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File #: 26-0292    Version: 1
Type: Department Staff Report Status: Agenda Ready
File created: 3/10/2026 In control: Human Resources
On agenda: 3/24/2026 Final action:
Title: Group Health Insurance Update March 2026
Indexes: Benefits, Human Resources, Insurance
Attachments: 1. Indian River County Financials December 2025
Related files: 26-0129
Date Ver.Action ByActionResultAction DetailsMeeting DetailsVideo
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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 ...

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