Sample Monthly Actuarial Report.pdf
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- Health & Welfare Actuarial & Broker Consultant
- Solicitation number
- RFP AABA 2027000049 5
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a monthly actuarial report prepared by Segal for the State of Colorado Department of Personnel and Administration (DPA) evaluating the financial performance of the state's self-funded medical, prescription drug, and dental benefit plans for the period ending August 31, 2026. The report analyzes experience for the first two months of Fiscal Year 2027 and provides full-year projections based on actual claims data from Cigna, MedImpact, and Delta Dental, as well as Kaiser Permanente fully insured plan performance through July 2026. The self-funded medical and prescription drug plans generated an estimated incurred surplus of approximately $11.2 million or 11.9 percent of budget year-to-date, though full-year projections indicate a deficit of approximately $9.8 million or 1.7 percent over budget. The self-funded dental plan produced an incurred loss of approximately $374,000 or 6.8 percent of budget year-to-date. The report includes detailed breakdowns by plan type (Copay Basic, Copay Plus, HDHP with HSA, and dental plans) with month-by-month financial summaries, loss ratios, claims experience, and reserve fund tracking.
Key financial metrics indicate that medical and prescription drug claims and administrative fees through August 2026 totaled $1,653.27 per employee per month or $814.73 per member per month, representing a 1.9 percent decrease from the prior month. Prescription drug costs continue to experience double-digit trends with a 41.9 percent increase year-over-year, while prescription drug rebates declined 26.4 percent, primarily due to DPA's adoption of anti-obesity medication coverage including the Zepbound program effective May 1, 2026. The stop loss threshold was increased from $500,000 to $1,500,000 combined medical and pharmacy individual specific deductible for FY2027, resulting in reduced stop loss premiums of $1.1 million paid year-to-date compared to $3.5 million for the same period in FY2026. The reserve ending balance as of August 31, 2026 was approximately negative $14.0 million and is projected to reach $23.2 million by the end of FY2027 with advanced contributions scheduled for June 2027. The actuarial certification is provided by Deborah Donaldson, FSA, MAAA, Senior Vice President of Segal, confirming compliance with Qualification Standards for Actuaries Issuing Statements of Opinion in the United States.
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Deborah Donaldson, FSA, MAAA Senior Vice President M 303.908.9031 Ddonaldson@segalco.com
7951 E Maplewood Avenue Suite 327
Greenwood Village, CO 80111-4774 segalco.com
6006857v6/14622.001
October 7, 2026
Ms. Jennifer Valdez Statewide Benefits Manager State of Colorado Department of Personnel & Administration 1525 Sherman Street Denver, CO 80203
Dear Jennifer:
Segal has completed its review of financial results for the State of Colorado Department of Personnel and Administration’s (DPA’s) self-funded plan through August 2026, which represents the first two months of Fiscal Year 2027. The exhibits included in this report provide experience on both a paid and an incurred basis.
The results rely on medical and prescription drug claims provided by Cigna and MedImpact, as well as paid dental claims provided by Delta Dental. In addition, the attachment also provides performance on the Kaiser plans through July 2026.
Medical/Rx The self-funded medical and prescription drug plans through August 2026 are estimated to generate an incurred surplus of approximately $11.2M or 11.9% of budget. Medical and prescription drug claims and administrative fees for this period were $1,653.27 PEPM, or $814.73 PMPM, or roughly a 1.9% decrease from last month. It is anticipated that the plans will generate a surplus over the first few months of the plan year as members meet their deductibles and out of pocket maximums.
We project FY27 incurred medical and prescription drug experience will end in a deficit of approximately $9.8M or 1.7% higher than budget. As noted on the Budget Summary results page, the reserve ending balance at the end of August 2026 is approximately -$14.0M, and by the end of FY27, expected to be $23.2M with the additional advanced contributions infusion in June 2027.
Prescription drugs continue to have double digit trends with a 41.9% increase from the same period last year. In addition, the table below indicates a 26.4% reduction in PMPM rebates this year. The plan continues to experience reductions to prescription drug rebates. This is primarily a result of the change in anti-obesity medication strategy adopted by DPA, which included grandfathering in PY 2026 and more recently the implementation of the Zepbound program effective May 1, 2026.
Prior Fiscal Year
(July-Aug.)
Current Fiscal Year
(July-Aug.)
Percent Change
Gross PMPM Rx Claim Cost $227.64 $268.40 17.9% Expected PMPM Rebates ($79.90) ($58.81) -26.4% Net PMPM Rx Cost $147.74 $209.59 41.9%
The financial summary reflects estimated stop loss reimbursements based upon our projections of historical data given the lag in actual reimbursements. The stop loss threshold was increased from $500,000 to $1,500,000 combined medical and pharmacy individual specific deductible.
There are no members with medical and pharmacy paid claims exceeding this amount through August 2026.
Projected stop loss reimbursements on an incurred basis for FY2026 were $14.2M under the $500,000 threshold, and under the higher stop-loss threshold of $1,500,000, reimbursements are projected to be $2.5M for FY2027. As a result of moving to the $1,500,000 threshold, DPA will take on additional claims liability, which has been factored into the projections. Results will vary to the extent that actual large claims experience and resulting reimbursements are higher or lower than expected. Stop loss premiums were also reduced for FY2027 with a total of $1.1M paid year-to-date compared to $3.5M for the same period in FY2026.
The self-funded medical and prescription drug plans generated a paid surplus year-to-date of approximately $15.8M or 16.7% lower than budget.
Dental The self-funded dental plan has generated an incurred loss year-to-date of approximately $374K or 6.8% of budget. Claims and administrative fees for this period were $80.81 PEPM, or
$39.47 PMPM.
The self-funded dental plans generated a paid loss year-to-date of approximately $350K or 6.3% of budget.
Actuarial Certification Our internal proprietary pricing model develops aggregate revenue and expense projections.
Our Health Technical Services unit, comprised of actuaries and programmers, is responsible for the initial development and maintenance of this model. The client team programs the assumptions and the calculation methods, validates the model, and reviews the results under my supervision. We are not aware of any material inconsistencies among the assumptions used in the model and the combination of assumptions used in the model does not produce unreasonable results in the aggregate.
This document has been prepared for the exclusive use and benefit of the State of Colorado DPA, based upon information provided by you and your other service providers or otherwise made available to Segal at the time this document was created. Segal makes no representation or warranty as to the accuracy of any forward-looking statements and does not guarantee any particular outcome or result. Except as required by law or required for DPA’s proper administration, this document should not be copied, reproduced, or shared with other parties without Segal’s consent and, in such instances, should only be shared in its entirety. This document does not constitute legal, tax or investment advice or create or imply a fiduciary relationship. You are encouraged to discuss any issues raised with your legal, tax and other advisors before taking, or refraining from taking, any action
I am a Fellow of the Society of Actuaries, a Fellow of the Conference of Consulting Actuaries, and a Member of the American Academy of Actuaries. I meet the Qualification Standards for Actuaries Issuing Statements of Opinion in the United States promulgated by the American Academy of Actuaries and am qualified to render an opinion with regard to loss reserves, actuarial liabilities, and related items.
Sincerely yours, Debbie Donaldson, FSA, MAAA Senior Vice President and Actuarial Consultant
State of Colorado Division of Human Resources Self-Funded Medical and Dental Plans Historical and Projected Incurred Costs
Based on actual experience through 8/31/2026
Time Period Plan Member Months
Contributions Incurred Claims Incurred Reinsurance
Recoveries Net Incurred Claims Claims Loss Ratio Incurred Rx Rebates Expenses Profit/(Loss) Profit/Loss Percent
FY2026 Medical/Rx (12 months) Copay Basic 260,830 $207,354,162 $187,545,282 ($4,540,796) $183,004,486 88.3% ($12,839,439) $19,673,973 $17,515,143 8.4%
Copay Plus 217,273 $180,800,568 $254,388,889 ($8,562,048) $245,826,841 136.0% ($20,526,179) $16,388,541 ($60,888,635) -33.7% HDHP with HSA 120,777 $96,064,102 $70,359,259 ($1,138,913) $69,220,346 72.1% ($4,964,715) $12,451,545 $19,356,926 20.2% Sub-total 598,880 $484,218,832 $512,293,430 ($14,241,757) $498,051,673 102.9% ($38,330,333) $48,514,059 ($24,016,566) -5.0%
Dental Basic 315,003 $10,461,977 $7,779,538 $7,779,538 74.4% $856,128 $1,826,311 17.5% Basic Plus 572,078 $22,700,028 $21,473,010 $21,473,010 94.6% $1,554,818 ($327,799) -1.4% Sub-total 887,081 $33,162,005 $29,252,548 $29,252,548 88.2% $2,410,946 $1,498,512 4.5%
Self-funded plan Total $517,380,837 $541,545,978 ($14,241,757) $527,304,220 101.9% ($38,330,333) $50,925,005 ($22,518,055) -4.4%
FY2027 Medical/Rx (Actual YTD - 2 month) Copay Basic 45,124 $41,046,319 $31,337,404 ($153,247) $31,184,157 76.0% ($2,151,678) $2,305,421 $9,708,420 23.7%
Copay Plus 36,959 $35,230,521 $42,524,324 ($206,140) $42,318,184 120.1% ($3,216,466) $1,996,084 ($5,867,280) -16.7% HDHP with HSA 20,035 $18,167,413 $9,665,853 ($56,156) $9,609,697 52.9% ($637,070) $1,790,607 $7,404,178 40.8% Sub-total 102,118 $94,444,253 $83,527,581 ($415,543) $83,112,038 88.0% ($6,005,215) $6,092,112 $11,245,318 11.9%
Dental Basic 51,739 $1,645,325 $1,444,309 $1,444,309 87.8% $150,981 $50,034 3.0% Basic Plus 98,133 $3,895,218 $4,071,576 $4,071,576 104.5% $247,904 ($424,262) -10.9% Sub-total 149,872 $5,540,543 $5,515,885 $5,515,885 99.6% $398,886 ($374,228) -6.8%
Self-funded plan Total $99,984,796 $89,043,465 ($415,543) $88,627,923 88.6% ($6,005,215) $6,490,997 $10,871,091 10.9%
FY2027 Medical/Rx (Projected - 12 months) Copay Basic 270,344 $245,931,534 $213,833,009 ($919,482) $212,913,527 86.6% ($12,886,440) $13,816,328 $32,088,119 13.0%
Copay Plus 221,389 $211,052,115 $287,637,301 ($1,236,840) $286,400,461 135.7% ($20,641,278) $11,948,648 ($66,655,715) -31.6% HDHP with HSA 119,905 $108,756,513 $78,357,032 ($336,935) $78,020,097 71.7% ($4,721,802) $10,722,015 $24,736,203 22.7% Sub-total 611,638 $565,740,163 $579,827,342 ($2,493,258) $577,334,084 102.0% ($38,249,520) $36,486,992 ($9,831,394) -1.7%
Dental Basic 307,099 $9,772,798 $7,970,952 $7,970,952 81.6% $896,650 $905,195 9.3% Basic Plus 582,903 $23,157,392 $22,476,138 $22,476,138 97.1% $1,473,119 ($791,865) -3.4% Sub-total 890,002 $32,930,190 $30,447,091 $30,447,091 92.5% $2,369,769 $113,331 0.3%
Self-funded plan Total $598,670,353 $610,274,433 ($2,493,258) $607,781,175 101.5% ($38,249,520) $38,856,761 ($9,718,063) -1.6%
(2) Medical/Rx expenses include administration fees, Stop Loss premiums, EBU, Wellness, HSA and Marathon fees.
(3) Dental expenses include administration and EBU fees.
(4) The FY2026 figures include emergency supplemental funding effective November 1, 2025.
(1) Contribution amounts shown above reflect an estimate of # employees x PEPM budget rate by coverage tier. In practice, no contributions are collected by CO DPA in July and contributions are doubled in June.
State of Colorado, DPA Loss Ratio Exhibit
102% 100% 106% 104%
89%
102%
0%
25%
50%
75%
100%
125%
$0
$100,000,000
$200,000,000
$300,000,000
$400,000,000
$500,000,000
$600,000,000
$700,000,000
FY23 FY24 FY25 FY26 FY27 (2 Months) FY27 (Projection)
Self Funded Plan Performance & Projection (Includes Cigna and Delta Dental)
Expenses Budget Loss Ratio
Expenses and budget are shown on an incurred basis.
L os s R at io
State of Colorado Division of Human Resources Self-Funded Medical and Dental Plans
Paid Costs Based on actual experience through 8/31/2026
Time Period Plan Member Months Contributions Paid Claims Paid Reinsurance
Recoveries Net Paid Claims Claims Loss Ratio Paid Rx Rebates Expenses Profit/(Loss)
Profit/Loss Percent
FY2025 Medical/Rx (12 months) Copay Basic 237,452 $163,900,007 $150,216,022 ($3,410,450) $146,805,572 89.6% ($9,901,132) $16,488,959 $10,506,609 6.4%
Copay Plus 212,794 $154,219,332 $226,704,820 ($4,108,338) $222,596,482 144.3% ($19,213,160) $14,776,677 ($63,940,667) -41.5% HDHP with HSA 124,701 $87,345,049 $66,149,023 ($1,305,418) $64,843,605 74.2% ($4,688,233) $8,659,391 $18,530,286 21.2% Sub-total 574,947 $405,464,388 $443,069,865 ($8,824,206) $434,245,659 107.1% ($33,802,525) $39,925,027 ($34,903,772) -8.6%
Dental Basic 316,708 $10,659,270 $7,669,903 $7,669,903 72.0% $866,158 $2,123,209 19.9% Basic Plus 550,477 $18,517,071 $20,182,789 $20,182,789 109.0% $1,505,487 ($3,171,205) -17.1% Sub-total 867,185 $29,176,341 $27,852,692 $27,852,692 95.5% $2,371,645 ($1,047,996) -3.6%
Self-funded plan Total $434,640,730 $470,922,558 ($8,824,206) $462,098,351 106.3% ($33,802,525) $42,296,672 ($35,951,768) -8.3%
FY2026 Medical/Rx (12 months) Copay Basic 260,830 $205,457,281 $184,784,729 ($5,074,434) $179,710,295 87.5% ($13,777,490) $19,673,973 $19,850,502 9.7%
Copay Plus 217,273 $178,751,016 $253,471,430 ($8,814,879) $244,656,551 136.9% ($24,021,327) $16,388,541 ($58,272,749) -32.6% HDHP with HSA 120,777 $95,047,993 $70,370,273 ($1,587,761) $68,782,512 72.4% ($5,793,594) $9,110,008 $22,949,067 24.1% Sub-total 598,880 $479,256,290 $508,626,431 ($15,477,073) $493,149,358 102.9% ($43,592,410) $45,172,522 ($15,473,180) -3.2%
Dental Basic 315,003 $10,970,170 $7,767,700 $7,767,700 70.8% $856,128 $2,346,341 21.4% Basic Plus 572,078 $19,876,818 $21,404,803 $21,404,803 107.7% $1,554,818 ($3,082,803) -15.5% Sub-total 887,081 $30,846,987 $29,172,503 $29,172,503 94.6% $2,410,946 ($736,462) -2.4%
Self-funded plan Total $510,103,278 $537,798,935 ($15,477,073) $522,321,861 102.4% ($43,592,410) $47,583,468 ($16,209,642) -3.2%
FY2027 Medical/Rx (2 months) Copay Basic 45,124 $41,046,319 $30,916,603 ($283,563) $30,633,040 74.6% ($3,690,191) $2,305,421 $11,798,049 28.7%
Copay Plus 36,959 $35,230,521 $43,628,894 ($837,450) $42,791,444 121.5% ($5,673,278) $1,996,084 ($3,883,729) -11.0% HDHP with HSA 20,035 $18,167,413 $10,688,685 ($104,939) $10,583,745 58.3% ($1,418,851) $1,151,607 $7,850,911 43.2% Sub-total 102,118 $94,444,253 $85,234,182 ($1,225,952) $84,008,229 89.0% ($10,782,319) $5,453,112 $15,765,231 16.7%
Dental Basic 51,739 $1,645,325 $1,376,984 $1,376,984 83.7% $150,981 $117,359 7.1% Basic Plus 98,133 $3,895,218 $4,114,453 $4,114,453 105.6% $247,904 ($467,139) -12.0% Sub-total 149,872 $5,540,543 $5,491,437 $5,491,437 99.1% $398,886 ($349,780) -6.3%
Self-funded plan Total $99,984,796 $90,725,619 ($1,225,952) $89,499,666 89.5% ($10,782,319) $5,851,997 $15,415,451 15.4%
(2) Medical/Rx expenses include administration fees, Stop Loss premiums and Marathon fees. Please note that these expenses do not include HSA funds provided by the State.
(3) Dental expenses include administration fees.
(4) Rebates paid on a quarterly basis.
(5) The FY2026 projections include emergency supplemental funding effective November 1, 2025.
(1) For FY2025, FY2026, and FY2027, contribution amounts shown above reflect an estimate of # employees x PEPM budget rate by coverage tier. In practice, no contributions are collected by CO DPA in July and contributions are doubled in June.
Plan Year Reserve Beginning Balance Revenue Expense Reserve Ending Balance Premium Stablization Reserve
2022 $68,215,954 $506,988,125 $514,706,232 $60,497,847 $22,131,062 2023 $60,497,847 $536,030,895 $558,949,174 $37,579,568 $24,767,960 2024 $37,579,568 $615,886,096 $606,176,345 $47,289,319 $28,480,336 2025 $47,289,319 $693,934,774 $720,261,511 $20,962,582 $39,547,817 2026 $20,962,582 $787,384,540 $799,428,407 $8,918,715 $40,295,143 Jul-26 $8,918,715 $3,276,925 $43,313,881 ($31,118,241) $3,006,642
Aug-26 ($31,118,241) $79,556,497 $62,420,662 ($13,982,406) $3,170,333 Sep-26 ($13,982,406) $69,182,966 $68,101,985 ($12,901,425) $3,878,105 Oct-26 ($12,901,425) $69,203,962 $72,329,662 ($16,027,125) $3,383,832 Nov-26 ($16,027,125) $77,892,966 $70,265,463 ($8,399,622) $3,475,443 Dec-26 ($8,399,622) $69,043,431 $70,182,240 ($9,538,431) $4,314,259 Jan-27 ($9,538,431) $69,047,875 $71,897,278 ($12,387,833) $3,323,770 Feb-27 ($12,387,833) $78,167,764 $72,390,640 ($6,610,710) $3,468,542 Mar-27 ($6,610,710) $69,073,145 $74,375,051 ($11,912,616) $4,655,260 Apr-27 ($11,912,616) $69,088,669 $76,451,324 ($19,275,271) $4,046,025 May-27 ($19,275,271) $78,447,411 $76,568,233 ($17,396,093) $3,706,438 Jun-27 ($17,396,093) $138,165,965 $97,522,702 $23,247,170 $5,154,937 2027 $8,918,715 $870,147,577 $855,819,122 $23,247,170 $45,583,588
Notes
(1) Historical plan year balances tie to the operating reports provided by CO DPA.
(2) Based on data through August 2026.
(3) The fund balance for PY2026 includes emergency supplemental funding effective November 1, 2025.
State of Colorado, DPA Fund Balance Tracking
(4) Revenue and Expense amounts include income and costs associated with self-funded and fully insured coverages, including medical, prescription drug, dental, vision, life, disability, wellness, and spending accounts.
(5) Due to timing of contribution payments, it is likely that the reserve ending balance will be negative as of July 2027.
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
$70.0
$80.0
2022 2023 2024 2025 2026 2027
M ill io ns
Plan Year Ending Fund Balance vs. Premium Stabilization Reserve (PSR)
Premium Stablization Reserve Reserve Ending Balance
State of Colorado DPA Monthly Financial Report
July 2026-August 2026
© 2026 by The Segal Group Inc.
The fees listed below are included in the Actuarial Exhibits (Page 4 & 6) HSA Contributions, EBU fees, Wellness credits and Marathon fees
Monthly Financial Report:
Items included in self-funded budget, and have been included in the following exhibits are:
EBU fees, approximate annual cost $2.9M
Cigna/MedImpact Rx EBU fees: $1.7M Dental EBU fees: $1.2M
Items that were not included in the budget but that are paid from the fund include:
Wellness Program Funds approximate annual cost: $904K Vision, approximate annual cost: $3.9M
Total annual Marathon fees for both fully and self insured business: $10.7M Marathon fees are included in the Medical/Rx Administration Fees of the Monthly Financial Report
State of Colorado, DPA Self-Funded Plan Notes
Medical/Rx Budget
Total $ PEPM
Budget $94,444,253 $1,877
Total Plan Costs $78,880,941 $1,567
Surplus / (Deficit) $15,563,312 $309.26
Costs as a Percentage of Budget 83.5%
Dental Budget
Total $ PEPM
Budget $5,540,543 $75.70
Total Plan Costs $5,690,336 $77.75
Surplus / (Deficit) ($149,793) ($2.05)
Costs as a Percentage of Budget 102.7% Note: Amounts shown reflect actual totals year-to-date, net of ISL reimbursements and Rx rebates.
Note: Total Plan Costs include HSA funds provided by the State
YTD Performance to Self Funded Budget State of Colorado, DPA
$99,984,796
$79,687,946
$1,118,244
$3,205,197 $559,890
$15,413,519
Budget Actual Surplus
Total Net Claims Cost Stop Loss Premium Medical/Rx/Dental Administration HSA Funding Surplus
25,162 24,633 23,718 22,151
2 12 12 12
FY2027 FY2026 FY2025 FY2024
Category Total Paid PEPM Medical/Rx Administration $3,006,298 $59.74 $80.95 $74.32 $72.92 Stop Loss Premium $1,118,244 $22.22 $70.95 $65.09 $44.87 HSA Funding $559,890 $11.13 $11.30 $12.14 $13.18 Gross Medical Claims $58,074,135 $1,154.00 $1,222.01 $1,096.75 $1,010.95 ISL Reimbursements ($1,225,952) ($24.36) ($52.36) ($31.00) ($44.40) Gross Rx Claims $27,160,046 $539.70 $498.68 $460.01 $347.68 Rx Rebates ($9,811,720) ($194.97) ($129.67) ($136.31) ($117.11) Total $78,880,941 $1,567.46 $1,701.86 $1,541.00 $1,328.10 Increase/Decrease -7.9% 10.4% 16.0%
* Medical/Rx Administration fees in FY24-FY27 include Base Admin fees, Marathon Fees and EBU fees.
36,595 36,174 35,368 33,882
2 12 12 12
FY2027 FY2026 FY2025 FY2024
Category Total Paid PEPM Dental Administration $198,899 $2.72 $5.55 $5.59 $5.74 Gross Dental Claims $5,491,437 $75.03 $67.20 $65.63 $63.72 Total $5,690,336 $77.75 $72.76 $71.21 $69.46 Increase/Decrease 6.9% 2.2% 2.5%
* Dental Administration fees in FY24-FY27 include ASO fees and EBU fees.
Historical Self-Funded Plan Cost Summary State of Colorado, DPA
Number of Months in Year to Date July 01, 2026 - August 31, 2026
Average Medical/Rx Enrollment Number of Months in Year-to-Date
July 01, 2026 - August 31, 2026
Average Dental Enrollment
Employee/Employer Share of Total Plan Cost
Date EE Lives Total Medical/Rx
Plan Cost Total Dental Plan
Cost Employee Medical
Contributions Employee Dental
Contributions Net Employer
Cost
Jul-26 25,217 $47,087,196 $2,842,344 $4,170,907 $776,801 $45,168,532
Aug-26 25,107 $31,793,745 $2,847,992 $4,156,481 $759,812 $44,952,263
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total 50,324 $78,880,941 $5,690,336 $8,327,388 $1,536,613 $90,120,795
Employee Total Costs: $9,864,001 Total Employee Percentage: 10% Employer Total Costs: $90,120,795 Total Employer Percentage: 90%
Total Overall Cost: $99,984,796
Employer/Employee Contribution Share State of Colorado, DPA
8.8%
91.2%
Medical/Rx
EE Medical Contributions
Net Employer Cost
27.7%
72.3%
Dental
EE Dental Contributions
Net Employer Cost
FY2027 as of 08/31/2026 FY2026 FY2025
Claimants over ISL as a Percentage Gross Claims
0% 6% 5%
Specific Stop Loss - Paid Basis
FY2027 as of 08/31/2026 FY2026 FY2025 Specific Deductible $1,500,000 $500,000 $500,000
Specific Contract Basis Incurred Incurred Incurred ISL Claims Type Medical/Rx Medical/Rx Medical/Rx
ISL Premium $1,118,244 $20,972,206 $18,525,260 Reimbursements $1,225,952 $15,477,073 $8,824,206
Loss Ratio 110% 74% 48%
Specific Stop Loss - Incurred Basis
FY2027 as of 08/31/2026 FY2026 FY2025 Specific Deductible $1,500,000 $500,000 $500,000
Specific Contract Basis Incurred Incurred Incurred ISL Claims Type Medical/Rx Medical/Rx Medical/Rx
Claimants over ISL 0 37 26 ISL Premium $1,118,244 $20,972,206 $18,525,260
Reimbursements $406,383 $14,021,794 $8,002,766
Note: The large claims are medical and pharmacy claims
Large Paid Claims & Stop Loss Detail State of Colorado, DPA
FY2027 FY2026 FY2025
100% 94% 95%
0% 6% 5%
Other Claimants Claimants over ISL
FY2027 as of 08/31/2026 FY2026 # Claimants Plan Paid Avg Spend Per Patient # Claimants Plan Paid Avg Spend Per Patient
$25,000 - $100,000 314 $13,449,584 $42,833 3,071 $146,614,867 $47,742 $100,000 - $199,999 17 $2,290,284 $134,723 519 $70,964,760 $136,734 $200,000 - $299,999 3 $754,848 $251,616 128 $30,624,001 $239,250 $300,000 - $399,999 0 $0 $0 44 $15,340,316 $348,644 $400,000 - $499,999 0 $0 $0 32 $14,145,526 $442,048 $500,000 - $599,999 0 $0 $0 11 $5,939,347 $539,941 $600,000 - $699,999 0 $0 $0 9 $6,036,907 $670,767 $700,000 - $799,999 0 $0 $0 4 $2,977,751 $744,438 $800,000 - $899,999 0 $0 $0 4 $3,378,710 $844,678 $900,000 - $999,999 0 $0 $0 2 $1,849,339 $924,669 $1,000,000 - $1,499,999 0 $0 $0 6 $7,252,400 $1,208,733 $1,500,000 - $1,999,999 0 $0 $0 0 $0 $0 $2,000,000 and Up 0 $0 $0 1 $3,239,320 $3,239,320 Total 334 $16,494,716 $49,385 3,831 $308,363,244 $80,492 Note: The distribution table does not include claimants that have claims under $25,000
Large Claimants Above $500,000
# Plan Patient Relationship Medical Pharmacy Claimant Total Amount Above ISL Diagnosis
Total $0 $0
Note: The large claims include Medical and Pharmacy claims
Note: Due to differences in timing, the stop loss reimbursements shown above may differ from actual claims experience shown on other exhibits.
State of Colorado, DPA FY2027 Claim Distribution
Plan Paid Range
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Under $100,000 $100,000 - $199,999
$200,000 - $299,999
$300,000 - $399,999
$400,000 - $499,999
$500,000 - $599,999
$600,000 - $699,999
$700,000 - $799,999
$800,000 - $899,999
$900,000 - $999,999
$1,000,000 - $1,499,999
$1,500,000 - $1,999,999
$2,000,000 and Up
Distribution of Large Claims
FY2025 FY2026 FY2027
Self-funded Medical/Rx Financial Exhibits
Fixed Costs Paid Claims Employee
Medical/Rx Lives
Medical/Rx Administration*
Stop Loss Premium HSA Funding Total Fixed Cost
Gross Paid Medical Claims Gross Rx Claims Total Claims
Amounts over ISL Rx Rebates Net Claims Cost
Medical/Rx Plan Costs
Medical/Rx Budget Surplus / (Deficit) Cost/Budget
Jul-25 24,445 $822,345 $1,750,970 $279,121 $2,852,437 $26,451,540 $11,689,707 $38,141,247 $713,947 $0 $37,427,300 $40,279,737 $38,534,995 ($1,744,742) 104.5%
Aug-25 24,431 $2,901,530 $1,721,782 $277,381 $4,900,694 $27,954,948 $10,959,086 $38,914,033 $2,482,204 ($10,014,802) $26,417,027 $31,317,721 $38,523,037 $7,205,316 81.3%
Sep-25 24,447 $1,109,442 $1,732,244 $278,119 $3,119,805 $26,207,543 $12,201,297 $38,408,841 $376,697 $0 $38,032,144 $41,151,949 $38,567,893 ($2,584,056) 106.7%
Oct-25 24,494 $2,016,713 $1,736,921 $273,206 $4,026,841 $28,268,358 $12,725,732 $40,994,090 $315,202 $0 $40,678,887 $44,705,728 $38,661,335 ($6,044,393) 115.6%
Nov-25 24,598 $2,911,941 $1,744,306 $274,096 $4,930,343 $28,436,506 $11,758,354 $40,194,859 $317,826 ($10,760,970) $29,116,063 $34,046,406 $41,046,713 $7,000,307 82.9%
Dec-25 24,716 $1,996,279 $1,752,039 $268,896 $4,017,214 $32,503,949 $12,592,160 $45,096,109 $285,909 $0 $44,810,200 $48,827,414 $41,228,138 ($7,599,276) 118.4%
Jan-26 24,697 $1,111,800 $1,758,285 $266,345 $3,136,430 $29,218,731 $11,267,646 $40,486,378 $1,355,703 $0 $39,130,675 $42,267,105 $41,217,630 ($1,049,474) 102.5%
Feb-26 24,738 $2,038,394 $1,749,769 $279,855 $4,068,018 $28,704,778 $11,155,349 $39,860,126 $301,429 ($12,181,185) $27,377,511 $31,445,530 $41,266,315 $9,820,786 76.2%
Mar-26 24,757 $2,027,385 $1,755,084 $309,449 $4,091,919 $35,085,148 $12,340,231 $47,425,380 $4,450,093 $0 $42,975,287 $47,067,205 $41,287,799 ($5,779,406) 114.0%
Apr-26 24,767 $2,017,238 $1,762,398 $277,581 $4,057,217 $34,386,061 $13,810,407 $48,196,468 $892,110 $0 $47,304,358 $51,361,575 $41,305,615 ($10,055,960) 124.3%
May-26 24,775 $2,897,304 $1,750,833 $277,398 $4,925,536 $30,426,001 $13,113,619 $43,539,620 $2,590,627 ($9,636,487) $31,312,506 $36,238,042 $41,340,233 $5,102,191 87.7%
Jun-26 24,730 $2,349,944 $1,757,573 $280,082 $4,387,600 $33,575,269 $13,794,012 $47,369,281 $1,395,325 $0 $45,973,956 $50,361,556 $41,239,129 ($9,122,427) 122.1%
Jul-26 25,217 $1,781,488 $561,464 $279,945 $2,622,896 $31,473,704 $13,629,121 $45,102,825 $638,525 $0 $44,464,300 $47,087,196 $47,314,662 $227,466 99.5%
Aug-26 25,107 $1,224,810 $556,780 $279,945 $2,061,536 $26,600,431 $13,530,925 $40,131,356 $587,427 ($9,811,720) $29,732,209 $31,793,745 $47,129,591 $15,335,846 67.5%
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 50,324 $3,006,298 $1,118,244 $559,890 $4,684,432 $58,074,135 $27,160,046 $85,234,182 $1,225,952 ($9,811,720) $74,196,509 $78,880,941 $94,444,253 $15,563,312 83.5%
PEPM $59.74 $22.22 $11.13 $93.09 $1,154.00 $539.70 $1,693.71 $24.36 ($194.97) $1,474.38 $1,567.46 $1,876.72 $309.26
% Change -37.0% -219.3% -1.6% -76.3% -5.9% 7.6% -1.6% -114.9% 26.1% -3.4% -7.7% 12.7% 116.2% -23.4%
FY2026 295,595 $24,200,316 $20,972,206 $3,341,530 $48,514,052 $361,218,831 $147,407,600 $508,626,431 $15,477,073 ($42,593,444) $450,555,914 $499,069,966 $484,218,832 ($14,851,134) 103.1%
FY2026 PEPM $81.87 $70.95 $11.30 $164.12 $1,222.01 $498.68 $1,720.69 $52.36 ($144.09) $1,524.23 $1,688.36 $1,638.12 ($50.24)
* Medical/Rx Administration fees include Base Admin fees, Marathon Fees and EBU fees.
State of Colorado, DPA Total Plan Cost Detail, Medical/Rx
$0
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
$60,000,000
Aug-2025 Sep-2025 Oct-2025 Nov-2025 Dec-2025 Jan-2026 Feb-2026 Mar-2026 Apr-2026 May-2026 Jun-2026 Jul-2026 Aug-2026
Medical/Rx Plan Costs
Medical/Rx Budget
$0.0
$50.0
$100.0
$150.0
$200.0
$250.0
$300.0
$350.0
$400.0
$450.0
$500.0
$550.0
Budget Actual
M ill io ns
FY2026
FY2027
Medical/Rx
Lives Medical/Rx
Administration* Stop Loss Premium HSA Funding Total Fixed Cost
Gross Paid Medical Claims
Gross Rx Claims Total Claims
Amounts over ISL Rx Rebates Net Claims Cost
Medical/Rx Plan Costs
Medical/Rx Budget
Surplus / (Deficit) Cost/Budget
Jul-26 5,338 $377,110 $118,852 $279,945 $775,907 $4,274,951 $1,452,548 $5,727,499 $1,419 $0 $5,726,080 $6,501,987 $9,108,503 $2,606,516 71.4%
Aug-26 5,312 $259,139 $117,801 $279,945 $656,884 $3,530,112 $1,431,074 $4,961,186 $103,520 ($1,291,129) $3,566,536 $4,223,420 $9,058,910 $4,835,490 46.6%
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 10,650 $636,249 $236,653 $559,890 $1,432,791 $7,805,063 $2,883,622 $10,688,685 $104,939 ($1,291,129) $9,292,616 $10,725,407 $18,167,413 $7,442,006 59.0%
Average 5,325 $318,124 $118,326 $279,945 $716,396 $3,902,531 $1,441,811 $5,344,342 $52,470 ($645,565) $4,646,308 $5,362,704 $9,083,706 $3,721,003
PEPM $59.74 $22.22 $52.57 $134.53 $732.87 $270.76 $1,003.63 $9.85 ($121.23) $872.55 $1,007.08 $1,705.86 $698.78
% Change -0.7% -37.0% -219.3% 1.2% -52.2% -8.4% -10.4% -9.0% -150.4% 27.4% -12.4% -17.7% 12.5% 56.0%
FY2026 64,349 $5,267,003 $4,565,516 $3,341,530 $13,174,049 $51,141,822 $19,228,451 $70,370,273 $1,587,761 ($5,660,827) $63,121,684 $76,295,734 $96,064,102 $19,768,368 79.4%
FY2026 Average 5,362 $438,917 $380,460 $278,461 $1,097,837 $4,261,819 $1,602,371 $5,864,189 $132,313 ($471,736) $5,260,140 $6,357,978 $8,005,342 $1,647,364
FY2026 PEPM $81.85 $70.95 $51.93 $204.73 $794.76 $298.82 $1,093.57 $24.67 ($87.97) $980.93 $1,185.66 $1,492.86 $307.21
* Medical/Rx Administration fees include Base Admin fees, Marathon Fees and EBU fees.
Total Plan Cost Detail, HDHP Plan State of Colorado, DPA
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
Jul-2026 Aug-2026 Sep-2026 Oct-2026 Nov-2026 Dec-2026 Jan-2027 Feb-2027 Mar-2027 Apr-2027 May-2027 Jun-2027
Medical/Rx Plan Costs
Medical/Rx Budget
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
$70.0
$80.0
$90.0
$100.0
FY2026 FY2027
M ill io ns
Budget Actual
Medical/Rx Lives
Medical/Rx Administration*
Stop Loss Premium HSA Funding Total Fixed Cost
Gross Paid Medical Claims
Gross Rx Claims Total Claims
Amounts over ISL Rx Rebates
Net Claims Cost
Medical/Rx Plan Costs
Medical/Rx Budget
Surplus / (Deficit) Cost/Budget
Jul-26 10,639 $751,606 $236,880 $0 $988,486 $11,892,745 $4,802,135 $16,694,880 $134,800 $0 $16,560,080 $17,548,567 $20,557,798 $3,009,231 85.4%
Aug-26 10,608 $517,497 $235,246 $0 $752,743 $9,250,933 $4,970,789 $14,221,722 $148,763 ($3,358,008) $10,714,951 $11,467,694 $20,488,521 $9,020,827 56.0%
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 21,247 $1,269,103 $472,127 $0 $1,741,229 $21,143,678 $9,772,924 $30,916,603 $283,563 ($3,358,008) $27,275,032 $29,016,261 $41,046,319 $12,030,059 70.7%
Average 10,624 $634,551 $236,063 $0 $870,615 $10,571,839 $4,886,462 $15,458,301 $141,781 ($1,679,004) $13,637,516 $14,508,130 $20,523,160 $6,015,029
PEPM $59.73 $22.22 $0.00 $81.95 $995.14 $459.97 $1,455.10 $13.35 ($158.05) $1,283.71 $1,365.66 $1,931.86 $566.20
% Change 3.5% -37.2% -219.3% 0.0% -86.5% -10.4% 12.4% -3.2% -209.0% 30.8% -5.3% -10.1% 12.8% 68.0%
FY2026 123,041 $10,080,505 $8,729,620 $0 $18,810,125 $135,207,533 $49,577,196 $184,784,729 $5,074,434 ($13,461,764) $166,248,531 $185,058,656 $207,354,162 $22,295,506 89.2%
FY2026 Average 10,253 $840,042 $727,468 $0 $1,567,510 $11,267,294 $4,131,433 $15,398,727 $422,869 ($1,121,814) $13,854,044 $15,421,555 $17,279,514 $1,857,959 FY2026 PEPM $81.93 $70.95 $0.00 $152.88 $1,098.88 $402.93 $1,501.81 $41.24 ($109.41) $1,351.16 $1,504.04 $1,685.24 $181.20
* Medical/Rx Administration fees include Base Admin fees, Marathon Fees and EBU fees.
Total Plan Cost Detail, Copay Basic Plan State of Colorado, DPA
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
$18,000,000
$20,000,000
$22,000,000
Jul-2026 Aug-2026 Sep-2026 Oct-2026 Nov-2026 Dec-2026 Jan-2027 Feb-2027 Mar-2027 Apr-2027 May-2027 Jun-2027
Medical/Rx Plan Costs
Medical/Rx Budget
$0.0
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
$140.0
$160.0
$180.0
$200.0
$220.0
FY2026 FY2027
M ill io ns
Budget
Actual
Medical/Rx Lives
Medical/Rx Administration*
Stop Loss Premium HSA Funding Total Fixed Cost
Gross Paid Medical Claims
Gross Rx Claims Total Claims
Amounts over ISL Rx Rebates
Net Claims Cost
Medical/Rx Plan Costs
Medical/Rx Budget
Surplus / (Deficit) Cost/Budget
Jul-26 9,240 $652,772 $205,731 $0 $858,503 $15,306,008 $7,374,438 $22,680,446 $502,306 $0 $22,178,140 $23,036,643 $17,648,362 ($5,388,281) 130.5%
Aug-26 9,187 $448,175 $203,734 $0 $651,909 $13,819,386 $7,129,062 $20,948,448 $335,144 ($5,162,583) $15,450,722 $16,102,630 $17,582,159 $1,479,529 91.6%
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 18,427 $1,100,947 $409,465 $0 $1,510,412 $29,125,394 $14,503,500 $43,628,894 $837,450 ($5,162,583) $37,628,862 $39,139,274 $35,230,521 ($3,908,752) 111.1%
Average 9,214 $550,473 $204,732 $0 $755,206 $14,562,697 $7,251,750 $21,814,447 $418,725 ($2,581,291) $18,814,431 $19,569,637 $17,615,261 ($1,954,376)
PEPM $59.75 $22.22 $0.00 $81.97 $1,580.58 $787.08 $2,367.66 $45.45 ($280.16) $2,042.05 $2,124.02 $1,911.90 ($212.12)
% Change 2.1% -36.9% -219.3% 0.0% -86.4% -2.2% 7.7% 1.1% -79.3% 22.6% -0.1% -3.4% 12.6% -148.0%
FY2026 108,205 $8,852,808 $7,677,070 $0 $16,529,878 $174,869,477 $78,601,953 $253,471,430 $8,814,879 ($23,470,853) $221,185,698 $237,715,576 $180,800,568 ($56,915,008) 131.5%
FY2026 Average 9,017 $737,734 $639,756 $0 $1,377,490 $14,572,456 $6,550,163 $21,122,619 $734,573 ($1,955,904) $18,432,142 $19,809,631 $15,066,714 ($4,742,917) FY2026 PEPM $81.82 $70.95 $0.00 $152.76 $1,616.09 $726.42 $2,342.51 $81.46 ($216.91) $2,044.14 $2,196.90 $1,670.91 ($525.99)
* Medical/Rx Administration fees include Base Admin fees, Marathon Fees and EBU fees.
State of Colorado, DPA Total Plan Cost Detail, Copay Plus Plan
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
Jul-2026 Aug-2026 Sep-2026 Oct-2026 Nov-2026 Dec-2026 Jan-2027 Feb-2027 Mar-2027 Apr-2027 May-2027 Jun-2027
Medical/Rx Plan Costs
Medical/Rx Budget
$0.0
$50.0
$100.0
$150.0
$200.0
$250.0
FY2026 FY2027
M ill io ns
Budget
Rolling 12 Paid Claims - Medical/Rx
$529.24 $536.60 $550.40 $562.50 $581.98 $595.41 $606.21
$208.63 $221.61 $231.78 $239.40 $241.44 $245.30 $252.39
$737.87 $758.21 $782.18 $801.89 $823.42 $840.71 $858.60
$100.00
$200.00
$300.00
$400.00
$500.00
$600.00
$700.00
$800.00
$900.00
$1,000.00
Medical Rolling 12 PMPM Rx Rolling 12 PMPM Total Claims PMPM July 2026 Trended Forward at 9%
Self-funded Dental
Paid Claims Employee Dental
Lives Dental
Administration Dental Basic
Claims Dental Basic Plus
Claims Total Dental Plan
Cost Dental Budget Budget Surplus /
(Deficit)
Jul-25 35,994 $0 $690,682 $2,005,821 $2,696,503 $2,753,180 $56,677
Aug-25 35,946 $200,084 $619,757 $1,892,331 $2,712,173 $2,749,977 $37,804
Sep-25 35,986 $199,696 $677,085 $1,854,746 $2,731,527 $2,752,595 $21,068
Oct-25 36,067 $199,929 $698,580 $1,889,327 $2,787,835 $2,757,831 ($30,005)
Nov-25 36,161 $200,289 $503,555 $1,369,527 $2,073,371 $2,763,791 $690,420
Dec-25 36,306 $200,167 $648,012 $1,789,002 $2,637,180 $2,773,562 $136,382
Jan-26 36,240 $201,849 $655,783 $1,760,919 $2,618,551 $2,769,389 $150,838
Feb-26 36,272 $201,348 $636,543 $1,697,449 $2,535,340 $2,769,490 $234,151
Mar-26 36,235 $201,570 $692,231 $1,796,104 $2,689,905 $2,765,680 $75,775
Apr-26 36,245 $201,456 $674,816 $1,815,015 $2,691,288 $2,766,177 $74,889
May-26 36,240 $201,478 $597,387 $1,609,158 $2,408,023 $2,765,035 $357,012
Jun-26 36,397 $403,080 $673,269 $1,925,405 $3,001,754 $2,775,298 ($226,456)
Jul-26 37,027 $0 $687,847 $2,154,496 $2,842,344 $2,801,578 ($40,765)
Aug-26 36,163 $198,899 $689,137 $1,959,956 $2,847,992 $2,738,965 ($109,028)
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 73,190 $198,899 $1,376,984 $4,114,453 $5,690,336 $5,540,543 -$149,793
PEPM $2.72 $18.81 $56.22 $77.75 $75.70 -$2.05
% Change -104.4% 4.9% 12.3% 6.4% -0.9% 277.7%
FY2026 434,089 $2,410,946 $7,767,700 $21,404,803 $31,583,449 $33,162,005 $1,578,556
FY2026 PEPM $5.55 $17.89 $49.31 $72.76 $76.39 $3.64
* Dental Administration fees include ASO fees and EBU fees.
State of Colorado, DPA Total Plan Cost Detail, Dental
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
Total Dental Plan Cost Dental Budget $0.0
$5.0
$10.0
$15.0
$20.0
$25.0
$30.0
$35.0
FY2026 FY2027
M ill io ns
Budget
Rolling 12 Paid Claims - Dental
$32.17
$32.06
$32.03 $32.09
$32.44 $32.57
$33.11
$30.50
$31.00
$31.50
$32.00
$32.50
$33.00
$33.50
Dental Rolling 12 PMPM July 2026 Trended Forward at 3%
Kaiser Permanente
Premiums shown in the following exhibits reflect premiums collected by Kaiser.
Medical and pharmacy claims shown reflect the amounts paid by Kaiser on a fully insured basis.
The fully insured exhibits do not include the following plan expenses:
EBU fees, approximate annual cost: $719K
Wellness Program Funds, approximate annual cost: $384K
State of Colorado, DPA Fully Insured Plan Notes
Medical/Rx
Lives Gross Paid
Medical Claims Gross Paid Rx Claims Total Claims
HSA
Contributions
Medical/Rx Premium Surplus / (Deficit) Loss Ratio
Jul-25 10,918 $13,382,151 $1,686,307 $15,068,458 $85,620 $14,180,855 ($973,223) 106.9%
Aug-25 10,885 $10,261,518 $1,399,084 $11,660,602 $85,740 $14,145,700 $2,399,358 83.0%
Sep-25 10,899 $9,828,135 $1,517,174 $11,345,309 $86,640 $14,154,592 $2,722,643 80.8%
Oct-25 10,927 $10,444,900 $1,558,065 $12,002,965 $86,880 $14,190,943 $2,101,097 85.2%
Nov-25 10,927 $12,496,421 $1,494,095 $13,990,516 $87,660 $14,191,765 $113,589 99.2%
Dec-25 10,955 $12,127,490 $1,576,562 $13,704,052 $87,840 $14,233,518 $441,626 96.9%
Jan-26 10,927 $10,864,020 $1,741,700 $12,605,720 $87,540 $14,205,696 $1,512,437 89.4%
Feb-26 10,922 $11,546,427 $1,451,752 $12,998,179 $87,660 $14,182,380 $1,096,541 92.3%
Mar-26 10,905 $12,612,395 $1,648,269 $14,260,663 $88,080 $14,145,034 ($203,709) 101.4%
Apr-26 10,900 $12,645,861 $1,742,213 $14,388,075 $88,560 $14,144,606 ($332,028) 102.3%
May-26 10,889 $12,333,867 $1,676,358 $14,010,225 $88,560 $14,135,081 $36,296 99.7%
Jun-26 10,858 $12,489,206 $1,742,159 $14,231,365 $88,860 $14,091,153 ($229,072) 101.6%
Jul-26 10,656 $9,897,554 $1,772,889 $11,670,442 $88,020 $15,446,396 $3,687,933 76.1%
Aug-26
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 10,656 9,897,554 $1,772,889 $11,670,442 $88,020 $15,446,396 $3,687,933 76.1%
Average 10,656 9,897,554 $1,772,889 $11,670,442 $88,020 $15,446,396 $3,687,933 76.1%
PEPM $928.82 $166.37 $1,095.20 $8.26 $1,449.55 $346.09
% Change PEPM -2.4% -16.0% 11.7% -11.8% 2.9% 10.4% 80.8%
FY2026 130,912 $141,032,391 $19,233,737 $160,266,129 $1,049,640 $170,001,323 $8,685,554 94.9%
FY2026 Average 10,909 $11,752,699 $1,602,811 $13,355,511 $87,470 $14,166,777 $723,796 94.9%
FY2026 PEPM $1,077.31 $146.92 $1,224.23 $8.02 $1,298.59 $66.35
Note: Kaiser fully insured data is shown on a paid basis through July 31, 2026 due to the timing of Kaiser reporting.
Note: EBU and Wellness fees are not included in this exhibit.
State of Colorado, DPA Premium vs. Claims, Total Medical/Rx
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
$18,000,000
Jul-2025 Aug-2025 Sep-2025 Oct-2025 Nov-2025 Dec-2025 Jan-2026 Feb-2026 Mar-2026 Apr-2026 May-2026 Jun-2026 Jul-2026
Gross Paid Rx Claims
Gross Paid Medical Claims
Medical/Rx Premium
Medical/Rx
Lives Gross Paid
Medical Claims Gross Rx
Claims Total Claims
HSA
Contributions Medical/Rx Premium Surplus / (Deficit) Loss Ratio
Jul-26 1,467 $699,524 $9,474 $708,998 $88,020 $1,903,414 $1,106,396 41.9%
Aug-26
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 1,467 $699,524 $9,474 $708,998 $88,020 $1,903,414 $1,106,396 41.9%
Average 1,467 $699,524 $9,474 $708,998 $88,020 $1,903,414 $1,106,396 41.9%
PEPM $476.84 $6.46 $483.30 $60.00 $1,297.49 $754.19
% Change PEPM 0.6% -50.8% -591.5% -58.0% 0.0% 13.2% 59.8%
FY2026 17,494 $12,579,190 $781,265 $13,360,455 $1,049,640 $19,712,499 $5,302,404 73.1%
FY2026 Average 1,458 $1,048,266 $65,105 $1,113,371 $87,470 $1,642,708 $441,867 73.1%
FY2026 PEPM $719.06 $44.66 $763.72 $60.00 $1,126.81 $303.10
Note: Kaiser fully insured data is shown on a paid basis through July 31, 2026 due to the timing of Kaiser reporting.
Note: EBU and Wellness fees are not included in this exhibit.
State of Colorado, DPA Premium vs. Claims, HDHP Plan
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
$1,600,000
$1,800,000
$2,000,000
Jul-2026 Aug-2026 Sep-2026 Oct-2026 Nov-2026 Dec-2026 Jan-2027 Feb-2027 Mar-2027 Apr-2027 May-2027 Jun-2027
Gross Rx Claims
Gross Paid Medical Claims
Medical/Rx
Lives Gross Paid
Medical Claims Gross Rx
Claims Total Claims
HSA
Contributions Medical/Rx Premium Surplus / (Deficit) Loss Ratio
Jul-26 9,189 $9,198,030 $1,763,415 $10,961,444 $0 $13,542,982 $2,581,538 80.9%
Aug-26
Sep-26
Oct-26
Nov-26
Dec-26
Jan-27
Feb-27
Mar-27
Apr-27
May-27
Jun-27
Total: Current Plan YTD 9,189 $9,198,030 $1,763,415 $10,961,444 $0 $13,542,982 $2,581,538 80.9%
Average 9,189 $9,198,030 $1,763,415 $10,961,444 $0 $13,542,982 $2,581,538 80.9%
PEPM $1,000.98 $191.90 $1,192.89 $0.00 $1,473.83 $280.94
% Change PEPM -2.9% -13.1% 15.2% -8.6% 10.1% 89.4%
FY2026 113,418 $128,453,202 $18,452,472 $146,905,674 $0 $150,288,824 $3,383,150 97.7%
FY2026 Average 9,452 $10,704,433 $1,537,706 $12,242,139 $0 $12,524,069 $281,929 97.7%
FY2026 PEPM $1,132.56 $162.69 $1,295.26 $0.00 $1,325.09 $29.83
Note: Kaiser fully insured data is shown on a paid basis through July 31, 2026 due to the timing of Kaiser reporting.
Note: EBU and Wellness fees are not included in this exhibit.
State of Colorado, DPA Premium vs. Claims, Copays Plans (Basic & Plus)
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
Jul-2026 Aug-2026 Sep-2026 Oct-2026 Nov-2026 Dec-2026 Jan-2027 Feb-2027 Mar-2027 Apr-2027 May-2027 Jun-2027
Gross Rx Claims
Gross Paid Medical Claims
File details come from the government source that posted it. Updated .