Flagler County workshop: consultants recommend ~9% premium increases after several million-dollar claims

Flagler County officials and their benefits consultant told commissioners at a June 2 workshop that recent large claims have driven a recommendation to raise both employer and employee contributions for the county's self-funded medical plan.

The county's benefits consultant, Sherry Binier of the Bailey Group, told the Board of County Commissioners workshop that the plan has seen several multi-hundred-thousand-dollar and million-dollar claim months in the last 18 months and that stop-loss insurance has reduced but not eliminated plan volatility. "I just received notice, last week. We have another million, $1,200,000 claim that's about to hit," Binier said. She told commissioners that the stop-loss coverage will reimburse most of that exposure.

The update summarized claims, prescription rebates, stop-loss premiums and administrative fees paid to Florida Blue (medical) and Optum (pharmacy). Binier said the county currently funds the plan using a flat-per-employee dollar amount rather than fully insured equivalents and that actuarial modeling recommended raising total funding by 11.79% to meet projected claims under current enrollment.

As a practical step, the insurance committee recommended an 8.78% increase in the county's employer contribution and a matching increase in employee contributions for fiscal year 2026. Binier presented the current monthly employee-only premium of $33.15 and a family premium of $364.63; under the committee's recommendation those would become about $36.06 and $396.66, respectively. She also showed the county's employer contribution would rise from $1,310.99 to about $1,426.14 per covered employee (presented at the workshop as the monthly employer contribution figure).

Binier said the plan has had significant high-cost claim recoverables in recent years: she listed recoverables of about $654,000 year-to-date and noted prior-year stop-loss recoverables near $1.2 million. She also described a January 2025 newborn NICU claim and other prior million-dollar individuals as factors driving the funding recommendation.

On ancillary benefits, staff and the consultant recommended moving dental and vision administration to Sun Life after a competitive request-for-proposal process that produced multiple bids. The consultant said moving the dental and vision contracts to Sun Life would expand network access and modestly reduce fees; the dental plan's actuary recommended a 9.41% funding adjustment to avoid future negative variances. Binier said vision is fully insured and that the board would see the Sun Life rates if the contract is approved.

No formal vote took place at the workshop. Staff told commissioners that those recommended changes would be on the consent or regular agenda at the next board meeting for formal action, and that if the board approves the contract changes they will be reflected in next year's budget figures.

What the recommendation means: if the board adopts the committee suggestions, both employees and the county would pay higher monthly amounts beginning in FY 2026 to close an actuarial funding gap. The consultant and staff emphasized the county remains a self-funded plan and that periodic spikes in claims are why stop-loss coverage is in place.

Remaining items and next steps: staff will place the dental/vision contract award and the proposed premium and contribution adjustments on an upcoming agenda so the board can take formal action. The consultant urged continued use of the employee clinic and wellness programs to reduce long-term claims.