Holmes commissioners renew with Aultcare
MILLERSBURG — A week after receiving an initial renewal quote, along with a third-quarter plan performance update, the Holmes County commissioners on Monday agreed to again contract with
However, they did so after representatives from
The initial renewal estimate included a total fixed cost of
Those costs are associated with PPO access and an individual stop loss of
The amended offer was made after the commissioners questioned the proposed increase. “It’s still a large amount of money. We thought that since we were taking on most of the risk ourselves, we wouldn’t have any increases,” said Commissioner
Miller also said he’s hopeful claims remain manageable, which helps to reduce the cost to the county.
As of
In a breakdown of claims paid, there was an increase, over last year, in claims paid for inpatient services and prescriptions. However, all other categories — outpatient, primary care physician, hospital-based physician and specialists — are down from the prior year’s claims, according to a report presented by Aultcare account executive
There are less than a handful of high-dollar claimants, who, in most cases, venture into the high claims area because of the cost of specialty drugs, she said.
The numbers show most members are using the plan well, with 63 percent of claims paid to in-network providers, 33 percent paid for approved referrals and only 5 percent coming from non-network providers without a referral.
The top 10 diagnosis-related groups represent all of the claims paid for inpatient services, according to the recap. And, nearly 93 percent of all outpatient claims in 2017 have been derived from the top 10 outpatient services — including prescriptions, laboratory and diagnostic services, surgical and emergency.
A total of 91 prescriptions for the top 10 paid drugs represent
In 2018, with the new third-party contract, employee premiums will remain the same, at
The annual maximum out-of-pocket cost (in-network) to employees is
Currently, there are 184 enrolled in the plan — 93 individuals and 91 families.
While individuals are responsible for the first
Coverage will remain essentially the same, with little changing but the addition of rehabilitative services for autism spectrum disorder, the inclusion of treatment of TMJ as an essential health benefit and access to telemedicine, provided at a cost of
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CREDIT: CHRISTINE L PRATT
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