Loss_Ratio_-_Medical_FY_24-25.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 is a Loss Ratio report for medical and pharmacy insurance for the City of Edinburg, Texas, covering the fiscal year October 2024 through September 2025. The report documents the performance metrics of the city's group medical insurance plan, including monthly premiums, paid claims, and loss ratios across both medical and pharmacy services.
The report reveals a total annual medical and pharmacy premium of $9,632,072.47 with total paid claims of $9,574,959.12, resulting in an overall loss ratio of 99.4% for the 12-month period. Monthly loss ratios fluctuated significantly throughout the year, ranging from a low of 68.4% in October 2024 to a high of 168.5% in June 2025, with particular spikes in May through July 2025 when loss ratios exceeded 100%. Medical paid claims totaled $6,985,553.87 while pharmacy paid claims reached $2,587,222.73, with minimal value-based care payments and capitation amounts of $2,182.52. This data directly supports the City of Edinburg's RFP for Group Employee Medical Insurance for FY 2026-2027, providing historical claims and premium information essential for vendors to evaluate and propose competitive options for both fully-funded and self-funded group insurance arrangements.
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Text version
Loss Ratio (Oct '24 to Sept '25)
Run Date: 7/2/2026
Metrics: (Medical and Pharmacy Premium, Medical Paid Claims, Pharmacy Paid Claims, VBC Payments, Capitation, Medical and Pharmacy Total Paid, Medical and Pharmacy Loss Ratio)
Rows: (Paid Month) Columns: (Metrics)
Paid Month: (Oct 2024 - Sep 2025) Database: (CITY OF EDINBURG 000243483: ALL)
Paid Month Medical and Pharmacy Premium Medical Paid Claims Pharmacy Paid Claims VBC Payments Capitation Medical and Pharmacy Total Paid Medical and Pharmacy Loss Ratio Oct 2024 $808,870.93 $374,021.12 $179,023.25 $5.53 $553,049.90 68.4% Nov 2024 $802,645.93 $441,817.93 $226,508.97 $3.74 $668,330.64 83.3% Dec 2024 $805,742.42 $499,699.89 $188,638.39 $258.47 $688,596.75 85.5% Jan 2025 $801,425.10 $538,424.30 $172,924.40 $5.39 $711,354.09 88.8% Feb 2025 $800,088.14 $490,067.60 $233,475.32 $252.74 $723,795.66 90.5% Mar 2025 $803,229.17 $374,098.95 $209,676.78 $244.01 $584,019.74 72.7% Apr 2025 $801,313.82 $518,249.53 $174,483.04 $249.83 $692,982.40 86.5% May 2025 $802,986.96 $608,414.34 $243,812.26 $247.03 $852,473.63 106.2% Jun 2025 $803,639.16 $1,096,741.65 $256,902.76 $238.30 $1,353,882.71 168.5% Jul 2025 $803,559.71 $926,988.52 $216,868.96 $220.41 $1,144,077.89 142.4% Aug 2025 $802,182.74 $545,391.75 $287,297.35 $224.17 $832,913.27 103.8% Sep 2025 $796,388.39 $571,638.29 $197,611.25 $232.90 $769,482.44 96.6% Total: Selected Filter(s) $9,632,072.47 $6,985,553.87 $2,587,222.73 $2,182.52 $9,574,959.12 99.4%
Oct '24 to Sept '25
File details come from the government source that posted it. Updated .