County reports record monthly medical claims; reinsurance (stop-loss) expected to cover major portion
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Summary
Washington County's employee health plan recorded its largest single-month medical claims amount, driven primarily by one high-cost claimant; county staff said a stop-loss payment of about $529,000 is expected to reimburse the plan.
County staff told the Financial Budget Committee Sept. 9 that the employee health insurance fund experienced its largest-ever monthly medical claims total, driven by a single high-cost claimant.
An employee-insurance presenter (Mr. Angel) said the county's medical claims for the month exceeded $1 million, with over half of that total attributable to one claimant. He said pharmaceutical claims were about $379,000 for the month. Total expenditures for the month were reported at approximately $1,478,000.
McConnell (comptroller remarks following) and Mr. Angel said the county purchases aggregate and specific stop-loss (reinsurance) coverage. Mr. Angel told the committee that specific stop-loss reimbursement had been approved and that the county expected a payment of roughly $529,000 related to the large claimant.
Mr. Angel said the county had paid about $233,000 so far in reinsurance premiums for the year and estimated the annual total will approach $400,000 depending on enrollment. He added that once the claimant has exceeded the specific deductible, additional treatments for that claimant would be reimbursed through Jan. 1 under the stop-loss arrangement.
Committee members asked for employee premium cost breakdowns by coverage tier; Mr. Angel offered to provide exact premium and contribution figures by email.
Ending: The committee received the employee insurance report and requested exact premium and county-cost figures to be circulated to members.
