Tippecanoe County officials say recent high medical claims strain self‑insurance fund; premium changes possible

Tippecanoe County officials told the County Council on April 8 that a spike in high medical claims in 2024 and ongoing large claims in early 2025 have cut into the county's self‑insurance balance and could force changes to employee premiums or plan design.

County auditor staff reviewed year‑end figures for the county's general and self‑insurance funds and then turned the presentation over to benefits staff for an explanation of recent claims activity and projections. The county's 2024 employer claims for Anthem totaled about $11.7 million, and combined 2024 spending on the health plan reached roughly $15.1 million, presenters said.

"We're in the thick of our really bad one or two years right now," said Sadie, a county benefits staff member, during the presentation. She told the council the county's stop‑loss carrier paid after members hit the plan's large‑claim deductible and that last year included several unusually costly prescriptions and heavy use of centers‑of‑excellence outpatient services.

Auditor staff said the general fund began the year with about $7.5 million available for appropriation and noted the fund that would back self‑insurance has fallen; the auditor said it has declined to around $4 million after drawing down roughly $3 million a year for the past two years. The presentation noted 2025 first‑quarter Anthem payments of about $3.1 million and a March single‑month payment of about $1.7 million. Benefits staff projected Anthem spending of about $12.7 million for 2025 based on recent trends.

Sadie said the county has already canceled its contract with Virta, a vendor the county had used for a diabetes‑focused wellness program, because it did not show a measurable return. "We're not seeing any return on investment from Virta at all," she said. She added the county will seek alternative wellness programming more closely targeted to the plan's top conditions.

The presentation included enrollment counts and concentration of high claims: county data showed approximately 745 full‑time and regular part‑time employees are benefit‑eligible (February 2025 figures), with about 1,500 total people covered when family members are included. The county reported 24 members with more than $75,000 in claims in the most recent 12‑month measurement period; six of those members were identified as cancer diagnoses. Presenters said several cases have claim totals that run into the hundreds of thousands of dollars and that such outlier years are expected occasionally.

Council members asked if an aging workforce contributes to rising claims. Sadie said she reviewed age‑bracket data and that a specific age group is driving a majority of high claims but that the workforce overall remains a mix of ages. She also told the council the county has not raised employee premium contributions in about 10 years and that the county's broker agrees the plan is unusually generous compared with market options.

Jennifer, an auditor's office staff member, recommended monitoring the funds and noted possible upcoming considerations for self‑insurance. Council members were told county leadership and the broker planned further discussion about rates and plan design.

The presentation did not include any formal council action on insurance rates; council members were told additional analysis and subsequent meetings will inform any decision about premium or plan changes.