Commission asks broker to pursue self‑funded (ASO) options as Blue Cross proposes 8.2% fully insured increase

Human Resources (interim director Sarah Denny) and broker representatives presented initial 2025–26 renewals for health benefits. Blue Cross Blue Shield’s early fully insured renewal proposal showed an 8.2% increase across the county’s PPO and high‑deductible options; staff noted that the county’s current experience rating (July–February) is about a 66.2% loss ratio, down from 95.4% the previous year.

Staff also presented an administrative services only (ASO)/self‑funding model using Blue Cross as the administrator. The ASO outline included fixed administrative fees (broker, carrier admin, pharmacy carve‑out and stop‑loss), an aggregate stop‑loss line (proposal included 15% aggregate costing roughly $82,535) and broker fees (~$53,676). Annualized administrative fees were shown at roughly $889,000 before claims. Lockton modeled historical scenarios and suggested that ASO could be cost‑effective over a multi‑year horizon because the county would retain rebates (pharmacy rebate split proposed 80/20 in county’s favor on the proposal) and excess underwriting gains.

Commissioners directed the broker to negotiate with Blue Cross and to pursue ASO options while also requesting specific concessions: a multi‑month administrative fee credit, raising aggregate threshold from 15% to 20% (if advantageous), and exploring individual stop‑loss deductible adjustments (e.g., $100,000 to $125,000) and a narrow‑network plan option as an employee choice. Staff noted Miami County has about $300,000 in existing health reserves and that Lockton recommended a three‑month premium reserve target.

Ending: Staff will return with further negotiated ASO and fully insured figures, the results of Lockton’s underwriting and narrow‑network option pricing for the commission’s April decision calendar; open enrollment was scheduled for late April with a July 1 effective date.