Consultants present 2026 health-plan renewal options; pharmacy changes and fund balance shape board choices

Consultants for the district presented a renewal analysis for the district’s self‑funded health plan, showing an actuarial funding need of 14.49 percent for the 2026 plan year that the consultants say can be netted down to a 7.35 percent increase after pharmacy savings and applied opt‑out funding. The presentation covered medical and pharmacy claims through June, stop‑loss reimbursements, catastrophic claimant counts, and the effect of a recently enacted Florida PBM transparency law on administrative fees.

Why it matters: a larger funding increase would raise the total monthly funding rate paid to the plan and could push more of the cost onto employees or into the district’s general operating funds; a smaller increase relies on one‑time or recurring internal offsets such as opt‑out funding and available fund balance.

Consultant Allison Prophet walked the board through claims and budget metrics. “Your current month expense to budget is running at 79.4%, and your plan year expense to budget is 96%,” Prophet said, citing the report through June. She told the board the first six months showed plan funding of roughly $16 million versus $15.37 million in actual plan costs, leaving about $630,000 of favorable variance for that period.

The consultants emphasized pharmacy as a major driver. Mark Dilling told the board, “it’s very important…