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

This is a large claims exhibits file supporting Volusia County, Florida's RFP 25-P-115TF for self-funded group health plan administrative services. The document presents three years of claims data (2022-2024) detailing individual claimants with paid claims exceeding $150,000 annually. The 2024 data covers 45 claimants with total paid claims of $12,114,442, the 2023 data covers 44 claimants with total paid claims of $12,094,915, and the 2022 data covers 27 claimants with total paid claims of $8,226,390. Claims are categorized by relationship type (employee, spouse, dependent) and diagnosis, with monthly payment distributions provided for 2023 and 2024. Notable high-cost diagnoses across the three-year period include Lennox-Gastaut Syndrome, malignant neoplasms of various sites, sepsis, end-stage renal disease, and multiple forms of heart disease. The per-member-per-month (PMPM) cost is calculated at $254.05 for the current plan year.

The large claims data demonstrates significant and recurring healthcare costs for Volusia County's self-insured plan, with annual expenditures for claimants over $150,000 consistently ranging between $8.2 million and $12.1 million. These exhibits serve as baseline information for prospective Administrative Services Only (ASO) contractors to understand the county's claims experience and cost profile. The data indicates that the county's plan population experiences substantial claims concentration among a relatively small number of high-cost cases, which impacts network adequacy requirements, stop-loss considerations, and utilization management strategies that potential respondents must address in their proposals.