Berkeley County approves move to self-funded employee health plan with captive stop‑loss, effective July 1

Deputy county administrator Chad Weinbrenner presented the commission on May 8 with a recommendation to shift Berkeley County’s employee health coverage from a fully insured model to a self-funded plan using a captive administered by Pareto Health and brokered by 1Digital. The commission voted to adopt the change, effective July 1.

Weinbrenner said the county’s review of multiple proposals found a captive self‑insurance option would limit premium volatility while preserving network access. "Being part of Pareto's self insurance captive would give you a lot of opportunity to limit yourself to risk exposure," Weinbrenner said, explaining the county would buy stop‑loss insurance to cap exposure.

Nut graf: Commissioners and staff framed the move as a budgetary and benefits-management step intended to contain long-term health‑care costs while maintaining physician networks and improving member navigation. Staff said core provider networks would remain large and that vendor proposals included member services intended to improve access to care.

Key points presented in the meeting: staff reported expected annual claim spending in the county’s group of roughly $2.05 million to $2.7 million and said stop‑loss coverage being negotiated would cap the county’s aggregate exposure (presentations cited a stop‑loss layer that would limit county liability beyond a negotiated threshold). The recommended plans include a high‑deductible HSA option with a $3,000 individual / $6,000 family deductible to replace the county’s existing $9,100 deductible plan; primary-care office visits were quoted at $25 copay and specialist visits at $50 copay; pharmacy tiers were presented as $10 (tier 1), $40 (tier 2) and $65 (tier 3). Weinbrenner said the proposed third‑party administrator, Wellnet, emphasizes member outreach and a concierge-style model and told commissioners it “answer[s] their phones within 6 seconds.”

Staff said the proposed captive through Pareto also provides a guarantee against so‑called "lasers" (individual stop‑loss surcharges based on a single catastrophic claimant) for the life of the plan after initial underwriting; that guarantee was presented as a risk-management advantage versus a standard self-funded placement.

The commission also reviewed ancillary coverage recommendations (dental and vision) and an online enrollment tool that staff said will be provided at no cost to the county and is intended to streamline onboarding. Commissioners and staff discussed timelines, employee education and handling of preauthorized or scheduled care; Weinbrenner said preauthorized procedures could be flagged and coordinated with Wellnet during open enrollment.

After committee review and public discussion, a commissioner moved, a second was recorded, and the commission approved the new plan by voice vote. Staff said vendors will support on-site employee education and the county will implement the change for the July 1 plan year start.

Ending: The commission approved the self-funded plan and instructed staff to proceed with vendor onboarding, employee education and the implementation steps outlined in the presentation. County officials said they expect ongoing reporting and analytics from the broker and plan administrator to monitor claims and cost containment.