Stop Loss RFP Large Claim Report 2025.xlsx

The document is a large claims report for the City of Jersey City's self-funded medical and prescription drug plan for the year 2025, detailing 267 individual medical claims. The report provides a comprehensive breakdown of medical procedures, diagnoses, and associated costs, ranging from relatively minor treatments to extensive medical interventions. The claims cover a wide spectrum of medical conditions, including orthopedic procedures (spine surgeries, joint replacements), cancer treatments, cardiovascular interventions, neurological conditions, and mental health services.

The claims data suggests a complex and high-cost medical insurance environment, with individual claims ranging from approximately $37,000 to over $464,000. Notable high-cost claims include multiple cancer treatments involving chemotherapy and immunotherapy, extensive spine and joint surgeries, dialysis procedures, and treatments for chronic conditions. The data appears to be supporting the city's upcoming Request for Proposals (RFP) for self-funded medical and prescription drug excess stop-loss coverage, which will expire on December 31, 2025. The comprehensive claims history will likely be critical for potential insurers in assessing risk and developing pricing strategies for the city's stop-loss insurance coverage.