Commissioners direct staff to set health-plan premium equivalents at midpoint and to review Samaritan Fund option

DeKalb County commissioners on Feb. 17 heard a detailed pre‑renewal presentation from Apex (broker) and Kinetic Health (care-management) on the county’s self‑funded health plan performance through the first six months of the 2025–26 plan year.

Apex reported enrollment at about 216 employees and year‑to‑date total plan costs of approximately $2,048,000, $350,000 lower than the comparable six months the previous year. Pharmacy spend was higher year‑to‑date; pharmacy rebates are on a lag and expected to begin restoring offset to fixed costs. Consultants identified 24 claimants with $10,000+ spend (24 claimants = roughly $1.2M YTD; high-risk claimants include oncology and specialty drug therapies), noted two potential lasers (high-cost ongoing cases), and summarized stop‑loss/per‑member specific deductible parameters.

Apex recommended setting premium equivalents at the midpoint projection (roughly a 2.4% increase versus current equivalents) rather than the maximum liability scenario, arguing the county has about $500,000 in surplus and will begin receiving pharmacy rebates that strengthen the fund. Commissioners agreed and directed staff to prepare contribution modeling for the midpoint to set employee contribution rates. They also asked the county attorney to review a sample contract for the Samaritan Fund — a third‑party program that, for a one‑time county payment (sample $55,000 per qualifying employee), would move qualifying high-cost employees to a third‑party plan for 12 months — before deciding whether to participate.