6-Exhibit B-4 - 2025 Monthly Claims- 9-25 thru 12-25.pdf
PDF 236 KB Posted
- Attached to
- 27-002V Stop Loss Insurance
- Solicitation number
- 27-002V
- Issued by
- Savannah CDP, Texas
About this file
This is a Self-Funded Monthly Claims Report prepared for the Schertz-Cibolo-Universal City Independent School District (Customer Number 237586) in Texas, documenting health insurance claims data for the period of September through December 2025. The report tracks claims across two product lines: Open Access EPO (Exclusive Provider Organization) and Open Access POS (Point of Service), with monthly breakdowns showing estimated employee enrollment, customer-funded claims, and stop loss claim information for each month during the specified period.
The Open Access EPO product generated total claims of $3,092,228.54 across 4,480 estimated employees over the four-month period, with monthly claims ranging from $571,830.57 to $1,064,331.04. The Open Access POS product generated total claims of $741,347.91 across 347 estimated employees, with monthly claims ranging from $90,987.78 to $288,021.43. The combined grand total claims across both products for the September through December 2025 period reached $3,833,576.45, with no individual or aggregate stop loss claims incurred during this timeframe. The report indicates that estimated employee counts exclude retroactive changes and that audited counts will be used for final accounting results, with notes that Rx Rebate dollars are excluded from pharmacy claims data.
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Text version
September - 25 Through December - 25
Product Month *(1) Estimated
Employees *(2) Customer Funded Claims
*(3) Individual Stop Loss Claims
*(4) Aggregate Stop Loss Claims
Total Claims
Open Acc EPO 09/01/2025 1,123 $771,057.83 $0.00 $0.00 $771,057.83
10/01/2025 1,119 $571,830.57 $0.00 $0.00 $571,830.57
11/01/2025 1,119 $1,064,331.04 $0.00 $0.00 $1,064,331.04
12/01/2025 1,119 $685,009.10 $0.00 $0.00 $685,009.10
Open Acc EPO Total 4,480 $3,092,228.54 $0.00 $0.00 $3,092,228.54
Open Acc POS 09/01/2025 86 $90,987.78 $0.00 $0.00 $90,987.78
10/01/2025 87 $206,336.63 $0.00 $0.00 $206,336.63
11/01/2025 87 $288,021.43 $0.00 $0.00 $288,021.43
12/01/2025 87 $156,002.07 $0.00 $0.00 $156,002.07
Open Acc POS Total 347 $741,347.91 $0.00 $0.00 $741,347.91
Grand Total $3,833,576.45 $0.00 $0.00 $3,833,576.45
SELF FUNDED MONTHLY CLAIMS REPORT
SCHERTZ-CIBOLO-UNIVERSAL CITY INDEPENDENT SCHOOL DISTRICT
Customer Number 237586
(1) Due to timing, current month lives are NOT available and therefore the prior month's lives are used for both months. Estimated Employee counts are unedited and exclude retroactive changes.
Audited counts will be used for accounting results.
(2) If applicable, claims displayed include charges for the National Advantage Program, Value-Based Pricing and/or specific buy-up program fees/ad hoc service charges that are billed through the claim wire. The monthly Claim Detail Report is available to identify specific claim wire billed fees/charges.
(3) Stop Loss claim values (including 0.00) display only if applicable. Absence of values in a Stop Loss column indicates that arrangement is not in effect.
(4) Stop Loss claims may be greater than displayed if subject to a year end reconciliation.
(5) If applicable, Rx Rebate dollars are excluded in the pharmacy claims and, as such, this data will not match the monthly Claim Detail Reports or Fund Summary Reports.
EXHIBIT B-4: 2025
File details come from the government source that posted it. Updated .