333.45 $21,442.13 $147,105.27 $52,731.26 $37,569.01 $258,847.67 $88,679.99
202101 500 1,038 $36,576.70 $57,744.59 $94,321.29 $0.00 $1,672.89 $1,672.89 $345.80 $126,096.53 $79,674.79 $42,610.64 $55,270.39 $303,652.35 $42,142.18
202102 498 1,036 $37,016.50 $58,031.94 $95,048.44 $0.00 $1,669.57 $1,669.57 $350.74 $109,354.52 $94,493.43 $53,161.63 $34,796.18 $291,805.76 $59,262.14
202103 495 1,034 $36,063.60 $57,237.86 $93,301.46 $0.00 $1,672.79 $1,672.79 $533.92 $70,085.78 $216,072.07 $63,012.98 $65,907.54 $415,078.37 $91,677.09
202104 501 1,043 $37,089.80 $57,863.17 $94,952.97 $0.00 $1,680.84 $1,680.84 $533.92 $74,416.66 $71,238.12 $48,622.35 $52,163.20 $246,440.33 $46,801.26
202105 502 1,053 $36,723.30 $58,068.31 $94,791.61 $0.00 $1,690.50 $1,690.50 $515.12 $83,593.85 $188,121.71 $75,855.10 $38,498.64 $386,069.30 $47,936.28
202106 490 1,042 $36,356.80 $58,279.77 $94,636.57 $0.00 $1,684.06 $1,684.06 $637.50 $62,873.82 $118,783.16 $67,199.28 $63,422.09 $312,278.35 $63,637.12
202107 486 1,041 $35,701.99 $57,818.07 $93,520.06 $0.00 $1,682.45 $1,682.45 $775.20 $138,348.90 $122,230.69 $63,808.86 $57,404.99 $381,793.44 $69,559.22
202108 487 1,048 $35,550.50 $57,970.72 $93,521.22 $0.00 $1,684.06 $1,684.06 $785.40 $145,770.97 $168,725.50 $110,204.59 $57,437.10 $482,138.16 $75,720.90
202109 480 1,027 $33,879.26 $54,833.18 $88,712.44 $0.00 $1,640.59 $1,640.59 $1,104.10 $286,356.24 $179,623.21 $84,730.09 $67,354.12 $618,063.66 $99,280.95
Total 5,918 12,458 $433,955.55 $690,377.39 $1,124,332.94 $0.00 $39,841.30 $39,841.30 $6,546.58 $1,339,290.64 $1,625,061.46 $762,405.59 $618,562.47 $4,345,320.16 $805,494.41
Grouping Avg 493 1,038 $36,162.96 $57,531.45 $93,694.41 $0.00 $3,320.11 $3,320.11 $545.55 $111,607.55 $135,421.79 $63,533.80 $51,546.87 $362,110.01 $67,124.53
Monthly Avg 493 1,038 $36,162.96 $57,531.45 $93,694.41 $0.00 $3,320.11 $3,320.11 $545.55 $111,607.55 $135,421.79 $63,533.80 $51,546.87 $362,110.01 $67,124.53 $433,100.20
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.
$453,810.31
$560,328.52
$720,089.30
$5,197,202.45
$433,100.20
$353,088.21
$508,962.17
$295,456.35
$436,211.20
$378,237.03
Grand Total
$389,687.85
$397,386.75
$356,131.54
$347,813.22
Monitoring by Utilization and Enrollment Company: CITY OF ST CLOUD Group: 33709 Current Paid Period: From 10/2020 to 09/2021
Enrollment Premium Capitation Fee for Service Claims
This Florida Blue report is proprietary and confidential. Report Run: 06/13/2022 2:55 PM Page 1 of 2
Paid Year Month Employee Only
Employee & Spouse
Employee & Children
Family Spouse Only Spouse & Children
Children Only Total Contracts
Total Members
202010 238 74 56 122 0 0 0 490 1,029
202011 242 74 55 123 0 0 0 494 1,034
202012 243 74 56 122 0 0 0 495 1,033
202101 246 74 57 123 0 0 0 500 1,038
202102 245 73 57 123 0 0 0 498 1,036
202103 242 72 57 124 0 0 0 495 1,034
202104 245 74 59 123 0 0 0 501 1,043
202105 243 74 59 126 0 0 0 502 1,053
202106 233 71 58 128 0 0 0 490 1,042
202107 231 68 57 130 0 0 0 486 1,041
202108 230 67 57 133 0 0 0 487 1,048
202109 227 66 59 128 0 0 0 480 1,027
Total 2,865 861 687 1,505 0 0 0 5,918 12,458
Grouping Avg 239 72 57 125 0 0 0 493 1,038
Monthly Avg 239 72 57 125 0 0 0 493 1,038
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: 06/13/2022 2:55 PM Page 2 of 2
| S1 Monitoring by Utiliza Page1 |
| S2 Monitoring by Utiliza Page2 |
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