Claims review: early catastrophic claims push City of Clearwater renewal projection to 5.3%

At the June 2, 2021, City of Clearwater Benefits Committee meeting, staff and consultants reviewed the plan’s claims experience through April and presented a renewal projection that would raise plan costs by 5.3% for the upcoming renewal period.

Consultant Sean Fleming of the Garing Group led the review and summarized the key drivers. Fleming said the plan recorded approximately $6,800,000 in funding into the plan through the first four months of the year, with roughly $320,000 paid to Cigna for administration and about $512,000 earmarked for reinsurance (the stop‑loss layer that applies after the plan’s stated retention). Fleming said total gross paid claims through April were about $6,200,000 (roughly $4,600,000 medical and $1,500,000 pharmacy). Pharmacy rebates of just under $1,100,000 and other items left the plan with a year‑to‑date surplus of about $900,000.

Catastrophic claims and stop‑loss Fleming identified several high‑cost claims as the primary reason the early months look above average. "We have a claim that's almost $1,100,000," he said, and noted the plan’s stop‑loss retention…