Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Employee Benefits topic
No spam. Unsubscribe anytime.
Pennridge staff review stop‑loss renewal, insurer negotiations and a specialty‑drug savings program
Summary
Benefits advisor Jim Pine presented stop‑loss renewal options, reporting a negotiated 7.5% renewal from RMTS with one large "laser" exposure remaining; the district also reviewed a PrudentRx program that could lower out‑of‑pocket costs for about 20 members and save the plan roughly $70,000 a year.
Pennridge School District staff reviewed proposals for the district’s July 1 stop‑loss renewal and described an optional specialty‑drug savings program during the June 10 committee meetings.
Jim Pine of Conrad Segal told the committees that the district’s current stop‑loss policy has an individual attachment point of $225,000 and that the current carrier is RMTS. RMTS’s initial renewal proposal generated a higher premium and large “laser” (individual‑specific) exposures; after negotiations using a competing Avalon proposal, Pine said RMTS reduced the renewal increase to about 7.5% (roughly $900,000–$905,000 in annual premium) and eliminated one of two $500,000 lasers, leaving one $500,000 laser in place. Pine said the broker reviewed claims history for that remaining laser and believed the member was unlikely to reach the $500,000 exposure in the coming plan year, calling RMTS’s final offer “the best offer for the district” based on available market quotes and the district’s risk profile.
Pine explained that stop‑loss carriers price coverage to protect employers from very large individual claims (for example, gene or cell therapies currently costing in the millions). He also described material variation in carrier pricing across the market and said stop‑loss is more volatile than standard group coverages because of a small number of very high claims.
Separately, the committee heard about the PrudentRx program, a third‑party administrator that works with the district’s pharmacy benefit manager to access manufacturer assistance for very high‑cost specialty medications. Pine said the program would target roughly 20 of the district’s roughly 2,000 covered members. Under the program members who enroll would see their out‑of‑pocket for impacted specialty drugs reduced to $0 while the plan would also realize savings; Pine estimated members’ out‑of‑pocket savings of about $175,000 and plan savings of roughly $70,000 total, with an additional pool of manufacturer funds shared among vendors and administrators. The program requires affected members to actively enroll after outreach (letters and calls); Pine and staff described safeguards for late enrollees who present at the pharmacy before they are placed into the program.
No vote was recorded during the committee discussion; Pine said the stop‑loss renewal will appear on the upcoming board agenda. Staff said they will discuss the PrudentRx option with employee associations and communicate details and timelines to affected members if the district pursues it.
The presentation included comparisons of alternate carriers and a summary of advisory work the district used to negotiate the carrier renewal and to evaluate the PrudentRx approach.
