ESBD_540156_1784577532092_Exhibit A-4 Medical Plan & Claim Information.xlsx
XLSX spreadsheet 19 KB Posted
- Attached to
- RFP 2607-002 Stop Loss Insurance
- Solicitation number
- 2607002
- Issued by
- Travis County, Austin City, Texas
About this file
This file is a Medical Plan and Claim Information exhibit for Travis County Healthcare District – Central Health, documenting membership enrollment and self-funded medical and pharmacy claims data spanning March 1, 2023, through April 30, 2026. The exhibit presents monthly membership reporting across four enrollment categories (Employee Only, Employee+Spouse, Employee+Child(ren), and Employee+Family), with total employees and members tracked throughout the reporting period. Medical membership grew from 1,327 employees and 2,383 total members in March 2023 to 2,025 employees and 3,466 total members by April 2026. The data supports the Stop Loss Insurance RFP 2607-002 procurement for Texas by providing baseline enrollment and claims information necessary for stop loss insurance underwriting and rate development.
The claims data demonstrates monthly self-funded medical claims ranging from approximately $693,000 to $2,062,000, with individual stop loss claims appearing beginning October 2023 and varying from $0 to $728,547 monthly. Pharmacy claims ranged from approximately $371,000 to $783,000 monthly. Individual stop loss claims are documented separately from customer-funded claims, indicating the district's existing stop loss arrangement, while no aggregate stop loss claims are reflected during the reporting period. The data includes notes indicating that employee counts are unedited estimates excluding retroactive changes, with audited counts to be used for final accounting, and that certain claim adjustments such as rebates may be excluded from the pharmacy claims figures. This historical claims and enrollment information serves as the actuarial foundation for evaluating stop loss insurance proposals in the Texas procurement.
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Medical Membership
| TRAVIS COUNTY HEALTHCARE DISTRICT - CENT - 0000000097013764 |
| Membership Reporting Time Period March 01, 2023 - April 30, 2026 |
| Month/Year | Employee Only | Employee+Spouse | Employee+Child(ren) | Employee+Family | Total Employees | Total Members |
| Mar-23 | 834 | 78 | 276 | 139 | 1,327 | 2,383 |
| Apr-23 | 833 | 75 | 281 | 143 | 1,332 | 2,404 |
| May-23 | 849 | 78 | 284 | 143 | 1,354 | 2,442 |
| Jun-23 | 870 | 78 | 288 | 147 | 1,383 | 2,492 |
| Jul-23 | 876 | 80 | 295 | 148 | 1,399 | 2,516 |
| Aug-23 | 902 | 79 | 301 | 149 | 1,431 | 2,569 |
| Sep-23 | 912 | 79 | 309 | 152 | 1,452 | 2,612 |
| Oct-23 | 926 | 78 | 316 | 155 | 1,475 | 2,648 |
| Nov-23 | 932 | 79 | 320 | 157 | 1,488 | 2,677 |
| Dec-23 | 937 | 79 | 317 | 162 | 1,495 | 2,696 |
| Jan-24 | 951 | 78 | 328 | 161 | 1,518 | 2,732 |
| Feb-24 | 990 | 83 | 340 | 162 | 1,575 | 2,807 |
| Mar-24 | 1,012 | 95 | 372 | 157 | 1,636 | 2,929 |
| Apr-24 | 1,030 | 96 | 368 | 156 | 1,650 | 2,930 |
| May-24 | 1,038 | 97 | 371 | 159 | 1,665 | 2,955 |
| Jun-24 | 1,043 | 94 | 370 | 162 | 1,669 | 2,971 |
| Jul-24 | 1,047 | 98 | 379 | 164 | 1,688 | 3,015 |
| Aug-24 | 1,074 | 94 | 383 | 166 | 1,717 | 3,051 |
| Sep-24 | 1,081 | 91 | 390 | 167 | 1,729 | 3,068 |
| Oct-24 | 1,090 | 89 | 385 | 169 | 1,733 | 3,056 |
| Nov-24 | 1,093 | 94 | 387 | 168 | 1,742 | 3,066 |
| Dec-24 | 1,095 | 97 | 392 | 165 | 1,749 | 3,066 |
| Jan-25 | 1,123 | 98 | 389 | 168 | 1,778 | 3,100 |
| Feb-25 | 1,115 | 96 | 391 | 167 | 1,769 | 3,086 |
| Mar-25 | 1,180 | 96 | 396 | 172 | 1,844 | 3,205 |
| Apr-25 | 1,176 | 96 | 398 | 172 | 1,842 | 3,205 |
| May-25 | 1,171 | 93 | 400 | 171 | 1,835 | 3,190 |
| Jun-25 | 1,169 | 94 | 398 | 172 | 1,833 | 3,198 |
| Jul-25 | 1,189 | 95 | 402 | 178 | 1,864 | 3,240 |
| Aug-25 | 1,192 | 98 | 403 | 185 | 1,878 | 3,285 |
| Sep-25 | 1,212 | 102 | 408 | 182 | 1,904 | 3,311 |
| Oct-25 | 1,231 | 100 | 404 | 184 | 1,919 | 3,326 |
| Nov-25 | 1,246 | 102 | 403 | 184 | 1,935 | 3,338 |
| Dec-25 | 1,265 | 107 | 409 | 184 | 1,965 | 3,393 |
| Jan-26 | 1,292 | 108 | 419 | 176 | 1,995 | 3,410 |
| Feb-26 | 1,311 | 111 | 412 | 174 | 2,008 | 3,404 |
| Mar-26 | 1,318 | 110 | 417 | 178 | 2,023 | 3,435 |
| Apr-26 | 1,328 | 115 | 419 | 180 | 2,042 | 3,466 |
Monthly Claims
| SELF FUNDED MONTHLY CLAIMS REPORT | ||||
| TRAVIS COUNTY HEALTHCARE DISTRICT - CENTRAL HEALTH | ||||
| Customer Number 285663 | 23-Mar | Through | 26-Apr |
| Product | Month | *(1) Estimated Employees | *(2) Customer Funded Claims | *(3) Individual Stop Loss Claims | *(4) Aggregate Stop Loss Claims | Total Claims |
| Medical | 03/01/2023 | 1,327 | $816,459.00 | $0.00 | $0.00 | $816,459.00 |
| 04/01/2023 | 1,332 | $693,219.82 | $0.00 | $0.00 | $693,219.82 | |
| 05/01/2023 | 1,354 | $960,979.72 | $0.00 | $0.00 | $960,979.72 | |
| 06/01/2023 | 1,383 | $949,267.36 | $0.00 | $0.00 | $949,267.36 | |
| 07/01/2023 | 1,399 | $1,256,070.50 | $0.00 | $0.00 | $1,256,070.50 | |
| 08/01/2023 | 1,431 | $955,867.82 | $0.00 | $0.00 | $955,867.82 | |
| 09/01/2023 | 1,452 | $927,882.33 | $0.00 | $0.00 | $927,882.33 | |
| 10/01/2023 | 1,475 | $1,681,365.99 | $20,571.11 | $0.00 | $1,701,937.10 | |
| 11/01/2023 | 1,488 | $1,626,774.63 | $352,846.53 | $0.00 | $1,979,621.16 | |
| 12/01/2023 | 1,495 | $862,218.97 | $317,360.47 | $0.00 | $1,179,579.44 | |
| 01/01/2024 | 1,518 | $1,209,088.90 | $728,547.30 | $0.00 | $1,937,636.20 | |
| 02/01/2024 | 1,575 | $958,912.97 | $293,901.93 | $0.00 | $1,252,814.90 | |
| 03/01/2024 | 1,636 | $920,245.45 | $0.00 | $0.00 | $920,245.45 | |
| 04/01/2024 | 1,650 | $1,739,486.20 | $0.00 | $0.00 | $1,739,486.20 | |
| 05/01/2024 | 1,665 | $1,026,997.30 | $0.00 | $0.00 | $1,026,997.30 | |
| 06/01/2024 | 1,669 | $867,501.66 | $0.00 | $0.00 | $867,501.66 | |
| 07/01/2024 | 1,688 | $1,456,010.69 | $10,131.10 | $0.00 | $1,466,141.79 | |
| 08/01/2024 | 1,717 | $1,165,651.35 | $117,589.47 | $0.00 | $1,283,240.82 | |
| 09/01/2024 | 1,729 | $1,476,440.22 | $4,925.42 | $0.00 | $1,481,365.64 | |
| 10/01/2024 | 1,733 | $1,253,164.78 | $171,657.54 | $0.00 | $1,424,822.32 | |
| 11/01/2024 | 1,742 | $1,027,159.38 | $0.00 | $0.00 | $1,027,159.38 | |
| 12/01/2024 | 1,749 | $1,546,289.65 | $1,209.73 | $0.00 | $1,547,499.38 | |
| 01/01/2025 | 1,778 | $1,270,572.86 | $2,903.29 | $0.00 | $1,273,476.15 | |
| 02/01/2025 | 1,769 | $1,310,741.99 | $2,730.48 | $0.00 | $1,313,472.47 | |
| 03/01/2025 | 1,844 | $2,062,340.52 | $0.00 | $0.00 | $2,062,340.52 | |
| 04/01/2025 | 1,842 | $1,259,429.68 | $0.00 | $0.00 | $1,259,429.68 | |
| 05/01/2025 | 1,835 | $1,074,641.71 | $0.00 | $0.00 | $1,074,641.71 | |
| 06/01/2025 | 1,833 | $1,687,062.86 | $130,815.36 | $0.00 | $1,817,878.22 | |
| 07/01/2025 | 1,864 | $1,347,649.99 | $839.26 | $0.00 | $1,348,489.25 | |
| 08/01/2025 | 1,878 | $1,997,338.64 | $203,207.80 | $0.00 | $2,200,546.44 | |
| 09/01/2025 | 1,904 | $1,422,060.64 | $48,553.82 | $0.00 | $1,470,614.46 | |
| 10/01/2025 | 1,919 | $1,578,515.08 | $34,667.84 | $0.00 | $1,613,182.92 | |
| 11/01/2025 | 1,935 | $1,416,994.84 | $201,181.43 | $0.00 | $1,618,176.27 | |
| 12/01/2025 | 1,965 | $1,563,287.07 | $127,349.60 | $0.00 | $1,690,636.67 | |
| 01/01/2026 | 1,995 | $1,573,500.06 | $101,608.90 | $0.00 | $1,675,108.96 | |
| 02/01/2026 | 1,995 | $1,528,871.46 | $80,303.81 | $0.00 | $1,609,175.27 | |
| 03/01/2026 | 2,025 | $1,758,163.36 | $0.00 | $0.00 | $1,758,163.36 | |
| 04/01/2026 | 2,025 | $1,902,772.07 | $34,190.85 | $0.00 | $1,936,962.92 |
| Pharmacy | 03/01/2023 | 1,327 | $408,685.96 | $0.00 | $0.00 | $408,685.96 |
| 04/01/2023 | 1,332 | $371,652.32 | $0.00 | $0.00 | $371,652.32 | |
| 05/01/2023 | 1,354 | $432,260.99 | $3,220.61 | $0.00 | $435,481.60 | |
| 06/01/2023 | 1,383 | $388,035.18 | $50,823.90 | $0.00 | $438,859.08 | |
| 07/01/2023 | 1,399 | $428,176.23 | $50,823.90 | $0.00 | $479,000.13 | |
| 08/01/2023 | 1,431 | $396,457.45 | $50,823.90 | $0.00 | $447,281.35 | |
| 09/01/2023 | 1,452 | $380,342.53 | $50,823.90 | $0.00 | $431,166.43 | |
| 10/01/2023 | 1,475 | $344,126.09 | $88,020.55 | $0.00 | $432,146.64 | |
| 11/01/2023 | 1,488 | $402,862.32 | $103,079.43 | $0.00 | $505,941.75 | |
| 12/01/2023 | 1,495 | $435,441.20 | $61,623.18 | $0.00 | $497,064.38 | |
| 01/01/2024 | 1,518 | $423,008.45 | $9,941.66 | $0.00 | $432,950.11 | |
| 02/01/2024 | 1,575 | $445,633.88 | $108,231.75 | $0.00 | $553,865.63 | |
| 03/01/2024 | 1,636 | $475,063.01 | $0.00 | $0.00 | $475,063.01 | |
| 04/01/2024 | 1,650 | $592,873.97 | $0.00 | $0.00 | $592,873.97 | |
| 05/01/2024 | 1,665 | $496,158.29 | $0.00 | $0.00 | $496,158.29 | |
| 06/01/2024 | 1,669 | $585,350.91 | $0.00 | $0.00 | $585,350.91 | |
| 07/01/2024 | 1,688 | $518,907.02 | $12,390.45 | $0.00 | $531,297.47 | |
| 08/01/2024 | 1,717 | $513,048.15 | $55,377.60 | $0.00 | $568,425.75 | |
| 09/01/2024 | 1,729 | $582,746.97 | $54,991.67 | $0.00 | $637,738.64 | |
| 10/01/2024 | 1,733 | $482,000.51 | $53,422.00 | $0.00 | $535,422.51 | |
| 11/01/2024 | 1,742 | $625,147.74 | $55,068.30 | $0.00 | $680,216.04 | |
| 12/01/2024 | 1,749 | $476,469.83 | $70,114.22 | $0.00 | $546,584.05 | |
| 01/01/2025 | 1,778 | $507,353.46 | $98,798.98 | $0.00 | $606,152.44 | |
| 02/01/2025 | 1,769 | $547,264.37 | $78,397.24 | $0.00 | $625,661.61 | |
| 03/01/2025 | 1,844 | $708,249.27 | $0.00 | $0.00 | $708,249.27 | |
| 04/01/2025 | 1,842 | $692,036.72 | $0.00 | $0.00 | $692,036.72 | |
| 05/01/2025 | 1,835 | $719,245.24 | $0.00 | $0.00 | $719,245.24 | |
| 06/01/2025 | 1,833 | $704,915.88 | $0.00 | $0.00 | $704,915.88 | |
| 07/01/2025 | 1,864 | $810,580.55 | $0.00 | $0.00 | $810,580.55 | |
| 08/01/2025 | 1,878 | $783,094.48 | $84,585.73 | $0.00 | $867,680.21 | |
| 09/01/2025 | 1,904 | $709,189.24 | $47,302.21 | $0.00 | $756,491.45 | |
| 10/01/2025 | 1,919 | $760,695.79 | $164,505.21 | $0.00 | $925,201.00 | |
| 11/01/2025 | 1,935 | $835,513.66 | $135,795.42 | $0.00 | $971,309.08 | |
| 12/01/2025 | 1,965 | $746,735.44 | $108,960.80 | $0.00 | $855,696.24 | |
| 01/01/2026 | 1,995 | $686,931.88 | $152,007.46 | $0.00 | $838,939.34 | |
| 02/01/2026 | 1,995 | $610,651.01 | $143,398.76 | $0.00 | $754,049.77 | |
| 03/01/2026 | 2,025 | $815,938.82 | $0.00 | $0.00 | $815,938.82 | |
| 04/01/2026 | 2,025 | $777,875.56 | $0.00 | $0.00 | $777,875.56 |
(1) Due to timing, current month lives are NOT available and therefore the prior month's lives are used for both months. Estimated Employee counts are unedited and exclude retroactive changes. Audited counts will be used for accounting results.
(2) If applicable, claims displayed include charges for the National Advantage Program, Value-Based Pricing and/or specific buy-up program fees/ad hoc service charges that are billed through the claim wire. The monthly Claim Detail Report is available to identify specific claim wire billed fees/charges.
(3) Stop Loss claim values (including 0.00) display only if applicable. Absence of values in a Stop Loss column indicates that arrangement is not in effect.
(4) Stop Loss claims may be greater than displayed if subject to a year end reconciliation.
(5) If applicable, Rx Rebate dollars are excluded in the pharmacy claims and, as such, this data will not match the monthly Claim Detail Reports or Fund Summary Reports.
Sheet3
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