Highlands County committee approves plan to eliminate "high" health insurance tier, county to absorb rate increase

A Highlands County committee on a routine meeting approved Alternative 2 of a 2026 plan and rate review, voting to eliminate the county's highest-cost health plan and revise mid-tier deductibles and copays. The committee recorded unanimous support during a roll-call vote and directed staff to bring the recommendation to the county board for final approval in October.

The committee's financial snapshot showed the employee benefit fund balance at $25,834 as of Aug. 6, down about $155,000 from the prior month. A committee member said the county would have to contribute additional funds in September to keep the employee benefit fund solvent. The committee agreed the county would absorb the modeled 7.7% increase under the selected alternative rather than pass the full increase to employees.

Why it matters: committee members and the plan consultant said a small pool of participants in the richest plan is driving outsized claims costs. Sean, a presenter from the Gearing Group, noted the richest plan had an approximately 175% loss ratio and substantially higher per-employee claim averages, and that moving people into larger tiers should spread costs more evenly across participants.

The committee reviewed several scenarios. Under the baseline projection shown in the packet, the program would require an 11.8% increase if no plan changes were made. Alternative 2, which the committee approved, removes the high plan and makes specific mid-plan adjustments; the packet modeled the resulting increase at about 7.7%. Key design changes shown in the packet include a mid-plan single deductible raised to $2,000 and a single out-of-pocket maximum raised to $5,000 (up from $4,500), primary-care copays to $60 (from $30) and specialist copays to $75 (from $55). The approved design also includes a $500 pharmacy deductible on the mid plan.

A presenter explained differences among tiers using per-employee claim averages included in the packet: roughly $582 per month on the high-deductible plan, $2,223 on the mid plan and about $3,200 on the richest plan, illustrating the concentration of cost among a small number of high-utilizing participants. The packet also showed dental trend at roughly 4% and a dental projection that would require roughly a 15% rate increase for dental benefits.

Committee members discussed how to explain the changes to employees. Members said employees typically care most about take-home pay and monthly payroll deductions, and requested materials that show concrete comparisons: what employees currently pay, how a given alternative changes their monthly contributions, and how prior changes affected plan costs. Several members said it would be useful to show a modeled "status quo" projection alongside the actually implemented design changes to demonstrate the effect of earlier steps.

A committee member moved that the committee approve Alternative 2, "by eliminating the high plan and changing the mid plan deductibles as presented," and a second was recorded. The clerk called members for a roll-call vote; Becky, Giselle, Lena, Jonathan, Aria, Samantha (Sam), Dustin and Daniel were recorded as voting yes. The motion passed. Committee members directed staff to present the approved design to the full Highlands County board for final approval, with a target presentation on Oct. 7 and an effective date of Jan. 1, 2026.

Administratively, the packet and staff discussion noted operational next steps: the county's benefits administrator (referred to in the transcript as "Ben Tech"/"bintech" in different places) needs three to four weeks to implement rate and payroll changes after final approval; open enrollment is planned for October through early November; and payroll deductions tied to the Jan. 1 effective date would begin on the first payroll in December. The committee also noted claims data lag: the claims experience in the packet ran through June; July claims were not available at the packet's preparation and often arrive around the 15th of the following month.

The committee emphasized that final adoption by the full county board is required to implement the changes and that the county contribution to absorb the increase has already been discussed with the board. Staff will return with the final presentation and the materials the committee requested to help explain impacts to employees.