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

Exhibit J is a large claims analysis document prepared for Volusia County Government detailing claimant payments exceeding $150,000 across three fiscal years (2022-2024). The exhibit provides a comprehensive breakdown of the county's self-funded health plan's most expensive medical cases, categorized by claimant relationship (employee, spouse, dependent), diagnosis, and monthly payment distributions. The 2024 data encompasses 45 claimants with total paid claims of $12,114,442, the 2023 data includes 44 claimants totaling $12,094,915 in paid claims, and the 2022 data covers 27 claimants with $8,226,390 in aggregate claims. The document presents monthly payment distributions for each claimant from January through December, with diagnoses ranging from rare neurological conditions such as Lennox-Gastaut Syndrome and epilepsy to complex medical conditions including malignant neoplasms, sepsis, end-stage renal disease, and cardiac disorders. The per-member-per-month (PMPM) rate referenced throughout the document is $254.05.

The large claims data reveals significant healthcare expenditure patterns for Volusia County's approximately 3,047 total subscribers and demonstrates the financial impact of catastrophic and chronic illness on a self-funded health plan. The top individual claimant in 2024, a dependent with Lennox-Gastaut Syndrome, generated $1,656,710 in annual claims, while the second-highest claimant, an employee with malignant neoplasm, incurred $699,049. These large claims represent a substantial portion of the county's total annual healthcare expenditures, which the procurement summary indicates fluctuate between $152 million and $153 million annually. The distribution of payments across both calendar months and multiple claimants illustrates the ongoing and intensive nature of these high-cost medical cases, with several claimants generating consistent monthly expenses throughout the year and others requiring episodic intensive treatments.