19-Attachment F - CoA MedRx Claims Experience 08-2026.pdf

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Attached to
2027 Stop Loss Insurance Policy
Solicitation number
RFP 200-27 MRH
Issued by
Orange County, Texas

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Written by GovTribe AI ·

This is a monthly medical and pharmacy gross claims experience report for the City of Amarillo covering the period from January 2023 through August 2026. The document presents historical claims data that serves as supporting documentation for the City's 2027 Stop Loss Insurance Policy procurement, providing actuarial information necessary for insurers to evaluate risk and prepare competitive proposals. The report tracks employee and member counts, medical claims, pharmacy claims, and total claims expenses on a monthly basis across all groups within the City's health plan.

The data demonstrates significant claims activity over the 45-month period, with total claims ranging from approximately $1.36 million to $3.24 million monthly. Year-to-date figures show 2026 total claims of $20,075,895 through August, compared to full-year 2025 totals of $27,833,979 and full-year 2024 totals of $24,684,362. Medical claims consistently represent the larger expense category, followed by pharmacy claims. Employee counts remained relatively stable, ranging from 2,047 to 2,188 employees, while member counts (including dependents) ranged from 4,393 to 4,663 members. This historical claims experience data is essential for stop loss carriers to assess the City's claim patterns, establish appropriate attachment points, and determine premium rates for the upcoming 2027 coverage period.

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Other files

File Type Posted
2-2. Stop Loss RFP for 2027 Scope of Work.pdf PDF
9-Attachment L - 2025 ACTIVE MEDICAL PLAN 1 BOOKLET.PDF PDF
20-Attachment R - CoA 2026 Stop Loss Policy.pdf PDF
10-01. RFP 200-27 MRH Notice to Bidders.pdf PDF
17-Attachment K - 2025 ACTIVE MEDICAL PLAN 2 SCHEDULE OF BENEFITS.PDF PDF
1-Attachment A - Respondent Information and Signature Page.pdf PDF
13-Attachment O - 2025 RETIREES MEDICAL PLAN 2 BOOKLET.PDF PDF
6-Attachment J - 2025 ACTIVE MEDICAL PLAN 1 SCHEDULE OF BENEFITS.PDF PDF
21-Attachment Q - CoA De-ID High-Cost Claimants 08-2026.pdf PDF
12-Attachment I - 2025 RETIREES SCHEDULE OF BENEFITS MEDICAL PLAN 2.PDF PDF
5-Attachment E - COA Medical Membership 09-24-2026.xlsx XLSX spreadsheet
15-Attachment M - 2025 ACTIVE MEDICAL PLAN 2 BOOKLET.PDF PDF
14-Attachment H - 2025 RETIREES SCHEDULE OF BENEFITS MEDICAL PLAN 1.PDF PDF
8-Attachment B - City of Amarillo Vendor Acknowledment Form.pdf PDF
4-Attachment S - Certificate of Insurance Requirements Sample.pdf PDF
11-08. Attachment C - CEP List Revised 10.03.2024 .pdf PDF
18-Attachment P - PRESCRIPTION BENEFIT COVERAGE 01.01.2026.pdf PDF
7-Attachment D - RFP References Template.pdf PDF
3-Attachment G - CoA Stop Loss Questionnaire 2027 Locked.xlsx XLSX spreadsheet
16-Attachment N - 2025 RETIREES MEDICAL PLAN 1 BOOKLET.PDF PDF
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9/24/2026CITY OF AMARILLO

Monthly Medical & Pharmacy Gross Claims Experience Reporting Period: 202301 - 202608 Group: ALL

Paid Month Employee Count Member Count Medical Pharmacy Total

Jan-23 2047 4393 895,141$ 584,283$ 1,479,424$ Feb-23 2082 4437 726,456$ 634,932$ 1,361,388$ Mar-23 2101 4456 1,000,829$ 652,493$ 1,653,322$ Apr-23 2115 4463 1,257,853$ 643,785$ 1,901,638$ May-23 2119 4466 1,189,310$ 745,664$ 1,934,974$ Jun-23 2118 4459 1,192,795$ 691,281$ 1,884,076$ Jul-23 2118 4459 945,660$ 632,398$ 1,578,058$

Aug-23 2121 4469 897,411$ 802,995$ 1,700,406$ Sep-23 2116 4438 938,904$ 657,242$ 1,596,146$ Oct-23 2107 4419 1,404,686$ 769,217$ 2,173,903$ Nov-23 2111 4432 1,580,945$ 755,361$ 2,336,306$ Dec-23 2115 4444 1,808,391$ 729,277$ 2,537,668$ Jan-24 2164 4552 1,195,119$ 746,225$ 1,941,344$ Feb-24 2135 4500 1,032,694$ 699,051$ 1,731,745$ Mar-24 2138 4504 1,109,858$ 804,714$ 1,914,572$ Apr-24 2142 4507 1,114,252$ 806,776$ 1,921,028$ May-24 2134 4500 1,059,564$ 865,395$ 1,924,959$ Jun-24 2141 4515 1,342,770$ 806,591$ 2,149,361$ Jul-24 2126 4492 1,144,490$ 938,398$ 2,082,888$

Aug-24 2121 4496 1,144,236$ 864,578$ 2,008,814$ Sep-24 2116 4470 1,444,080$ 778,207$ 2,222,287$ Oct-24 2109 4469 1,387,360$ 935,808$ 2,323,168$ Nov-24 2093 4441 1,289,045$ 738,666$ 2,027,711$ Dec-24 2104 4443 1,432,236$ 1,004,249$ 2,436,485$ Jan-25 2134 4504 1,254,830$ 833,040$ 2,087,870$ Feb-25 2127 4513 1,190,676$ 885,136$ 2,075,812$ Mar-25 2129 4513 1,297,185$ 905,361$ 2,202,546$ Apr-25 2140 4535 1,346,574$ 961,503$ 2,308,077$ May-25 2127 4529 1,320,606$ 1,052,581$ 2,373,187$ Jun-25 2147 4554 1,635,415$ 865,503$ 2,500,918$ Jul-25 2156 4559 1,017,443$ 934,884$ 1,952,327$

Aug-25 2134 4540 1,210,068$ 1,109,326$ 2,319,394$ Sep-25 2149 4569 1,244,702$ 1,153,593$ 2,398,294$ Oct-25 2137 4546 1,587,461$ 1,020,831$ 2,608,292$ Nov-25 2132 4545 1,479,282$ 982,877$ 2,462,159$ Dec-25 2165 4593 1,329,857$ 1,215,245$ 2,545,102$ Jan-26 2172 4643 1,139,399$ 816,100$ 1,955,499$ Feb-26 2188 4663 1,150,353$ 981,060$ 2,131,413$ Mar-26 2164 4623 1,436,594$ 1,014,834$ 2,451,428$ Apr-26 2142 4572 1,385,041$ 915,005$ 2,300,046$ May-26 2147 4568 1,937,579$ 1,006,122$ 2,943,701$ Jun-26 2157 4580 2,134,354$ 1,100,745$ 3,235,099$ Jul-26 2144 4558 1,518,995$ 1,261,919$ 2,780,914$

Aug-26 2147 4594 1,245,956$ 1,031,839$ 2,277,795$

2026-YTD 2158 4600 11,948,271$ 8,127,624$ 20,075,895$

2025 2140 4542 15,914,099$ 11,919,881$ 27,833,979$ 2024 2127 4491 14,695,704$ 9,988,658$ 24,684,362$ 2023 2106 4445 13,838,381$ 8,298,927$ 22,137,308$

ALL GROUPS TOTAL

*Member Count contains employee/spouse/child(ren) Data Source: Medical-Aetna; Pharmacy-MaxorPBM TOTAL ALL GROUPS 1 of 1

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