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Amherst County agrees to absorb $434,412 health-plan increase, adds lower-deductible option for employees
Summary
After a presentation by Pierce Group Benefits, the Board of Supervisors voted to fund a roughly $434,412 premium increase for 2026 and to add a new Key Advantage 250 plan option for employees; the change comes amid pharmacy-driven inflation and an estimated $554,000 potential exit fee if the county leaves the Local Choice pool.
Crystal Kaminsky, a benefits consultant with Pierce Group Benefits, told the Amherst County Board of Supervisors that the county—s health plan faces a 14.4% renewal increase for 2026 driven primarily by pharmacy spending. "Pharmacy benefits are driving about 40% of the overall cost for medical spend," Kaminsky said, pointing to recently high utilization of GLP‑1 drugs and other specialty prescriptions.
Kaminsky described the county—s participation in the Local Choice (TLC) pooled program administered by the Virginia Department of Human Resource Management, noting the pool covers more than 335 employer groups and roughly 60,000 lives. She said the design of TLC bundles medical, behavioral health, prescription, dental and vision benefits and generally stabilizes premiums versus the fully insured market.
The county—s renewal this year, Kaminsky said, would increase employer costs by about $434,412 if the county keeps its current contribution strategy and plan lineup. She also warned that leaving the TLC pool would likely trigger an adverse experience adjustment; Pierce estimated Amherst County—s potential exit fee at roughly $554,000 based on preliminary claims assumptions. "If you were to decide to leave the Local Choice, there is this adverse adjustment fee," Kaminsky said, adding groups that depart typically cannot return to TLC for three years.
To give employees a lower-out-of-pocket choice, Pierce modeled adding a new Key Advantage 250 plan. The Key Advantage 250 would lower individual deductibles to $250 (family $500) and cap out-of-pocket exposure at about $3,000 for individuals and $5,000 for families, with a higher employee premium share for those who select it. Kaminsky and county staff said adding the third option could be achieved without increasing the county—s total contribution if the employer contribution strategy remains unchanged.
Board members pressed presenters on enrollment timing, plan selection mechanics and distributional impacts. Kaminsky said employees may move plans during open enrollment (two weeks in May) or following qualifying life events; changes would take effect July 1. A supervisor asked whether anyone had modeled the per-employee impact of shifting some of the premium to employees; staff said that could be recalculated but the recommendation was to fund the full county share this year.
After questions, the board approved a motion to fund the roughly $434,412 premium increase and to add the Key Advantage 250 option. The chair announced the motion passed by voice vote.
What happens next: open enrollment will run for two weeks in May; staff must notify TLC of the county—s employer contribution and plan choices by April 1 (per the schedule presented). Pierce and staff will provide plan materials to employees ahead of open enrollment.
Sources: Presentation and questions to Pierce Group Benefits; board motion and voice vote at the budget work session.
