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Benefits consultant tells Keystone Central SD finance committee cooperative model limits stop-loss risk; recommends spousal exclusion and copay changes
Summary
Benecon presenter Kathy outlined a cooperative self-funded health plan for Keystone Central School District, explained the cooperative's layered stop-loss and cross-share protections and identified $100,000 per-person stop-loss as Keystone's current threshold; she recommended reviewing copays and spousal enrollment to reduce costs.
Kathy, a presenter from Benecon, told the Keystone Central School District finance committee that joining or remaining in a school-district cooperative spreads the risk of very large medical claims and can prevent insurers from "lasering" individual high-cost members.
Kathy said Benecon manages multiple public-school consortiums and negotiates ASO arrangements with carriers such as Highmark Blue Cross Blue Shield. She said Benecon uses independent actuaries to set rates and that, in the Benecon cooperative model, Keystone’s stop-loss attachment point would be $100,000 per individual per year. "In our program, 95% of your premium is going to pay claims," Kathy said, arguing the cooperative is a more transparent model than some…
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