Client

An Indiana city with 500 employees

Challenge

The client was heading into renewal season with three established large claimants who accrued over $1,800,000 in claims in 2023. Apex had ensured the city was protected — the plan was only responsible for $375,000 of the total claims cost.

However, due to the claims history and an anticipated loss ratio of 102%, the stop loss carrier set the city’s renewal to an increase of 20.1%. This would have significant fiscal implications for both the city and its plan members.

Solution

Apex clinical staff reviewed the city’s claims experience and case management notes from providers and determined there was no significant clinical risk for 2024. Simultaneously, financial analysts reviewed historical loss ratios and found that despite claims in 2023, the carrier’s historical loss ratio did not merit a 20% increase.

Our team presented our finding to the carrier and argued that the data indicated the city should receive a renewal decrease of 3.4%. Apex also requested a “participating agreement” that would reward the city with a premium credit in 2025 if plan performance in was strong in 2024.

Results

Upon reviewing Apex’s first-party data, the carrier recognized the renewal increase was not warranted. They offered a flat renewal (0% change) and the requested participating agreement. Our team was not content — we entered a second set of negotiations and demonstrated that the 3.4% reduction was in the best interest of both the carrier and, most importantly, the city.

After considering Apex’s argument, the carrier approved a 3.4% decrease from the previous year’s stop loss rates — a total savings of $545,000. Additionally, the participating agreement creates the possibility of additional savings through a premium credit between $150,000 and $220,000 in 2025.