High_Cost_Claimant_($100K)_ISL_Summary_Mar_23-Sept_23,_Oct_23-Sept_24,_Oct_24-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 file is a High Cost Claimant Insurance Summary report for the City of Edinburg, Texas, detailing paid insurance claims exceeding $100,000 across three fiscal periods. The report analyzes claims data from the City of Edinburg's employee medical insurance program, categorizing claims by claimant ID and tracking paid amounts across four service categories: Facility Inpatient, Facility Outpatient, Professional, and Pharmacy services. The data spans three distinct periods: March 2023 through September 2023, October 2023 through September 2024, and October 2024 through September 2025. The report was generated on July 2, 2026, and serves as a baseline analysis for understanding high-cost claimant patterns within the municipal insurance program.
The report demonstrates significant and escalating healthcare costs for high-cost claimants within the City's employee medical insurance plan. During the March-September 2023 period, six claimants with claims exceeding $100,000 generated total paid claims of $967,907.61. This increased substantially in the October 2023-September 2024 period, with ten high-cost claimants generating $1,876,810.88 in paid claims. The most recent period, October 2024-September 2025, shows dramatic cost growth with fifteen claimants generating $3,414,435.03 in total paid claims. The top individual claimant in the latest period incurred $920,378.79 in claims, indicating concentrated healthcare utilization among a small subset of covered employees. This escalating trend in high-cost claimant expenses is directly relevant to the City's RFP for Group Employee Medical Insurance for FY 2026-2027, as vendors evaluating this contract must account for these demonstrated cost patterns when structuring fully-funded or self-funded proposals.
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Text version
High Cost Claimant ($100K) ISL Summary (Mar '23 to Sept '23)
Run Date: 7/2/2026
Metrics: (Paid) Rows: (Claimant Id)
Columns: (Metrics) Database: (CITY OF EDINBURG 000243483: ALL)
High Cost Threshold: ($100,000) Paid Month: (Mar 2023 - Sep 2023)
Service Category: (FACILITY INPATIENT, FACILITY OUTPATIENT, PROFESSIONAL, PHARMACY)
Claimant Id Paid
TX12007440019880376933SUB $317,958.35
TX12007440018730250712SUB $194,345.33
TX12007440019980109795SUB $141,996.12
TX12007440018730268017SUB $108,334.79
TX12007440020550022195SUB $103,689.59
TX12007440018730250993SUB $101,583.43
Total: Selected Filter(s) $967,907.61
High Cost Claimant ($100K) ISL Summary (Oct '23 to Sept '24)
Run Date: 7/2/2026
Metrics: (Paid) Rows: (Claimant Id)
Columns: (Metrics) Database: (CITY OF EDINBURG 000243483: ALL)
High Cost Threshold: ($100,000) Paid Month: (Oct 2023 - Sep 2024)
Service Category: (FACILITY INPATIENT, FACILITY OUTPATIENT, PROFESSIONAL, PHARMACY)
Claimant Id Paid
TX12007440020290601267SUB $376,685.15
TX12007440018730250740SUB $214,030.29
TX12007440018730250993SUB $213,823.08
TX12007440019880376933SUB $212,425.76
TX12007440021040132147SUB $208,467.60
TX12007440019740417337DEP $154,621.95
TX12007440018730268017SUB $151,841.89
TX12007440019980109795SUB $126,629.57
TX12007440018920076828DEP $115,647.49
TX12007440018730250870SUB $102,638.10
Total: Selected Filter(s) $1,876,810.88
High Cost Claimant ($100K) ISL Summary (Oct '24 to Sept '25)
Run Date: 7/2/2026
Metrics: (Paid) Rows: (Claimant Id)
Columns: (Metrics) Database: (CITY OF EDINBURG 000243483: ALL)
High Cost Threshold: ($100,000) Paid Month: (Oct 2024 - Sep 2025)
Service Category: (FACILITY INPATIENT, FACILITY OUTPATIENT, PROFESSIONAL, PHARMACY)
Claimant Id Paid
TX12007440018730251036SUB $920,378.79
TX12007440018730250938SUB $419,554.15
TX12007440019890277208DEP $412,122.00
TX12007440018730250993SUB $266,234.16
TX12007440020940031400DEP $185,463.51
TX12007440020860570156DEP $173,239.02
TX12007440020760139049DEP $151,384.23
TX12007440020270426472SUB $129,903.34
TX12007440018730250431SUB $115,065.81
TX12007440018730250740SUB $113,948.25
TX12007440018730397355DEP $108,176.14
TX12007440019740194646SUB $106,197.45
TX12007440018730250405SUB $105,049.47
TX12007440021040132147SUB $104,616.07
TX12007440018730250668SUB $103,102.64
Total: Selected Filter(s) $3,414,435.03
| Mar '23 to Sept '23 |
| Oct '23 to Sept '24 |
| Oct '24 to Sept '25 |
File details come from the government source that posted it. Updated .