Larimer County explains new Surest medical plan: $0 deductible, co‑pay structure and portal issues

Larimer County benefits staff on Feb. 6 hosted a webinar for employees to explain the county’s new Surest medical plan, which has no deductible and relies on co‑pays until members reach in‑network out‑of‑pocket maximums of $5,000 for individuals and $10,000 for families. Rachel Sporleter, Benefits Team Lead, led the presentation and answered questions about coverage, the member portal and claims processing.

Why it matters: the Surest plan replaces traditional deductible‑based coverage for many county employees and changes how some outpatient services are reimbursed. Staff emphasized tools to avoid surprise charges — including a provider finder and clear co‑pay listings in the Surest portal — but also warned of a cumbersome reimbursement process for massage and acupuncture that the county is working to simplify.

Key plan features and examples

“The Surest is a $0 deductible plan,” Rachel Sporleter said, summarizing the core design. Preventive services such as annual exams, mammograms, colonoscopies and immunizations are covered at 100% when performed in network. Telehealth through Teladoc is also available at no charge, and many virtual mental‑health providers appear with $0 in‑network co‑pay tiles on the portal.

Benefits staff walked attendees through an example family scenario to show how co‑pays and out‑of‑pocket maximums apply: routine urgent care visits carry set co‑pays (Rachel used a $60 urgent‑care example), and when an individual reaches the $5,000 out‑of‑pocket threshold, that person’s subsequent covered in‑network claims are paid at 100% for the remainder of the plan year. Family coverage requires a combined amount to reach the family maximum.

Provider networks and prescriptions

The plan uses the UnitedHealthcare Choice Plus network (listed on member ID cards). For emergency care or out‑of‑network urgent care, members may pay up front and then submit a claim via the Surest portal for reimbursement (subject to co‑pays). Prescription coverage remains with CVS Caremark on a combined card; CVS maintains a monthly $0 preventive drug list members can review on the CVS portal.

Massage, acupuncture and claim friction

Rachel and Andrea Bilderback, who demonstrated the Surest member portal, cautioned that massage and acupuncture reimbursements currently require detailed invoice data that many providers do not generate because they don’t bill insurance. Andrea said the online submission flow is long and, in some cases, “pretty tedious right now on the site.” The county’s benefits staff are working with Surest and Assurant to implement a simpler reimbursement process and will email instructions to members when it is available. Until then, members can file claims now if they have the required invoice information, or wait for the streamlined process.

Additional resources and incentives

The county continues to offer a voluntary accident plan through Voya that pays members directly for covered injuries. SecondMD remains available as a free second‑opinion service; Rachel said the vendor typically responds in three to five days and that members who complete a SecondMD consultation receive a $100 gift card sent to their county email. The plan also offers a $75 wellness screening reward per covered member per plan year for biometric and preventive activities; staff said they can assist with some uploads through Navigate for members covered on the county plan.

Portal navigation and Q&A highlights

During a live portal demonstration, Benefits staff showed attendees how to search by service, locate providers, and view co‑pay amounts and provider ratings. Rachel noted that the portal defaults to the member’s home address but can be changed for travel. Staff advised that physician assistants (PAs) are not listed separately because they typically bill under the supervising physician’s TIN; members should search for the supervising physician or facility if they need a specific PA.

On processing timelines for claims, Andrea estimated reimbursement claims should show as “under review” within about 24–48 hours in many cases, but acknowledged delays can be longer depending on how the claim was filed and business days; one attendee reported a week‑long delay in their experience. Benefits staff said they will confirm timelines with Surest points of contact and follow up with members.

What’s next

Benefits staff asked members who have not received ID cards to email hr_benefits or put their name in the chat so replacements can be mailed. They also urged members to contact HR Benefits (Mon–Fri, 8:00 a.m.–4:30 p.m.) for help with the portal, claims or questions. The county will notify members when the massage/acupuncture reimbursement process is simplified and will provide confirmed guidance on claim display timelines.

The webinar concluded after a short Q&A; staff reiterated they are available to help one‑on‑one and will follow up with Surest and Assurant on outstanding portal and claims issues.