3-Exhibit A-0 - General Summary.pdf

Schertz - Cibolo - Universal City ISD

RFP for Medical Stop Loss

Christian Yantorno / CSG2

Current Plan Information

2 0

Proposed Plan

Aggregate Maximum: $1,000,000

1/1/2027

10/28/2026

Claim Summary

Aggregate Coverage:

Aggregate Contract: 24/12 24/12

TPA:

Specific Coverage: Med/Rx

Med/Rx Med/Rx Med/Rx

24/12

Med/Rx Med/Rx

$756.17

$470,343 $84,326 17.9% $5,473,433

YTD Claims

$1,000,000 $1,000,000

Enrollment PEPM Claims

EHN and Healthsmart (See details below)

Spec. Claims Loss Ratio

Sage PPO Network:

YTD Premium

* The current year reflects claims through the most recent month.

4,827 $1,133.92

2026 Plan Year $867,661 $447,263 51.5% $8,636,473 8,557 $1,009.29

2025 (4 Months) Plan Year

14,29824-25 Plan Year $1,393,002 $272,165 19.5% $10,811,694

Specific Contract: 24/12 24/12 24/12

Aggregating Specific: N/A N/A N/A

Specific Deductible: $200,000 $250,000 $300,000

Option 1 Option 2 Option 3 Option 4 Option 5 Option 6

Total: 1,137 $1,399,528 $42,296 $12,082,839

Family 362 $189.59 $3.10 $1,576.29

Enrollment Specific Rate Aggregate Rate Aggregate Factors

EE Only 775 $61.93 $3.10 $562.95

New Business

Agg Spec: N/A

TPA: Aetna PPO Network: Aetna

Location: Schertz, Tx 78154

Broker Location: Camden, NJ8211-Elementary And Secondary Schools

0%Commission:

Industry:

Eff. Date:

Deductible: $200,000 Options: Specific Advance NNL/50% RC

Specific Coverage Aggregate Coverage

Contract: 24/12 Coverage: Med/Rx Contract: 24/12 Coverage: Med/Rx

Due Date:

Carrier(s): Sun Life

Group Name: Schertz - Cibolo - Universal City ISD

Exhibit A-0: General Summary

RFP for Medical Stop Loss

Effective January 1, 2027, the District will transition to Sage TPA and will continue utilizing a two-tier plan structure. Tier 1 will utilize the EHN network with ClaimsBridge and a reimbursement target of 150% of

Medicare. Tier 2 will utilize HealthSmart professional providers with reimbursement at 200% of Medicare on a cash-pay basis. In addition, the District will implement Rx Valet to oversee international sourcing and cost-containment strategies for prescription medications.

Please note that the District completed a 12-month contract period from September 1, 2024 through August

31, 2025, followed by a four-month renewal period to align the health plan with a January 1 effective date. This transition was designed to position the plan for a calendar-year renewal cycle beginning January 1, 2026.

Thank you for your consideration of this opportunity. Please let us know if there are any questions or if additional information would be helpful during your evaluation.

Disclaimer: The information contained in this RFP document is generated utilizing data sourced by the broker and/or administrator and is simply our interpretation of the data. We do not warrant that the information provided to us (or our interpretation of the data) is accurate or complete. In addition to this document we are including the reports we relied on. Please be sure to independently review the source data included in this submission and do not rely solely on our interpretation. In no event shall XL Benefits be responsible or liable for any claims, liabilities, or damages due to the incompleteness or inaccuracy of the information we have provided.

Underwriting Notes:

The Schertz-Cibolo-Universal City Independent School District (SCUC ISD) provides public education to nearly

15,000 students in pre-kindergarten through 12th grade across Bexar and Guadalupe counties in Texas. The

District is committed to delivering high-quality educational programs and support services to students while maintaining a comprehensive employee benefits program for its workforce.

The District is currently operating with a 120% aggregate corridor, NNL/RC contract provisions, and monthly claims experience has been running above expected levels. For the current plan year, there is one member subject to a $400,000 laser. Detailed diagnosis information for current large claimants has been requested and will be provided upon receipt. To assist with underwriting review, detailed pharmacy claims data for the past 24 months, including plan year Rx utilization pivot tables, has been provided.

Rate History

Plan Name

Network Non-Network Network Non-Network

Medical Benefits

Deductible Tier 1: $2,000 (x2)

Tier 2: $4,000 (x2) N/A

Tier 1: $5,000 (x2)

Tier 2: $7,000 (x2) N/A

Out of Pocket Maximum Tier 1: $4,000 (x2)

Tier 2: $6,000 (x2) N/A

Tier 1: $6,550 (x2)

Tier 2: $8,500 (x2) N/A

Coinsurance 60-80% Not Covered 60-70% Not Covered

Office Copay $15 copay Not Covered 60-70% Not Covered

Hospital Deductible 60-80% Not Covered 60-70% Not Covered

Prescription Drug Benefit

Retail Mail Order Retail Mail Order

Rx Deductible

Rx OOP Maximum

Generic Copay N/A N/A N/A N/A

Brand Copay (Preferred) N/A N/A N/A N/A

Brand Copay (Non-preferred) N/A N/A N/A N/A

Specialty Drugs

Enrollment & Rates

EE Only 658 $0.00 117 $0.00

Family 307 $0.00 55 $0.00

Totals 965 $0 172 $0

N/A

N/A

N/A

Aetna Baptist ACO Plan 3 Aetna HDHP Plan 1

N/A

N/A

N/A

Rate History

Plan Year 24-25 2025 (4 Months) 2026

Carrier HM Life HM Life Sun Life

Specific Deductible $200,000 $200,000 $200,000 Aggregating Specific N/A N/A N/A

Specific Contract 24/12 24/4 24/12

Coverage Med/Rx Med/Rx Med/Rx

Aggregate Contract: 24/12 24/4 24/12

Coverage: Med/Rx Med/Rx Med/Rx

Average Enrollment EE Only 816 827 844

Family 375 380 378

Total Enrollment 14,296 14,481 14,667 8,556

Specific Rates EE Only $97.44 $97.44 $61.93

Family $97.44 $97.44 $189.59

Annual Premium $1,393,002 $470,343 $1,487,420 $867,661

Aggregate Rate:

Composite: $4.87 $4.87 $3.10 YTD

Annual Premium $69,631 $23,507 $45,469 $26,524

Aggregate Factors EE Only $837.37 $837.37 $562.95

Family $837.37 $837.37 $1,576.29

Attachment Point $11,971,042 $12,125,955 $12,853,539 $7,497,898

YTD

YTD

YTD

Large Claim Summary

Contract: 24/12 Specific Deductible: $200,000

Coverage: Med/Rx Aggregating Specific: N/A

Initials Paid Claims Deductible Specific Claims

1. Claimant 1 $350,502 $200,000 $150,502

2. Claimant 2 $300,792 $200,000 $100,792

3. Claimant 3 $220,871 $200,000 $20,871

4. Claimant 4 $196,953 $200,000 $0

5. Claimant 5 $192,177 $200,000 $0

6. Claimant 6 $171,827 $200,000 $0

7. Claimant 7 $171,031 $200,000 $0

8. Claimant 8 $163,454 $200,000 $0

9. Claimant 9 $139,746 $200,000 $0

10. Claimant 10 $123,878 $200,000 $0

11. Claimant 11 $107,133 $200,000 $0

12. Claimant 12 $105,096 $200,000 $0

Total: $272,165

$0 Stop Loss Premium: $1,393,002

$272,165 Loss Ratio: 19.54%

Contract: 24/4 Specific Deductible: $200,000

Coverage: Med/Rx Aggregating Specific: N/A

Initials Paid Claims Deductible Specific Claims

1. Claimant 1 $284,326 $200,000 $84,326

2. Claimant 2 $171,586 $200,000 $0

3. Claimant 3 $146,921 $200,000 $0

4. Claimant 4 $129,937 $200,000 $0

5. Claimant 5 $119,056 $200,000 $0

6. Claimant 6 $113,578 $200,000 $0

7. Claimant 7 $111,884 $200,000 $0

8. Claimant 8 $107,091 $200,000 $0

Total: $84,326

$0 Stop Loss Premium: $470,343

$84,326 Loss Ratio: 17.93%Stop Loss Reimbursements:

Aggregating Specific:

Bipolar Disorder, Current Episode Depressed, Severe, Without Psychotic Features

Encounter For Antineoplastic Chemotherapy

Acute Gastroenteropathy Due To Norwalk Agent

Malignant Neoplasm Of Overlapping Sites Of Left Female Breast

Paroxysmal Atrial Fibrillation

Encounter for Prophylactic Immunotherapy

Claimant

Stop Loss Reimbursements:

2025 (4 Months)

Condition

Other Specified Extrapyramidal And Movement Disorders

High Dollar Rx - Voranigo

Aggregating Specific:

Acute And Chronic Respiratory Failure With Hypoxia

High Dollar Rx - Skyrizi

High Dollar Rx - Verzenio

High Dollar Rx - Trikafta

Sepsis, Unspecified Organism

High Dollar Rx - Skyrizi

High Dollar Rx - Revlimid

High Dollar Rx - Voranigo

Autistic Disorder

High Dollar Rx - Xospata

Claimant

24-25

Condition

Acute Respiratory Failure with Hypoxia, High Dollar Rx - Augtyro

Paroxysmal Atrial Fibrillation

Large Claim Summary

Contract: 24/12 Specific Deductible: $200,000

Coverage: Med/Rx Aggregating Specific: N/A

Initials Paid Claims Deductible Specific Claims

1. Claimant 1 CN $378,327 $200,000 $178,327

2. Claimant 2 SM $312,181 $200,000 $112,181

3. Claimant 3 SM $294,012 $200,000 $94,012

4. Claimant 4 RC $262,743 $200,000 $62,743

5. Claimant 5 MP $168,067 $200,000 $0

6. Claimant 6 DR $161,922 $200,000 $0

7. Claimant 7 KK $137,382 $200,000 $0

8. Claimant 8 ED $132,028 $200,000 $0

9. Claimant 9 TC $127,864 $200,000 $0

10. Claimant 10 PL $103,217 $200,000 $0

11. Claimant 11 KP $102,676 $200,000 $0

12. Claimant 12 CB $102,663 $200,000 $0

Total: $447,263

$0 Stop Loss Premium: $867,661

$447,263 Loss Ratio: 51.55%Stop Loss Reimbursements:

Aggregating Specific:

High Dollar Rx - Xospata

High Dollar Rx - Revlimid

High Dollar Rx - Omvoh

High Dollar Rx - Verzenio

Claimant

ICD

Monthly Claim Summary

Contract: 24/12

Coverage: Med/Rx

Factors $837.37 $837.37 $837.37 $837.37

Month EE Only EE + SP EE + CH Family Total Medical Rx Total

Sep 2024 818 39 295 42 1,194 $67,916 $194,230 $262,146

Oct 2024 823 40 297 42 1,201 $317,287 $302,069 $619,356

Nov 2024 825 40 298 42 1,204 $335,252 $270,348 $605,600

Dec 2024 826 40 298 42 1,206 $482,637 $325,593 $808,229

Jan 2025 816 39 294 41 1,191 $423,593 $360,558 $784,152

Feb 2025 813 39 293 41 1,187 $380,515 $338,830 $719,345

Mar 2025 815 39 294 41 1,190 $440,862 $308,038 $748,900

Apr 2025 817 39 295 41 1,192 $596,930 $491,210 $1,088,140

May 2025 813 39 293 41 1,186 $461,025 $413,854 $874,878

Jun 2025 812 39 293 41 1,185 $697,219 $496,125 $1,193,343

Jul 2025 809 39 292 41 1,181 $909,212 $477,425 $1,386,636

Aug 2025 809 39 292 41 1,181 $721,184 $471,948 $1,193,133

Totals 9,796 471 3,534 496 14,298 $5,833,633 $4,450,226 $10,283,859

$272,165

-$800,000

$10,811,694

Contract: 24/4

Coverage: Med/Rx

Factors $837.37 $837.37 $837.37 $837.37

Month EE Only EE + SP EE + CH Family Total Medical Rx Total

Sep 2025 829 40 298 42 1,209 $862,046 $477,928 $1,339,973

Oct 2025 825 40 299 42 1,206 $778,167 $369,531 $1,147,698

Nov 2025 826 39 299 42 1,206 $1,352,352 $435,973 $1,788,326

Dec 2025 827 40 297 42 1,206 $841,011 $440,750 $1,281,761

Totals 3,307 159 1,193 168 4,827 $3,833,576 $1,724,182 $5,557,759

$84,326

$0

$5,473,433

24-25

Enrollment Claims

PEPM: $756.17 Specific Reimbursements:

Aggregate Deductible: $11,971,879 Ineligible Expenses:

Loss Ratio: 90.31% Total:

Enrollment Claims

PEPM: $1,133.92 Specific Reimbursements:

Aggregate Deductible: $4,041,985 Ineligible Expenses:

Loss Ratio: 135.41% Total:

Monthly Claim Summary

Contract: 24/12

Coverage: Med/Rx

Factors $562.95 $1,576.29 $1,576.29 $1,576.29

Month EE Only EE + SP EE + CH Family Total Medical Rx Total

Jan 2026 864 40 297 37 1,238 $1,208,782 $316,426 $1,525,208

Feb 2026 860 40 298 37 1,235 $815,600 $342,781 $1,158,382

Mar 2026 849 39 300 39 1,227 $939,446 $289,748 $1,229,193

Apr 2026 846 39 300 39 1,224 $879,343 $422,777 $1,302,120

May 2026 837 39 299 40 1,215 $745,291 $417,095 $1,162,385

Jun 2026 830 40 297 42 1,209 $729,438 $434,215 $1,163,653

Jul 2026 824 39 305 41 1,209 $1,046,563 $496,232 $1,542,795

Aug 2026 $0

Sep 2026 $0

Oct 2026 $0

Nov 2026 $0

Dec 2026 $0

Totals 5,910 276 2,096 275 8,557 $6,364,462 $2,719,274 $9,083,736

$447,263

$0

$8,636,473

Enrollment Claims

PEPM: $1,009.29 Specific Reimbursements:

Aggregate Deductible: $7,499,474 Ineligible Expenses:

Loss Ratio: 115.16% Total: