Medical_Premiums_and_Claims_-_City_of_Edinburg.pdf
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- Attached to
- Pharmacy Benefits 2025-2026
- Solicitation number
- 2025-011
- Issued by
- Hidalgo County, Texas
About this file
The document is a medical premiums and claims report for the City of Edinburg, covering the period from June 2022 to May 2025. The report provides detailed monthly metrics including medical subscriber months, medical member months, medical and pharmacy premiums, and medical paid claims across different coverage tiers (Single, Subscriber + Spouse, Subscriber + Dependent(s), Family).
The data reveals consistent growth in subscriber and member months, with total medical subscribers increasing from 1,024 in June 2022 to 1,096 in May 2025. Total medical and pharmacy premiums for the entire reporting period are $27,682,085.89, while total medical paid claims are $16,705,797.23. The monthly premiums show a gradual increase over time, ranging from $688,604.27 in June 2022 to $802,443.13 in May 2025. Medical paid claims fluctuate monthly, with notable variations such as a high of $664,155.67 in November 2022 and a low of $309,820.99 in August 2023, indicating potential variability in healthcare utilization throughout the reporting period.
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Medical Premiums and Claims - City of Edinburg
Run Date: 6/25/2025
Metrics: (Medical Subscribers Months, Medical Members Months, Medical and Pharmacy
Premium, Medical Paid Claims, Medical and Pharmacy Loss Ratio)
Rows: (Paid Month)
Columns: (Metrics)
Coverage Tier: (Single, Subscriber + Spouse, Subscriber + Dependent(s), Family)
Database: (CITY OF EDINBURG 000243483: ALL)
Reporting Period: (Jun 2022 - May 2023, Jun 2023 - May 2024, Jun 2024 - May 2025)
Paid Month Medical Subscribers Months Medical Members Months Medical and Pharmacy Premium Medical Paid Claims
Jun 2022 1,024 1,698 $688,604.27 $498,671.98
Jul 2022 1,024 1,689 $694,845.77 $446,210.56
Aug 2022 1,040 1,717 $697,334.91 $548,902.65
Sep 2022 1,033 1,707 $702,446.15 $424,447.63
Oct 2022 1,040 1,706 $714,701.29 $443,190.51
Nov 2022 1,034 1,703 $715,580.39 $664,155.67
Dec 2022 1,040 1,704 $715,437.82 $334,224.22
Jan 2023 1,057 1,715 $721,372.64 $484,604.75
Feb 2023 1,050 1,701 $716,648.38 $493,837.50
Mar 2023 1,072 1,724 $729,718.19 $537,886.14
Apr 2023 1,085 1,737 $740,605.78 $490,971.46
May 2023 1,088 1,734 $740,063.37 $324,548.51
Jun 2023 1,095 1,753 $744,692.00 $356,864.06
Jul 2023 1,106 1,763 $747,626.45 $354,272.24
Aug 2023 1,100 1,751 $747,878.58 $309,820.99
Sep 2023 1,096 1,740 $745,102.40 $534,618.57
Oct 2023 1,109 1,770 $809,166.77 $543,828.21
Nov 2023 1,107 1,771 $814,941.50 $363,633.25
Dec 2023 1,094 1,750 $810,898.39 $318,346.31
Jan 2024 1,099 1,749 $812,787.88 $431,207.99
Feb 2024 1,102 1,753 $812,400.61 $520,483.68
Mar 2024 1,102 1,743 $811,130.58 $440,626.85
Apr 2024 1,104 1,749 $811,175.12 $517,163.71
May 2024 1,095 1,739 $809,231.35 $632,888.58
Jun 2024 1,083 1,720 $803,815.33 $370,283.77
Jul 2024 1,093 1,725 $798,859.64 $420,750.36
Aug 2024 1,103 1,735 $801,329.22 $648,110.96
Sep 2024 1,096 1,727 $801,739.28 $406,452.46
Oct 2024 1,103 1,738 $808,327.10 $374,021.12
Nov 2024 1,091 1,717 $802,102.10 $441,817.93
Dec 2024 1,101 1,725 $805,198.59 $499,699.89
Jan 2025 1,098 1,717 $800,881.27 $538,424.30
Feb 2025 1,089 1,710 $799,544.31 $490,067.60
Mar 2025 1,096 1,719 $802,685.34 $374,098.95
Apr 2025 1,093 1,711 $800,769.99 $518,249.53
May 2025 1,096 1,701 $802,443.13 $608,414.34
Total: All 38,938 62,211 $27,682,085.89 $16,705,797.23
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