Attachment I – Medical Claims, Enrollment, HCCs.xlsx
XLSX spreadsheet 38 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 file contains medical claims, enrollment, and high-cost claimant data for the Gloucester County School Board's health insurance plan administered by Anthem Blue Cross and Blue Shield, covering the period from February 2025 through January 2026. The document presents comprehensive financial and utilization metrics across medical, pharmacy, dental, and vision coverage lines. Key membership metrics show approximately 583-586 medical subscribers representing 1,169-1,204 medical members per month, with similar enrollment levels for pharmacy coverage. Dental coverage showed zero enrollment throughout the period, while vision coverage maintained consistent participation with 581-586 subscribers and 1,195-1,204 members monthly. The rolling 12-month period generated total claim amounts of $10,275,463 when combining medical, pharmacy, and payment innovation adjustments, with quarterly breakdowns provided for trend analysis.
The data reveals significant claims cost variation across the measurement period, with medical claims per member per month (PMPM) averaging $485.35 and pharmacy PMPM averaging $229.58 across all months. High-cost claimants exceeding the $25,000 threshold numbered 80 individuals, accounting for $7,136,501 in combined medical and pharmacy claims, representing the concentrated cost drivers within the plan. The top claimant incurred $1,071,468 in medical and pharmacy costs, with malignant neoplasms identified as the most prevalent primary health condition among high-cost claimants. Pharmacy claims totaled $3,278,695 for the period, while dental and vision incurred minimal costs at $0 and $8,720 respectively, reflecting the plan's limited dental coverage. The report was generated on March 4, 2026, with data loaded through January 2026, using Anthem's standard paid claims reporting methodology and high-cost claimant identification parameters.
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FIN-01_1
| Membership and Claims by Month | |
| GLOUCESTER COUNTY SCHOOL BOARD | Segmentation: Total Account |
Current: Feb 2025 - Jan 2026 | 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
| 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 | 1,307 | $1,375.86 | $2,841.70 | $218.28 | $450.83 | $0.27 | $1,651,030 | $261,933 | $350 | $1,913,314 | $4.98 | $5,970 | $1,919,284 |
| Jul 2025 | 581 | 1,204 | 581 | 1,204 | 1,311 | $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 | $239.30 | $493.91 | $0.14 | $713,435 | $285,480 | $170 | $999,085 | $4.44 | $5,294 | $1,004,379 |
| 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 |
| Oct 2025 | 564 | 1,169 | 564 | 1,169 | 1,161 | $361.15 | $748.56 | $191.38 | $396.66 | $0.14 | $422,186 | $223,719 | $163 | $646,068 | $4.50 | $5,265 | $651,332 |
| Nov 2025 | 560 | 1,166 | 560 | 1,166 | 1,169 | $259.22 | $539.74 | $241.26 | $502.34 | $0.14 | $302,252 | $281,309 | $162 | $583,723 | $4.47 | $5,210 | $588,934 |
| Dec 2025 | 560 | 1,171 | 560 | 1,171 | 1,177 | $126.57 | $264.66 | $269.87 | $564.32 | $0.14 | $148,212 | $316,022 | $163 | $464,396 | $4.36 | $5,110 | $469,506 |
| Jan 2026 | 567 | 1,176 | 567 | 1,176 | 1,175 | $251.31 | $521.23 | $241.51 | $500.91 | $0.14 | $295,539 | $284,016 | $163 | $579,718 | $1.89 | $2,227 | $581,946 |
| Total | 6,907 | 14,281 | 6,907 | 14,281 | 14,957 | $485.35 | $1,003.52 | $229.58 | $474.69 | $0.16 | $6,931,322 | $3,278,695 | $2,366 | $10,212,383 | $4.42 | $63,081 | $10,275,463 |
| 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 1 2025 | 1,169 | 2,403 | 1,169 | 2,403 | 2,614 | $412.41 | $847.76 | $238.38 | $490.02 | $0.27 | $991,031 | $572,834 | $710 | $1,564,575 | $4.08 | $9,795 | $1,574,370 |
| QTR 2 2025 | 1,749 | 3,599 | 1,749 | 3,599 | 3,934 | $684.56 | $1,408.66 | $205.54 | $422.96 | $0.27 | $2,463,745 | $739,750 | $1,053 | $3,204,548 | $5.48 | $19,720 | $3,224,269 |
| QTR 3 2025 | 1,738 | 3,597 | 1,738 | 3,597 | 3,727 | $641.75 | $1,328.17 | $239.38 | $495.42 | -$0.01 | $2,308,358 | $861,044 | -$48 | $3,169,354 | $4.38 | $15,754 | $3,185,107 |
| QTR 4 2025 | 1,684 | 3,506 | 1,684 | 3,506 | 3,507 | $248.90 | $518.20 | $234.18 | $487.56 | $0.14 | $872,650 | $821,050 | $488 | $1,694,187 | $4.45 | $15,585 | $1,709,772 |
| QTR 1 2026 | 567 | 1,176 | 567 | 1,176 | 1,175 | $251.31 | $521.23 | $241.51 | $500.91 | $0.14 | $295,539 | $284,016 | $163 | $579,718 | $1.89 | $2,227 | $581,946 |
| Total | 6,907 | 14,281 | 6,907 | 14,281 | 14,957 | $485.35 | $1,003.52 | $229.58 | $474.69 | $0.16 | $6,931,322 | $3,278,695 | $2,366 | $10,212,383 | $4.42 | $63,081 | $10,275,463 |
| 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
| 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 |
| Oct 2025 | 0 | 0 | 564 | 1,169 | $0.00 | $0.00 | $1.00 | $2.07 | $0 | $1,170 |
| Nov 2025 | 0 | 0 | 561 | 1,167 | $0.00 | $0.00 | $0.16 | $0.34 | $0 | $190 |
| Dec 2025 | 0 | 0 | 561 | 1,172 | $0.00 | $0.00 | $0.25 | $0.52 | $0 | $290 |
| Jan 2026 | 0 | 0 | 567 | 1,177 | $0.00 | $0.00 | $0.97 | $2.01 | $0 | $1,140 |
| Total | 0 | 0 | 6,912 | 14,261 | $0.00 | $0.00 | $0.61 | $1.26 | $0 | $8,720 |
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: 01/2026 Run Date: 03/04/2026 |
HCC-01_1
| High Cost Claimant without Member Name > $25,000 | |
| GLOUCESTER COUNTY SCHOOL BOARD | Segmentation: Total Account |
Current: Feb 2025 - Jan 2026 • Prior 1: Feb 2024 - Jan 2025 • Prior 2: Feb 2023 - Jan 2024 | Data Set: Medical & Pharmacy | Paid/Incurred: Paid
| Claim Details | ||||
| Rank | Relationship | Active | ||
| (Yes/No) | Primary |
Health Condition Category Medical Total Claim Amount Pharmacy Total Claim Amount Total Claim Amount Most Recent Month Medical Claim Amount Most Recent Month Pharmacy Claim Amount
| 1 | Employee/Self | Y | Neoplasms - Malignant | $1,069,548 | $1,920 | $1,071,468.27 | $3,876 | $16 |
| 2 | Employee/Self | Y | Neoplasms - Malignant | $107,650 | $202,910 | $310,560.47 | $632 | $13,602 |
| 3 | Spouse/Partner | Y | Neoplasms - Malignant | $279,965 | $13,136 | $293,100.54 | $47,466 | $79 |
| 4 | Employee/Self | Y | Neoplasms - Malignant | $6,663 | $278,128 | $284,791.12 | $0 | $17,495 |
| 5 | Employee/Self | N | Neoplasms - Malignant | $252,839 | $131 | $252,969.31 | $1,397 | $0 |
| 6 | Employee/Self | Y | Musculoskeletal System | $32,416 | $201,468 | $233,884.36 | $413 | $13,935 |
| 7 | Spouse/Partner | Y | Nervous System | $15,430 | $153,200 | $168,629.50 | $498 | $20,963 |
| 8 | Employee/Self | Y | Circulatory System | $140,270 | $5,727 | $145,996.63 | $0 | $101 |
| 9 | Spouse/Partner | Y | Musculoskeletal System | $142,224 | $1,210 | $143,434.17 | $359 | $58 |
| 10 | Employee/Self | Y | Musculoskeletal System | $7,666 | $133,294 | $140,960.76 | $3,261 | $21 |
| 11 | Employee/Self | Y | Health Status | $130,478 | $407 | $130,884.66 | $3,351 | $0 |
| 12 | Spouse/Partner | Y | Circulatory System | $95,779 | $17,872 | $113,651.74 | $10,801 | $6,189 |
| 13 | Employee/Self | Y | Circulatory System | $105,997 | $4,183 | $110,180.79 | $2,473 | $0 |
| 14 | Spouse/Partner | N | Nervous System | $106,537 | $1,805 | $108,341.93 | $0 | $0 |
| 15 | Employee/Self | Y | Musculoskeletal System | $98,665 | $3,261 | $101,925.80 | $0 | $0 |
| 16 | Employee/Self | Y | Nervous System | $1,351 | $99,492 | $100,842.23 | $44 | $11,497 |
| 17 | Employee/Self | Y | Behavioral Health | $1,936 | $97,125 | $99,061.44 | $496 | $11,300 |
| 18 | Employee/Self | Y | Musculoskeletal System | $95,845 | $1,178 | $97,023.25 | $0 | $93 |
| 19 | Employee/Self | Y | Behavioral Health | $96,660 | $131 | $96,790.13 | $55 | $0 |
| 20 | Child/Other Dependent | Y | Newborn | $92,876 | $0 | $92,875.81 | $821 | $0 |
| 21 | Employee/Self | Y | Circulatory System | $81,985 | $8,092 | $90,077.47 | $2,397 | $1,075 |
| 22 | Spouse/Partner | Y | Neoplasms - Malignant | $86,985 | $1,168 | $88,153.16 | $12,854 | $0 |
| 23 | Employee/Self | Y | Circulatory System | $81,189 | $6,131 | $87,319.94 | $738 | $593 |
| 24 | Employee/Self | Y | Digestive System | $62,055 | $23,998 | $86,053.28 | $2,369 | $4,565 |
| 25 | Employee/Self | N | Injury & Poisoning | $83,676 | $1,307 | $84,982.73 | $0 | $0 |
| 26 | Employee/Self | Y | Health Status | $9,913 | $73,812 | $83,724.32 | $3,059 | $4,487 |
| 27 | Child/Other Dependent | Y | Behavioral Health | $71,574 | $11,879 | $83,453.01 | $11,200 | $1,550 |
| 28 | Employee/Self | Y | Neoplasms - Malignant | $1,828 | $79,974 | $81,802.29 | $0 | $0 |
| 29 | Spouse/Partner | N | Behavioral Health | $77,871 | $3,404 | $81,275.23 | $0 | $0 |
| 30 | Employee/Self | Y | Musculoskeletal System | $1,004 | $78,103 | $79,107.06 | $0 | $7,895 |
| 31 | Employee/Self | Y | Genitourinary System | $72,286 | $6,642 | $78,928.52 | $1,275 | $664 |
| 32 | Employee/Self | Y | Musculoskeletal System | $50,775 | $22,790 | $73,564.86 | $0 | $2,668 |
| 33 | Spouse/Partner | Y | Health Status | $61,776 | $11,150 | $72,926.11 | $2,166 | $380 |
| 34 | Employee/Self | Y | Diseases of the Skin | $1,415 | $70,430 | $71,844.79 | $0 | $7,282 |
| 35 | Spouse/Partner | Y | Circulatory System | $71,737 | $0 | $71,737.01 | $0 | $0 |
| 36 | Child/Other Dependent | Y | Newborn | $63,105 | $0 | $63,105.15 | $0 | $0 |
| 37 | Employee/Self | Y | Diseases of the Eye | $62,644 | $452 | $63,095.72 | $132 | $0 |
| 38 | Child/Other Dependent | Y | Health Status | $1,967 | $59,890 | $61,856.23 | $0 | $4,412 |
| 39 | Employee/Self | Y | Diseases of the Skin | $2,320 | $57,862 | $60,181.78 | $99 | $0 |
| 40 | Employee/Self | Y | Diseases of the Skin | $1,657 | $57,648 | $59,305.54 | $0 | $0 |
| 41 | Employee/Self | Y | Neoplasms - Malignant | $51,596 | $7,217 | $58,812.88 | $127 | $630 |
| 42 | Employee/Self | Y | Health Status | $55,461 | $820 | $56,281.67 | $14,001 | $3 |
| 43 | Spouse/Partner | Y | Musculoskeletal System | $53,944 | $1,340 | $55,283.88 | $331 | $0 |
| 44 | Spouse/Partner | Y | Digestive System | $394 | $52,585 | $52,979.44 | $0 | $0 |
| 45 | Spouse/Partner | Y | Circulatory System | $47,199 | $1,988 | $49,186.38 | $470 | $1 |
| 46 | Spouse/Partner | Y | Neoplasms - Malignant | $48,197 | $79 | $48,276.10 | $144 | $0 |
| 47 | Employee/Self | Y | Maternity | $48,238 | $0 | $48,238.49 | $0 | $0 |
| 48 | Employee/Self | Y | Behavioral Health | $12,674 | $34,052 | $46,726.06 | $434 | $2,919 |
| 49 | Child/Other Dependent | Y | Injury & Poisoning | $46,380 | $2 | $46,382.03 | $383 | $0 |
| 50 | Child/Other Dependent | Y | Newborn | $45,646 | $22 | $45,667.78 | $1,018 | $0 |
| 51 | Employee/Self | Y | Nervous System | $5,508 | $39,761 | $45,269.25 | $875 | $0 |
| 52 | Employee/Self | Y | Musculoskeletal System | $45,004 | $79 | $45,083.32 | $0 | $0 |
| 53 | Spouse/Partner | Y | Diseases of the Skin | $63 | $44,774 | $44,837.17 | $0 | $0 |
| 54 | Employee/Self | Y | Musculoskeletal System | $41,803 | $2,879 | $44,682.54 | $1,484 | $576 |
| 55 | Employee/Self | Y | Musculoskeletal System | $41,851 | $728 | $42,579.17 | $4,414 | $48 |
| 56 | Spouse/Partner | Y | Diseases of the Skin | $172 | $42,122 | $42,293.81 | $0 | $6,322 |
| 57 | Employee/Self | Y | Health Status | $617 | $40,236 | $40,852.92 | $0 | $3,795 |
| 58 | Employee/Self | Y | Circulatory System | $2,422 | $38,270 | $40,691.92 | $1,142 | $14,755 |
| 59 | Child/Other Dependent | Y | Digestive System | $39,357 | $660 | $40,017.58 | $152 | $0 |
| 60 | Child/Other Dependent | Y | Nervous System | $34,678 | $3,925 | $38,602.85 | $1,752 | $455 |
| 61 | Employee/Self | Y | Musculoskeletal System | $38,421 | $4 | $38,425.30 | $37 | $0 |
| 62 | Child/Other Dependent | Y | Behavioral Health | $1,578 | $36,410 | $37,988.33 | $0 | $3,356 |
| 63 | Employee/Self | Y | Maternity | $36,152 | $158 | $36,310.48 | $21,943 | $0 |
| 64 | Employee/Self | Y | Infectious/Parasitic | $26,247 | $7,521 | $33,767.94 | $0 | $1,059 |
| 65 | Employee/Self | Y | Circulatory System | $18,579 | $12,291 | $30,870.68 | $967 | $1,854 |
| 66 | Spouse/Partner | N | Digestive System | $18,872 | $11,755 | $30,626.92 | $0 | $0 |
| 67 | Employee/Self | Y | Health Status | $30,048 | $275 | $30,323.10 | $0 | $0 |
| 68 | Employee/Self | Y | Ill-Defined Conditions | $5,594 | $22,748 | $28,342.66 | $0 | $4,424 |
| 69 | Employee/Self | Y | Maternity | $27,375 | $273 | $27,647.97 | $318 | $0 |
| 70 | Employee/Self | Y | Neoplasms - Uncertain/Unspecified | $26,984 | $390 | $27,374.39 | $1,246 | $0 |
| 71 | Employee/Self | Y | Respiratory System | $24,666 | $2,538 | $27,203.62 | $0 | $2 |
| 72 | Employee/Self | Y | Digestive System | $26,000 | $753 | $26,752.86 | $0 | $11 |
| 73 | Employee/Self | Y | Musculoskeletal System | $25,045 | $1,702 | $26,747.46 | $428 | $9 |
| 74 | Employee/Self | Y | Genitourinary System | $26,551 | $47 | $26,597.64 | $0 | $0 |
| 75 | Employee/Self | Y | Musculoskeletal System | $17,286 | $9,252 | $26,537.92 | $198 | $2,078 |
| 76 | Employee/Self | Y | Circulatory System | $11,866 | $14,619 | $26,485.02 | $1,795 | $548 |
| 77 | Spouse/Partner | Y | Health Status | $8,158 | $17,789 | $25,947.13 | $107 | $1,031 |
| 78 | Spouse/Partner | Y | Musculoskeletal System | $2,902 | $22,727 | $25,628.88 | $495 | $4,835 |
| 79 | Employee/Self | N | Diseases of the Blood | $16,056 | $9,143 | $25,199.82 | $0 | $0 |
| 80 | Employee/Self | Y | Maternity | $25,215 | -$104 | $25,110.62 | $0 | $0 |
| Total | $4,863,362 | $2,273,140 | $7,136,501 | $166,490 | $179,632 |
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: 01/2026 Run Date: 03/04/2026 |
APT-01_1
| Audit Parameters Trail | |
| GLOUCESTER COUNTY SCHOOL BOARD | Segmentation: Total Account |
Current: Feb 2025 - Jan 2026 • Prior 1: Feb 2024 - Jan 2025 • Prior 2: Feb 2023 - Jan 2024 | Paid/Incurred: Paid
| Time Period | Rolling 12 Months |
| High Cost Claimant Threshold | $25,000 |
| Paid Amount Type | Reporting Paid Amount |
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.
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Latest Data Loaded: 01/2026 Run Date: 03/04/2026 image1.jpeg
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