22-Manor ISD - Top 20 HCC 50K - 1.2025-12.2025 (1).pdf
PDF 86 KB Posted
- Attached to
- Manor ISD - 2026 Medical RFP
- Solicitation number
- 26-010RFP – RE-ISSUED
- Issued by
- Travis County, Texas
About this file
This file is a Financial Overview High Cost Claimants Report prepared for Manor Independent School District (Manor ISD) in Texas, documenting enrollment and claims data for the top 20 high-cost claimants with paid expenses of $50,000 or more during the period of January 2025 through December 2025. The report details individual member information including encrypted member identification numbers, relationship status (subscriber or dependent), age and gender demographics, benefit band classifications, and leading diagnostic categories. The report presents a comprehensive breakdown of paid claims across four service categories: inpatient, outpatient, professional, and pharmacy services for each high-cost claimant during the specified twelve-month period.
The document serves as a data analytics tool supporting Manor ISD's 2026 Medical RFP, which is currently seeking proposals for self-funded medical and prescription drug plans, fully insured medical and prescription drug plans, and stop loss products. The high-cost claimants data provides essential baseline information for vendors responding to the solicitation, enabling them to assess the district's claims experience and cost drivers. The report indicates at least one identified claimant with significant pharmacy expenses totaling $846,814, demonstrating the substantial prescription drug costs within the district's covered population. This financial overview is instrumental for prospective bidders to understand the district's medical plan utilization patterns and cost structure when developing competitive proposals for the district's 2026 medical benefit programs.
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Text version
Fi na nc ia l O ve rv ie w : H ig h
Co st
C la im an ts
Re po rt D es cr ip tio n:
T hi s r ep or t p ro vi de s a d et ai le d lis tin g of th e to p h ig h co st cl ai m an ts w ith p ai d ex pe ns es o f $
,0 o r m or e fo r t he cu rr en t p er io d.
Ja n
De c 2
En cr yp te d M em be r I D
Re la tio ns hi p
Ag e/
Ge nd er
Ba nd
Le ad in g
Di ag no st ic C at eg or y
In pa tie nt
Pa id O ut pa tie nt
Pa id Pr of es sio na l Pa id Ph ar m ac y
Pa id
Pa id
Cu rr en tly
En ro lle d
Su bs cr ib er M al e
-3
No t A va ila bl e $0
$3 4, $3 ,7
$8
,8
$8
,2
No
De pe nd en t Fe m al e <1
-1
In ju ry /P oi so ni ng
$3
,9
$3 2, $3
,5
$4 9, $7
,7
Ye s
Su bs cr ib er M al e
-4
No t A va ila bl e $0
$1 3, $2 ,5
$5
,7
$5
,0
No
Su bs cr ib er M al e
-5
In fe ct io us
/P ar as iti c $3
,7
$7
3, $4
5, $4
$4
,4
No
De pe nd en t M al e
<1 -1
No t A va ila bl e $0
$3 7, $8 6, $1
,7
$2
,2
Ye s
Su bs cr ib er M al e
-5
Ci rc ul at or y $6
0, $9
2, $2
8, $1
1, $1
,5
Ye s
De pe nd en t M al e
<1 -1
M en ta l H ea lth $0
$6 ,9
$1
,9
$6
$1
,0
Ye s
Su bs cr ib er M al e
-4
No t A va ila bl e $0
$0 $3
,4
$1
,2
$1
,7
Ye s
Su bs cr ib er Fe m al e
-5
No t A va ila bl e
$0 $0
$3 7, $1
,1
$1
,6
Ye s
Sp ou se M al e
-5
Ge ni to ur in ar y
$0 $1
,5
$8
,5
$6 ,1
$1
,3
Ye s
Su bs cr ib er M al e
-3
No t A va ila bl e $0
$1 ,0
$1
,7
$1
,7
$1
,5
Ye s
De pe nd en t Fe m al e <1
-1
M us cu lo sk el et al
$1
,7
$2 ,5
$9
,6
$1
$1
,9
Ye s
Sp ou se Fe m al e
-5
In ju ry /P oi so ni ng
$6 7, $1 4, $2 4, $1 3, $1
,0
Ye s
Su bs cr ib er M al e
-5
Ci rc ul at or y $1
,8
$7
,2
$2 ,6
$4
$1
,3
Ye s
Su bs cr ib er Fe m al e
-4
Ge ni to ur in ar y $1
0, $9
5, $1
3, $3
$1
,9
Ye s
De pe nd en t Fe m al e <1
-1
Pe rin at al
$9 6, $0 $1
9, $0
$1
,2
Ye s
De pe nd en t Fe m al e <1
-1
Ge ni to ur in ar y $0
$4 2, $3 9, $2 9, $1
,5
Ye s
Su bs cr ib er
M al e
-5
M us cu lo sk el et al
$0 $9
7, $1
0, $3
$1
,8
Ye s
Su bs cr ib er Fe m al e
-5
No t A va ila bl e
$0 $2
,0
$1 ,5
$1
,3
$1
,9
No
Su bs cr ib er Fe m al e
-5
Ci rc ul at or y
$6 9, $2 8, $4 ,7
$0
$1
,0
Ye s
Hi gh
C os t C la im an t T ot al $1
,2
,2
$7
,8
$8
,5
$2 ,1
,0
$4
,9
,6
M
AN
O R
IN
D
EP
EN
D
EN
T
SC
H O
O L
D
IS
TR
IC
T:
A
LL
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