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Lakeway hears 11.5% renewal from Texas Health Benefits Pool; city told annual impact could be about $198,000
Summary
Presenters from Texas Health Benefits Pool told Lakeway council the pool is proposing an 11.5% renewal tied to market trends; the city’s per‑member cost would rise to $499.22/month, with an estimated annualized budget impact of roughly $198,000 if enrollment and claims remain consistent.
Heather Von Gotten of the Texas Health Benefits Pool told Lakeway council that the pool’s proposed average rate change for the 2026 plan year is 11.5 percent and that the city’s current total paid per member per month is $499.22, up from $402.73 the prior year. She said the 24‑month claims experience through April shows a 63% loss ratio for the group and that the pool’s overall 2024–25 loss ratio was 87.4 percent, warning those trends are driving higher renewals across the market.
Von Gotten highlighted that outpatient services are the main cost driver for Lakeway—outpatient point‑of‑service paid claims totaled $532,400 while inpatient paid claims were about $148,900—and estimated that if enrollment and claims remain consistent the annualized impact to the city would be about $198,000. “If the city's enrollment and claims remain consistent, the annualized impact would be about a $198,000,” she said. The presenter also noted industry drivers such as rising provider wages, facility fees, cancer‑care costs and increased GLP‑1 medication use as contributors to the trend in plan costs.
City members pressed for enrollment and utilization detail; Von Gotten reported roughly 171 covered members across plans and gave counts of employees who met deductibles and out‑of‑pocket limits. The council did not take action; staff and the presenters agreed to narrow options and return with more packet data for the June 15 meeting.
