Moore County reviews health insurance RFP after First Carolina Care exits commercial market

Moore County officials and outside benefits consultants reviewed responses to the county's health insurance request for proposals during an afternoon work session and said First Carolina Care has withdrawn its bid after announcing it was exiting the commercial market.

Marilyn McKinney, Moore County risk and benefits manager, introduced consultants from National Insurance Services, who described the evaluation of medical, dental and prescription drug proposals. Scott Fritz, a consultant with National Insurance Services, said the firm “shipped these opportunities out to other carriers and other relationships to get responses, so to make sure that we did a thorough analysis of the market.”

The consultants said Blue Cross Blue Shield emerged as the most viable medical bidder after First Carolina Care removed its proposal. Rick Labien, a National Insurance Services consultant, summarized the Blue Cross offer: the county's projected total cost under Blue Cross is roughly flat (the consultants reported “less than 2% change” from current expected costs), Blue Cross included a transition credit initially listed at $235,000 that the carrier later increased by $40,000, and Blue Cross reforecasted prescription drug rebates upward from about $700,000 to roughly $1,200,000 after reviewing Moore County's claims data.

Why it matters: the county insures about 794 employees and their dependents; health-plan cost changes feed directly into the county budget and the staff said they must have a final decision in time to implement any change by the July 1 plan-year deadline.

Details of proposals and next steps

Consultants recommended continuing Moore County's self-funded approach for medical and dental coverage, saying self-funding is more cost-effective for a group of the county's size. Blue Cross provided both a self-funded option and a fully insured comparison; the consultants noted the fully insured Blue Cross quote was substantially higher (the presentation showed a fully insured example about 29% above current expected cost).

Labien said the county's top provider report showed major local health systems are in Blue Cross's network and estimated “it's like a 96%, 97% match” between Blue Cross's provider network and the county's current network. Consultants cautioned that any plan change can leave a small number of providers out of network, and they will provide detailed network-matching data before a final recommendation.

On pharmacy coverage, the consultants presented a prescription-drug carve-out bid from a vendor identified in the presentation as Empirics. The consultants said that option was more actively managed and initially attractive when First Carolina Care appeared likely to remain the medical administrator, but Blue Cross has not agreed to integrate with Empirics. As a result, staff said they will likely prioritize a single-package solution with Blue Cross for this renewal and consider a pharmacy carve-out in a future year if appropriate.

Dental and ancillary topics

For dental coverage the consultants received multiple bids, including self-funded and fully insured options from Blue Cross, Delta Dental and MetLife. The presentation noted that MetLife historically has one of the largest dental networks and that Delta's network is roughly one-third the size of MetLife's in the consultants' preliminary checks. The consultants said MetLife had offered a competitive fully insured rate tied to a prior arrangement with First Carolina Care; staff will verify whether that arrangement remains valid given First Carolina Care's market exit.

The county's current self-funded dental plan includes an annual per-enrollee benefit cap presented in the meeting as $1,000. The consultants discussed flexible spending accounts as an existing employee option, noting an employee-contribution maximum in the presentation of roughly $2,500–$2,800 (the consultants said the IRS limit changes annually). The consultants also said dependent orthodontia is not included in the county's baseline plan but can be evaluated as a buy-up or optional benefit for interested employees.

Contracting, stop-loss and timing

Blue Cross included an ASO (administrative services only) stop-loss structure in its proposal; consultants said stop-loss (reinsurance) rates will be finalized after review of February claims data and that firm stop-loss pricing was expected within about one to two weeks. Consultants described that final stop-loss numbers as a near-term dependency before a binding contract can be executed.

Next steps and board process

Consultants said they will meet with county staff to complete a final data review, then present recommendations to the county's budget task force and the full board. Moore County staff noted they will work to meet the county's July 1 deadline if a vendor change is chosen.

Quotes

“...we did a thorough analysis of the market, so you know that we turned over every stone and every rock for you for that,” Scott Fritz said of the RFP outreach and evaluation.

“All of those are in network with Blue Cross. Overall, I don't have the numbers in front of me. It's like a 96%, 97% match Blue Cross' network versus the current network,” Rick Labien said when asked about provider continuity.

Ending

County staff and consultants will finalize stop-loss pricing once February claims are reviewed, verify dental-network matches and bring a finalist recommendation to the budget task force and the full board ahead of the July 1 renewal deadline.