June 17, 2021 Hood County Workshop

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The Hood County Commissioner's Court convened on June 17, 2021, for an informational workshop to review the 2021–2022 employee medical and vision benefits renewal, which faced a 9.5 percent increase in the current plan. The HR Director and County Attorney presented Option Two, a higher-deductible plan ($3,000 individual deductible versus the current $2,000), and proposed a Health Reimbursement Agreement to offset the increase by reimbursing employees for deductible costs exceeding $2,000. Discussion addressed cost-control strategies including wellness requirements with premium surcharges for non-compliance, telemedicine utilization, and network shopping, while court members raised concerns about the burden on employees without corresponding salary increases. The court directed staff to complete necessary research and analysis, with formal renewal action scheduled for the June 22 meeting and a June 30 deadline for submission to the Third-Party Administrator.

• Call to order and workshop purposeThe Commissioner's Court convened for a special informational workshop to discuss 2021–2022 employee medical and vision benefits renewal.
• HR Director opening remarks and renewal contextThe HR Director requested the workshop to answer court member questions about the renewal, noting prior one-on-one meetings revealed lingering concerns and that renewal action is scheduled for June 22.
• Current plan structure and deductible mechanicsThe HR Director outlined the existing two-thousand-dollar individual deductible, additional out-of-pocket maximum, and coinsurance structure requiring employee cost-sharing.
• Employee cost-control responsibilities and plan pricingThe HR Director stressed that employees drive plan costs through their healthcare utilization choices and encouraged shopping for cheaper services within the PPO network to combat the nine-point-five-percent renewal increase.
• Six-thousand-dollar maximum exposure and flex spending accountsThe HR Director reviewed worst-case employee out-of-pocket exposure for major procedures and introduced the existing flexible spending account program with current rollover limitations.
• Renewal plan comparison and Option Two structureThe HR Director compared the current plan to Option Two, which represents the closest renewal alternative, identifying a three-thousand-dollar individual deductible and specific cost differences.
• Health Reimbursement Agreement proposal for Option TwoThe HR Director proposed a Health Reimbursement Agreement (HRA) to offset Option Two's higher deductible by having the county reimburse employees for deductible amounts exceeding two-thousand dollars.
• HRA mechanics and county attorney legal inputThe County Attorney confirmed HRA is legally permissible as an informal agreement between county and employees with no statutory reimbursement limit, with budget authority held solely by the court.
• Taxability and administrative concerns with HRATax and administrative concerns regarding 1099 reporting and whether HRA reimbursements would be considered taxable income were raised; HR Director committed to research how other counties handle end-of-year reporting.
• Wellness check requirement and incentive programTAC recommended a wellness check initiative requiring employees to obtain free annual preventive screenings, with a fifty-dollar-per-month premium surcharge for non-compliance beginning the next plan year.
• Telemedicine and cost mitigation strategiesThe HR Director promoted MD Live virtual doctor services (free or ten dollars per visit) and emphasized employees should use telemedicine instead of urgent care or office visits to reduce plan costs.
• Family coverage deductibles and dependent enrollmentThe HR Director and court members discussed family-level deductibles, dependent coverage patterns, and how Option Two's higher deductible would impact employees with spouse or dependent coverage.
• Concerns about employee burden and deductible increasesCourt members and employees expressed concern about raising deductibles without corresponding pay increases, noting the psychological and financial burden on employees regardless of actual utilization.
• Commissioner summary and direction for HRA analysisA Commissioner summarized the preferred approach: keep Option Two with the three-thousand-dollar deductible, establish an HRA to reimburse the one-thousand-dollar difference, and maintain the current deductible floor for employees.
• Decision timeline and next stepsThe court and HR Director established that the renewal decision must be entered by June 30 with TAC, with formal action scheduled for the June 22 court meeting, and committed to completing necessary research.
• Employee health insurance plan comparison and cost implicationsThe county discussed maintaining current coverage versus switching to a Health Reimbursement Arrangement (HRA), with focus on cost differences and tax impact.
• Employee enrollment data and plan participationStaff discussed the basis for budget projections using approximately 300 enrolled employees, with monthly variations due to staffing and plan waivers.
• HIPAA compliance and reimbursement administration concernsPrior experience and legal considerations were discussed regarding HRA reimbursement processes, deductible tracking, and privacy protections.
• Reimbursement sustainability and budget consistency risksDiscussion focused on potential complications if county cannot fund reimbursements consistently year to year.
• Option Two cost estimate and budget recommendationStaff presented specific cost projection for Option Two with conservative budgeting approach.
• Next steps and timeline for decisionCommissioners discussed time constraints for making a final recommendation before end of June.