Finance committee weighs health insurance 'run‑out' exposure and stop‑loss mechanics

Staff briefed the committee on the town's health insurance run‑out exposure and how reinsurance (stop‑loss) and prescription rebate credits are processed. A staff presenter said roughly $300,000 remained unappropriated to cover run‑out claims and described an insurer attachment point of about $175,000 per claim, beyond which stop‑loss coverage applies.

A committee member asked whether any individual claims had exceeded the attachment point and whether the town expects reimbursement through reinsurance; staff said claims that hit the stop‑loss attachment point are processed through the strategic health group and Harvard Pilgrim relationships and that the timing for rebate credits can push recognition into October or November. "We still have about 300,000 that has not been appropriated, give or take," a presenter said when describing available capital to cover run‑out and stop‑loss timing issues.

Members asked for a follow‑up report; staff said that because some vendor finance staff recently retired and because the town is no longer a primary customer of the strategic health group, obtaining a consolidated report may take longer than usual.