Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Claims Management topic
No spam. Unsubscribe anytime.
Five high-dollar claimants strain McAllen plan; stop-loss recoupment eases near-term pressure
Summary
Staff reported five high-dollar claimants — including one near $3 million and another over $1 million — that have driven plan costs; staff said a recent stop-loss recoupment check of $2.3 million exceeded earlier estimates and improves near-term cash flow.
Staff told the commission five high-dollar claimants are being actively tracked and are the principal driver of an expected deficit if no changes are made. "We currently have 5 high dollar claimants that we're tracking," Jolie Perez said; she added that "1 particular claimant is already near $3,000,000 alone" and another claimant "has already surpassed $1,000,000," meaning two claimants alone exceed $4 million in claims.
The stop-loss program is being actively managed and staff said they recently received a recoupment payment that exceeded expectations: Perez said the budget had conservatively estimated a $1.4 million recoupment but the plan just received a $2.3 million payment on a claimant. Staff said that higher recoupments help but that the presence of multiple large claimants continues to pressure renewal pricing and stop-loss market responses.
