5-Exhibit B-3 - 2025 Large Claim Report- 9-25 thru 12-25.pdf
PDF 310 KB Posted
- Attached to
- 27-002V Stop Loss Insurance
- Solicitation number
- 27-002V
- Issued by
- Savannah CDP, Texas
About this file
This document is a Large Claim Report for the Schertz-Cibolo-Universal City Independent School District, prepared in connection with a stop loss insurance solicitation. The report identifies seven claimants whose medical and pharmacy claims exceeded $100,000 during the period of September 1, 2025, through December 31, 2025. The report lists claimant relationships (subscribers and children), claim amounts broken down by medical costs, prescription drug costs, and pooled amounts, with total claims ranging from $107,091 to $284,326. Associated diagnoses include paroxysmal atrial fibrillation, cancer-related treatments, movement disorders, gastroenteritis, bipolar disorder, and other significant medical conditions. Individual identifiers have been removed in compliance with state and federal health information privacy regulations.
This document serves as a supporting exhibit for the District's stop loss insurance procurement (Solicitation 27-002V), which invites proposals from insurance companies licensed in Texas to provide stop loss coverage. The large claim data presented provides prospective insurers with critical information regarding the District's claims history and risk profile to inform their underwriting and pricing decisions. The exhibit demonstrates the District's experience with high-cost medical claims, which is directly relevant to stop loss insurance carriers in evaluating their potential exposure and determining appropriate premium rates and coverage terms.
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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 9/1/2025 - 12/31/2025
Claimant Medical Rx Pooled Total Relationship Structure Last 4 digits
SSN
Claimant 1 $272,814 $11,512 $0 $284,326 Subscriber 237586-12-001 2060
Claimant 2 $146,126 $795 $0 $146,921 Child 237586-12-001 4366
Claimant 3 $129,817 $121 $0 $129,937 Subscriber 237586-10-001 280
Claimant 4 $113,578 $0 $0 $113,578 Child 237586-11-001 9107
Claimant 5 $111,637 $247 $0 $111,884 Child 237586-11-001 1402
Claimant 6 $107,098 $11,958 $0 $119,056 Subscriber 237586-10-001 7024
Claimant 7 $106,615 $476 $0 $107,091 Subscriber 237586-11-001 7235
Paroxysmal Atrial Fibrillation
Encounter For Antineoplastic Chemotherapy
ICD-10 Code Description
Other Specified Extrapyramidal And Movement Disorders
Acute Gastroenteropathy Due To Norwalk Agent
Malignant Neoplasm Of Overlapping Sites Of Left Female Breast
Encounter For Prophylactic Immunotherapy For Respiratory Syncytial Virus (rsv)
Bipolar Disorder, Current Episode Depressed, Severe, Without Psychotic Features
10/21/2026 Large Claim Exhibit
EXHIBIT B-3: 2025 LARGE CLAIM REPORT FOR 9-25 THRU 12-25
File details come from the government source that posted it. Updated .