ESBD_521004_1780005665914_Exhibit A-7 Large Claim Jan 26.xls
XLS spreadsheet 43 KB Posted
- Attached to
- HR Benefits - Medical, Dental, and Vision
- Solicitation number
- 2605-004
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Large Claim Report for Travis County Healthcare District - Central Health, documenting employee health insurance claims for the period of January through February 2026. The report tracks medical and prescription drug claims for employees across multiple benefit groups (BIC codes 000, 400, 410-437, 455, 460-467, 470-478, 481-482, and 490) against a $25,000 claim threshold. The document presents individual claim records with current experience-rated amounts and pooled claim amounts as of the March 7, 2026 run date.
The report details claim amounts segregated by medical expenses and pharmacy (RX drug) costs for each employee record. Medical claims range from $0 to $254,640.78, while prescription drug claims range from $0 to $59,683.17, with combined total current experience-rated amounts reaching as high as $254,809.17 per employee. Pooled claim amounts, representing historical or aggregate liability, vary significantly across records, with some employees showing zero pooled amounts and others displaying substantial balances exceeding $149,336.22. The report includes warnings regarding potential understatement of claims for employees who changed accounts during the policy period and contains privacy notifications indicating the data is confidential and restricted to auditing and benefit program evaluation purposes only.
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Text version
Sheet1
| Large Claim Report | ||
| Plan Sponsor Number: | 0285663 | |
| Plan Sponsor Name: | TRAVIS COUNTY HEALTHCARE DISTRICT - CENTRAL HEALTH | |
| Claim Threshold: | $25,000 | |
| BIC Group: | 000,400,410,415,419,420,430,431,432,433,434,435,436,437,455,460,461,465,466,467,470,471,474,475,476,477,478,481,482,490 | |
| Current Period Start Date: | 01-2026 | |
| Current Period End Date: | 02-2026 | |
| Run Date: | 3/7/2026 | |
| Clmt #/ | ||
| Dep Cd | Medical |
Current Experience Rated Amount RX Drug Current Experience Rated Amount Total Current Experience Rated Amount Current Pooled Claim Amount
| 1/0 | $39,082.01 | $4,099.44 | $43,181.45 | $0.00 |
| 1/0 | $0.00 | $844.14 | $844.14 | $0.00 |
| 1/0 | $39,082.01 | $4,943.58 | $44,025.59 | $0.00 |
| 3/2 | $2,411.37 | $28,010.69 | $30,422.06 | $0.00 |
| 1/0 | $37,104.01 | $12.16 | $37,116.17 | $0.00 |
| 1/0 | $22,719.49 | $21,658.52 | $44,378.01 | $0.00 |
| 1/0 | $26,552.70 | $1,765.14 | $28,317.84 | $0.00 |
| 1/0 | $0.00 | $0.00 | $0.00 | $47,205.24 |
| 1/0 | $1,127.69 | $867.08 | $1,994.77 | $54,138.40 |
| 2/2 | $34,558.60 | $31.38 | $34,589.98 | $0.00 |
| 1/0 | $0.00 | $0.00 | $0.00 | $122.72 |
| 1/0 | $0.00 | $0.00 | $0.00 | $(22,310.58) |
| 1/0 | $0.00 | $0.00 | $0.00 | $(22,187.86) |
| 2/2 | $282.00 | $0.00 | $282.00 | $80,059.44 |
| 2/2 | $1,077.44 | $0.00 | $1,077.44 | $(11,046.82) |
| 2/2 | $1,359.44 | $0.00 | $1,359.44 | $69,012.62 |
| 1/0 | $48,363.37 | $185.13 | $48,548.50 | $0.00 |
| 1/0 | $147.60 | $0.00 | $147.60 | $33,789.00 |
| WARNING -- For any employees who changed accounts during the current policy period, claim amounts shown on this report may be understated by amounts recorded under the prior account number. | ||||
| INDIVIDUAL'S PRIVACY CONCERN -- This report contains information which is personal and confidential and, without the express written consent of the individual to which the material pertains, should not be used or disclosed for any purpose other than auditing and/or evaluating the benefit program. | ||||
| 2/3 | $0.00 | $0.00 | $0.00 | $149,336.22 |
| 1/0 | $63,174.51 | $99.83 | $63,274.34 | $0.00 |
| 1/0 | $1,054.33 | $198.82 | $1,253.15 | $0.00 |
| 1/0 | $64,228.84 | $298.65 | $64,527.49 | $0.00 |
| 1/0 | $294.10 | $52.11 | $346.21 | $0.00 |
| 1/0 | $50,327.39 | $2.65 | $50,330.04 | $0.00 |
| 1/0 | $50,621.49 | $54.76 | $50,676.25 | $0.00 |
| 2/2 | $320.00 | $59,683.17 | $60,003.17 | $0.00 |
| 2/3 | $41,716.49 | $180.20 | $41,896.69 | $0.00 |
| 2/3 | $254,640.78 | $0.90 | $254,641.68 | $72,300.84 |
| 2/3 | $167.49 | $0.00 | $167.49 | $4,579.64 |
| 2/3 | $254,808.27 | $0.90 | $254,809.17 | $76,880.48 |
| 2/2 | $90.00 | $0.00 | $90.00 | $69,144.83 |
| 1/0 | $30,226.53 | $0.00 | $30,226.53 | $0.00 |
| 1/0 | $60,704.17 | $475.06 | $61,179.23 | $0.00 |
| 1/0 | $25,611.01 | $15.44 | $25,626.45 | $0.00 |
| 1/0 | $2,708.00 | $34,431.26 | $37,139.26 | $0.00 |
| 2/2 | $15,314.91 | $11,754.88 | $27,069.79 | $0.00 |
| 3/3 | $43,316.06 | $0.00 | $43,316.06 | $0.00 |
| 7/3 | $28,851.77 | $0.00 | $28,851.77 | $0.00 |
| 8/3 | $47,462.05 | $0.00 | $47,462.05 | $0.00 |
| 1/0 | $484.64 | $59,009.86 | $59,494.50 | $0.00 |
| 2/3 | $37,624.63 | $0.00 | $37,624.63 | $0.00 |
| 1/0 | $1,763.31 | $34,476.24 | $36,239.55 | $0.00 |
| 2/3 | $23,496.14 | $0.00 | $23,496.14 | $0.00 |
| 2/3 | $8,272.43 | $0.00 | $8,272.43 | $0.00 |
| 2/3 | $31,768.57 | $0.00 | $31,768.57 | $0.00 |
| 1/0 | $350.92 | $36,470.76 | $36,821.68 | $0.00 |
| 1/0 | $32,808.19 | $0.00 | $32,808.19 | $0.00 |
| 3/3 | $114,016.75 | $32.57 | $114,049.32 | $0.00 |
| 2/2 | $30,501.44 | $0.00 | $30,501.44 | $0.00 |
| WARNING -- For any employees who changed accounts during the current policy period, claim amounts shown on this report may be understated by amounts recorded under the prior account number. | ||||
| INDIVIDUAL'S PRIVACY CONCERN -- This report contains information which is personal and confidential and, without the express written consent of the individual to which the material pertains, should not be used or disclosed for any purpose other than auditing and/or evaluating the benefit program. | ||||
| 1/0 | $60,873.14 | $252.42 | $61,125.56 | $0.00 |
| 1/0 | $318.56 | $13,665.28 | $13,983.84 | $0.00 |
| 1/0 | $128.27 | $13,645.01 | $13,773.28 | $0.00 |
| 1/0 | $446.83 | $27,310.29 | $27,757.12 | $0.00 |
| WARNING -- For any employees who changed accounts during the current policy period, claim amounts shown on this report may be understated by amounts recorded under the prior account number. | ||||
| INDIVIDUAL'S PRIVACY CONCERN -- This report contains information which is personal and confidential and, without the express written consent of the individual to which the material pertains, should not be used or disclosed for any purpose other than auditing and/or evaluating the benefit program. |
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