The Keith County Board of Commissioners on June 18 approved several amendments to the county's employee health plan and delayed a decision on whether to cover gender dysphoria.

Spencer, a benefits advisor working with the county's insurer, reviewed recommended plan updates. Commissioners voted to remove an age limit on hearing aids, to change the plan's definition of "spouse" to "legally married spouse," and to remove an exclusion that denied coverage specifically for gambling addiction-related mental-health care. Each of those changes was carried by motion and roll call during the meeting.

Commissioners debated coverage for gender dysphoria at length. Spencer said the county's plan currently is silent on gender dysphoria, which effectively results in noncoverage; Meritaine (the plan administrator) recommended the county either expressly include coverage or provide a written statement declining it. Spencer advised that both choices carry legal risk: continuing noncoverage has produced litigation in some places, while adopting and later removing coverage could be harder to defend in a lawsuit. Several commissioners asked for more time to consult, and the board agreed to defer action until the July 23 meeting with all commissioners present. Spencer said that if the board later adopts coverage the amendment would be retroactive to July 1; if the board maintains the current silent posture Meritaine will request a written confirmation of that choice.

Commissioners also asked how benefit changes would affect premiums. Spencer said the renewal for stop-loss/reinsurance was already set and these modifications would not change rates for the current plan year, though claims for major procedures could affect future renewals.

The votes on the hearing-aid and spouse-definition amendments were recorded by roll call. Commissioners also directed staff to prepare any amendment paperwork and to circulate documents for signature as required.