DeKalb County commissioners on Tuesday approved new employee contribution percentages and Health Savings Account (HSA) matches for the county's 2025 health plan renewal while holding the overall premium-equivalent budget steady.

The county will budget an all-in premium equivalent of $4,951,695 for the plan year and set employee contributions at 8% for employee-only coverage, 14% for employee-spouse, 12% for employee-child and 15% for family coverage. The county approved HSA employer matches of $700 for employee-only, $1,000 for employee + spouse/child and $1,200 for family accounts.

County staff and the benefits consultant presented the recommendation, saying it reflects recent contract terms and the current financial position. "Our recommendation would most likely be a rate hold to the premium equivalence," the consultant said during the meeting. She added, "So no change in premium equivalence for the next plan year," while explaining how stop-loss, administration and HSA contributions were included in the valuation.

The budget recommendation places the county between a midpoint and a maximum-liability budgeting scenario, staff said. The benefits consultant explained that the county's expected claims liability was about $3.3 million and that, with fixed costs added, the all-in expected cost used in modeling was about $3.97 million. She said the plan's max-liability projection was roughly $4.58 million and that a reserve of about $250,000 would be sufficient to bridge a worst-case year under the chosen premium-equivalent approach.

County staff reported a current fund balance of about $2.3 million but noted there are outstanding liabilities to be paid from that balance. The consultant also said stop-loss reimbursements and UnitedHealthcare (UHC) pharmacy/medical rebates are expected to reduce net cost over time; year-to-date stop-loss reimbursements through March were near $100,000, she said.

Commissioners and staff spent substantial time on plan design details that remain to be finalized during implementation meetings with the insurer. Key plan design points discussed included: a $3,500 individual / $7,000 family deductible; $5,000 individual / $10,000 family out-of-pocket maximums; whether inpatient, outpatient and complex imaging services should be deductible-and-coinsurance; how therapy visits and routine labs/X-rays should be structured and tiered by site of care; and network choices for labs and imaging.

On therapy, commissioners agreed to an in-network co-pay of $25 per visit (out-of-network therapy to apply to the deductible). For inpatient and outpatient procedures, staff recommended making those deductible-and-coinsurance items, which the commission accepted for plan design direction.

Staff and the consultant also recommended using tiering and incentives to steer members to lower-cost, in-network labs and stand-alone imaging centers; the consultant noted IRS rules require that first-dollar coverage for HSA-qualified plans be limited, so incentives differ between the HSA and PPO designs. "On the HSA plan, the employee must meet their deductible before we can give them those incentives," the consultant said.

Commissioners voted to adopt the premium-percentage framework and the HSA match amounts during the meeting. A motion to approve the premium percentages and HSA matches was moved and seconded; after public comment, commissioners signaled their approval and the motion carried.

Staff will complete a three-hour implementation session with the insurer (PHP) to finalize the detailed plan design (visit limits, exact in-/out-of-network tiers, provider lists and the full summary of benefits). The consultant said the insurer will produce plan summaries and the open-enrollment materials in time for June open enrollment, and staff will circulate final contribution and premium figures to employees once calculations are finalized.

The commission also asked staff to provide a written list of in-network local labs, imaging and behavioral-health providers for the county so employees can find lower-cost sites of care during open enrollment.

What changed: The commission moved from the county's prior contribution structure (7% employee-only, 11% spouse, 10% child, 14% family) toward the approved structure that begins a phased increase to higher employee percentages while holding the county's overall premium-equivalent budget steady. The county maintained the recommendation to hold premium equivalents at $4,951,695 rather than budget to the plan's maximum liability.

Next steps: Staff will schedule the implementation meeting with PHP, finalize the summary of benefits and produce open-enrollment materials; commissioners asked that implementation discussions be public and that provider-network information be distributed to employees ahead of open enrollment.

(Reporting based on DeKalb County meeting transcript; implementation details and the final summary of benefits will be published by county staff prior to employee open enrollment.)