10-NISD 906022 Premium vs Claims Incurred.xlsx
XLSX spreadsheet 14 KB Posted
- Attached to
- Medical and Pharmacy Reinsurance
- Solicitation number
- RFP 2025-133
- Issued by
- Bexar County, Texas
About this file
The document is a confidential UnitedHealthcare premium and claims incurred spreadsheet for Northside Independent School District (NISD) covering medical and pharmacy services for calendar year 2023. The spreadsheet tracks monthly membership, subscribers, premiums, medical payments, capitation payments, managed pharmacy payments, and claims-to-premium ratios from January through December 2023. The data covers 18,023 to 18,749 members and 9,597 to 9,949 subscribers, with monthly premiums ranging from approximately $7.5 million to $7.8 million.
The financial analysis reveals a fluctuating claims-to-premium ratio between 79.9% and 112.3%, with total annual premium revenue of $91,477,975 and total payments of $90,497,437. The document indicates increasing medical and pharmacy payment trends, with monthly total payments rising from $6,246,278 in January to $8,475,165 in December 2023. The spreadsheet is marked as containing proprietary business information and protected health information, subject to confidentiality requirements and handling restrictions under applicable federal and state laws.
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Text version
PVCI Incl IBNR Stnd-Sum
| Premium vs Claims Incurred Including IBNR - Standard |
| NORTHSIDE ISD |
| Please Note: |
| For markets moving to service fees, premiums are shown with service fees included. For markets continuing to pay commissions, premium still includes commissions. |
Year/Month Members Subscribers Premium Premium PMPM
| Medical Payments | Capitation Payments | Managed Pharmacy Payments | ||||||||||
| Total Payments | Claims to Premium Ratio | Total Payments PMPM | 12 Month Rolling Average PMPM | |||||||||
| No data returned for this view. This might be because the applied filter excludes all data. | ||||||||||||
| 2023-01 | 18,749 | 9,949 | $7,817,207 | $416.94 | $3,244,065 | $490,023 | $2,512,190 | $6,246,278 | 79.9% | $333.15 | $333.15 | |
| 2023-02 | 18,212 | 9,771 | $7,602,301 | $417.43 | $3,241,688 | $474,531 | $2,429,418 | $6,145,636 | 80.8% | $337.45 | $335.27 | |
| 2023-03 | 18,183 | 9,760 | $7,594,430 | $417.67 | $4,119,399 | $473,017 | $2,915,624 | $7,508,039 | 98.9% | $412.92 | $360.87 | |
| 2023-04 | 18,158 | 9,742 | $7,667,222 | $422.25 | $4,115,415 | $472,107 | $2,555,366 | $7,142,887 | 93.2% | $393.37 | $368.92 | |
| 2023-05 | 18,122 | 9,729 | $7,657,148 | $422.53 | $4,249,313 | $471,168 | $2,985,558 | $7,706,039 | 100.6% | $425.23 | $380.08 | |
| 2023-06 | 18,132 | 9,718 | $7,659,332 | $422.42 | $4,520,637 | $471,302 | $2,971,561 | $7,963,500 | 104.0% | $439.20 | $389.87 | |
| 2023-07 | 18,110 | 9,696 | $7,617,680 | $420.63 | $4,749,080 | $470,963 | $2,854,906 | $8,074,949 | 106.0% | $445.88 | $397.81 | |
| 2023-08 | 18,075 | 9,677 | $7,601,193 | $420.54 | $4,455,309 | $470,839 | $3,331,474 | $8,257,621 | 108.6% | $456.85 | $405.14 | |
| 2023-09 | 18,023 | 9,655 | $7,557,168 | $419.31 | $3,989,693 | $469,357 | $2,641,780 | $7,100,830 | 94.0% | $393.99 | $403.91 | |
| 2023-10 | 17,977 | 9,637 | $7,575,248 | $421.39 | $4,428,388 | $468,435 | $3,189,212 | $8,086,035 | 106.7% | $449.80 | $408.45 | |
| 2023-11 | 17,996 | 9,640 | $7,579,287 | $421.17 | $4,325,204 | $468,095 | $2,997,159 | $7,790,458 | 102.8% | $432.90 | $410.65 | |
| 2023-12 | 17,930 | 9,597 | $7,549,759 | $421.07 | $5,054,950 | $466,033 | $2,954,182 | $8,475,165 | 112.3% | $472.68 | $415.76 |
| Total by Experience Period | |||||||||
| Current Period | 217,667 | 116,571 | $91,477,975 | $50,493,139 | $5,665,867 | $34,338,430 | $90,497,437 | 98.9% | $415.76 |
Prior Period No data returned for this view. This might be because the applied filter excludes all data.
| Average Membership/PMPM Premium and Payments by Experience Period | |||||||
| Current Period | 18,139 | 9,714 | $420.27 | $231.97 | $26.03 | $157.76 | $415.76 |
Prior Period 0 0 $0.00 $0.00 $0.00 $0.00 $0.00
| % Change | |||||||
| Current Period vs Prior Period | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
This document contains UnitedHealthcare's confidential and/or proprietary business information (PBI). PBI may only be used by the recipient person/entity to which it is addressed. Recipient is liable for using and protecting UnitedHealthcare's PBI from further disclosure or misuse, consistent with recipient's contractual obligations under any applicable administrative services agreement, group policy contract, non-disclosure agreement or other applicable contract or law, including but not limited to the U.S. Freedom of Information Act and state freedom of information law exemptions for 'trade secrets'. The document may also contain protected health information (PHI) and must be handled according to applicable state and federal law, including, but not limited to HIPAA. Recipients who misuse information may be subject to both civil and criminal penalties.
File details come from the government source that posted it. Updated .