Board advisers recommend 7% funding increase for self‑funded health plan; district to absorb employee share

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…