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Dodge County officials weigh move to self‑funded employee health plan; preliminary quotes due in June
Summary
Dodge County staff briefed the management council on pros and cons of a possible switch to a self‑funded employee health plan, citing network limits, HSA impacts, stop‑loss timing and a compressed timeline tied to open enrollment.
Dodge County management council members reviewed options for the county’s employee health coverage and discussed whether to pursue a self‑funded plan, with staff saying preliminary vendor quotes are due this month and a decision could go to the County Board as early as September.
The discussion centered on tradeoffs: potential long‑term cost savings and greater plan control versus narrower provider networks, limits on health savings account eligibility and the county’s local provider capacity to support a larger self‑funded population.
A staff presenter said the self‑funded option “might just be the easiest transition into self funding if it is viable for employees to understand and overall for the county,” and noted some advantages, including flexibility to shop stop‑loss coverage and pharmacy benefits management. The presenter added that stop‑loss carriers will provide preliminary quotes this month but typically require additional claims data later in the year to finalize pricing: “they will need more claims data in the course of this year to provide a firm quote and that usually comes in September,” and that “their preliminary quotes are pretty darn spot on.”
Staff discussed specific carrier features. The presenter said a narrow‑network option offered by a carrier identified as Sentivo would steer members toward primary care within a single hospital system, making referrals outside that system possible but less likely. Virtual visit access under that option is limited to four states, and staff noted the four states are not necessarily neighboring jurisdictions. Staff also said the Sentivo‑style product cannot be paired with a health savings account–qualified plan.
Council members and staff raised concerns about local capacity. Staff cautioned the county’s market has only a “couple” of direct primary care clinics and questioned whether those independent clinics have the bandwidth to serve an organization the size of Dodge County if the county pursued a highly focused primary‑care model.
Cost pressure under the current fully insured arrangement was a key driver for the review. A council member referenced a projected 2026 rate increase of 20.9 percent and said the county cannot remain “status quo” in the face of that projection. Staff said alternatives include moving to a higher‑deductible option within the current carrier network or pursuing self‑funding, but that final decisions will depend on the quotes and analytics.
On timing, staff outlined a compressed schedule tied to open enrollment: preliminary quotes expected this month, a fuller analysis in August with educational materials for the County Board, and a potential formal decision in September. Staff emphasized open‑enrollment deadlines (typically October–early November) and the county budget cycle constrain the timeline and require further claims data before firm stop‑loss pricing is available.
No formal motion to adopt a new plan was made at the meeting. Instead, staff were directed to continue gathering quotes and analysis from vendors and to return with recommendations and finalized stop‑loss pricing when available.
Next steps identified by staff include collecting the preliminary quotes currently being produced, reviewing them by the end of the month, and presenting educational information to the County Board in August, followed by a possible decision in September; staff cautioned that the September timing depends on receipt of final claims data and stop‑loss pricing.
