4-Exhibit B-5 - 2026 Large Claim Report thru 9-26.pdf
PDF 494 KB Posted
- Attached to
- 27-002V Stop Loss Insurance
- Solicitation number
- 27-002V
- Issued by
- Savannah CDP, Texas
About this file
This is a Large Claim Report document for the 2026 stop loss insurance coverage provided to Schertz-Cibolo-Universal City Independent School District (ISD) in Texas. The report, dated through September 26, 2026, documents claims activity under the stop loss insurance policy obtained through the District's consultant, Foundation Risk Partners, d/b/a Corporate Synergies. The report provides a detailed accounting of large individual and aggregate claims that have been submitted and processed during the specified reporting period, serving as supporting documentation for the insurance coverage and claims management under the District's stop loss insurance program.
The Large Claim Report functions as an exhibit supporting the District's stop loss insurance procurement and demonstrates the claims experience and utilization of the insurance coverage during the contract period. This documentation is essential for evaluating the performance and value of the stop loss insurance policy and assists in tracking the financial impact of major claims against the District's self-funded health benefit program. The report provides transparency regarding claim amounts and frequencies that trigger the stop loss coverage limits and informs future renewal negotiations and coverage decisions.
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Text version
SCHERTZ-CIBOLO-UNIVERSAL CITY INDEPENDENT SCHOOL DISTRICT
Large Claim Listing Contractholder Number - 237586
• This report is designed to meet your need for data in evaluating your benefit plan. We have removed individual member identifiers (e.g., name, ID number, etc.) because most plan sponsors find that their needs can be met without identifiers and also to comply with state and federal health information privacy regulations.
• Amounts below reflect Medical and RX costs.
Total Group
Claimants with over $100,000 in claims for 1/1/2026 - 9/30/2026
Claimant Medical Rx Pooled Total Relationship Structure Last 4 digits
SSN
Claimant 1 $525,019 $0 $0 $525,019 Child 237586-12-001 4366
Claimant 2 $328,534 $0 $0 $328,534 Subscriber 237586-10-001 7024
Claimant 3 $293,795 $0 $0 $293,795 Spouse 237586-12-001 8291
Claimant 4 $262,743 $0 $0 $262,743 Child 237586-12-001 676
Claimant 5 $182,480 $0 $0 $182,480 Child 237586-10-001 5566
Claimant 6 $132,706 $0 $0 $132,706 Subscriber 237586-10-001 8352
Claimant 7 $129,809 $0 $0 $129,809 Subscriber 237586-10-001 3377
Claimant 8 $116,551 $0 $0 $116,551 Subscriber 237586-10-001 9882
Claimant 9 $108,013 $0 $0 $108,013 Subscriber 237586-10-001 1406
Claimant 10 $106,371 $0 $0 $106,371 Subscriber 237586-11-001 8445
Claimant 11 $101,148 $0 $0 $101,148 Subscriber 237586-10-001 6164
Central Cord Syndrome At C5 Level Of Cervical Spinal Cord, Subsequent Encounter
Bradycardia, Unspecified
Palpitations
Sick Sinus Syndrome
Spondylolisthesis, Lumbar Region
Intraductal Carcinoma In Situ Of Right Breast
ICD-10 Code Description
Intestinal Failure
Chronic Venous Hypertension (idiopathic) With Inflammation Of Right Lower Extremity
Nonrheumatic Mitral (valve) Insufficiency
Single Liveborn Infant, Delivered By Cesarean
Encounter For Antineoplastic Radiation Therapy
10/21/2026 Large Claim Exhibit
EXHIBIT B-5: 2026 LARGE CLAIM REPORT THRU SEPTEMBER 2026
File details come from the government source that posted it. Updated .