Exhibit_E_St_Cloud_BCBS_Runout_1021_to_0922.pdf

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Attached to
Onsite Clinic Management Services for Employee Health Center
Solicitation number
2024-007
Issued by
Polk County, Florida

About this file

Written by GovTribe AI ·

This document is a Florida Blue Monitoring by Utilization and Enrollment report for the City of St. Cloud, covering two different Predictable Cost Plan health insurance contracts (05771 and 05772) for the period from October 2021 to September 2022. The reports detail monthly medical claims, capitation, and fee-for-service expenses across various categories including inpatient, outpatient, physician, and other medical services, with pharmacy costs also tracked. Both plans show zero enrolled contracts and members throughout the reporting period, and maintain a 0.00% Medical Loss Ratio (MLR).

The reports provide granular financial data broken down by month, with total medical expenses ranging from negative values (indicating credits or adjustments) to positive claims. For Plan 05771, the grand total medical expenses are $131,514.05, while Plan 05772 shows total medical expenses of $265,173.44. Despite the extensive financial tracking, the reports indicate no active enrollment during the contract period, suggesting these might be run-out reports for claims processing after the conclusion of an insurance contract or during a transition period. The detailed breakdown includes categories like Value Based Programs, Inpatient, Outpatient, Physician, and Other medical services, providing a comprehensive view of potential medical expense allocations.

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Premium

Paid Year Month

Contracts Members Premium PCP Specialty Total Capitation

Value Based Programs

Inpatient Outpatient Physician Other Total Medical Pharmacy Grand Total MLR

202110 0 0 $0.00 $0.00 $0.00 $0.00 $260.64 $1,153.98 $23,993.71 $8,155.13 $5,320.30 $38,623.12 $950.36 $39,834.12 0.00%

202111 0 0 $0.00 $0.00 $1.61 $1.61 $300.46 $20,562.79 $5,795.14 $5,356.40 $8,055.82 $39,770.15 $0.00 $40,072.22 0.00%

202112 0 0 $0.00 $0.00 $0.00 $0.00 $332.15 $47,551.29 $249.02 ($46.77) $1,121.02 $48,874.56 $2.44 $49,209.15 0.00%

202201 0 0 $0.00 $0.00 $0.00 $0.00 $321.20 ($4,920.24) $2,331.43 $2,434.26 $770.16 $615.61 $0.00 $936.81 0.00%

202202 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ($61.37) ($1,464.57) $444.19 ($1,081.75) $0.00 ($1,081.75) 0.00%

202203 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1,628.35 $327.65 $0.00 $1,956.00 $0.00 $1,956.00 0.00%

202204 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $118.56 $606.41 $724.97 $0.00 $724.97 0.00%

202205 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $543.59 $543.59 $0.00 $543.59 0.00%

202206 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $427.00 $0.00 $427.00 $0.00 $427.00 0.00%

202207 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ($971.00) $0.00 ($143.59) ($1,114.59) $0.00 ($1,114.59) 0.00%

202208 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $803.52 $0.00 $803.52 $0.00 $803.52 0.00%

202209 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ($796.99) $0.00 ($796.99) $0.00 ($796.99) 0.00%

Total 0 0 $0.00 $0.00 $1.61 $1.61 $1,214.45 $64,347.82 $32,965.28 $15,314.19 $16,717.90 $129,345.19 $952.80 $131,514.05 0.00%

Grouping Avg 0 0 $0.00 $0.00 $0.13 $0.13 $101.20 $5,362.32 $2,747.11 $1,276.18 $1,393.16 $10,778.77 $79.40 $10,959.50 0.00%

Monthly Avg 0 0 $0.00 $0.00 $0.13 $0.13 $101.20 $5,362.32 $2,747.11 $1,276.18 $1,393.16 $10,778.77 $79.40 $10,959.50 0.00%

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.

Monitoring by Utilization and Enrollment Company: CITY OF ST CLOUD Group: 33709 Current Paid Period: From 10/2021 to 09/2022 Plan: PREDICTABLE COST PLAN 05771

Enrollment Capitation Fee for Service Claims

This Florida Blue report is proprietary and confidential. Report Run: 10/17/2022 12:08 PM Page 1 of 2

No data exists for selected account and/or parameter criteria.

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: 10/17/2022 12:08 PM Page 2 of 2

Premium

Paid Year Month

Contracts Members Premium PCP Specialty Total Capitation

Value Based Programs

Inpatient Outpatient Physician Other Total Medical Pharmacy Grand Total MLR

202110 0 0 $0.00 $0.00 $0.00 $0.00 $825.36 $91,483.57 $47,729.43 $29,954.15 $11,596.54 $180,763.69 $30,593.46 $212,182.51 0.00%

202111 0 0 $0.00 $0.00 $0.00 $0.00 $857.94 $0.00 ($3,592.82) $12,329.67 $5,249.71 $13,986.56 $29.90 $14,874.40 0.00%

202112 0 0 $0.00 $0.00 $0.00 $0.00 $886.95 $0.00 $26,748.62 $5,260.66 $1,596.41 $33,605.69 $0.00 $34,492.64 0.00%

202201 0 0 $0.00 $0.00 $0.00 $0.00 $886.95 $0.00 $1,713.08 $653.44 $2,504.69 $4,871.21 ($45.00) $5,713.16 0.00%

202202 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ($2,513.68) $2,027.08 $354.28 ($132.32) $0.00 ($132.32) 0.00%

202203 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.51 $272.45 $302.96 $0.00 $302.96 0.00%

202204 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $879.19 $100.00 $979.19 $0.00 $979.19 0.00%

202205 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $183.15 $1,340.95 $1,524.10 $0.00 $1,524.10 0.00%

202206 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $295.00 ($45.23) $249.77 $0.00 $249.77 0.00%

202207 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ($1,972.63) ($2,265.28) $0.00 ($4,237.91) $0.00 ($4,237.91) 0.00%

202208 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ($968.24) $0.00 $0.00 ($968.24) $0.00 ($968.24) 0.00%

202209 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $68.18 $125.00 $193.18 $0.00 $193.18 0.00%

Total 0 0 $0.00 $0.00 $0.00 $0.00 $3,457.20 $91,483.57 $67,143.76 $49,415.75 $23,094.80 $231,137.88 $30,578.36 $265,173.44 0.00%

Grouping Avg 0 0 $0.00 $0.00 $0.00 $0.00 $288.10 $7,623.63 $5,595.31 $4,117.98 $1,924.57 $19,261.49 $2,548.20 $22,097.79 0.00%

Monthly Avg 0 0 $0.00 $0.00 $0.00 $0.00 $288.10 $7,623.63 $5,595.31 $4,117.98 $1,924.57 $19,261.49 $2,548.20 $22,097.79 0.00%

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.

Monitoring by Utilization and Enrollment Company: CITY OF ST CLOUD Group: 33709 Current Paid Period: From 10/2021 to 09/2022 Plan: PREDICTABLE COST PLAN 05772

Enrollment Capitation Fee for Service Claims

This Florida Blue report is proprietary and confidential. Report Run: 10/17/2022 12:09 PM Page 1 of 2

No data exists for selected account and/or parameter criteria.

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: 10/17/2022 12:09 PM Page 2 of 2

S1 Monitoring by Utiliza Page1
S2 Monitoring by Utiliza Page2
S1 Monitoring by Utiliza Pa (2)
S2 Monitoring by Utiliza Pa (2)

File details come from the government source that posted it. Updated .