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DeKalb County approves 2025 HSA and PPO employee plans, keeps spousal carve-out and tobacco surcharge
Summary
The DeKalb County Commissioners on June 5 approved two employee health plans — an HSA-eligible high-deductible plan and a PPO/copay plan — kept a longstanding spousal carve-out and a $25 monthly tobacco surcharge, and set timelines and payroll deadlines for open enrollment and Health Savings Account processing.
DeKalb County Commissioners approved two employee health plans and several related policies at their June 5 meeting, voting to adopt an HSA-qualified high-deductible plan (listed in materials as HDHP/HSA) and a PPO/copay option, keep the existing spousal carve-out and retain a $25 monthly surcharge for tobacco users.
The measures matter because they set employees' 2025 coverage rules, out-of-pocket limits and the county’s administrative deadlines for open enrollment and payroll deposits. County staff also said they will seek HSA vendor information and finalize logistics so payroll can begin making HSA deposits for employees who enroll.
Lauren (staff member), who presented the plans and Summary of Benefits and Coverage (SBC) packets, reviewed key numbers: the HSA/HDHP shows a $3,500 in-network individual deductible and $7,000 family deductible, with out-of-network amounts doubled; the out-of-pocket limits are $5,000 individual and $10,000 family in‑network, and double for out-of-network. Preventive services were confirmed as covered at 100 percent before the deductible. Pharmacy copays and specialty pharmacy rules were also summarized.
Lauren said, "Today we have our SBCs, or summary of benefits and coverage," and walked commissioners through differences between the HSA (deductible-first) and the copay/PPO option (first-dollar copay amounts). She reviewed typical copays cited in the SBCs: $30 primary care, $60 specialist, $25 for certain therapy visits, and pharmacy tiers (example: $10 generic 30‑day; $25 generic 90‑day; $60 preferred brand 30‑day; $150 preferred brand 90‑day). She also described network arrangements (the PHP Freedom Network and an encore network for nonlocal care) and noted LabCorp as the in‑network laboratory provider for preventive testing.
Commission action and logistics - The board voted to approve the HSA/HDHP plan; a commissioner moved to "accept the HDHP, also known as HSA coverage plan, as presented," and the motion carried. (Action recorded: motion approved.) - The board then approved the PPO/copy plan on a separate motion; that motion also carried. - Commissioners asked staff to change labeling in distributed materials from the technical "HDHP" to the more familiar "HSA" and to present the copay option as "PPO" because employees commonly recognize those labels.
Payroll and HSA vendor steps - Staff confirmed the county currently has an existing HSA relationship with UMB but that UMB has no local branches in the county. The county payroll system can send an HSA contribution file to the chosen bank, and staff said employees can later transfer balances to another HSA if they wish (a balance transfer process similar to a rollover). - The county set internal deadlines to meet payroll processing: staff said payroll must have final data and HSA details by Monday, June 30, so the July 11 pay (the county’s first July payroll) can be processed (payroll file initiated July 9). Commissioners asked staff to solicit proposals or information from local banks and a vendor the presenter mentioned (Lively) and to present side‑by‑side vendor materials at the next available meeting. Staff said they would contact vendors and the county treasurer for local bank contacts; commissioners agreed to decide on a vendor at the upcoming meeting.
Wellness incentive and eligibility for new hires - The board kept the county’s wellness incentive (a $50 per pay reduction in health-plan premium for employees who complete the required screening and physician consultation). For employees newly eligible after July 1, the board approved a 90‑day window after hire for the employee to complete the wellness steps and receive the retroactive premium credit if they complete the program within 90 days. Commissioners directed staff to apply that 90‑day rule for recent hires who fall into the current open‑enrollment period.
Spousal carve-out and tobacco surcharge - The board voted to keep the longstanding spousal carve-out: spouses who are offered employer‑sponsored coverage through their own employer are not eligible to enroll on the county plan. The carve‑out remains in force. - The board also decided to keep the tobacco surcharge. The policy charges a $25 monthly surcharge for employees who attest they use tobacco products; employees who attest they have quit may have the surcharge removed after the county’s established verification period (staff noted a standard six‑month lookback for quit attestations).
What comes next - Staff will collect HSA vendor materials and local bank proposals and present them to the commissioners for a decision at the next meeting. Payroll and benefits staff will prepare employee communications reflecting the approved plans, the HSA vendor decision timeline, the June 30 payroll data cutoff for July payroll processing, and the 90‑day rule for new hires.
The commissioners closed the discussion after staff summarized follow‑up tasks and deadlines. The approved HSA and PPO plans and the retained spousal carve‑out and tobacco surcharge will be reflected in the employee materials distributed before the county’s open‑enrollment deadline.
