Daniels County reviews health‑plan quotes as trustees aim to smooth rate spikes

Daniels County commissioners spent a substantial portion of their April 20 meeting reviewing healthcare trust quotes from Mako, which presented plan options and the actuarial rationale behind recommended rate changes.

Pam Wallally and Mako staff walked commissioners through member‑only rates and plan design choices — for example, a $500 deductible plan (RM500) with a $1,500 out‑of‑pocket maximum and 80/20 co‑insurance on many services — and explained why pharmacy costs and increases in insured values can change county premium loads. Wallally explained the trust’s participation rule: roughly 75% of eligible employees must enroll in the employer plan or show other group coverage to participate.

Wallally and Jason Riddle explained how the trust smooths larger actuarial recommendations with reserves rather than repeatedly buying rates to zero. “They learned their lesson,” Mako representatives said of trustees who previously bought down rates and later faced sharp catch‑up increases; the presenters recommended measured reserve usage to moderate volatility.

On plan mechanics, staff clarified that preventive visits are typically covered or co‑paid at low cost, pharmacy has separate structures (e.g., a $50 pharmacy deductible on some plans), and 90‑day fills may reduce dispensing fees for chronic medications. Commissioners asked about how follow‑up surgical care and MRIs are managed; Mako confirmed no prior authorization is strictly required for MRIs but hospital billing practices sometimes create confusion that staff will help resolve.

Commissioners set a special meeting for Wednesday to consider final renewals and asked staff to confirm participation rates and any remaining open questions about the trust’s corridor/capital strategy.

Next steps: staff will verify the county’s 75% participation, finalize comparisons of current county plan to trust options, and present a recommendation at the special meeting.