Clearwater City reviews healthcare plan performance and claims costs for 2021

The Clearwater Benefits Committee meeting on February 9, 2022, focused on the city's self-funded health insurance plan and its financial performance for the previous year. The discussion highlighted key figures related to claims, administrative costs, and the overall impact on the city’s budget.

The meeting began with an overview of the city's health plan, which is self-funded, meaning the city pays for claims directly rather than through a fully insured model. For the calendar year 2021, the city projected total claims costs at approximately $19.5 million, with about $935,000 allocated to Cigna for administering the plan. This model allows the city to retain any surplus if claims are lower than expected.

A significant aspect of the discussion was the stop-loss insurance, which protects the city from catastrophic claims. The city covers the first $300,000 of any individual claim, with reinsurance covering amounts beyond that. The cost for this stop-loss coverage was reported at around $1.5 million for the year.

The committee reviewed the total claims, which included nearly $15 million in medical claims and about $4.8 million in pharmacy claims, resulting in net claims of approximately $19.8 million after accounting for stop-loss insurance. The city also received rebates on certain high-cost medications, totaling just under $1.1 million.

Overall, the health plan finished the year with a deficit of about $1.6 million, exceeding expected costs. This outcome was a notable shift from the previous year, where the plan had a positive balance of approximately $1.39 million.

The meeting concluded with a discussion on the implications of these financial results and potential adjustments to the plan moving forward. The committee aims to monitor trends in claims and costs closely as they plan for the upcoming year.