Laura Lingle of Gallagher presented updated claims through May and funding projections to the Marion County School Board during its July 17 work session, saying the district should consider a 7% funding increase for the self‑funded health plan in calendar year 2026. "If you adopted a 7% increase, the projected loss would be 2.3 [million], but you would still be maintaining that 120‑day reserve in the self funded health plan," Lingle said.

Lede: Consultants and district benefits staff told the board that medical and pharmacy cost trends and several high‑cost claimants have pushed the district’s self‑funded plan toward a multi‑million dollar shortfall, and recommended a 7% premium funding increase for the 2026 plan year; district staff said the board would absorb the increase so employees would not see higher contributions.

Nut graf: The recommendation follows updated claims data and actuarial projections presented July 17. Gallagher’s presentation showed increases in both medical and pharmacy trend assumptions and several large individual claims; presenters said the district is required to keep at least 60 days of reserves in the plan, and a 7% funding increase would reduce—but not eliminate—a projected loss while preserving required reserves.

Body: Laura Lingle of Gallagher reviewed claims through May and noted two plan members who have exceeded the stop‑loss threshold (stated in the presentation as $400,000). She said the district saw six additional claimants at or above 50% of stop‑loss (about $200,000) and that the district’s rolling 12‑month per‑member per‑month total claims had increased versus last year (from $752 to $886 in the presenter’s table). Lingle described medical trend at about 8.7% and pharmacy trend at about 11.4% and said the combined claims experience in the presentation was being modeled at about 10.6% overall.

The consultants quantified potential outcomes under different funding scenarios. "If we did not do anything, to increase funding for the plan in 2026, the self funded health plan would lose roughly $8,000,000," Lingle said, and added that a 7% increase would reduce the projected loss to roughly $2.3 million while maintaining the district’s statutory reserve requirement. She also reminded the board the plan must maintain at least 60 days of reserve (presenters calculated this as roughly $12 million).

Board members asked whether employees would see a contribution increase. The presentation and benefits staff clarified that the recommendation is structured so the district would absorb the board portion of the increase and that employees’ contribution amounts would not increase for plan participants under the proposed approach. "So there will not be an increase in cost to the employee," said a board member after the benefit team’s clarification; presenters confirmed that was the intention.

The benefits team also reported on vendor procurement and upcoming actions: two RFPs (TPA and PBM) were awarded to Florida Blue and contracting was nearing finalization for signature; stop‑loss RFP work was underway; and the district plans several routine audits (dependent eligibility, PBM, medical claims) in the coming year.

Ending: The board did not take an immediate vote on July 17; presenters said final contract paperwork and formal budget decisions would follow in month‑end and August board processes. Staff flagged additional legislative changes affecting plan design (dependent care FSA limits and telemedicine rules for HSA‑compatible plans) that may affect plan options for 2026.

Speakers:[{"name":"Laura Lingle","role_title":"Presenter","affiliation_type":"business","affiliation_name":"Gallagher","first_reference":{"timecode":"00:08:43","transcript_line_range":[523,603]}},{"name":"Boston Ellis","role_title":"Benefits staff (presenter)","affiliation_type":"government","affiliation_name":"Marion County Public Schools","first_reference":{"timecode":"00:07:14","transcript_line_range":[434,444]}},{"name":"Dr. Brewer","role_title":"Interim Superintendent","affiliation_type":"government","affiliation_name":"Marion County Public Schools","first_reference":{"timecode":"00:04:28","transcript_line_range":[267,268]}},{"name":"Board Member Campbell","role_title":"Board member","affiliation_type":"government","affiliation_name":"Marion County School Board","first_reference":{"timecode":"00:21:43","transcript_line_range":[1300,1319]}}],"authorities":[{"type":"statute","name":"Internal Revenue/ HSA regulations (referenced)","citation":"stated in presentation","referenced_by":["Laura Lingle"]}],"actions":[],"discussion_decision":{"discussion_points":["Rising medical and pharmacy trends and several large claims drive projected losses","Stop‑loss reimbursements for claimants over threshold reduce district exposure","Vendor RFPs for TPA and PBM awarded to Florida Blue; contracting pending"],"directions":["Staff to finalize contracts with Florida Blue and present for signature in August","Staff to proceed with stop‑loss RFP and standard audits (dependent eligibility, PBM, medical claims)"],"decisions":[]},"clarifying_details":[{"category":"reserve requirement","detail":"District required to maintain at least 60 days of reserves in self funded health plan","value":"60","units":"days","approximate":false,"source_speaker":"Laura Lingle"},{"category":"stop_loss_threshold","detail":"Stop loss attachment in presentation referred to as $400,000","value":"400000","units":"USD","approximate":false,"source_speaker":"Laura Lingle"},{"category":"projected_losses","detail":"Projected loss if no funding increase: roughly $8,000,000; projected loss with 7% increase: about $2,300,000","value":"-8000000","units":"USD","approximate":true,"source_speaker":"Laura Lingle"}],"proper_names":[{"name":"Gallagher","type":"business"},{"name":"Florida Blue","type":"business"}],"community_relevance":{"geographies":["Marion County"],"funding_sources":["Board contributions","employee contributions","stop‑loss reimbursements"],"impact_groups":["district employees","employees with dependents","retirees on plan"]},"meeting_context":{"engagement_level":{"speakers_count":4,"duration_minutes":57,"items_count":1},"implementation_risk":"medium","history":[{"date":"2025-06-XX","note":"Prior presentation included claims through March; this update included claims through May."}]},"searchable_tags":["health insurance","self-funded plan","benefits","budget"],"provenance":{"transcript_segments":[{"block_id":"block_523","local_start":0,"local_end":120,"evidence_excerpt":"Good morning, Chair Conrad, board members, Doctor. Brewer. Happy to be here again this morning to give an update on the self funded health plan.","tc_start":"00:08:43","tc_end":"00:09:43","reason_code":"topicintro"},{"block_id":"block_1263","local_start":0,"local_end":120,"evidence_excerpt":"On the next slide, though, is again where our projections and our recommendations would be at the 7% increase.","tc_start":"00:21:03","tc_end":"00:21:23","reason_code":"topicfinish"}]},"salience":{"overall":0.78,"overall_justification":"Direct budgetary impact on district operations and employee costs; clear decision pending","impact_scope":"local","impact_scope_justification":"Affects Marion County school district employees and board budget","attention_level":"high","attention_level_justification":"Budget and employee contributions are high‑interest issues for community and board","novelty":0.35,"novelty_justification":"Standard annual benefits update with updated claims; new legislative items noted","timeliness_urgency":0.78,"timeliness_urgency_justification":"Next fiscal and plan year decisions required this summer for 2026 plan year","legal_significance":0.25,"legal_significance_justification":"Reserve requirement set by regulation; stop‑loss contract obligations","budgetary_significance":0.88,"budgetary_significance_justification":"Multi‑million dollar projected losses and plan funding choices affect district budget","public_safety_risk":0.00,"public_safety_risk_justification":"Not a public safety issue","environmental_impact":0.00,"environmental_impact_justification":"Not applicable","affected_population_estimate":7000,"affected_population_estimate_justification":"Estimated number of employees and dependents covered (presented as 'subscribers' and 'members')","affected_population_confidence":0.5,"affected_population_confidence_justification":"Participant counts referenced in presentation but not singled out in transcript","budget_total_usd":2300000.0,"budget_total_usd_justification":"Projected loss with 7% funding increase as stated in presentation","decision_deadline":"2025-08","decision_deadline_justification":"Contracts and budget decisions expected in August meetings","policy_stage":"proposal","policy_stage_justification":"Staff recommendation presented but no formal board vote during work session","follow_up_priority":9,"follow_up_priority_justification":"High, because of near‑term budget and contract decisions","fact_check_risk":0.10,"fact_check_risk_justification":"Numbers came from actuary/consultant; verify exact dollar totals and stop‑loss terms with plan documents","uncertainty":0.45,"uncertainty_justification":"Claims experience can shift month to month; legislative clarifications pending","source_diversity":0.25,"source_diversity_justification":"Primary source was vendor consultant and district staff"},"engagement_forecast":{"newsworthiness":{"national":0.05,"regional":0.15,"local":0.85,"justification":"Primarily local fiscal impact on school district employees and budget"},"notify_recommendation":{"audience":"city","reason":"District budget and employee benefits changes affect local audiences; recommend notifying local education and municipal reporters","audience_regions":["Marion County"],"justification":"High local impact and imminent board/budget decisions"},"notify_thresholds":{"local_min":0.5,"regional_min":0.7,"national_min":0.9},"predicted_interest":{"national":0.05,"regional":0.15,"local":0.85,"justification":"Employees, unions, and local taxpayers are likely to follow"},"predicted_click_through":0.35,"predicted_click_through_justification":"Specialized audience but high local salience","predicted_read_time_minutes":3.5,"predicted_read_time_minutes_justification":"Article contains technical figures"},"graph_signals":{"jurisdictions":["US-FL-MARION"],"jurisdictions_justification":"Marion County, Florida","ontology_topics":["employee benefits","healthcare costs","public budget"],"ontology_topics_justification":"Matches benefits and budget categories","entities":[{"id":"org:gallagher","name":"Gallagher","type":"business"}],"entities_justification":"Vendor presenter"}} ,{