Summary

This file contains actuarial and claims experience data for the Texas A&M University System's self-insured employee group medical plan for the fiscal year ending August 31, 2025, with claims paid through November 30, 2025. The document provides comprehensive claims lag reporting and analysis across three primary service categories: Inpatient Facility Claims, Outpatient Facility Claims, and Professional & Other Medical Expense. The data spans from September 2022 through August 2025 (36 months), tracking claims incurred by month and their subsequent payment patterns, demonstrating typical healthcare claims processing cycles. The total medical claims paid for fiscal year 2025 amount to $323,564,386, representing a significant decrease from prior fiscal years ($960,809,935 for FY2023 and $480,809,935 for FY2024), with inpatient facility payments totaling $55,074,766, outpatient facility payments reaching $126,853,474, and professional and other medical expenses at $141,636,146.

The attachments provide detailed breakdowns by patient demographics (active members, retirees under age 65, and retirees age 65 and over), geographic distribution by three-digit zip codes throughout Texas and other states, and service utilization metrics including hospital admits, patient visits, and charges. Major diagnostic categories and ICD-10 classifications detail claim distribution by clinical condition, with notable concentrations in musculoskeletal conditions, circulatory diseases, and neoplasms. The data identifies top billing providers by National Provider Identifier (NPI), with Scott & White Hospital College Station representing the highest eligible charges at $24,840,028, followed by University of Texas MD Anderson Cancer Center and St. Joseph Regional Health Center. Monthly utilization trends show declining admission and visit volumes in fiscal year 2025 compared to prior years, reflecting potential shifts in care delivery patterns or plan membership changes.