Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Health Insurance topic
No spam. Unsubscribe anytime.
Jones County officials weigh higher deductibles, reference-based pricing and wellness changes as health costs climb
Summary
At a May 19 Jones County work session, county leaders and staff reviewed a $250,000 renewal increase, considered raising the employee deductible to $6,000, tying HRA eligibility to wellness participation and exploring reference-based pricing and pooled purchasing; no formal policy was adopted.
The Jones County Board discussed mounting employee health insurance costs at a May 19 work session, with staff saying renewals have produced roughly a $250,000 increase and the county has absorbed about $750,000 in added insurance costs over three years.
"Our health insurance carrier... is Cigna," said Ms. Risner, the staff presenter, describing the county’s current fully insured plan and the county’s health reimbursement arrangement. "The deductible for the current plan year is $5,000. For the next plan year, it'd be $6,000," she said, and noted the HRA begins after the first $1,000 and the county currently pays roughly 75% of premiums.
County officials and staff reviewed alternatives to the fully insured model, including level-funded plans (partial self-funding with a stop-loss carrier), fully self-funded approaches and reference-based pricing, which ties payments to Medicare rates. Ms. Risner warned that reference-based pricing can expose employees to balance billing and collections while giving counties leverage to negotiate provider bills.
"They're saying they will not accept that type of insurance," a meeting participant said of some medical centers discussing reference-based plans. A committee member urged legal and policy research, saying court rulings often force payment after disputes but that patients and employers can face delayed bills and collection notices in the interim.
Board members emphasized the role of high-cost outlier claims in driving renewals. "We pay a 100% of it," one committee member said, describing the county’s responsibility under its benefit design and arguing that a few large claims can substantially raise premiums for all employees.
Discussion turned to the county’s wellness program and participation incentives. Ms. Risner said the county’s wellness incentive can pay employees up to $1,000 for meeting screening and health-coaching requirements. A committee member cited a figure shared by the county broker that "81% maybe of the employees" were not getting a yearly doctor visit; staff said they are investigating Cigna data (which currently runs about three months behind) and that the 81% figure appears skewed.
Participants suggested several near-term actions: adopt clearer participation metrics or targets, request an anonymized internal claims analysis that separates employee versus dependent or spouse claims, consider modest increases in wellness incentives (for example, a $25 monthly change was discussed), and maintain the HRA while modestly raising the deductible to $6,000 as approved previously.
Several speakers urged countywide collaboration or pooled purchasing with other counties to increase bargaining power for reference-based pricing. Chair cautioned that multi-county pools have broken up in the past when carriers withdrew, and that pooled approaches require sufficient buy-in to be effective.
No formal vote on plan redesign was taken at the work session. The meeting closed with a motion to adjourn; staff said they would return with data and options, including a de-identified claim analysis and legal review of provider acceptance under reference-based pricing arrangements.
The county said it will continue studying the options and invited employees and stakeholders to propose ideas for controlling costs.
