TO: The Honorable Board of County Commissioners
THROUGH: John A. Titkanich, Jr., County Administrator
FROM: Suzanne M. Boyll, Director of Human Resources
DATE: July 28, 2025
SUBJECT: Approval County's Stop Loss Policy Renewal with Highmark FY25/26
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BACKGROUND
The County is self-insured in its Group Health Insurance Program and carries a policy that reimburses the County for claims that exceed a specific limit. This type of policy is called a stop loss policy, excess loss policy, or reinsurance policy. The County’s current stop loss policy is with Highmark and has an individual stop loss deductible of $300,000 for individual claims and an aggregating specific stop loss deductible of $100,000. The County also carries aggregate stop loss coverage for the entire medical/pharmacy plan as a whole. Below is an explanation of individual stop loss, aggregating specific stop loss deductible, and aggregated stop loss coverages.
· Individual Stop Loss Specific Deductible (ISL) - IRC’s liability on each individual on the plan (currently ISL is $300k)
· Aggregating Specific Deductible (ASD) - For any ISL claims in excess of $300k, IRC takes the liability for an additional $100k in claims. This can either be satisfied by one member in excess of $300k, or multiple members. The purpose of an aggregating specific deductible is to lower premiums paid to the stop-loss carrier in exchange for the plan sponsor potentially paying a bit more in claims throughout the policy period.
· Aggregated Stop Loss (ASL) - ASL protects the plan from unexpected, catastrophically high claims that exceed the limits of potential reserves. The aggregate stop loss coverage provides a $1M policy to IRC in the event the claims paid in the plan year exceeded 125% of expected claims.
The current annual premium for the stop loss policy with Highmark is $1,084,465 with a total fixed cost liability of $1,184,465 inclu...
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