25-Manor ISD Large Claim Reporting - 9.2025-3.2026.xlsx

This is a Large Claim Reporting document for Manor Independent School District's self-funded medical plan covering the period from September 2025 through March 2026. The report details high-cost claims exceeding the $25,000 threshold across multiple service categories including facility inpatient, facility outpatient, professional services, and pharmacy. The document identifies 35 claimants with their encrypted member IDs, relationship descriptions (subscriber, spouse, or dependent child), medical paid amounts, pharmacy paid amounts, and primary diagnoses. The claims encompass a wide range of medical conditions including malignant neoplasms, chronic renal failure, developmental disorders, respiratory failure, and various musculoskeletal and systemic conditions.

The aggregate medical paid claims total $2,342,561.41, with pharmacy paid claims totaling $1,217,656.18, representing combined high-cost claims of approximately $3.56 million for the six-month period. Individual claim amounts vary significantly, ranging from approximately $531.81 to $466,227.13 in medical costs, with pharmacy costs ranging from $0.00 to $336,971.00. This claims data directly supports Manor Independent School District's 2026 Medical RFP, which is soliciting proposals for self-funded medical and prescription drug plans, fully insured medical and prescription drug plans, and stop loss products. The district previously rejected all prior proposals and is re-soliciting to ensure adequate competition and best value.