Exhibit_L_-_Medical_Discount_Pricing_File_(3_TABS_TO_COMPLETE,_DO_NOT_SUBMIT)_FINAL.xlsx

Exhibit L - Medical Discount Pricing File for Volusia County, Florida Self-Funded Group Health Plan Administrative Services

This is a medical claims re-pricing exhibit prepared for the Volusia County, Florida RFP 25-P-115TF for self-funded group health plan administrative services. The document contains detailed claims data incurred from January 1, 2024 through December 31, 2024, with payments processed through February 28, 2025. The file is organized into three primary sections—Facility, Ancillary, and Professional services—and presents historical claims information by provider, service type, and visit category to establish baseline pricing benchmarks for proposal evaluation. Bidders are instructed to use this data to calculate their aggregate allowed amounts and average discount percentages, which must be transferred to Exhibit B, Section 8, Item 2 of their proposals.

The facility services section documents $57.78 million in total billed amounts across 11,604 inpatient admits and outpatient/emergency room visits, with major providers including AdventHealth Daytona Beach, AdventHealth Orlando, and Orlando Health Inc. Ancillary services total $6.78 million in billed claims covering radiology ($991,676), laboratory ($5.44 million), and durable medical equipment ($351,339). Professional services claims total $14.55 million, encompassing primary care and specialist office visits ($11.48 million) and ancillary professional services including anesthesiology, emergency medicine, and pathology ($3.07 million). All service categories currently show 100% discount percentages with zero allowed amounts, indicating this is a template requiring bidders to complete pricing information. The combined total billed amount across all three categories is $79.11 million, representing the claims experience baseline for the approximately 3,047 total subscribers covered under the county's self-funded plan.