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Austin County keeps UMR as TPA, approves Tokyo Marine stop‑loss renewal without laser
Summary
Austin County Commissioners voted to keep UMR as the county's third‑party administrator and approved Tokyo Marine's stop‑loss renewal (without a laser). Benefits consultant Scott warned a recent large claim had tightened market competition and urged the court to accept the firm offer.
Austin County Commissioners on Oct. 28 voted to keep UMR as the county's third‑party administrator and to accept Tokyo Marine's stop‑loss renewal without applying a laser to any employee case.
Scott, the county's benefits consultant, told the court that UMR manages claims processing, utilization review and a nurse line that helps control costs. He highlighted a per‑claim processing fee increase from $24.57 to $25.87 and said the county's utilization and negotiation practices have driven medical allowed amounts down compared with the prior year. "UMR is your third party administrator. What they do is they control your claims," Scott said.
Commissioners debated stop‑loss proposals after Scott reported a large claim—about $200,000—had appeared in October and prompted some carriers to withdraw. He summarized two firm offers: Tokyo Marine (with a longer look‑back and higher renewal figure) and an alternate insurer whose current quote appeared cheaper but reflected different exposure assumptions. Scott recommended Tokyo Marine's renewal without a laser and told the court he preferred the firm that does not impose a laser on an individual employee. "That would be my recommendation," he said.
After discussion about look‑back periods, aggregate attachments and how carriers handle historic claims, the court approved the Tokyo Marine stop‑loss program without the laser. The court earlier approved continuing UMR as the county TPA by motion (Reid moved; Ren seconded).
The commission also approved MetLife renewals for group life, dental and vision. Scott said the basic life plan will see a 3.1% county cost increase and that voluntary products showed no increase; the court accepted the MetLife package. He described a new buy‑up dental option with a $3,000 annual maximum and added adult orthodontia that employees may elect. Scott also credited Smith Rx for quarterly prescription savings of approximately $60,000 and said staff will continue outreach to increase participation in cost‑connect programs.
Next steps: staff will finalize the stop‑loss paperwork with the carrier and will bring further claims reports and purchasing details to a future court meeting as requested by commissioners.
