Amherst County risked a 33.5% Anthem renewal; consultants offered benefit changes and a Local Choice quote is pending

Pierce Group told the Amherst County Board of Supervisors at a budget workshop that Anthem has proposed a 33.5% renewal increase if the county keeps its current fully insured benefits, and consultants presented two benefit redesigns that would cut that hike to about 20% or roughly 15% on a blended basis.

The county27s insurance consultant David Charland, vice president of employee benefits at Pierce Group, said the county moved to Anthem effective July 1, 2024 after its prior carrier exited the market. Charland said the firm has about five months of Anthem utilization data and that "we were fortunate to move July first of 20 24 at a premium decrease of approximately 4% to Anthem keeping your benefits rich and intact." Gray [last name redacted], vice president of consulting services at Pierce Group, reviewed that utilization data for the board.

Why it matters: rising health premiums are a principal driver of the FY26 budget gap the county is trying to close. County staff incorporated the insurance estimates into revenue/expenditure projections and said health plan costs materially affect whether the board can fund a proposed 3% cost-of-living adjustment for employees.

What the data show: Pierce Group reported the county group has 227 employees with about 400 total covered members, an average plan-member age of 33 and an approximately even male-female split. Year-to-date paid claims through November were about $1,263,000 versus $1,121,000 in premiums, a net loss ratio the consultant summarized as 113% for the period shown. Consultants said the group27s spending pattern so far looks like a "shock loss" year driven by a small number of high-cost claims (examples given included an outpatient prosthetic-related injury and other complex episodes) rather than broad, persistent overuse.

Renewal options presented: consultants said keeping identical plan design produced Anthem27s 33.5% offer. Alternative 1 raised some copays and doubled the individual deductible (from $500 to $1,000), increased out-of-pocket maximums and moved certain therapy copays to the deductible; Pierce Group said that design would reduce the renewal to roughly a 20% increase. Alternative 2 raised deductibles higher (individual to $1,500; family deductible to $3,000) and would reduce the blended increase to about 14%–16% (Pierce Group reported a 16.2% outcome for one plan and 14.4% for another, yielding an approximate blended 15% outcome).

Market checks and next steps: Pierce Group said Sentara declined to quote so far, that one market quote was declined, and that the Local Choice pool (a long-standing Virginia public-entity pool) had agreed to provide a quote by the end of the week. The consultant told the board that Local Choice typically produces smaller swings and cited an example figure: "if you'd been with a local choice this year, you would have gotten an 18% increase" (the consultant said this was Local Choice's top increase among its groups this cycle). Staff told the board they will distribute a spreadsheet comparing Anthem27s alternatives and the Local Choice quote to the board and asked to return with refined numbers at the March 12 budget workshop.

Participation and HSA plan notes: consultants said the county27s high-deductible HSA plan has low enrollment (19 participants) and that employees have generally preferred the richer PPO designs; consultants cautioned that switching participation patterns affect both premium and out-of-pocket impacts for employees.

Board direction: the board asked staff to (a) obtain and circulate the Local Choice quote when it arrives, (b) prepare a side-by-side comparison of the Anthem renewal and the alternate plan designs, (c) show the board the projected monthly employee payroll contributions under each option, and (d) resume discussion at the March 12 budget workshop. The consultants remained available during the meeting to answer additional technical questions.

What was not decided: no formal motion or vote was taken on insurer selection, benefit changes, or employee-share adjustments. Sentara had not returned a binding quote at the time of the workshop, and staff emphasized they would not finalize renewals until they had compared all competitive offers.

Taper: consultants warned that early-year large claims can skew first-year results after a carrier change because of timing and incurred-but-not-yet-reported claims; they urged the board to weigh short-term rate shock against potential longer-term stability from pool membership (Local Choice) or benefit shifts.