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AGENDA ITEM REVIEW FORM
3.B.
Employee Benefit Trust Board Meeting
Meeting Date:
10/16/2024
Department Head:
Adela Cortez
Submitted By:
Maria Barajas Gutierrez, Human Resources Coordinator, Human Resources Department

ITEM:

Discussion only on any and all matters regarding the Medical and Dental Plan Performance. (Oscar Diaz, Vice President of CBIZ-Business Development)
 

SUMMARY:

The Fiscal Year 2023-24 plan ended with a $3.084M after the Stop-Loss Insurance recovery, which is significantly higher than the 2022-23 plan year.  Although the plan performed well, there were some items that impacted the plan during the 2023-24 year, as follows:
  • Unpaid claims by the Third-Party Administrator to our Mexico Administrator (SIARMED), resulted in an underpayment of over $200,000 and this artificially improved the 2023-24 plan year.  These unpaid claims rolled over to plan year 2024-25 and were paid in July and August 2024.
  • An employee’s claims were mistakenly paid by Medicare as the primary payor. By correcting this, the paid claims in the month of June increased significantly.
For the 2024-25 plan year, the annualized cost projection is vastly magnified due to the rollover of SIARMED’s unpaid claims. However, it is expected that claims will normalize, assuming no other fluctuations arise.
 

RECOMMENDATION / SUGGESTED MOTION:

THIS ITEM IS FOR DISCUSSION PURPOSES ONLY. NOT AN ACTION ITEM.

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