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County adopts dual‑option health plan, raises stop‑loss threshold and adds biosimilars
Summary
Jefferson County voted to offer a dual‑option employee medical plan (Mountain View CCO plus a PPO), raise the specific stop‑loss from $60,000 to $70,000, adjust co‑pays (example $40 primary/$60 specialty) and opt into biosimilars coverage as part of efforts to reduce claim volatility.
Benefits consultant Carlos presented options to address rising claims in the county’s self‑funded plan and recommended a dual‑option approach that offers employees a Mountain View CCO network option alongside a PPO. He presented modeling showing that raising the specific stop‑loss (ISL) from $60,000 to $70,000 and offering a dual option could reduce the county’s fixed cost increases from an estimated 24% to about 12% (consultant’s projection), depending on enrollment mix.
Carlos also recommended adjusting co‑pays (examples discussed included $40 primary care and $60 specialty) and adding coverage for biosimilars — lower‑cost alternatives for certain specialty drugs — to reduce exposure to very high‑cost prescriptions. Commissioners discussed risk, aggregate exposure, and the tradeoff of shifting some cost to employees via deductibles and co‑pays.
A motion to approve the dual‑option plan (Option 1 dual), increase the ISL to $70,000, adopt the co‑pay adjustments and opt into biosimilars was moved, seconded and passed by roll call. Commissioners asked benefits staff to provide final rate options (examples at 10%, 15%, 20% deltas) and to return with enrollment materials ahead of open enrollment.
