Loss_Ratio_-_Medical_2023-2024.pdf

PDF 20 KB Posted

Attached to
Group Employee Medical Insurance FY 2026-2027
Solicitation number
RFP 2026-018
Issued by
Hidalgo County, Texas

About this file

Written by GovTribe AI ·

This is a loss ratio analysis report for the City of Edinburg's group medical and pharmacy insurance for the period October 2023 through September 2024. The document provides monthly metrics tracking medical premiums, medical paid claims, pharmacy paid claims, value-based care (VBC) payments, total paid amounts, and loss ratios for the City's self-funded health plan. The report spans a 12-month period with consistent monthly premium collections averaging approximately $809,000 and documents the relationship between premiums collected and claims paid across both medical and pharmacy services.

Over the 12-month period, the City of Edinburg collected total medical and pharmacy premiums of $9,697,475.67 and paid total claims of $7,815,314.37, resulting in an overall loss ratio of 80.6 percent. Monthly loss ratios ranged from a low of 62.2 percent in December 2023 to a high of 112.4 percent in August 2024, with significant variation indicating fluctuating claims experience throughout the year. Medical claims totaled $5,613,776.13, pharmacy claims reached $2,198,605.39, and VBC payments amounted to $2,932.85. This historical claims data is relevant to the City's FY 2026-2027 group employee medical insurance RFP, which seeks proposals for both fully-funded and self-funded group medical insurance options to compare vendor offerings against the City's demonstrated claims experience and organizational needs.

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Loss Ratio - Oct 2023-Sep 2024

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 2023 - Sep 2024) 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 2023 $809,166.77 $543,828.21 $114,590.85 $395.56 $658,814.62 81.4% Nov 2023 $814,941.50 $363,633.25 $174,550.79 $172.86 $538,356.90 66.1% Dec 2023 $810,898.39 $318,346.31 $186,176.49 $172.86 $504,695.66 62.2% Jan 2024 $812,787.88 $431,207.99 $151,245.80 $331.01 $582,784.80 71.7% Feb 2024 $812,400.61 $520,483.68 $189,764.94 $330.60 $710,579.22 87.5% Mar 2024 $811,130.58 $440,626.85 $193,075.71 $327.79 $634,030.35 78.2% Apr 2024 $811,175.12 $517,163.71 $144,754.38 $318.79 $662,236.88 81.6% May 2024 $809,231.35 $632,888.58 $248,474.98 $313.17 $881,676.73 109.0% Jun 2024 $803,815.33 $370,283.77 $151,745.12 $293.72 $522,322.61 65.0% Jul 2024 $798,859.64 $420,750.36 $208,148.19 $255.79 $629,154.34 78.8% Aug 2024 $801,329.22 $648,110.96 $252,962.98 $11.53 $901,085.47 112.4% Sep 2024 $801,739.28 $406,452.46 $183,115.16 $9.17 $589,576.79 73.5% Total: Selected Filter(s) $9,697,475.67 $5,613,776.13 $2,198,605.39 $2,932.85 $7,815,314.37 80.6%

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