Exhibit_J_-_Large_Claims_2022-2024_(3_TABS_to_VIEW)_FINAL.xlsx

XLSX spreadsheet 52 KB Posted Jun 30, 2025

Attached to: 25-P-115TF Self-Funded Group Health Plan Administrative Services
Solicitation number: 25-P-115TF
Issued by: Volusia County, Florida

About this file

Written by GovTribe AI · Jul 2, 2025

The document is an Excel spreadsheet titled "Exhibit J - Large Claims 2022-2024" for Volusia County Government, detailing high-cost health insurance claims over $150,000 for the years 2022, 2023, and 2024. The related state and local contract opportunity is a Request for Proposals (RFP) for a self-funded group health plan administrative services contract, seeking a provider to manage health benefits for county employees, retirees, and COBRA participants. The contract is structured for an initial five-year term with a potential five-year renewal, effective January 1, 2027, with the county intending to award a single Administrative Services Only (ASO) contract.

The claims data reveals significant medical expenses across various diagnoses, with total annual claims over $150,000 ranging from approximately $8.2 million in 2022 to $12.1 million in 2024. The claims data includes detailed medical conditions such as cancer, epilepsy, heart diseases, and complex medical treatments, with individual claim amounts ranging from $150,000 to over $2 million. The spreadsheet breaks down claims by relationship type (employee, spouse, dependent) and provides monthly payment tracking, which could be instrumental in evaluating the county's healthcare utilization and potential cost management strategies for the upcoming administrative services contract.

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Other files

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25-P-115TF_Self-Funded_Group_Health_Plan_Administrative_Services_(Addendum_#6_Revision).pdf	PDF	Aug 6, 2025
25-P-115TF_Self-Funded_Group_Health_Plan_Administrative_Services.pdf	PDF	Jul 1, 2025
Exhibit_D_-_Insurance_Requirements_(For_DRAFT_Contract)_FINAL_.pdf	PDF	Jun 30, 2025
25-P-115TF_Self-Funded_Group_Health_Plan_Admin_Srvs_Agreement_FINAL_DRAFT.pdf	PDF	Jun 30, 2025
Exhibit_M_-_Pharmacy_Claims_Pricing_File_(1_TAB_TO_COMPLETE,_DO_NOT_SUBMIT)_FINAL.xlsx	XLSX spreadsheet	Jun 30, 2025
Exhibit_L_-_Medical_Discount_Pricing_File_(3_TABS_TO_COMPLETE,_DO_NOT_SUBMIT)_FINAL.xlsx	XLSX spreadsheet	Jun 30, 2025
Exhibit_K_–_Medical_Claims_Pricing_File_(3_TABS_TO_COMPLETE,_DO_NOT_SUBMIT)_FINAL.xlsx	XLSX spreadsheet	Jun 30, 2025
Exhibit_I_-_Census_(3_TABS_to_VIEW)_FINAL.xlsx	XLSX spreadsheet	Jun 30, 2025
Exhibit_H_-_Claims_Experience_(2_TABS_to_VIEW)_FINAL.xlsx	XLSX spreadsheet	Jun 30, 2025
Exhibit_G_-_County_Computing_Security_Procedures_FINAL.pdf	PDF	Jun 30, 2025
Exhibit_F_-_HIPPA_Business_Associate_Agreement_FINAL.pdf	PDF	Jun 30, 2025
Exhibit_E_-_Human_Trafficking_Affidavit_FINAL.pdf	PDF	Jun 30, 2025
Exhibit_C_-_Summary_Plan_Document_(2025)_FINAL.pdf	PDF	Jun 30, 2025
Attachment_B.1_Pharmacy_Pricing_Guarantees_(1_TAB_TO_COMPLETE)_FINAL.xlsx	XLSX spreadsheet	Jun 30, 2025
Exhibit_B_-_Fees_and_Performance_Guarantees_FINAL.docx	DOCX document	Jun 30, 2025
Exhibit_A.4_-_Onsite_Job_Descriptions_FINAL.pdf	PDF	Jun 30, 2025
Exhibit_A.3_-_Claims_Reporting_Fields_FINAL.pdf	PDF	Jun 30, 2025
Attachment_A.2_-_Network_and_Formulary_Disruption_(4_TABS_TO_COMPLETE)_FINAL.xlsx	XLSX spreadsheet	Jun 30, 2025
Attachment_A.1_-_Worksheet_Health_Plan_Administrative_Services_FINAL.docx	DOCX document	Jun 30, 2025
Exhibit_A_-_Scope_of_Services_FINAL.pdf	PDF	Jun 30, 2025

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2024 Claimants Over $150K

Claimant Payments over $150,000

Volusia County Government

Paid Dates: 1/1/2024 - 12/31/2024

Case #	Relationship	Diagnosis	YTD	Paid Month												Remember to Delete Hidden Section in email Version
				202301	202302	202303	202304	202305	202306	202307	202308	202309	202310	202311	202312	Stop Loss - None
1	Dependent	Lennox-Gastaut Syndrome, Intractable, W Status Epilepticus	$1,656,710	$224,179	$70,076	$52,636	$75,772	$77,066	$90,766	$51,910
2	Employee	Malignant Neoplasm Of Left Kidney, Except Renal Pelvis	$699,049
3	Spouse	I/I React D/T Indwelling Urethral Catheter, Init	$562,392
4	Dependent	Single Liveborn Infant, Delivered By Cesarean	$536,795
5	Employee	Other Overlap Syndromes	$366,261
6	Employee	Paresthesia Of Skin	$328,044
7	Spouse	Sepsis, Unspecified Organism	$322,029
8	Employee	Mastitis Without Abscess	$320,461
9	Employee	Intervertebral Disc Disorders W Radiculopathy, Lumbar Region	$318,726
10	Spouse	Sepsis, Unspecified Organism	$300,943
11	Spouse	Nonfamilial Hypogammaglobulinemia	$291,854
12	Employee	Athscl Heart Disease Of Native Coronary Artery W/O Ang Pctrs	$254,834
13	Employee	Sepsis Due To Enterococcus	$248,276
14	Dependent	Single Liveborn Infant, Delivered Vaginally	$241,341
15	Spouse	Thrombosis Due To Cardiac Prosth Dev/Grft, Initial Encounter	$228,491
16	Employee	Traum Subdr Hem W/O Loss Of Consciousness, Init	$224,701
17	Employee	Encntr For Gyn Exam (General) (Routine) W/O Abn Findings	$224,134
18	Spouse	Nontraumatic Intcrbl Hemorrhage In Hemisphere, Cortical	$223,667
19	Employee	Athscl Heart Disease Of Native Cor Art W Unstable Ang Pctrs	$216,685
20	Employee	Dizziness And Giddiness	$212,953
21	Spouse	Malignant Neoplasm Of Unsp Site Of Unspecified Female Breast	$209,512
22	Employee	Wedge Compression Fracture Of Third Lumbar Vertebra, Init	$208,833
23	Employee	Malignant Neoplasm Of Sigmoid Colon	$199,950
24	Spouse	Myasthenia Gravis Without (Acute) Exacerbation	$199,789
25	Employee	Multiple Sclerosis	$199,670
26	Employee	Other Spondylosis With Radiculopathy, Lumbar Region	$195,959
27	Spouse	Stiff-Man Syndrome	$195,075
28	Employee	Malignant Neoplasm Of Sigmoid Colon	$186,903
29	Spouse	Non-St Elevation (Nstemi) Myocardial Infarction	$185,867
30	Dependent	Single Liveborn Infant, Delivered Vaginally	$185,281
31	Employee	Dislocation Of Other Internal Joint Prosthesis, Init Encntr	$184,281
32	Employee	Cervical Disc Disorder At C5-C6 Level With Radiculopathy	$179,454
33	Employee	Sepsis, Unspecified Organism	$179,342
34	Employee	Malignant Neoplasm Of Cervix Uteri, Unspecified	$176,046
35	Employee	End Stage Renal Disease	$173,470
36	Spouse	Type 2 Diabetes Mellitus With Other Specified Complication	$171,015
37	Employee	Encntr For Checking And Test Of Card Pacemaker Pulse Gnrtr	$170,207
38	Spouse	Displ Suprcndl Fx W/O Intrcndl Extn Low End R Femr, 7Thb	$169,299	$3,410	$247,860	$209,454	$33,416	$62,307	$2,819	$29,784
39	Employee	Supraventricular Tachycardia, Unspecified	$168,206	$383,662	$120	$0	$0	$0	$0	$0
40	Employee	Encounter For Screening For Malignant Neoplasm Of Colon	$165,395	$35,307	$208,746	$109,887	$7,050	$741	$197	$327
41	Employee	Athscl Heart Disease Of Native Coronary Artery W/O Ang Pctrs	$163,932	$18,632	$8,301	$21,050	$22,013	$12,964	$7,492	$240,247
42	Employee	Malignant Neoplasm Of Left Kidney, Except Renal Pelvis	$161,647	$65,256	$25,515	$60,686	$27,235	$26,511	$61,081	$26,009
43	Employee	Nonrheumatic Aortic (Valve) Stenosis	$155,321
45	Employee	DISPLACED BICONDYLAR FRACTURE OF RIGHT TIBIA, INIT	$151,641	$78	$96,401	$78,350	$101,165	$4,069	$0	$0
Total Claimants Over $150,000 in Paid Claims			$12,114,442	$730,525	$657,019	$532,062	$266,650	$183,657	$162,355	$348,278	$0	$0	$0	$0	$0

PMPM Current PY $254.05

&"Arial,Bold"&11 25-P-115TF &"Arial,Bold"&11Exhibit J - Large Claims 2022-2024

2023 Claimants Over $150K

Claimant Payments over $150,000

Volusia County Government

Paid Dates: 1/1/2023 - 12/31/2023

Case #	Relationship	Diagnosis	YTD	Paid Month												Remember to Delete Hidden Section in email Version
				202301	202302	202303	202304	202305	202306	202307	202308	202309	202310	202311	202312	Stop Loss - None
1	Dependent	Epilepsy, Unsp, Not Intractable, With Status Epilepticus	$1,061,460	$224,179	$70,076	$52,636	$75,772	$77,066	$90,766	$51,910
2	Spouse	Myelodysplastic Syndrome, Unspecified	$651,561
3	Spouse	Pneumonia, Unspecified Organism	$496,336
4	Employee	Sepsis, Unspecified Organism	$440,766
5	Spouse	Traum Subdr Hem W Loc Of Unsp Duration, Init	$383,782
6	Spouse	Other Pulmonary Embolism Without Acute Cor Pulmonale	$379,646
7	Employee	Nonrheumatic Mitral (Valve) Insufficiency	$379,191
8	Employee	Type 2 Diabetes W Diabetic Peripheral Angiopathy W Gangrene	$361,764
9	Employee	Malignant Neoplasm Of Left Kidney, Except Renal Pelvis	$334,006
10	Employee	Sepsis, Unspecified Organism	$328,107
11	Dependent	Encounter For Antineoplastic Radiation Therapy	$316,005
12	Spouse	Malignant Neoplasm Of Ovrlp Sites Of Right Female Breast	$312,994
13	Spouse	Sepsis, Unspecified Organism	$301,570
14	Spouse	Malignant Neoplasm Of Central Portion Of Left Female Breast	$299,324
15	Employee	Malignant Neoplasm Of Floor Of Mouth, Unspecified	$285,437
16	Employee	Malignant Neoplasm Of Unsp Site Of Unspecified Female Breast	$284,374
17	Employee	Crohn'S Disease Of Both Small And Lg Int W/O Complications	$279,197
18	Employee	Intraductal Carcinoma In Situ Of Right Breast	$272,360
19	Spouse	Malig Neoplasm Of Upper-Outer Quadrant Of Left Female Breast	$260,219
20	Dependent	Adolescent Idiopathic Scoliosis, Thoracolumbar Region	$252,530
21	Spouse	Ankylosing Spondylitis Of Unspecified Sites In Spine	$243,693
22	Spouse	Spinal Stenosis, Lumbar Region With Neurogenic Claudication	$231,766
23	Employee	Syncope And Collapse	$229,472
24	Employee	End Stage Renal Disease	$218,536
25	Employee	Other Persistent Atrial Fibrillation	$210,280
26	Dependent	Other Specified Injury Of Thoracic Aorta, Initial Encounter	$200,506
27	Employee	Sepsis, Unspecified Organism	$199,248
28	Employee	Unspecified Atrial Fibrillation	$198,409
29	Spouse	Athscl Heart Disease Of Native Cor Art W Unstable Ang Pctrs	$195,895
30	Employee	Intervertebral Disc Disorders W Radiculopathy, Lumbar Region	$190,499
31	Dependent	Hypoglycemia, Unspecified	$189,592
32	Spouse	Anemia, Unspecified	$180,292
33	Employee	Unspecified Atrial Fibrillation	$174,748
34	Employee	Abrasion, Left Lower Leg, Initial Encounter	$173,822
35	Employee	Hypothyroidism, Unspecified	$166,612
36	Employee	Other Spondylosis With Myelopathy, Cervical Region	$164,091
37	Dependent	Primary Atelectasis Of Newborn	$163,485
38	Employee	Ulcerative Colitis, Unspecified, Without Complications	$160,954	$3,410	$247,860	$209,454	$33,416	$62,307	$2,819	$29,784
39	Spouse	Myasthenia Gravis Without (Acute) Exacerbation	$157,743	$383,662	$120	$0	$0	$0	$0	$0
40	Employee	Sepsis, Unspecified Organism	$155,595	$35,307	$208,746	$109,887	$7,050	$741	$197	$327
41	Spouse	Other Spondylosis With Radiculopathy, Lumbosacral Region	$155,430	$18,632	$8,301	$21,050	$22,013	$12,964	$7,492	$240,247
42	Spouse	Melena	$152,489	$65,256	$25,515	$60,686	$27,235	$26,511	$61,081	$26,009
43	Spouse	Ulcerative Colitis, Unspecified With Rectal Bleeding	$150,940	$28,136	$44,581	$77,458	$28,744	$24,273	$42,551	$37,815
44	Dependent	Oth Maternal Infec/Parastc Diseases Comp Preg, Third Tri	$150,189	$78	$96,401	$78,350	$101,165	$4,069	$0	$0
Total Claimants Over $150,000 in Paid Claims			$12,094,915	$758,661	$701,600	$609,520	$295,394	$207,930	$204,905	$386,093	$0	$0	$0	$0	$0

PMPM Current PY $254.05

&"Arial,Bold"&11 25-P-115TF &"Arial,Bold"&11Exhibit J - Large Claims 2022-2024

2022 Claimants Over $150K

Claimant Payments over $150,000

Volusia County Government

Paid Dates: 1/1/2022 - 12/31/2022

Case # Relationship Diagnosis YTD

1	Dependent	Other Encephalitis And Encephalomyelitis	$2,005,316
2	Subscriber	Acute Lymphoblastic Leukemia Not Having Achieved Remission	$442,144
3	Spouse/Domestic Partner	Malignant Neoplasm Of Overlapping Sites Of Right Bronchus And Lung	$363,966
4	Spouse/Domestic Partner	Encounter For Antineoplastic Chemotherapy	$362,674
5	Spouse/Domestic Partner	Postprocedural Hemorrhage And Hematoma Of A Respiratory System Organ Or Structure Following A Respiratory System Procedure	$346,861
6	Subscriber	Infection And Inflammatory Reaction Due To Internal Left Knee Prosthesis, Initial Encounter	$333,115
7	Spouse/Domestic Partner	Nonfamilial Hypogammaglobulinemia	$327,939
8	Subscriber	Type 1 Diabetes Mellitus With Unspecified Diabetic Retinopathy Without Macular Edema	$313,432
9	Spouse/Domestic Partner	Malignant Neoplasm Of Nasal Cavity	$273,690
10	Spouse/Domestic Partner	Sepsis Due To Enterococcus	$271,065
11	Subscriber	Encounter For Antineoplastic Chemotherapy	$240,459
12	Subscriber	Spinal Stenosis, Cervical Region	$232,393
13	Subscriber	Malignant Neoplasm Of Left Kidney, Except Renal Pelvis	$214,899
14	Subscriber	Other Complete Intestinal Obstruction….Unspecified As To Partial Versus Complete Obstruction	$214,847
15	Spouse/Domestic Partner	Malignant Neoplasm Of Upper-Outer Quadrant Of Left Female Breast	$207,103
16	Subscriber	Malignant Neoplasm Of Upper-Outer Quadrant Of Left Female Breast	$203,031
17	Spouse/Domestic Partner	Myelodysplastic Syndrome, Unspecified	$194,572
18	Subscriber	Hypertensive Heart Disease With Heart Failure	$181,570
19	Spouse/Domestic Partner	Sepsis, Unspecified Organism	$180,394
20	Subscriber	Crohn'S Disease Of Small Intestine Without Complications	$172,518
21	Subscriber	Nonrheumatic Mitral (Valve) Insufficiency	$172,478
22	Subscriber	Unspecified Convulsions	$170,025
23	Subscriber	Paralytic Ileus	$164,319
24	Spouse/Domestic Partner	Encounter For Antineoplastic Chemotherapy	$163,228
25	Subscriber	End Stage Renal Disease	$160,778
26	Subscriber	Crohn'S Disease, Unspecified, Without Complications	$160,276
27	Subscriber	End Stage Renal Disease	$153,298
Total Claimants Over $150,000 in Paid Claims			$8,226,390

&"Arial,Bold"&11 25-P-115TF &"Arial,Bold"&11Exhibit J - Large Claims 2022-2024 image1.jpeg

File details come from the government source that posted it. Updated Jul 2, 2025.