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District health fund remains strong at $22 million; staff to present claims analysis to insurance committee in May
Summary
District staff reported a February 2025 health fund balance of about $22 million. February claims ran 6.7% over budget driven by medical claims; pharmacy claims were below budget for the month. Staff scheduled a Path team presentation to the insurance committee on May 14 and a vitality deep dive on April 28.
District risk-management staff presented a February snapshot of the Santa Rosa County Schools self-funded health plan and told the board the fund remained healthy with a balance just over $22 million.
Staff reported that February ran hotter than budget by 6.7 percent (roughly $129,000). Medical claims were about 6.9 percent (roughly $86,000) over the expected claims budget for the month, while pharmacy claims came in 26 percent under budget (about $191,000 under budget). Combined, claims for the month were approximately $104,000 under the expected claims budget when pharmacy and medical are taken together. Staff cautioned these are single-month figures and can fluctuate because of fill patterns, 90-day prescriptions and the timing of claims.
The district has one high-cost claimant who has exceeded 50 percent of the individual specific stop-loss attachment (the district’s individual spec was cited at $250,000), representing about 9.1 percent of the district’s net claims for the period. The benefits team said it will use a Path (planning, analytics and total health) consultant to analyze in-depth claims patterns and present storyboards to the insurance committee on May 14. The district will also run a vitality (wellness program) deep dive on April 28. Staff said a fuller analysis and recommendations will be ready for the May 15 board meeting.
