Effingham County reviews HSA, retiree HRA, dependent-care options and an imaging discount program

Mark, a benefits broker with USI, presented a menu of voluntary and employer-funded options meant to reduce county health-plan claims and give employees more portable, tax-advantaged ways to pay medical and dependent-care costs. The presentation came during the Board of Commissioners work session on March 18.

The presentation outlined four families of options: health savings accounts (HSAs) paired with high-deductible health plans; dependent-care accounts (described as an HRA for dependents); coverage for significant others/domestic partners; and two approaches to retiree or “gap” coverage for older employees. Mark also recommended an “imaging center discount” vendor that would arrange no-cost imaging at contracted radiology centers.

Why it matters: Commissioners and staff cited rising claim costs and an aging workforce as reasons to consider incentives that would move older employees to separate retiree plans or to Medicare while still assisting with drug and out-of-pocket costs. Several options Mark described would change how claims are bucketed and potentially reduce pressure on the county’s self-funded plan.

Key points from the presentation

- HSA vs. FSA: Mark explained that an HSA must be paired with a high-deductible health plan and described it as an individually owned, portable bank account. He said, “I actually have an HSA. I’ve had 1 for 10 years now. If I leave my company, if I retire, whatever it is, that is my money, it is my bank account.” He contrasted HSAs with flexible spending accounts (FSAs), which have rollover limits and employer-driven rules.

- Contribution limits and portability: Mark estimated, without confirming precise figures on the spot, that contribution caps for HSAs were “something like $4,800 for an individual and $8,600 for a family” and noted there are catch-up contributions for people 55 and older; he prefaced those numbers by saying he did not have the exact current limits at the meeting.

- Dependent-care accounts (dependent HRA): The broker described a county-set account that employees could use for dependent expenses such as daycare. Effingham County could decide whether and how much to contribute or to offer a matching contribution.

- Significant-other/domestic-partner coverage: Mark said the county could add domestic-partner coverage at any time with the carrier (identified in the presentation as Meritain/Aetna). Commissioners raised concerns about potential fraud and about the county using public funds to cover relationships that are not legally documented; legal and operational guardrails would be needed if the board elects to permit that coverage. Mark said Georgia has no statewide law defining domestic partnerships and that a local ordinance could provide definitions and qualifying-event rules.

- Retiree/gap coverage options: Mark offered two principal approaches: (1) create a separate division on the county’s carrier for older workers (e.g., ages 55–65) so those employees’ claims are segregated, or (2) establish a retiree HRA (health reimbursement account) funded by the county that employees approaching retirement could use for prescriptions and other out-of-pocket Medicare costs after they move to Medicare. He described the retiree HRA as a county-funded “bucket” that can be sized and conditioned by policy (for example, by requiring a minimum service period to qualify).

- Imaging center discount program: Mark recommended a vendor (referred to as Know the Cost) that contracts with accredited radiology centers to schedule MRIs, CTs and other imaging for employees with no copay and no charge to the county plan. He said the vendor is paid by participating radiology centers and that no minimum employee participation is required. Commissioners asked whether local hospitals participate; Mark said he would follow up and that initial searches showed options primarily in Savannah, Pooler and Statesboro for some procedures.

Next steps and follow-up

Mark said staff would return with implementation details and education materials for open enrollment. Commissioners asked staff to check carrier rules, vendor networks and any state-level legal constraints before committing to coverage changes. No ordinance or funding decision was taken at the meeting; staff was tasked with bringing follow-up cost and network information to a future session.

Ending: The presentation closed with an agreement to continue the conversation. Mark said he would provide more precise contribution limits, vendor contract terms and a local-network check for the imaging program so commissioners could weigh cost, accessibility and plan design options before a possible rollout during open enrollment.