RFP - COG-GUC - Monthly Experience Reports - December 2025.xls

This is a monthly healthcare experience report for self-funded health insurance plans administered by the City of Greenville and Greenville Utilities Commission (GUC) in North Carolina, covering the period January through August 2025. The document presents detailed claims experience data across multiple health plan products including dental PPO plans (DENT and DPPO), medical plans (CORE and ENHANCED Open Access Plans), HSA plans for family and individual coverage, vision plans (CIGNA VISION), and COBRA coverage options. The report is organized by account (GUC, Greenville Housing Authority, and City of Greenville with multiple departmental branches), benefit option, and product type, with data broken down monthly to track utilization patterns and cost trends across active employees, pre-65 retirees, post-65 retirees, and COBRA participants. Total membership across all accounts ranges from approximately 8,400 to 8,600 members monthly, with total subscribers varying between 4,300 and 4,350 during the reported period.

The report details claims experience on a self-funded, experience-rated basis, with all claims included in the analysis and accounting for paid claim dollars including cost containment service deductions. Fixed charges, in-network claims, out-of-network claims, and prescription drug claims are tracked separately, with gross claims and stop loss amounts calculated to derive net claims figures. Cumulative claims for the eight-month period total approximately $17.9 million across all accounts and product lines, with monthly variations reflecting seasonal utilization patterns. The report indicates stop loss protection was applied selectively to certain benefit options and accounts, particularly in April, May, June, July, and August, with significant stop loss recoveries recorded for specific high-cost claims in the Greenville Housing Authority Enhanced Open Access Plan and City of Greenville various medical and pharmaceutical benefit options. This experience data serves as the foundation for retrospective rate calculations and contract performance evaluation under the self-funded administrative services organization (ASO) arrangement.