Exhibit_H_-_Claims_Experience_(2_TABS_to_VIEW)_FINAL.xlsx

This is a Claims Experience document for Volusia County Government's self-funded group health plan, detailing monthly claims payments and claim lags from January 2021 through February 2025. The document presents comprehensive claims data across medical, facility, professional, and pharmacy categories for approximately 3,047 total members across an average of 6,260 subscribers. Monthly claims summaries show total medical claims ranging from approximately $1.3 million to $6.9 million, with pharmacy claims ranging from approximately $785,000 to $1.6 million, resulting in grand totals varying between $3.2 million and $6.9 million monthly. The claims lag analysis demonstrates the timing and distribution of claim payments across multiple months, indicating how current and prior-month claims are settled, with most claims paid within 2-4 months of the service month. Over the entire 50-month period reviewed, total claims expenditures reached approximately $152.6 million for medical claims and $52.9 million for pharmacy claims, representing cumulative health plan costs that form the basis for the RFP 25-P-115TF solicitation for administrative services.

The data reveals consistent claims processing patterns essential for evaluating prospective Administrative Services Only (ASO) vendors, with inpatient facility costs typically ranging from $400,000 to $1.4 million monthly and outpatient facility costs ranging from $475,000 to $2.1 million monthly. Professional claims costs fluctuate between $600,000 and $1.8 million monthly, while pharmacy expenditures demonstrate increasing trends in recent months, particularly from mid-2024 forward. The claims lag analysis indicates mature claim settlement procedures with the vast majority of claims processed within the initial paid month and subsequent three months, demonstrating operational efficiency and predictable cash flow requirements. This historical claims data serves as the benchmark for evaluating bidder qualifications, performance guarantees, claims processing capabilities, and financial stability assessments in the county's procurement of comprehensive health plan administration services effective January 1, 2027.