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County staff recommend holding employee rates flat despite 17% stop‑loss increase
Summary
Deputy administrator Chad Werner and One Digital’s Ann Phelps recommended the county keep FY27 health‑plan budget rates and employee contributions flat because the self‑insured plan is running below the budgeted maximum and carries a roughly $942,000 surplus, although stop‑loss fixed costs will rise by about 17%. The commission approved delegating authority to finalize renewal documents.
Deputy County Administrator Chad Werner and One Digital account executive Ann Phelps presented the Berkeley County FY27 health‑insurance renewal and recommended the commission hold employer and employee budget rates flat for the coming plan year.
Phelps said the county’s self‑insured plan is currently running below its budgeted maximum and that the plan shows a surplus of about $942,000 through April. She recommended renewing the current arrangement in the plan’s captive with Wellnet as third‑party administrator and HCC (stop‑loss) while continuing to monitor claims experience. "We are recommending that you keep your budget rates flat for this year because the plan is running very well in this first year," Phelps told the commission.
Werner and Phelps said the 17% increase in stop‑loss costs applies to fixed stop‑loss fees rather than total premiums for members; the rise reflects broader market pressure on stop‑loss carriers and immature claims data for the county’s first year as a self‑insured plan. Phelps outlined that the county budgeted conservatively to the carrier's "max" (125% of expected claims) and is currently running at about 88% of expected claims and roughly 30% under the budgeted maximum for many months.
The presenters highlighted other details: dental costs show higher utilization (driving a 7% increase capped by the carrier), pharmacy and prescriptions account for roughly half of plan spend, and the plan has four high‑cost claims above $75,000 (one already hit the individual stop‑loss threshold). Phelps recommended an action plan that includes evaluating the pharmacy benefit manager (PBM) contract and stop‑loss carrier options once another year of claims data is available.
Commission discussion touched on whether enrollment increases affected the stop‑loss calculation, how "leverage trend" was applied, and the prospect of renegotiating PBM language to return more rebates to the county. After questions, the commission voted to authorize the appropriate county officers to sign renewal/authority documents to implement the recommended plan structure.
The county will revisit stop‑loss and PBM decisions once additional claim experience is available and as part of next year’s negotiation work plan.
