Exhibit H – Claims Experience Summary

This document is a claims experience exhibit submitted by Volusia County, Florida in support of its RFP 25-P-115TF for self-funded group health plan administrative services. The exhibit presents comprehensive claims data spanning from January 2021 through February 2025, detailing medical and pharmacy claims paid by the county's self-insured health plan. The data is organized into two primary sections: a Claims Summary by Month showing monthly membership, contract counts, and detailed breakdowns of inpatient facility claims, outpatient facility claims, professional claims, and pharmacy claims; and a Claims Lags analysis demonstrating the timing and lag pattern of claims payments by service month. The membership data indicates relatively stable enrollment ranging from approximately 3,047 to 3,202 contracts with 6,171 to 6,349 total members throughout the period, while medical claims payments fluctuate monthly between approximately $2.0 million and $4.0 million, with pharmacy claims ranging between $0.8 million and $1.6 million monthly.

The cumulative claims data reveals total medical claims paid of approximately $152.6 million over the 50-month observation period, with total pharmacy claims of approximately $52.9 million, resulting in combined grand total claims of approximately $205.5 million. The Claims Lags section provides detailed analysis of payment timing, indicating that the majority of claims are paid within one to two months of service delivery, with the diagonal of each matrix representing current-month paid claims and subsequent columns representing prior-period claims adjustments and lag payments. This historical claims experience data serves as a critical baseline for prospective vendors to understand the county's anticipated claims volume, cost trends, and administrative processing requirements when submitting proposals for the January 1, 2027 contract effective date.