CITY_OF_EDINBURG_000243483_AL_-_City_of_Edinburg_Monthly_Financial_(Oct_'23_to_Sept_'24).pdf
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- Attached to
- Group Employee Medical Insurance FY 2026-2027
- Solicitation number
- RFP 2026-018
- Issued by
- Hidalgo County, Texas
About this file
This is a monthly financial dashboard for the City of Edinburg's group employee medical insurance plan provided by Blue Cross and Blue Shield of Texas for the period October 2023 through September 2024. The dashboard presents comprehensive health plan performance metrics and utilization data for the City of Edinburg's 1,744 covered members (1,099 subscribers and 645 dependents).
The financial performance shows significant increases in healthcare costs during the reporting period. Total paid claims increased 90.8% from $4,094,098 (prior year) to $7,812,382 (current year), with paid per-employee-per-month (PEPM) rising 10.6% from $535.74 to $592.34. Medical plan paid claims grew 93.0% to $5,613,776, while pharmacy paid claims increased 85.5% to $2,198,605. The plan maintained strong in-network utilization at 99.9% and achieved a 76.4% discount percentage. High-cost claimants (members with expenses exceeding $50,000) represented 36.1% of total paid claims during the current period, compared to 30.9% in the prior period. Primary diagnostic categories driving costs included neoplasms ($59 PEPM), circulatory conditions ($36 PEPM), and health status conditions ($7 PEPM). The data reflects the baseline utilization and cost structure that will inform the City's upcoming FY 2026-2027 group medical insurance procurement, whether through fully-funded or self-funded options.
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Text version
Blue Insight℠ Monthly Financial Dashboard
10/01/2023 to 09/30/2024
CITY OF EDINBURG 000243483: ALL
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2026 Health Care Service Corporation. All rights reserved.
Oct 2022 - Sep 2023
Oct 2023 - Sep 2024 % Change Benchmark
Allowed $5,107,284 $9,828,495 92.4%
Paid $4,094,098 $7,812,382 90.8%
Paid PEPM $535.74 $592.34 10.6% $974.65
Medical Plan Performance
Plan Share 78.4% 79.7% 83.4%
In-Network Paid % 99.8% 99.9% 99.2%
Discount % 73.7% 76.4% 65.5%
Members 1,743 1,744 0.1%
Subscribers 1,092 1,099 0.6%
Dependents 651 645 -0.9%
Key Metrics
Paid
PEPM
10.6%
Utilization
Cost and Case Mix
High Cost Claimants
Benchmark
-1.6%
-2.8%
7.7%
Claimant Distribution % of Total Paid % of Total Unique Members
Dollar Range Prior Current Benchmark Prior Current Benchmark No Claims 0.0% 0.0% 0.0% 22.4% 16.5% 15.8%
$50K and - 69.1% 63.9% 51.9% 77.0% 82.3% 82.6%
$50K-$100K 7.3% 12.1% 14.6% 0.3% 0.7% 1.0%
$100K-$300K 15.9% 19.2% 19.5% 0.3% 0.4% 0.6%
$300K and + 7.8% 4.8% 14.0% 0.1% 0.0% 0.1%
HCC Subtotal 30.9% 36.1% 48.1% 0.6% 1.2% 1.6%
CITY OF EDINBURG 000243483: ALL.
Executive Financial Dashboard
Month by Month Comparison (Paid PEPM) HCC Overall Benchmark
Prior Current Prior Current March $222 $205 $678 $575 $987 April $229 $195 $633 $600 $957 May $77 $432 $435 $805 $1,060 June $119 $131 $491 $482 $902 July $182 $195 $475 $575 $844 August $104 $309 $405 $816 $929 September $228 $117 $637 $537 $959 May $0 $0 $0 $0 $1,002 June $0 $0 $0 $0 $937 July $0 $0 $0 $0 $1,005 August $0 $0 $0 $0 $1,097 September $0 $0 $0 $0 $1,019
Spend by Service Category (Paid PEPM) HCC Overall Benchmark
Inpatient Prior $39 $74 Current $64 $108 $194
Outpatient Prior $61 $176 Current $78 $185 $268
Professional Prior $31 $131 Current $29 $133 $264
Pharmacy Prior $35 $155 Current $43 $167 $249
Top Diagnostic Categories (Paid PEPM)
HCC Overall Benchmark
Prior Current Prior Current Neoplasms $72 $59 $81 $64 $89 Circulatory $9 $36 $23 $58 $72 Health Status $2 $7 $41 $47 $66 Infectious/Parasitic $8 $24 $19 $37 $23 Digestive $7 $14 $30 $35 $51
• Claims are reported on a paid basis.
• Benchmarks are based on BCBSTX's non-HMO book of business. The Paid PEPM benchmark metrics are age/gender adjusted to the client's population.
• Benchmarks are based on the current period Oct 2023 - Sep 2024.
• High Cost Claimants are defined as members with paid expenses greater than $50K within the reporting period.
• The Discount % metric excludes Medicare Primary.
• Prior HCC includes spend for HCC identified throughout the full prior period. Current includes only spend for HCC identified within the current period.
• The report includes Medical and Pharmacy claims.
• Reporting Segments: ALL
• Characteristics: ALL
• Group/Sections: ALL
Overall Financial Summary Oct 2022 - Sep 2023
Oct 2023 - Sep 2024 % Change Oct 2022 -
Sep 2023 Total
Paid (Medical) $2,908,982 $5,613,776 93.0% $2,908,982 HCA Draft Amount $0 $0 0.0% $0 Pharmacy Paid $1,185,116 $2,198,605 85.5% $1,185,116
Overall $4,094,098 $7,812,382 90.8% $4,094,098
PEPM
Paid (Medical) $381 $426 11.8% $381 HCA Draft Amount $0 $0 0.0% $0 Pharmacy Paid $155 $167 7.5% $155
Overall $536 $592 10.6% $536
Report prepared on 7/2/2026
CITY OF EDINBURG 000243483: ALL.
Executive Financial Dashboard - Supporting Data
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