HomeMy WebLinkAboutMINUTES - 11181986 - 1.95 To: BOARD OF SUPERVISORS �/y�t
FROM; `A I ra
Mark Finucane, Health Services Director ^^�a,{� �
DATE: WJcoull,,u u
November 5, 1986 � ��J
SUBJECT;
Reinsurance Level in Health Plan Medi-Cal Contract #83-81918
SPECIFIC REQUEST(S) OR RECOMMENDATION(S ) & BACKGROUND AND JUSTIFICATION
I . RECOMMENDATION:
Forward letter to State of California, Department of Health Services indicating
the Board' s desire to increase the reinsurance threshold in Contract #83-81918
from $25,000 per enrollee per year to $100,000 per enrollee per year.
II . FINANCIAL IMPACT:
This action will represent a premium revenue gain of $130,000 in FY 1986-87 with
an anticipation of a $50,000 loss in reinsurance recovery. Consequently, this
action should result in a positive net revenue of $80,000.
III . REASONS FOR RECOMMENDATION/BACKGROUND:
The premiums which the State has paid to the PHP Contractors over the years has
always had a reinsurance withhold included in the calculations. For FY 1986-87
this withhold was based on a $25,000 reinsurance threshold which would limit the
risk to the contractor for any Medi-Cal enrollee. Because the contracting
Health Plans have contended that the premium withhold has exceeded reinsurance
recoveries over the years, the State Actuary was instructed to calculate what
impact various reinsurance levels would have on PHP premiums. This has been
done, and the Department of Health Services has given each PHP Contractor the
ability to select the reinsurance level to be included in their contract.
The Contra Costa Health Plan has analyzed past years' reinsurance recovery data
and increased premium potential and recommends that our contract with the State
be modified to raise our reinsurance level to $100,000 and gain a new premium
structure.
IV. CONSEQUENCES OF NEGATIVE ACTION:
If the letter is not sent to the State by December 1, 1986, we will not be able
to make this change for this fiscal year, and we would not receive the additional
premium amounts. We would still have the $25,000 reinsurance threshold and will
continue to submit claims at the end of the year as has been done in years past.
CONTINUED ON ATTACHMENT: _ YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATUREIS): V
ACTION OF BOARD ON Lvov ember_ 18 , 1986 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT _I ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES'. AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
cc: Health Services Dept. (Contracts & Grants) ATTESTED _ Alovembet 18 , 1986
County Administrator PHIL BATCHELOR, CLERK OF THE BOARD OF
Auditor-Controller SUPERVISORS AND COUNTY ADMINISTRATOR
X38217-83 BY-2 DEPUTY