Loss_Ratio_-_Oct_2022-Sep_2023.pdf

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Attached to
Pharmacy Benefits 2025-2026
Solicitation number
2025-011
Issued by
Hidalgo County, Texas

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Written by GovTribe AI ·

The document is a Loss Ratio report for the City of Edinburgh covering the period from October 2022 to September 2023, detailing medical and pharmacy insurance financial metrics. The report tracks monthly premium collections, medical and pharmacy paid claims, value-based care (VBC) payments, and calculates the overall medical and pharmacy loss ratio for each month.

The financial data shows total medical and pharmacy premiums of $8,779,427.29 for the year, with total paid claims of $7,315,837.96, resulting in an overall loss ratio of 83.3%. Monthly loss ratios fluctuated significantly, ranging from a low of 59.6% in August 2023 to a high of 110.1% in November 2022, indicating variable healthcare spending patterns. The consistent monthly premium amounts (around $715,000-$747,000) suggest a stable funding model, while the claims expenses varied considerably, potentially reflecting seasonal health trends or specific high-cost medical events during certain months.

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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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