Subject:
Title
Group Health Insurance Stop Loss (Excess Insurance) placement CY2025
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Fiscal Impact:
Selection of the recommended carrier (Option 2) will result in a 4% premium increase to $7.83 PEPM (a projected 2025 cost of $341,639). The specific deductible will increase from $1,000,000 to $1,050,000 per individual with potential for additional claims cost towards the aggregating deductible which is increased to $312,000 and only applies if claims exceed the $1,050,000 specific deductible. The Plan’s maximum premium + aggregating deductible exposure for this renewal period is projected at $653,639 for 2025. This is a potential overall 2% increase from $641,858 for premium + aggregating deductible in 2024.
Dept/Office:
Human Resources
Requested Action:
Recommendation
That the Board of County Commissioners approve Option 2 for the renewal of Stop Loss Insurance with Symetra Financial for the self-insured group health insurance program and authorize the Human Resources Director to execute all documents necessary to bind this coverage effective 1/1/2025.
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Summary Explanation and Background:
Stop Loss coverage for a self-funded health plan provides a limit of financial exposure for the benefit plan when any individual member incurs a catastrophic claim. After successfully self-funding this exposure for several years, change in federal law through the Affordable Care Act (ACA) changed the financial landscape for employer’s coverage on catastrophic claims effective January 1, 2014, therefore the County began purchasing Stop Loss coverage with a high deductible through Symetra Financial. Stop Loss contracts are renewed each year.
The Office of Human Resources, along with the County’s Benefits Consultants RobinsonBush, had requested 2025 renewal options from alternative Stop-Loss Insurance Carriers and received the following responses:
• Sun Life - Not competitive, declined to quote
• HCC/Tokio Marine - Not competitive, declined to quote
The following summarizes the Symetra renewal options received:
The recommended proposed renewal contract is based on claims incurred any time prior to December 31, 2025, and paid January 1, 2025 through December 31, 2025 (Paid basis). This is advantageous to the county in that the contract basis allows eligible claims incurred at any time prior to December 31, 2025, to be counted toward the Stop Loss deductible for claims paid in 2025 for any individual member (“run-in” claims). RobinsonBush Consulting, the County’s Benefit Consultant, and the office of Human Resources/Employee Benefits recommend the 2025 renewal proposal as submitted by Symetra.
Clerk to the Board Instructions:
Please provide a copy of the Clerk’s Memo to Human Resources.