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Forsyth County proposes benefit changes after sharp rise in health claims; staff seeks board sign‑off before open enrollment
Summary
County staff told commissioners April 21 that rising claims have driven the health plan toward a $5.3 million FY25 deficit and a projected FY26 funding gap. Staff proposed plan design changes, increased stop‑loss limits, pharmacy copay adjustments and a new five‑tier premium structure to reduce the gap.
Forsyth County staff briefed the Board of Commissioners on April 21 about a sharp increase in health insurance claims that has left the county's self‑insured plan running a deficit and prompted proposed plan design changes for FY2026.
The county's benefits team and finance staff said that claims through March 31 exceeded the premium revenue the plan was budgeted to collect, producing a projected FY2025 internal fund shortfall of about $5.3 million. County leadership has identified $4.45 million of one‑time general‑fund balance to shore up the internal service health fund through June 30.
Why it matters: Forsyth County provides employer‑sponsored health coverage to roughly 4,000 members (employees, dependents and eligible retirees under age 65). The plan is partially self‑funded; changes to premiums and design affect county budgets and employee take‑home costs.
Findings presented - Claims and budget mismatch: Staff said 3‑year averages used in…
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