Hall County will raise its stop-loss threshold for workers’ medical plans beginning in 2016 in the hopes of generating health care savings over the long term.
Employers like Hall County purchase stop-loss coverage from private insurers to protect them against catastrophic losses on employee health plans.
The Board of Commissioners voted Tuesday to raise the limit to $225,000 from $175,000.
Officials looked at claims in prior years to gauge whether the threshold should be raised or lowered in 2016.
Officials said claims of more than $175,000 have decreased since 2010.
“Since 2010, with the exception of one year, the additional risk of $50,000 per claim was outweighed by what we’d save in premiums,” Moats said.
Were the new threshold in place this year, Moats added, the county would have saved an estimated $210,000 in premium costs while only taking on an additional $50,000 in risk. Three additional claims exceed $125,000 so far this year.
Moreover, one claim that already exceeds $288,000 would have alone produced about $160,000 in net savings if the new threshold were in place today, Moats said.
Alternatively, decreasing the stop-loss threshold to $150,000 would have driven premiums up about $282,000. And a reduction to $125,000 would have increased premiums more than $600,000, which officials said did not make financial sense.
But one bad year in the number and costs of stop-loss claims could upend the expected savings.
“It’s a balancing act and is somewhat of a gamble, no matter which option we select,” Moats said. “So all we can do is look at the claims history and make the best decision possible.”