CITY_OF_EDINBURG_000243483_AL_-_City_of_Edinburg_Monthly_Financial_(Oct_'24_to_Sept_'25).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 Blue Insight Monthly Financial Dashboard report for the City of Edinburg's group employee medical insurance plan administered by Blue Cross and Blue Shield of Texas, covering the period from October 1, 2024, to September 30, 2025. The report provides comprehensive analysis of the City's health plan performance, member demographics, and healthcare spending patterns. The plan covers 1,709 members (1,099 subscribers and 610 dependents), reflecting a 2.0% decrease in overall membership compared to the prior year period.
The City's total paid claims increased 22.5% year-over-year, rising from $7,812,382 to $9,572,777, with medical claims accounting for $6,985,554 and pharmacy claims totaling $2,587,223. The paid per-employee per-month (PEPM) cost increased 22.6% to $725.93, compared to the benchmark of $1,088.55. High-cost claimants (members with expenses exceeding $50,000) accounted for 44.0% of total paid claims in the current period, up from 36.1% in the prior year, with top diagnostic categories including neoplasms at $106 PEPM, health status conditions at $8 PEPM, and circulatory conditions at $29 PEPM. The plan achieved a 99.9% in-network utilization rate with a 73.3% network discount, and the plan share increased from 79.7% to 82.3%, indicating improved cost management relative to the benchmark.
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Blue Insight℠ Monthly Financial Dashboard
10/01/2024 to 09/30/2025
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 2023 - Sep 2024
Oct 2024 - Sep 2025 % Change Benchmark
Allowed $9,828,495 $11,469,138 16.7%
Paid $7,812,382 $9,572,777 22.5%
Paid PEPM $592.34 $725.93 22.6% $1,088.55
Medical Plan Performance
Plan Share 79.7% 82.3% 84.5%
In-Network Paid % 99.9% 99.9% 99.0%
Discount % 76.4% 73.3% 65.2%
Members 1,744 1,709 -2.0%
Subscribers 1,099 1,099 0.0%
Dependents 645 610 -5.4%
Key Metrics
Paid
PEPM
22.6%
Utilization
Cost and Case Mix
High Cost Claimants
Benchmark
2.5%
1.3%
7.8%
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% 16.5% 15.0% 14.7%
$50K and - 63.9% 56.0% 49.9% 82.3% 83.7% 83.4%
$50K-$100K 12.1% 8.4% 14.7% 0.7% 0.6% 1.1%
$100K-$300K 19.2% 17.4% 20.2% 0.4% 0.6% 0.7%
$300K and + 4.8% 18.3% 15.1% 0.0% 0.2% 0.1%
HCC Subtotal 36.1% 44.0% 50.1% 1.2% 1.3% 1.9%
CITY OF EDINBURG 000243483: ALL.
Executive Financial Dashboard
Month by Month Comparison (Paid PEPM) HCC Overall Benchmark
Prior Current Prior Current October $207 $140 $594 $501 $1,088 November $237 $200 $486 $612 $1,068 December $118 $225 $461 $625 $1,128 January $188 $272 $530 $647 $1,016 February $233 $269 $645 $664 $928 March $205 $175 $575 $532 $997 April $195 $270 $600 $633 $1,054 May $432 $343 $805 $777 $1,154 June $131 $810 $482 $1,222 $1,078 July $195 $568 $575 $1,031 $1,155 August $309 $332 $816 $756 $1,222 September $117 $225 $537 $704 $1,184
Spend by Service Category (Paid PEPM) HCC Overall Benchmark
Inpatient Prior $64 $108 Current $138 $164 $212
Outpatient Prior $78 $185 Current $71 $201 $301
Professional Prior $29 $133 Current $45 $164 $294
Pharmacy Prior $43 $167 Current $65 $196 $281
Top Diagnostic Categories (Paid PEPM)
HCC Overall Benchmark
Prior Current Prior Current Neoplasms $59 $106 $64 $115 $96 Health Status $7 $8 $47 $54 $71 Circulatory $36 $29 $58 $47 $80 Injury/Poisoning $4 $15 $14 $29 $60 Genitourinary $3 $6 $23 $29 $40
• 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 2024 - Sep 2025.
• 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 2023 - Sep 2024
Oct 2024 - Sep 2025 % Change Oct 2023 -
Sep 2024 Total
Paid (Medical) $5,613,776 $6,985,554 24.4% $5,613,776 HCA Draft Amount $0 $0 0.0% $0 Pharmacy Paid $2,198,605 $2,587,223 17.7% $2,198,605
Overall $7,812,382 $9,572,777 22.5% $7,812,382
PEPM
Paid (Medical) $426 $530 24.5% $426 HCA Draft Amount $0 $0 0.0% $0 Pharmacy Paid $167 $196 17.7% $167
Overall $592 $726 22.6% $592
Report prepared on 7/2/2026
CITY OF EDINBURG 000243483: ALL.
Executive Financial Dashboard - Supporting Data
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