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County health-plan report: paid claims slightly above premium, high-cost drugs flagged for 2025
Summary
A SEMCO representative presented Richland County’s health-plan fourth-quarter snapshot, reporting paid claims slightly above premiums, eight high-dollar claimants beyond the $150,000 pooling point, 107 potentially avoidable ER visits and plans to exclude two high-cost weight-loss drugs in 2025.
A representative from SEPCO/SEMCO presented Richland County’s fourth-quarter health-plan summary at the Feb. 27 commissioners meeting, reporting that paid claims for the past 12 months exceeded billed premiums and identifying high-cost claimants and prescription drivers.
Cindy Herring, filling the SEMCO presentation slot, told commissioners the county had “an overall loss ratio of a 2.3 last 12 months,” and that paid claims totaled about $10,900,000 compared with billed premium of about $10,600,000. Herring said eight claimants exceeded the county’s…
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