TO: The Honorable Board of County Commissioners
THROUGH: John A. Titkanich, Jr., County Administrator
FROM: Suzanne M. Boyll, Human Resources Director
DATE: December 30, 2025
SUBJECT: Group Health Insurance Update January 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.
The County has received the updated financial reporting for the plan year October 1, 2024, through September 30, 2025 (attached). During this period, the financials reflect the plan ended the year with a $2.5M deficit. Medical claims have increased by 19.2% over the prior plan year and Rx Claims have increased by 32.2% over the prior plan year. The total medical claims net of insurance stop loss were $17.4M and total Rx claims less rebates were $7.4M.
For the plan year ending September 30, 2025, total medical claims were $17.4M, with 75 high-cost claimants (over $50,000 paid) totaling $8.6M. In the prior plan year, the total medical claims were $14M and there were 62 high-cost claimants totaling $6.6M.
For the plan year ending September 30, 2025, total Rx claims less rebates were $7.4M. In the prior plan year, total Rx claims less rebates were $5.4M. Weight loss GLP-1 utilization accounts for $2.3M of the Rx claims and 23% of the total Rx claims for the plan year ending September 30, 2025.
ANALYSIS
The County’s health insurance trust fund remains well funded with a balance of as of September 30, 2025, of $21,562,606. The fiscal year end fund balance history is noted below:
|
Fiscal Year End Fund Balance History |
|
September 30, 2020 |
September 30, 2021 |
September 30, 2022 |
September 30, 2023 |
September 30, 2024 |
September 30, 2025 |
|
$12,807,209 |
$15,003,116 |
$19,873,421 |
$22,814,781 |
$24,727,464 |
$21,562,606 |
STAFF 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 report back in March 2026 with updated financial information through December 2025.
Attachments: Group Insurance Financial Reporting Through September 2025