Rockingham County commissioners heard a detailed benefits briefing April 3 from Gallagher consultants and county staff showing a projected all‑in increase of about 9% for the county’s self‑funded medical plan for the 2025–26 plan year.

The briefing, led by Gallagher and county finance staff, said most of the upward pressure comes from higher stop‑loss (catastrophic‑claim) pricing and recent high‑dollar claims. Gallagher reported a proposed stop‑loss renewal that would raise specific stop‑loss costs by about 45%, which the consultant said equates to roughly $384,000 in additional premium; an alternative that increases the specific deductible to $200,000 would trim that jump to roughly 25%, according to the presentation. Gallagher also identified two current claimants they flagged as likely to exceed the county’s specific stop‑loss threshold and said the carrier underwriting option that assigns “lasers” to those claimants would add an estimated $410,000 of potential direct liability if those individuals exhaust their laser amounts.

Why it matters: health‑plan costs are paid from a dedicated internal service fund and from departmental contributions; large swings in stop‑loss pricing or catastrophic reimbursements affect the county’s reserves and the budget the commissioners approve. Finance staff told the board there remains multiple millions of dollars in the county’s health fund but that increases of the size shown would use more reserves or require higher employer and/or employee contributions.

Gallagher summarized options the county can take before finalizing the renewal: (a) accept the carriers’ straight renewal (the highest immediate premium increase), (b) take a higher deductible (for example $200,000) to lower stop‑loss premium, or (c) accept a renewal with claimant‑specific lasers (lower premium now but explicit potential liabilities). Gallagher said carriers other than the incumbent were either non‑competitive or declined to quote at current experience levels, so switching carriers does not guarantee lower costs this year.

Commission discussion and next steps: Commissioners and staff focused questions on the tradeoffs between a higher stop‑loss deductible and the laser option. Several commissioners said they preferred not to accept lasers unless the premium savings clearly exceeded the county’s potential exposure. County finance staff and Gallagher agreed to run final price comparisons and draft a motion for the board to act on at a near‑term meeting; Gallagher expects final stop‑loss quotations to be available in mid‑April and recommended waiting for those to avoid locking into a worst‑case renewal.

Context and supporting details: Gallagher reported that the plan’s recent year‑to‑date loss ratio is elevated (above 100% in the most recent reporting period), driven by a small number of very large medical claims; five members account for a disproportionate share of recent medical spend, and one large case is expected to fall off COBRA at year end. Gallagher also reviewed pharmacy and dental renewals: the dental contract was under a two‑year rate guarantee with no admin increase for 2025, while the pharmacy contract is part of the incumbent medical administration arrangement where prescription rebates are shared with the county (75% returned to the county under current contract language).

What the board directed: Commissioners asked staff to return with specific motion language and side‑by‑side cost scenarios (status‑quo renewal, higher deductible, renewal with lasers and expected county cash‑flow impacts) and to provide quarterly stop‑loss receivable projections for internal‑service fund accounting so that year‑end financial statements reflect expected reimbursements. No formal vote on the medical renewal was taken April 3.

Ending: Staff said they would provide final stop‑loss quotes and modeled budget impacts to the commissioners for a decision at the next available meeting, and that quarterly reporting will include incurred‑but‑not‑reported estimates for stop‑loss reimbursements to aid fiscal planning.