Subject:
Title
Group Health Insurance Stop Loss (Excess Insurance) placement CY2027
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Fiscal Impact:
The estimated maximum fiscal impact for 2027, including premium and aggregating deductible exposure, is $809,313, a 12.8% increase from the prior year. The specific deductible remains unchanged at $1,050,000 per individual. The aggregating deductible also remains unchanged at $312,000 and applies only to claims exceeding the specific deductible.
Dept/Office:
Human Resources
Requested Action:
Recommendation
That the Board of County Commissioners approve 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, upon the County Attorney’s Office and Risk Management approval, to bind this coverage effective 1/1/2027.
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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. The Stop Loss policy is renewed annually.
The County’s Benefits Consultant marketed 2027 renewal options for the County’s Stop Loss insurance coverage and received a total of 11 responses. The marketing summary is attached. Of the 11 carriers that responded, 9 declined to quote as their pricing was not competitive. After reviewing the available options, the County’s Benefit Consultant and the office of Human Resources recommend renewing with Symetra for 2027. Symetra did provide an alternative option to reduce the premium by increasing the aggregate deductible, however, this did not have any significant reduction of the total maximum fiscal impact (premium + aggregating deductible) and would increase the threshold to reach coverage for a catastrophic claim. In addition, Symetra provided alternative options with a lower individual deductible so we could evaluate whether increasing the premium for a lower deductible would be offset by potential savings based on historical claim data. Modeling of these scenarios resulted in higher net losses and therefore are not recommended. Based on the analysis, renewing under the current terms is recommended.
The following summarizes the terms of the recommended Symetra renewal:
Symetra has offered to continue the experience refund introduced in last year’s policy. The refund provides a portion of the premium back to the County if reimbursements under the annual policy do not exceed 60% of the total premium paid. Under the recommended option, the estimated refund is $74,597 if claims do not exceed 60% of the total premium paid under the policy for 2027.
Clerk to the Board Instructions:
Please return a copy of the Board Action Memorandum to Human Resources.