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
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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 $...
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