County insurance advisers recommend plan changes, $250,000 reserve use to limit a projected 24% spike in medical costs

Grand County commissioners heard a presentation on Thursday recommending changes to the county's employee health plans to blunt a large projected increase in medical funding for 2026. Kelsey Heller of Hub International, the county's insurance broker, told the board the county's medical program is running well above budget because overall utilization rose and two very high-cost claimants generated roughly $1.07 million in claims between them.

The insurance committee's proposal would use $250,000 from the existing medical reserve and make plan design changes — including removing the county's EPO option and modestly raising deductibles on the PPO and high-deductible plans — to reduce an estimated 24% funding increase to about 12.1%. Heller said, “By using $250,000 from that budget and making plan design changes, you're able to reduce the overall increase to about 12.1%, which essentially is cutting that increase almost at half.”

Why it matters: Commissioners were told the county is paying about $2,084 per employee per month so far in 2025 and that the two high-cost claimants accounted for about $580,000 and $490,000 in claims, respectively. County staff and the insurance committee said continuing to rely on the reserve without further action would deplete the fund if high claims persist. A county official told the board they have “grave concerns” about the fund balance if the trend continues.

Hub recommended several plan design changes: eliminate the low-enrollment EPO plan (23 employees enrolled), increase deductibles on the PPO and HDHP by modest amounts (for example, a $250 increase for individual PPO deductibles and matching family increases), and boost the county's health savings account contribution for HDHP participants (from $850 to $900 for individuals and $1,700 to $1,800 for families). Heller said the recommended package would have the smallest impact on employees while reducing the county's budget pressure.

Rich Chimenos, who offered help coordinating provider negotiations, addressed the board after the presentation: “If you're interested, I would like very much to invest my time in working through some potential options with Hub, with your insurance subcommittee.” He asked the county's TPA, EBMS, to provide data on top providers receiving plan payments so the county could explore rate negotiations.

No final vote was taken Thursday. Commissioners were told the committee's recommendation will be finalized next week and the budget numbers will be adjusted after stop-loss and contract figures are confirmed. Kelsey Heller and county staff said the recommendation shares the increase with employees and reduces the projected budget impact by combining plan design changes with use of reserves.