Loss_Ratio_-_Medical_2022-2023.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 is a loss ratio analysis document for the City of Edinburg's group employee medical insurance plan covering the period from October 2022 through September 2023. The document presents monthly metrics tracking medical and pharmacy premiums, medical paid claims, pharmacy paid claims, value-based care (VBC) payments, total paid amounts, and loss ratios for the self-funded plan administered through the city's benefits program.
The data reveals significant monthly variability in loss ratios, ranging from a low of 59.6% in August 2023 to a high of 110.1% in November 2022, with an overall annual loss ratio of 83.3% across the twelve-month period. Total medical and pharmacy premiums for the period reached $8,779,427.29, while total paid claims and VBC payments combined equaled $7,315,837.96. Medical paid claims represented the largest expense category at $5,328,994.62, followed by pharmacy paid claims at $1,980,556.37. This historical claims and loss ratio data serves as a baseline for the City of Edinburg's FY 2026-2027 group employee medical insurance RFP, which seeks proposals from vendors for both fully-funded and self-funded group medical insurance options to support the city's organizational needs.
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Loss Ratio - Oct 2022-Sep 2023
Metrics : (Medical and Pharmacy Premium, Medical Paid Claims, Pharmacy Paid Claims, VBC Payments, Medical and Pharmacy Total Paid, Medical and Pharmacy Loss Ratio)
Rows : (Loss Ratio Month) Columns : (Metrics)
Loss Ratio Month : (Oct 2022 - Sep 2023) Database : (CITY OF EDINBURG 000243483: ALL)
Funding Type : (PREM)
Loss Ratio Month Medical and Pharmacy Premium
Medical Paid Claims
Pharmacy Paid Claims
VBC
Payments
Medical and Pharmacy Total Paid
Medical and
Pharmacy Loss Ratio
Oct 2022 $714,701.29 $443,190.51 $159,700.84 $706.90 $603,598.25 84.5% Nov 2022 $715,580.39 $664,155.67 $123,225.97 $709.54 $788,091.18 110.1% Dec 2022 $715,437.82 $334,224.22 $205,462.69 $716.11 $540,403.02 75.5% Jan 2023 $721,372.64 $484,604.75 $136,478.07 $538.45 $621,621.27 86.2% Feb 2023 $716,648.38 $493,837.50 $170,572.83 $540.71 $664,951.04 92.8% Mar 2023 $729,718.19 $537,886.14 $188,668.28 $560.74 $727,115.16 99.6% Apr 2023 $740,605.78 $490,971.46 $195,750.79 $561.00 $687,283.25 92.8% May 2023 $740,063.37 $324,548.51 $148,646.92 $565.90 $473,761.33 64.0% Jun 2023 $744,692.00 $356,864.06 $181,201.54 $577.20 $538,642.80 72.3% Jul 2023 $747,626.45 $354,272.24 $171,297.02 $278.68 $525,847.94 70.3% Aug 2023 $747,878.58 $309,820.99 $135,697.74 $276.25 $445,794.98 59.6% Sep 2023 $745,102.40 $534,618.57 $163,853.68 $255.49 $698,727.74 93.8% Total: Selected Filter(s) $8,779,427.29 $5,328,994.62 $1,980,556.37 $6,286.97 $7,315,837.96 83.3%
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