Exhibit_H_-_Claims_Experience_(2_TABS_to_VIEW)_FINAL.xlsx

This exhibit contains detailed claims experience data for Volusia County Government's self-funded group health plan covering the period from January 2021 through February 2025. The document presents two primary data sets: a Claims Summary by Month showing membership, contract numbers, and payment breakdowns by category (inpatient, outpatient, facility, professional, medical, and pharmacy claims), and a comprehensive Claims Lags analysis tracking when claims from specific service months were actually paid across subsequent months. The Claims Summary reflects an average membership of approximately 6,250 members across roughly 3,170 contracts, with monthly total claims payments ranging from approximately $3.2 million to $6.9 million. Medical claims (combining facility and professional components) consistently represent the largest expense category, typically ranging from $2.4 million to $5.4 million monthly, while pharmacy claims range from approximately $760,000 to $1.6 million monthly. The data demonstrates relatively consistent claim lags, with most claims being paid within two to three months of service delivery, though the lags analysis shows that approximately 40-50% of claims are paid in the month of service or the immediate following month, with remaining claims distributed across subsequent months.

The total claims paid across the entire period from January 2021 through February 2025 reached approximately $205.5 million, comprised of $152.6 million in medical claims and $52.9 million in pharmacy claims. This historical claims experience data serves as a critical baseline for evaluating bids in the 25-P-115TF RFP for administrative services only (ASO) contract beginning January 1, 2027. The exhibits demonstrate stable enrollment and predictable claims patterns, with December 2024 representing an anomalous high-cost month at $6.9 million in total claims. The claims lag patterns indicate consistent administrative processing efficiency, with the majority of claims flowing through the system within a standard 60-90 day payment window, information essential for prospective vendors to understand cash flow requirements and reserve adequacy for the self-funded plan going forward.