TO: The Honorable Board of County Commissioners
THROUGH: John A. Titkanich, Jr., County Administrator
FROM: Suzanne M. Boyll, Human Resources Director
DATE: March 10, 2026
SUBJECT: Group Health Insurance Update March 2026
__________________________________________________________________
BACKGROUND
On June 3, 2025, the Board of County Commissioners BOCC approved the County’s group insurance program for the plan year October 1, 2025 through September 30, 2026. During this meeting there was discussion regarding projected plan performance and the potential impact of the increased cost related to GLP-1 for weight loss. It was noted that under the new pharmacy PBM, Rightway, GLP-1 weight loss medications would require prior authorization criteria for BMI and co-morbidity to be met in order to be covered under the plan. Ultimately, there were no changes made to the group health plan, there were no increases in group health plan premiums, and it was determined staff would continue to monitor plan financials and report back to the Board.
At the January 13, 2026, BOCC meeting, information was reviewed with the BOCC reflecting the group health insurance plan performance through the plan year October 1, 2024, through September 30, 2025. The financials reflect the plan ended the year with a $2.5M deficit. Staff notified the BOCC that an update regarding plan performance would be provided in March 2026 with the most recent financial information for the current plan year.
The County has received the updated financial reporting for the first quarter of the current plan (FY26 Q1) October 1, 2025, through December 30, 2025. For FY26 Q1, the loss ratio is 131.7% and represents a deficit of $2M.
For FY26 Q1, total medical claims were $5.6M and there were 27 high-cost claimants (over $50,000 paid) totaling $2.7M. For FY25 Q1, the total medical claims were $3.9M and there were 13 high-cost claimants totaling $1.1M. FY26 Q1 medical claims reflect an increase from FY25 Q1 of approximately $1.7M.
For FY26 Q1, total gross Rx claims were $2.7M. For FY25 Q1, total gross Rx claims were $2.2M. FY26 Q1 Rx claims reflect an increase from FY25 Q1 of approximately $0.5M.
FUNDING
The County’s health insurance trust fund remains well funded with a balance of as of December 30, 2025, of $23,844,623 as reflected below:
|
Fund Balance Change Through 1st Quarter FY 25/26 |
|
September 30, 2025 |
December 31, 2025 |
Inc./Dec. |
% Inc./Dec. |
|
$21,485,956 |
$23,844,623 |
$2,358,667 |
10.98% |
The Fiscal Year End Fund Balance History is reflected below:
|
Fiscal Year End Fund Balance History |
|
September 30, 2021* |
September 30, 2022** |
September 30, 2023 |
September 30, 2024 |
September 30, 2025 |
|
$15,003,116 |
$19,873,421 |
$22,814,781 |
$24,727,464 |
$21,485,956 |
*On November 16, 2021, the Board of County Commissioners approved a $1.2M transfer from the CARES Act Fund into the Health Insurance Fund to cover a portion of the $2.8M in COVID-19 related claims incurred by employees, spouses, and their dependents.
**On March 1, 2022, the Board of County Commissioners approved a $1.9M transfer from the CARES Act Fund into the Health Insurance Fund to cover the remaining unreimbursed COVID-19 related claims incurred by employees, spouses, and their dependents which had increased to a balance of $3.1M.
RECOMMENDATION
At this time there is no immediate action required; however, staff recommends the Board be prepared to consider whether any changes related to GLP-1 coverage may be necessary should the medical and Rx trend continue to exceed budgeted annual premiums. Staff and representatives from Lockton will be available to discuss possible options. Staff will provide recommendations to the BOCC regarding funding and benefits for the upcoming plan year for FY26/27 in May/June 2026.