Attachment 1. Mem and Claims Oct 2023 - Sept 2024-GLOUCESTER COUNTY SCHOOL BOARD(Total Account)_FIN-01_20260317 03_29 PM (2).xlsx
XLSX spreadsheet 926 KB Posted
- Attached to
- RFP 26-025-CJ GCPS- Employee Medical, Stop Loss, Dental, Vision, Disability & Voluntary Benefits Coverage
- Solicitation number
- RFP-115259
- Issued by
- Frederick County, Virginia
About this file
This is a membership and claims report for the Gloucester County School Board's health insurance coverage for the period October 2023 through September 2024. The document provides detailed financial and enrollment data for medical, pharmacy, dental, and vision benefits administered by Anthem Blue Cross and Blue Shield.
The report shows monthly and quarterly membership metrics, with medical and pharmacy subscribers averaging approximately 595 across the 12-month period, serving approximately 1,217 medical members and 1,210 pharmacy members per month. Total medical claims for the period amounted to $7,019,744, while pharmacy claims totaled $3,350,320. Dental coverage showed zero enrollment throughout the period, while vision coverage served approximately 7,063 subscribers with 14,470 members and generated $8,480 in claims. Per-member-per-month (PMPM) costs for medical claims averaged $484.25, pharmacy claims averaged $231.12, and vision claims averaged $0.59. Capitation payments averaged $0.27 PMPM, with total claims and capitation costs reaching $10,444,698 for the 12-month period. Enrollment showed a slight decline from October 2023 through September 2024, with medical and pharmacy membership decreasing from approximately 1,217 to 1,147 members by the final month. The data includes payment innovation costs, which contributed an additional $70,440 to total costs over the measurement period.
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FIN-01_Visualization
FIN-01_1
| Membership and Claims by Month | |
| GLOUCESTER COUNTY SCHOOL BOARD | Segmentation: Total Account |
Current: Oct 2023 - Sep 2024 | Data Set: Medical, Pharmacy, Dental & Vision | Paid/Incurred: Paid
| Medical and Pharmacy Membership by Month | Medical and Pharmacy Financials by Month | ||||||
| Membership | Financials | Innovation | |||||
| Month | Medical Subscribers | Medical Members | Pharmacy Subscribers | Pharmacy Members | Capitated Members | Medical |
Claim PMPM Medical Claim PEPM Pharmacy Claim PMPM Pharmacy Claim
| PEPM | Capitation | |
| PMPM | Total | |
| Medical | Total | |
| Pharmacy | Medical Capitation | Total Claim |
with
| Capitation | Payment Innovation Claim |
| PMPM | Total |
| Payment Innovation | Total Claim Amount With Payment Innovation |
and Capitation
| Oct 2023 | 595 | 1,217 | 595 | 1,217 | 1,263 | $369.67 | $756.11 | $252.36 | $516.17 | $0.28 | $449,886 | $307,123 | $349 | $757,357 | $3.85 | $4,687 | $762,044 |
| Nov 2023 | 593 | 1,210 | 593 | 1,210 | 1,276 | $941.07 | $1,920.22 | $168.65 | $344.12 | $0.28 | $1,138,689 | $204,063 | $353 | $1,343,106 | $4.07 | $4,920 | $1,348,026 |
| Dec 2023 | 600 | 1,226 | 600 | 1,226 | 1,287 | $407.60 | $832.87 | $195.56 | $399.59 | $0.27 | $499,721 | $239,756 | $349 | $739,826 | $3.07 | $3,767 | $743,593 |
| Jan 2024 | 597 | 1,219 | 597 | 1,219 | 1,290 | $494.48 | $1,009.66 | $249.35 | $509.14 | $0.27 | $602,766 | $303,957 | $352 | $907,075 | $4.05 | $4,940 | $912,015 |
| Feb 2024 | 596 | 1,215 | 596 | 1,215 | 1,288 | $495.69 | $1,010.52 | $233.55 | $476.11 | $0.27 | $602,269 | $283,760 | $349 | $886,378 | $3.88 | $4,715 | $891,093 |
| Mar 2024 | 595 | 1,218 | 595 | 1,218 | 1,287 | $412.64 | $844.70 | $212.57 | $435.14 | $0.27 | $502,596 | $258,907 | $350 | $761,854 | $4.06 | $4,939 | $766,793 |
| Apr 2024 | 596 | 1,221 | 596 | 1,221 | 1,292 | $337.80 | $692.03 | $228.39 | $467.89 | $0.27 | $412,448 | $278,862 | $352 | $691,662 | $4.29 | $5,236 | $696,898 |
| May 2024 | 591 | 1,207 | 591 | 1,207 | 1,282 | $566.41 | $1,156.79 | $244.17 | $498.67 | $0.27 | $683,661 | $294,711 | $347 | $978,720 | $4.58 | $5,523 | $984,242 |
| Jun 2024 | 586 | 1,204 | 586 | 1,204 | 1,274 | $337.55 | $693.53 | $251.50 | $516.73 | $0.27 | $406,406 | $302,802 | $346 | $709,554 | $5.39 | $6,492 | $716,046 |
| Jul 2024 | 583 | 1,203 | 583 | 1,203 | 1,272 | $478.67 | $987.73 | $238.40 | $491.93 | $0.27 | $575,846 | $286,795 | $348 | $862,988 | $5.12 | $6,163 | $869,151 |
| Aug 2024 | 585 | 1,209 | 585 | 1,209 | 1,287 | $542.06 | $1,120.25 | $259.25 | $535.77 | $0.27 | $655,345 | $313,428 | $349 | $969,123 | $11.48 | $13,880 | $983,003 |
| Sep 2024 | 550 | 1,147 | 550 | 1,147 | 1,285 | $427.30 | $891.11 | $240.76 | $502.10 | $0.27 | $490,109 | $276,155 | $351 | $766,615 | $4.51 | $5,178 | $771,793 |
| Total | 7,067 | 14,496 | 7,067 | 14,496 | 15,383 | $484.25 | $993.31 | $231.12 | $474.08 | $0.27 | $7,019,744 | $3,350,320 | $4,194 | $10,374,258 | $4.86 | $70,440 | $10,444,698 |
| Medical and Pharmacy Membership by Quarter | Medical and Pharmacy Financials by Quarter | ||||||
| Membership | Financials | Innovation | |||||
| Quarter | Medical Subscribers | Medical Members | Pharmacy Subscribers | Pharmacy Members | Capitated Members | Medical |
Claim PMPM Medical Claim PEPM Pharmacy Claim PMPM Pharmacy Claim
| PEPM | Capitation | |
| PMPM | Total | |
| Medical | Total | |
| Pharmacy | Medical Capitation | Total Claim |
with
| Capitation | Payment Innovation Claim |
| PMPM | Total |
| Payment Innovation | Total Claim Amount With Payment Innovation |
and Capitation
| QTR 4 2023 | 1,788 | 3,653 | 1,788 | 3,653 | 3,826 | $571.67 | $1,167.95 | $205.57 | $419.99 | $0.27 | $2,088,297 | $750,942 | $1,051 | $2,840,289 | $3.66 | $13,374 | $2,853,663 |
| QTR 1 2024 | 1,788 | 3,652 | 1,788 | 3,652 | 3,865 | $467.59 | $955.05 | $231.82 | $473.50 | $0.27 | $1,707,631 | $846,624 | $1,051 | $2,555,307 | $4.00 | $14,595 | $2,569,902 |
| QTR 2 2024 | 1,773 | 3,632 | 1,773 | 3,632 | 3,848 | $413.69 | $847.44 | $241.29 | $494.29 | $0.27 | $1,502,515 | $876,376 | $1,045 | $2,379,936 | $4.75 | $17,250 | $2,397,186 |
| QTR 3 2024 | 1,718 | 3,559 | 1,718 | 3,559 | 3,844 | $483.65 | $1,001.92 | $246.24 | $510.12 | $0.27 | $1,721,300 | $876,378 | $1,048 | $2,598,726 | $7.09 | $25,221 | $2,623,947 |
| Total | 7,067 | 14,496 | 7,067 | 14,496 | 15,383 | $484.25 | $993.31 | $231.12 | $474.08 | $0.27 | $7,019,744 | $3,350,320 | $4,194 | $10,374,258 | $4.86 | $70,440 | $10,444,698 |
| Note: Quarterly summaries are based on the most current rolling 12 months (), causing some quarters to include less than 3 calendar months of data. |
| Dental and Vision Membership by Month | Dental and Vision Financials by Month | |||||
| Membership | Financials | |||||
| Month | Dental Subscribers | Dental Members | Vision Subscribers | Vision | ||
| Members | Dental |
Claim PMPM Dental Claim PEPM Vision Claim PMPM Vision Claim
| PEPM | Total |
| Dental | Total |
Vision
| Oct 2023 | 0 | 0 | 595 | 1,216 | $0.00 | $0.00 | $0.69 | $1.40 | $0 | $835 |
| Nov 2023 | 0 | 0 | 593 | 1,209 | $0.00 | $0.00 | $0.34 | $0.69 | $0 | $410 |
| Dec 2023 | 0 | 0 | 599 | 1,223 | $0.00 | $0.00 | $0.79 | $1.62 | $0 | $970 |
| Jan 2024 | 0 | 0 | 597 | 1,217 | $0.00 | $0.00 | $0.74 | $1.51 | $0 | $900 |
| Feb 2024 | 0 | 0 | 596 | 1,213 | $0.00 | $0.00 | $0.28 | $0.57 | $0 | $340 |
| Mar 2024 | 0 | 0 | 595 | 1,216 | $0.00 | $0.00 | $0.56 | $1.14 | $0 | $680 |
| Apr 2024 | 0 | 0 | 596 | 1,219 | $0.00 | $0.00 | $0.74 | $1.51 | $0 | $900 |
| May 2024 | 0 | 0 | 591 | 1,205 | $0.00 | $0.00 | $0.24 | $0.50 | $0 | $295 |
| Jun 2024 | 0 | 0 | 586 | 1,202 | $0.00 | $0.00 | $0.10 | $0.21 | $0 | $125 |
| Jul 2024 | 0 | 0 | 583 | 1,201 | $0.00 | $0.00 | $1.03 | $2.13 | $0 | $1,240 |
| Aug 2024 | 0 | 0 | 583 | 1,205 | $0.00 | $0.00 | $0.84 | $1.74 | $0 | $1,015 |
| Sep 2024 | 0 | 0 | 549 | 1,144 | $0.00 | $0.00 | $0.67 | $1.40 | $0 | $770 |
| Total | 0 | 0 | 7,063 | 14,470 | $0.00 | $0.00 | $0.59 | $1.20 | $0 | $8,480 |
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and Community Care Health Plan of Georgia, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc., and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI) underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
| Pharmacy claims runout/paid through date is always set to the Latest Data Loaded month, for every time period. Medical claims runout/paid through date is indicated in the report header. |
| Latest Data Loaded: 02/2026 Run Date: 03/17/2026 |
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