County insurance broker warns 2026 health plan may run a nearly $800,000 shortfall; RFP finalists due before budget adoption

Hub International presented a mid‑year review of McLennan County’s self‑funded health plan on July 17 and told the commissioners that paid claims through June 2025 are running above the prior 12‑month average, driven in part by several high‑cost claimants that triggered stop‑loss reimbursements in June. Broker representatives said the county’s individual stop‑loss deductible is $175,000. They reported that in 2023 there were 14 claimants with costs over $100,000 and three reached the stop‑loss threshold; in 2024 there were 17 such claimants and seven reached stop‑loss; in calendar 2025 the broker had identified six claimants over $100,000 so far and three had already exceeded the $175,000 deductible in June. Those cases — notably oncology and other high‑cost medical therapies — are a key driver of premium and stop‑loss expense. Using enrollment averages and claims through June, Hub projected total health plan cost pressure for 2026 that would produce an estimated operating shortfall of roughly $788,000 under current plan designs and contribution levels. Hub noted the county’s opening fund balance for the plan was about $5.5 million on Dec. 31, 2024 and staff estimated a $4.4 million balance entering 2026; under the forecast the plan would end 2026 with about $3.6 million. Hub and staff told the court that a pending RFP process for third‑party administration and pharmacy benefit management could reduce administrative fees or improve pharmacy rebates, and that finalist presentations are scheduled before final budget adoption. Hub recommended that the court anticipate asking employees for an inflationary contribution increase if vendor negotiations do not sufficiently close the projected gap. Commissioners asked for comparative performance data by plan tier (PPO vs HSA/high‑deductible) and for a removal of high‑cost claimants from plan‑tier comparisons to better understand plan performance.