Jones County board approves insurance renewal and directs staff to study alternatives to contain rising costs

The Jones County Board of Commissioners on May 5 approved a negotiated renewal of the county's health insurance plan while voting to have staff and consultants explore alternatives including level-funded and reference-based pricing options.

Jonathan Shaw of NFP, who described himself as the county's benefits broker, presented the renewal and the trade-offs among the options. Shaw said the county previously experienced a roughly 133% loss ratio in a prior year that was later adjusted, and that this plan year has run more favorably at about a 94% loss ratio. He told commissioners five members accounted for about $1.1 million in claims this plan year and pointed to specialty medications as the largest cost driver.

"Last year, we had roughly a 133% loss ratio for, you know, plan year 2024 to 2025," Shaw said. "This year is running more favorably. So in total, we have right at about a 94% loss ratio." He added that specialty drugs and a handful of high-cost claimants are the chief contributors to volatility.

Commissioners pressed Shaw on several plan-design levers: whether GLP-1 obesity drugs would be covered under the county's Cigna formulary (Shaw said coverage is limited and requires elevated A1c plus comorbidities), how the county could increase participation in the wellness program (81.3% of members were reported not to have a wellness visit on the screening metric cited), and the operational and member-experience risks of a reference-based pricing approach. Shaw warned reference-based pricing can lower plan spend but also can produce balance-billing and lengthy collections processes for members when providers do not accept the program's payment levels.

Shaw summarized the options presented: keep the fully insured arrangement with negotiated rate relief (the "near-term" option he recommended to meet the renewal timeline), move to a level-funded plan (a partial step toward self-funding that would add roughly 3% to fixed costs but yield better data access), or pursue reference-based pricing (lowest cost on paper but with significant member disruption and administration). He said the initial renewal before negotiation had been about 24% but that negotiations and plan design changes had reduced the county's renewal to roughly 10% under the option presented.

A commissioner moved to accept the renewal package as presented for this plan year and to direct staff to immediately begin a review of alternatives: fully insured versus level-funded versus reference-based pricing; to hold mandatory department-head meetings to educate employees; and to return implementation options with data and timing. The motion passed. Shaw and county staff were instructed to prioritize employee communication and to plan a possible January 1 alignment if a mid-year design change were selected.

Shaw also recommended several design changes aimed at steering utilization and increasing preventive care participation, including tying HRA reimbursements or some deductible supplements to completion of a preventive physical and wellness-program activities. He advised caution if the board pursued reference-based pricing, noting it had produced significant balance-bill follow-up work in other counties.

The county also approved switching its group dental carrier from Cigna to Aflac, a move staff said would reduce dental costs by roughly $11,000 and includes a $50,000 performance guarantee to expand in-network dentists in the region.

Next steps: staff will schedule department-head briefings and prepare follow-up materials and cost data on the alternative funding approaches; the board signaled that any change that would substantially alter member experience would be considered with attention to implementation timelines and member communication.