SUBJECT
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Approve annual Stop Loss reinsurance with Aetna for the self-insured Employee Health Plan for a one-year premium of $809,000.
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DESCRIPTION
Polk County Government maintains a self-funded employee medical and pharmacy plan covering more than 8,000 participants across both the Board of County Commissioners and Constitutional Offices. To protect the health fund against catastrophic claims, the County purchases annual “stop loss” reinsurance. This policy currently reimburses the health fund for eligible claims that exceed the policy’s individual deductible for any covered participant.
Current Policy (Expiring 12/31/25)
• Carrier: Aetna
• Specific Deductible: $1,000,000
• Premium: $636,000
2026 Renewal Proposal (1/1/26 - 12/31/26)
Aetna has provided a firm renewal quote for 2026, maintaining all current coverage terms, including:
• Same individual stop loss deductible: $1,000,000
• Premium: $809,000
• Represents a 27.2% increase over the expiring premium, consistent with market expectations after multiple high-cost claims, including one member exceeding $3M in total claims in 2024 and another exceeding $1M in 2025.
Our health insurance consultants (Willis Towers Watson) solicited several quotes. Several national carriers declined to quote based on recent high-cost claim experience, and Aetna’s renewal remained the most competitive and financially favorable at the existing deductible level.
RECOMMENDATION
Request Board approval authorizing the Risk Management Director to bind stop loss reinsurance with Aetna, effective January 1, 2026, for a one-year premium of $809,000. The BoCC and all Constitutional Office representatives are in agreement with this recommendation.
FISCAL IMPACT
Funds are available in the Employee Health Insurance Fund.
CONTACT INFORMATION
Mark Thomas, Risk Management Director
(863) 534-5265