Loss_Ratio_-_Oct_2023-Sep_2024.pdf

20 KB Posted

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

About this file

Written by GovTribe AI ·

The document is a Loss Ratio Report for the City of Edinburgh, covering the period from October 2023 to September 2024, and appears to be related to a Pharmacy Benefits Management contract. The report provides a monthly breakdown of medical and pharmacy financial metrics, including premiums, paid claims, and value-based care (VBC) payments for a 12-month period.

The loss ratio data shows monthly medical and pharmacy premiums consistently around $800,000-$815,000, with total medical and pharmacy paid claims varying between $504,695 in December 2023 and $901,085 in August 2024. The medical and pharmacy loss ratio fluctuates monthly, ranging from a low of 62.2% in December 2023 to a high of 112.4% in August 2024, with an overall annual loss ratio of 80.6%. The data suggests significant variability in healthcare claims and suggests the need for careful financial monitoring of the pharmacy benefits program.

View the file

Other files

File Type Posted
Pharmacy_Benefits_2025-2026_(Addendum_#1_Revision).pdf PDF
HCC_with_no_PHI_-_City_of_Edinburg_.xlsx XLSX spreadsheet
City_of_Edinburg_RFP#_2025-011_Pharmacy_Benefit_Management.pdf PDF
COE_-_HCC_with_No_PHI_md.pdf PDF
Loss_Ratio_-_Oct_2024_-_Current.pdf PDF
Medical_Premiums_and_Claims_-_City_of_Edinburg.pdf PDF
BI_Monthly_CITY_OF_EDINBURG_000243483_ALL_202504.pdf PDF
Employee_Benefit_Guide_2024-2025.pdf PDF
Loss_Ratio_-_Oct_2022-Sep_2023.pdf PDF
SBC_HMO_Active___Final_FY_23-24.pdf PDF
SBC_PPO_Retiree___Final_FY_23-24.pdf PDF
SBC_HMO_Retiree___Final_23-24.pdf PDF
Employee_Census_2025.xlsx XLSX spreadsheet
SBC_PPO_Active___Final_FY_23-24.pdf PDF
Rules_for_Electronic_Bidding_.pdf PDF
COE_HCC_NO_PHI_100000_2022-2023.pdf PDF
COE_HCC_NO_PHI_100000_2023-2024.pdf PDF
COE_HCC_NO_PHI_25000_2022-2023.pdf PDF
COE_HCC_NO_PHI_25000_Current.pdf PDF
COE_HCC_NO_PHI_100000_Current.pdf PDF
COE_HCC_NO_PHI_25000_2023-2024.pdf PDF
Show all 21

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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%

© 2025 MedeAnalytics, Inc. All rights reserved.

File details come from the government source that posted it. Updated .