Attachment 1A. Mem and Claims Oct 2024 - Sept 2025-GLOUCESTER COUNTY SCHOOL BOARD(Total Account)_FIN-01_20260317 03_28 PM.xlsx
XLSX spreadsheet 930 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 data report for health insurance services provided to the Gloucester County School Board for the period of October 2024 through September 2025. The report presents comprehensive utilization and financial data across medical, pharmacy, dental, and vision coverage administered by Anthem Blue Cross and Blue Shield.
The report documents membership trends and claim payments across all service categories for a 12-month period. Medical and pharmacy membership averaged approximately 1,173 to 1,204 subscribers with 1,194 to 1,200 members per month. Medical claim costs ranged from a low of $286.13 PMPM (per member per month) in December 2024 to a high of $1,375.86 PMPM in June 2025, with total medical claims reaching $7,553,305 for the period. Pharmacy claims averaged $223.98 PMPM, totaling $3,215,221 for the 12-month term. Capitated members averaged 1,305 per month. Dental coverage showed no subscribers or members throughout the period. Vision coverage maintained consistent participation with 579 to 586 subscribers and approximately 1,194 to 1,206 members monthly, generating $9,480 in total claims. The total claim amount including payment innovation and capitation for the entire period reached $10,835,303. Data was current as of February 2026 with a report run date of March 17, 2026, indicating claims were paid and processed through that timeframe.
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FIN-01_Visualization
FIN-01_1
| Membership and Claims by Month | |
| GLOUCESTER COUNTY SCHOOL BOARD | Segmentation: Total Account |
Current: Oct 2024 - Sep 2025 | 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 2024 | 577 | 1,173 | 577 | 1,173 | 1,334 | $391.35 | $795.59 | $264.73 | $538.17 | $0.27 | $459,055 | $310,526 | $364 | $769,946 | $4.39 | $5,146 | $775,092 |
| Nov 2024 | 583 | 1,193 | 583 | 1,193 | 1,348 | $476.63 | $975.34 | $198.18 | $405.54 | $0.27 | $568,625 | $236,428 | $367 | $805,420 | $4.23 | $5,046 | $810,467 |
| Dec 2024 | 586 | 1,196 | 586 | 1,196 | 1,361 | $286.13 | $583.97 | $200.97 | $410.17 | $0.23 | $342,206 | $240,357 | $313 | $582,875 | $3.72 | $4,450 | $587,326 |
| Jan 2025 | 585 | 1,194 | 585 | 1,194 | 1,305 | $352.00 | $718.44 | $226.45 | $462.18 | $0.27 | $420,285 | $270,377 | $347 | $691,009 | $3.15 | $3,760 | $694,769 |
| Feb 2025 | 583 | 1,199 | 583 | 1,199 | 1,298 | $322.37 | $662.98 | $193.34 | $397.63 | $0.27 | $386,518 | $231,816 | $352 | $618,686 | $4.33 | $5,192 | $623,878 |
| Mar 2025 | 586 | 1,204 | 586 | 1,204 | 1,316 | $502.09 | $1,031.59 | $283.24 | $581.94 | $0.27 | $604,513 | $341,018 | $358 | $945,889 | $3.82 | $4,603 | $950,492 |
| Apr 2025 | 585 | 1,202 | 585 | 1,202 | 1,317 | $359.94 | $739.58 | $186.16 | $382.51 | $0.27 | $432,653 | $223,770 | $352 | $656,775 | $6.04 | $7,265 | $664,040 |
| May 2025 | 583 | 1,197 | 583 | 1,197 | 1,310 | $317.51 | $651.91 | $212.24 | $435.76 | $0.27 | $380,062 | $254,047 | $351 | $634,460 | $5.42 | $6,485 | $640,945 |
| Jun 2025 | 581 | 1,200 | 581 | 1,200 | 1,302 | $1,375.86 | $2,841.70 | $213.41 | $440.77 | $0.27 | $1,651,030 | $256,086 | $350 | $1,907,467 | $4.98 | $5,970 | $1,913,437 |
| Jul 2025 | 581 | 1,204 | 581 | 1,204 | 1,306 | $705.93 | $1,462.88 | $229.03 | $474.63 | $-0.29 | $849,935 | $275,758 | $-382 | $1,125,311 | $4.75 | $5,719 | $1,131,029 |
| Aug 2025 | 578 | 1,193 | 578 | 1,193 | 1,205 | $598.02 | $1,234.32 | $230.70 | $476.18 | $0.14 | $713,435 | $275,231 | $170 | $988,836 | $4.44 | $5,294 | $994,130 |
| Sep 2025 | 579 | 1,200 | 579 | 1,200 | 1,211 | $620.82 | $1,286.68 | $249.84 | $517.80 | $0.14 | $744,988 | $299,806 | $164 | $1,044,959 | $3.95 | $4,740 | $1,049,699 |
| Total | 6,987 | 14,355 | 6,987 | 14,355 | 15,613 | $526.18 | $1,081.05 | $223.98 | $460.17 | $0.20 | $7,553,305 | $3,215,221 | $3,105 | $10,771,632 | $4.44 | $63,671 | $10,835,303 |
| 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 2024 | 1,746 | 3,562 | 1,746 | 3,562 | 4,043 | $384.58 | $784.59 | $221.03 | $450.92 | $0.26 | $1,369,887 | $787,311 | $1,043 | $2,158,241 | $4.11 | $14,643 | $2,172,884 |
| QTR 1 2025 | 1,754 | 3,597 | 1,754 | 3,597 | 3,919 | $392.36 | $804.63 | $234.42 | $480.74 | $0.27 | $1,411,316 | $843,212 | $1,056 | $2,255,584 | $3.77 | $13,554 | $2,269,138 |
| QTR 2 2025 | 1,749 | 3,599 | 1,749 | 3,599 | 3,929 | $684.56 | $1,408.66 | $203.92 | $419.61 | $0.27 | $2,463,745 | $733,903 | $1,053 | $3,198,702 | $5.48 | $19,720 | $3,218,422 |
| QTR 3 2025 | 1,738 | 3,597 | 1,738 | 3,597 | 3,722 | $641.75 | $1,328.17 | $236.53 | $489.53 | -$0.01 | $2,308,358 | $850,795 | -$48 | $3,159,105 | $4.38 | $15,754 | $3,174,858 |
| Total | 6,987 | 14,355 | 6,987 | 14,355 | 15,613 | $526.18 | $1,081.05 | $223.98 | $460.17 | $0.20 | $7,553,305 | $3,215,221 | $3,105 | $10,771,632 | $4.44 | $63,671 | $10,835,303 |
| 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 2024 | 0 | 0 | 577 | 1,182 | $0.00 | $0.00 | $0.53 | $1.08 | $0 | $625 |
| Nov 2024 | 0 | 0 | 582 | 1,199 | $0.00 | $0.00 | $1.34 | $2.77 | $0 | $1,610 |
| Dec 2024 | 0 | 0 | 585 | 1,206 | $0.00 | $0.00 | $0.46 | $0.95 | $0 | $555 |
| Jan 2025 | 0 | 0 | 581 | 1,184 | $0.00 | $0.00 | $0.64 | $1.31 | $0 | $760 |
| Feb 2025 | 0 | 0 | 583 | 1,198 | $0.00 | $0.00 | $0.28 | $0.57 | $0 | $330 |
| Mar 2025 | 0 | 0 | 586 | 1,203 | $0.00 | $0.00 | $0.47 | $0.97 | $0 | $570 |
| Apr 2025 | 0 | 0 | 585 | 1,201 | $0.00 | $0.00 | $0.78 | $1.60 | $0 | $935 |
| May 2025 | 0 | 0 | 583 | 1,195 | $0.00 | $0.00 | $0.83 | $1.70 | $0 | $990 |
| Jun 2025 | 0 | 0 | 581 | 1,197 | $0.00 | $0.00 | $0.45 | $0.92 | $0 | $535 |
| Jul 2025 | 0 | 0 | 582 | 1,200 | $0.00 | $0.00 | $0.73 | $1.50 | $0 | $875 |
| Aug 2025 | 0 | 0 | 579 | 1,188 | $0.00 | $0.00 | $0.94 | $1.93 | $0 | $1,120 |
| Sep 2025 | 0 | 0 | 580 | 1,194 | $0.00 | $0.00 | $0.48 | $0.99 | $0 | $575 |
| Total | 0 | 0 | 6,984 | 14,347 | $0.00 | $0.00 | $0.66 | $1.36 | $0 | $9,480 |
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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