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Commissioners approve Blue Cross renewal amid questions about HRA and consumer cash payments
Summary
Jefferson County approved a renewal with Blue Cross for the 2025 plan year after staff outlined stop‑loss and aggregate increases; commissioners asked benefits staff to research whether employees who pay cash can be reimbursed from the HRA while still crediting deductibles.
Jefferson County commissioners approved a Blue Cross renewal for the 2025 plan year on Aug. 25 after a detailed presentation from benefits staff about stop‑loss, aggregate funding and cost‑containment options.
Benefits staff said the renewal contains an increased aggregate funding requirement and a higher stop‑loss premium; the presenter summarized the overall impact as roughly a 15.93% increase driven largely by aggregate funding adjustments. "When you go down to it, it's about a 15.93% increase," the benefits consultant said, citing elevated claims experience year to date.
The board spent considerable time on the county’s HRA rules after a commissioner raised an example in which paying cash for a service (rather than routing it through insurance) made the employee unable to be reimbursed from the HRA because the HRA administrator relies on Explanation of Benefits (EOB) submissions to verify expenses.
Benefits staff said there are technical and contractual limits with the current administrator (eBenefits) and the county’s self‑funded design: an EOB is the standard verification mechanism, and paying cash without submitting codes may not credit the deductible or qualify for HRA reimbursement unless additional verification is provided. Staff advised it could explore options so employees who pay cash and submit medical codes could be reimbursed, but they cautioned about abuse and administrative complexity.
Commissioners approved the renewal by motion and roll call and asked staff to return with options on HRA redesign and concrete verification steps (e.g., submission of specific medical codes and insurer confirmation). Benefits staff noted several cost‑containment programs (diabetes prevention, MSK programs, claims integrity solutions) that may reduce future claims and were offered as voluntary add‑ons tied to cost‑avoidance fees rather than fixed fees.
Staff will provide an updated claims trend through July and follow up on HRA verification options before open enrollment.
