Another insurance option reviewed

Jay County Commissioners have a decision to make regarding health insurance.

Commissioners heard from another insurance broker and third-party administrator during a special session Friday.

Representatives from Understand, Service and Innovate (USI) Insurance pitched a partially self-funded insurance plan to commissioners in August. The county’s current insurance broker, OneDigital, brought in a representative of captive manager ParetoHealth to speak with commissioners Tuesday about another partially self-funded option.

Broker Steve Stockton of Bixler Insurance and Unified Group Services representatives David Swinford and Forrest Williamson met with commissioners Friday to share their options for a partially self-funded plan. The third-party health insurance administrator based out of Anderson handles approximately 298 cases on a partially self-funded basis. Portland has provided its employees health insurance plans on a partially self-funded basis through the group for nearly eight years.

“We’re an independent TPA (third-party administrator), we don’t work for UHC (United Healthcare) or Anthem. I always tell people we work for you,” said Williamson, vice president of sales at Unified Group Services.

Williamson noted groups on partially self-funded plans can still have benefits and coverage as well as financial protections in place. 

“What we want to do is help you create stability, give you control to create benefit plans that in the reality of it, meet your peoples’ needs,” he said.

Williamson talked about the importance of engaging with clients and serving their needs, starting with a dedicated claims account manager. He also noted his company has various programs available — one includes its Pharmacy Benefit Manager partnerships — to save money.

Swinford explained he visits Portland at least three times a year and sits down with city officials to discuss claims, benefits and other specifics with their health insurance. 

“Customer service is the key,” said Williamson.

Unified Group Services offered options with $75,000 and $100,000 caps for how much the county would need to pay on a high claim until insurance kicks in.

Both options projected the county’s annual total cost for partially self-funded health insurance to come in between $1.5 million and $1.7 million.

According to estimates from Unified Group Services, the county would pay about $95,202 annually in administration costs. Under the $75,000 cap, Jay County would pay a maximum $1.08 million in claims annually. Jay County would pay a maximum $1.187 million in claims under the $100,000 cap. (Between the two options, Unified Group Services expects the county to have between $860,000 and $950,000 in claims next year.) 

Commissioners president Chad Aker asked about “lasers,” which are higher deductibles applying to individuals with more claims or higher risk. (The individual’s plan stays the same, but the employer takes a financial hit.) Williamson explained companies can apply a “no new laser” policy with a rate cap — captive manager ParetoHealth offered that option in its informational presentation to commissioners Tuesday — but clients pay for it in their premium. The other option, he said, is allowing lasers to avoid higher premiums.

“The goal with self-funding is to get your premium (down) and control your cost,” said Williamson. “Over 80% of lasers do not hit.”

He pointed to mitigation efforts as a way to avoid additional lasers, noting 60% of lasers are applied because of pharmaceutical costs. 

Answering a question from commissioner Brian McGalliard, Swinford confirmed Portland has a no new laser policy but does pay more for its plan.

McGalliard talked about the benefits to having a local broker like Stockton, whose business is based out of Portland.

“The big key to me is having somebody like Steve … that I can trust,” said McGalliard. “Really trying to figure this out — this is not what I do for a living. I need somebody like Steve, I (can) say, ‘Steve, advise me. Tell me what I need to do. What’s the best thing to do for the county? And then explain it to me.’”

Former Jay County auditor Nancy Culy — she returned to work as an employee in the auditor’s office in recent years — noted the county initially started doing business with its current broker, OneDigital, because of a past local tie within the company.

Williamson shared concerns about the county joining the ParetoHealth captive, saying clients are facing 19% increases next year. Looking at Jay County’s plan and size, he said, he doesn’t think the county is a great fit for a captive group. He noted his company would evaluate captive groups annually to see if they make sense for the county’s needs.

McGalliard pointed to significant cost savings over the next several years if Jay County switched to a partially self-funded plan. Swinford said every four out of five years turn out positive and explained their goal is to help clients build a reserve for the year with harsher claims.

Stockton advocated for Unified Group Services.

“These guys, if you decide to move to them, they’re working for you, because it’s really your plan. They’re just facilitating it,” he said. 

Commissioners McGalliard and Aker, absent Rex Journay, took no formal action Friday. They meet next at 5 p.m. Monday.