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County health-plan report shows 106% loss ratio; officials urge education on ER vs. urgent care
Summary
A Q4 2025 report to Ross County commissioners showed a 106.3% loss ratio for the county health plan, noted ten large claims above $150,000, and highlighted $1.2 million in emergency-room costs tied to 338 visits; the presenter urged member education on urgent-care use to reduce avoidable ER spend.
Melissa presented the county health-plan fourth-quarter (Q4 2025) report, reporting a Ross County loss ratio of 106.3% (SEPCO subco 104.9%) and noting 10 large claims exceeding $150,000 (ranging from approximately $166,000 to $556,000) that are excluded as a single line item when actuaries calculate renewal impacts.
She highlighted plan savings tied to network discounts and utilization patterns: Anthem network discounts produced approximately $10.9 million in savings for Ross County claims, 89%–90% of prescriptions were filled with generics, and outpatient care accounted for the largest share of dollars (about 48.7% of spending). Melissa said prescription fills totaled 17,799 in 2025, with 91.5% filled at retail locations and 7.9% by mail order.
Emergency-room use and outreach: Melissa reported that 237 members made 338 emergency-room visits in 2025, costing roughly $1.2 million, and she encouraged an education campaign to steer non-emergency needs to urgent care or retail clinics. "We love the emergency room. They are wonderful. They save lives. They're also the most expensive place for care," Melissa said, adding that misuse for non-emergencies — for example, visits that would be better served by urgent care — drives up plan costs.
Why it matters: A loss ratio above 100% indicates claims exceeded premium revenue in the period reported, and large claims can materially affect renewal calculations. Melissa said plan managers will refine renewal estimates as first-quarter data becomes available and that the insurer's actuaries adjust for large claims when setting renewal figures.
Next steps: Melissa offered to provide flyers and materials for a member-education campaign and said staff would circulate the first-quarter reports when ready; commissioners thanked her for the briefing.
