Advisers: Keep Lewis County self‑insured; Milliman projects 13.5% rise in 2025–26 costs

Susie Phillips, a consultant with Gilroy, Kernan & Gilroy, told Lewis County officials that Milliman projects claims and expenses for the county’s self‑insured health plan will rise about 13.5% for the 2025–26 plan year to roughly $16.6 million and that a fully insured contract would be materially more expensive.

That projection, Phillips said during a county presentation, assumes an average enrollment of 621 and blends a 5.3% medical trend with a 12.2% pharmacy trend. She told officials the county’s eight‑month experience for the current plan year shows a 102% loss ratio — a negative variance of about $251,000 — but noted a large pharmaceutical rebate and four remaining months could change the final year outcome. “So it’s not over until it’s over,” Phillips said.

The difference between fully insured proposals and the county’s projected self‑insured cost was stark in the consultant’s summary. Phillips said Excellus BlueCross BlueShield and other carriers responded to a county RFP; several carriers declined to quote, and UnitedHealthcare and Emblem missed the submission deadline. Excellus…