15-Manor ISD Large Claim Reporting 9.2023-12.2025.xlsx

This is a large claim reporting spreadsheet for Manor Independent School District's health plan covering the period from September 2023 through December 2025. The document tracks high-cost medical and pharmacy claims across plan members, including subscribers, spouses, and dependent children, categorized by service type (facility inpatient, facility outpatient, professional, and pharmacy services). The report identifies 26 claimants in the 2023-2024 period with total paid claims of $3,627,737.63, 44 claimants in the 2024-2025 period with total paid claims of $6,042,070.21, and 28 claimants in the 2025-2026 period (September through December) with total paid claims of $2,572,909.85. Claims are filtered using varying high-cost thresholds ($50,000 for 2023-2024 and 2024-2025 periods, and $25,000 for the 2025-2026 period) to identify the district's most expensive healthcare utilization cases.

The data reveals significant healthcare cost concentration among a small percentage of plan members, with individual claims ranging from approximately $50,000 to over $750,000 in annual paid benefits. Primary diagnosis codes indicate the claimant population includes members with chronic and complex conditions such as hereditary factor VIII deficiency, chronic renal failure, malignant neoplasms, multiple sclerosis, and various high-acuity conditions requiring both medical and pharmaceutical interventions. The spreadsheet serves as an analytical tool for the district's 2026 Medical RFP, in which Manor ISD is soliciting proposals for self-funded medical and prescription drug plans, fully insured medical and prescription drug plans, and stop loss products to manage its healthcare costs effectively.