Kossuth County reviews self‑insured health fund, asks staff for alternate rate scenarios and HSA options

Kossuth County supervisors spent significant time in a workshop reviewing the county’s self‑insured health insurance fund, recent claims experience and options for changing plan design, including a potential high‑deductible plan and health savings account (HSA) contributions.

A county staff member (Doug) reported the fund’s current balance and projections: the fund was projected to end October with $2,479,440.81, down from a starting balance earlier in the fiscal year. He summarized renewal rates, expected claims and administrative costs provided by Wellmark and shown in the board packet. Doug said the insurer’s suggested per‑member expected claims were about $979.24 per month for single coverage and about $2,448.10 per month for family coverage; when multiplied by current enrollment the annual projection in the packet reached roughly $2.94 million under the insurer’s suggested rates.

Doug also presented a self‑funded high‑deductible alternative (the packet labeled as a “high deductible” option) that projected lower expected claims — roughly $813 per month for single coverage under the proposed high‑deductible option. He said a weighted average conversion of the county’s enrollment into a two‑tier family/single structure produced an estimated expected cost for family coverage around $2,091 per month under one high‑deductible scenario.

Board members explored options including: increasing traditional deductibles and out‑of‑pocket maximums; offering one or more high‑deductible plans paired with HSAs; and keeping employer contribution dollars constant while allowing employees to choose how the dollars are applied (premium vs. HSA). The board discussed whether to move from a four‑tier contribution schedule (single/employee+spouse/employee+children/family) to a two‑tier schedule (single/family) and the effect that could have on revenue and enrollment mix.

Several supervisors said they want to protect the fund balance and asked for alternatives showing the projected effect on fund balance under multiple scenarios. The county’s stop‑loss feature (a $75,000 specific stop‑loss threshold referenced in the discussion) and a year of large invoices were discussed as drivers of recent fund balance declines.

Supervisors asked staff to obtain comparative quotes and sample plan designs from the insurer (Wellmark) showing: the current traditional plan, one or two high‑deductible plan options that meet federal HSA minimums, and an intermediate plan option. They also asked for comparisons presented both in two‑tier and four‑tier rate formats and for examples showing employer contribution approaches (premium contribution vs. employer HSA contribution). The board asked staff to return with side‑by‑side spreadsheets showing expected claims, administrative costs and projected annual liability under each option so supervisors could evaluate tradeoffs between employee cost, employer contribution and fund sustainability.

No formal vote was taken. Supervisors discussed policy tradeoffs — protecting the fund balance versus shifting more cost to employees — and asked staff to deliver concrete rate comparisons and HSA contribution scenarios before the next decision point, with an eye to changes effective July 1 of the following year if the board decides to proceed.

The board also asked staff to clarify plan coverage specifics flagged in the packet (for example, benefit limits such as coverage for infertility treatment) before making any plan changes.