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County staff warns rising pharmacy and high-cost claims drove health plan to 131% loss ratio through May
Summary
County staff told the Kankakee County Board that the employee group health plan showed about $7.13 million in premiums and roughly $9.34 million in paid claims through May 2025, producing a medical and pharmacy loss ratio near 131%.
County staff briefed the Kankakee County Board on July 8 on the county’s group health plan performance through May 2025, reporting about $7.13 million in premiums paid and roughly $9.34 million in claims paid (medical and pharmacy combined), which the presenters described as a medical/pharmacy loss ratio near 131%.
Mike Lynch (presenting) explained that the plan covers roughly 417 employees and about 884 dependents and that the county’s stop‑loss reinsurance covers claims individually over $110,000. Lynch said a small number of very high-cost claimants and sharp increases in pharmacy spending — particularly nonspecialty GLP-1 drugs (for example, brand names discussed generically in the presentation) and specialty biologic drugs — accounted for much of the cost increase. He presented a per‑member‑per‑month cost increase and said the county’s year-to-date paid claims included one month with an anomaly that reflected a large claim that hit in May.
Lynch and Anita Speckman told the board staff will seek competitive renewals and intends to issue RFPs to approximately seven carriers; renewal pricing was expected in mid‑ to late August. Board members asked whether the $9.34 million figure represented paid amounts or billed charges; presenters confirmed the number represented claims paid under existing contracts. Lynch also noted that some high-cost members have since left the plan and underwriting adjustments will remove them from renewal calculations.
County leaders said they were briefing the board ahead of budget deliberations because the county generally bears 75% of premium costs with employees paying 25% and the increase would affect the county’s 2026 budget if trends continue. Lynch said Blue Cross’s stop‑loss arrangement mitigates extremely large individual claims above the $110,000 threshold but does not eliminate the plan’s exposure to rising pharmacy costs.
The board received the presentation and requested staff continue to pursue competitive quotes and return in August/September with renewal options and financial implications for the 2026 budget.
