Jefferson County commissioners heard a detailed presentation on possible changes to the county’s self-funded health plan and stop-loss arrangements, with the county’s broker laying out several options to reduce an estimated 2026 premium increase. The presentation focused on a choice between higher fixed costs or accepting more variable aggregate liability, plus network and plan design changes that could cut the insurer's proposed increases.

The county's broker presented Blue Cross and other carrier renewal numbers and said that, as of August, the county's plan stood at about a 108% loss ratio versus the target of 85%. That gap, the presenter said, explains carrier recommendations to raise the aggregate and consider changes to plan design. The broker described eight Blue Cross options and additional offers from SelectHealth and others: (1) add a Mountain View (CCO) narrow-network option to steer care toward lower-cost hospitals in the region; (2) modestly increase primary-care and specialist co-pays; (3) increase employee deductibles to $3,000/$6,000 or $4,000/$8,000; (4) move to HSA/HRA-style plans; and (5) raise the stop-loss specific deductible from $60,000 to $70,000 or higher. The broker emphasized trade-offs: raising specific deductibles lowers fixed stop-loss premiums but increases the county's variable aggregate liability.

Why it matters: Commissioners and staff described the county as self-funded with reserves that have been drawn down by recent large claims. The county must balance limiting fixed premium increases against exposing the county to larger variable payouts if claims remain high. Staff and the broker repeatedly described the aggregate as a variable liability that does not necessarily materialize but can be large if claims trend upward.

Supporting details: The broker said the county received an aggregate settlement after exceeding its aggregate threshold in a prior year and noted large recent claims including oncology and specialty-drug costs. The presentation included options that combined a Mountain View CCO offering with increased co-pays (an option staff said would be likely to reduce aggregate exposure) and proposals to use a pharmacy program for certain high-cost specialty medications to reduce prescription spending; the presenter cautioned that prescriptions moved off the primary plan may not count toward stop-loss attachment and would therefore shift some risk to the county. Commissioners asked the broker to return with modeled scenarios combining the Mountain View network plus the recommended stop-loss and co-pay changes so the board could compare estimated total expected cost and maximum liability.

Discussion versus decision: The meeting produced no final change to the county health plan. Commissioners directed staff and the broker to produce the combined-option pricing (Mountain View network plus a raised specific deductible and modest co-pay increases), and to return with an updated proposal before the county's 2026 plan decisions. The broker said he would apply the combined changes to the renewal worksheet and present the results to the board.

Ending note: Commissioners and staff asked for final numbers showing both expected and maximum estimated costs under the combined options, and for an explicit explanation of how reserves would be used to fund increased aggregate exposure if the county adopts the broker's recommendation.