High_Cost_Claimant_($50K)_ISL_Summary_Mar_23-Sept_23,_Oct_23-Sept_24,_Oct_24-Sept_25.pdf
PDF 92 KB Posted
- 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 High Cost Claimant Insurance Summary report for the City of Edinburg, Texas, documenting paid claims for individuals exceeding a $50,000 annual threshold across three distinct fiscal periods. The report analyzes claims data categorized by service type, including facility inpatient, facility outpatient, professional services, and pharmacy, extracted from the city's employee medical insurance database as of July 2, 2026.
The data spans three fiscal years: March 2023 through September 2023, October 2023 through September 2024, and October 2024 through September 2025. The first period identified 11 high-cost claimants with total paid claims of $1,265,787.32, with the highest individual claim at $317,958.35. The second period identified 25 claimants with aggregate paid claims of $2,822,650.64, representing a significant increase in both claimant count and total expenditure, with the highest claim reaching $376,685.15. The third period identified 26 claimants with paid claims totaling $4,216,432.66, demonstrating continued growth in high-cost claimant expenses, with the highest individual claim at $920,378.79. This progressive increase in high-cost claimant utilization and associated expenses indicates a critical trend in the city's group medical insurance costs, directly relevant to the city's FY 2026-2027 group employee medical insurance procurement for both fully-funded and self-funded coverage options.
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Text version
High Cost Claimant ($50K) 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: ($50,000) 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
TX12007440018730251000SUB $78,544.76
TX12007440020821370016SUB $59,583.17
TX12007440018730250870SUB $54,619.37
TX12007440018730250740SUB $54,204.85
TX12007440018730250378SUB $50,927.56
Total: Selected Filter(s) $1,265,787.32
High Cost Claimant ($50K) 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: ($50,000) 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
TX12007440018730250786SUB $78,224.84
TX12007440020240312639SUB $77,997.88
TX12007440018730397017DEP $74,254.93
TX12007440018960221613SUB $73,184.72
TX12007440018730250551SUB $72,366.56
TX12007440020250532621DEP $64,011.13
TX12007440019740194646SUB $63,022.34
TX12007440018730397280DEP $62,037.10
TX12007440018730250875SUB $59,624.48
TX12007440018730267942SUB $57,520.61
TX12007440018730250938SUB $54,660.00
TX12007440019600157860SUB $54,029.92
TX12007440020440123483SUB $52,527.09
TX12007440018730250481SUB $52,221.96
TX12007440020450525647DEP $50,156.20
Total: Selected Filter(s) $2,822,650.64
High Cost Claimant ($50K) ISK 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: ($50,000) 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
TX12007440020360356784SUB $93,332.66
TX12007440018730250605SUB $86,958.17
TX12007440018730251000SUB $85,855.15
TX12007440020860203705DEP $82,701.51
TX12007440018730250863SUB $75,543.68
TX12007440018730397017DEP $74,214.45
TX12007440018730250392SUB $73,999.77
TX12007440018240637889SUB $66,100.93
TX12007440018730397131DEP $55,890.58
TX12007440020730288090DEP $53,916.01
TX12007440018960221613SUB $53,484.72
Total: Selected Filter(s) $4,216,432.66
| 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 .