August 20, 2024 Hood County Special Called Meeting

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Hood County Commissioners Court held a special called meeting to review and compare health insurance plan options for county employees. The court heard presentations on three primary alternatives: Curative, a newer carrier emphasizing preventive care with zero-deductible benefits; United Healthcare with standard PPO coverage; and United Healthcare paired with Non-Stop Health, which pre-loads out-of-pocket maximums onto employee cards. Discussion focused on plan design features, provider networks, premium costs across employee tiers, estimated savings, and implications for employee out-of-pocket expenses, with particular attention to impacts on single parents and provider accessibility concerns.

• Call to order and openingThe special called meeting of Hood County Commissioners Court was opened with invocation and pledges in the central jury room.
• Insurance broker introductionDaniel Anderson and Brian, partners in the insurance business for 19–20 years, presented health plan options to the court.
• Curative carrier background and plan philosophyCurative is a newer health insurance carrier that invented the rapid COVID test and created their health plan based on preventive care philosophy.
• Baseline visit requirement and processCurative requires all enrollees 18 and over to complete a 30–45 minute Zoom baseline visit with a care coordinator to qualify for zero deductible benefits.
• Care navigator services and out-of-pocket savingsCare navigators help employees navigate prescriptions, find providers, and assist with service approval; estimated $1 million in employee out-of-pocket savings annually.
• Pharmacy network and limitationsCurative uses HB pharmacy as primary provider within 15 miles with same-day or 24-hour mail order delivery; employees outside 15 miles access larger pharmacy network.
• Provider network and out-of-network doctor accommodationCurative uses First Health Network as their large national provider network; if current doctor is not in-network, Curative will attempt to add them within 90–120 days.
• Rate comparison and transition creditCurative's proposed one-year rate matches the county's current rate; two-year guarantee at $848.81; includes $30,000 transition credit.
• County savings calculations and budget impactBased on 308 employee-only equivalent enrollment, Curative one-year plan saves approximately $180,000 versus Blue Cross renewal; two-year guarantee saves approximately $67,680 versus renewal.
• HSA and FSA eligibilityCurative plan is not HSA-qualified; however, FSA accounts remain eligible and separate from the health insurance plan.
• United Healthcare plan comparisonUnited Healthcare offers two plan options similar to current TAC plan with $5,000 deductible, lower out-of-pocket limits, and lower premiums than renewal.
• United Healthcare Open Access plan with Non-Stop Health pairingThe presenter described a proposed health plan combining United Healthcare's Open Access network with Non-Stop Health, which loads a Visa card with the full out-of-pocket maximum per individual or dependent family.
• United Healthcare network coverage and specialist accessThe presenter confirmed United Healthcare operates as a national PPO with open access, with approximately 95% network coverage across the country.
• Out-of-network dermatologist scenario and HSA/FSA eligibilityThe presenter explained that out-of-network providers cannot use the Non-Stop card, and HSA contributions are not available when the card is fully loaded with out-of-pocket maximum.
• Plan design details and copay structureThe presenter detailed the copay structure under the HSA plan paired with Non-Stop, clarifying that copays do not apply until the deductible is met.
• Non-preferred specialty medications and current plan exposureThe presenter noted that unlike the Curative plan with zero out-of-pocket, Non-Stop plans have minor exposure for non-preferred specialty medications.
• Non-Stop option breakdown and estimated employee savingsThe presenter displayed three Non-Stop options paired with the identical United Healthcare plan, showing estimated employee out-of-pocket savings based on utilization.
• First-dollar coverage and deductible options (backend exposure)The presenter explained that Non-Stop offers a first-dollar coverage model where options can include $1,000 or $2,000 backend exposure instead of full upfront deductible.
• Non-Stop risk underwriting and budget predictabilityThe presenter described how Non-Stop underwrites risk based on expected utilization and benefits from predictable claim exposure per person.
• Renewal impacts and claims reservesThe presenter explained that renewals under Non-Stop have been favorable, with rate history showing decreases over time in participating counties.
• Reserve fund rollover and renewal calculationThe presenter clarified how the claims reserve works when utilization is lower than projected.
• Non-Stop compatibility with other carriersThe presenter confirmed that Non-Stop is a separate program that can pair with any carrier except Curative.
• Option Three scenario: $4,500 loaded card with remaining out-of-pocketThe presenter walked through a detailed scenario where an employee has $4,500 loaded on the Non-Stop card and must pay the remaining $1,000 of the $6,500 out-of-pocket maximum.
• Option Two and Three burden distributionOptions Two and Three shift more financial responsibility to employees than Option One.
• Real-life medical cost exampleA county employee described how current plan costs compared to proposed options.
• Employee premium impact for family coverageCommissioners discussed the monthly premium differences between Curative and United Healthcare with Non-Stop for family-tier employees.
• Family tier rate comparison and loaded card benefitThe presenter clarified the cost structure for family tier employees.
• Tier-by-tier premium comparison (employee, spouse, children)The presenter detailed the per-tier costs under Non-Stop paired with United Healthcare.
• Internal rate shifting and payroll customizationThe presenter explained that the county can adjust internal employee rates and payroll deductions regardless of carrier-quoted tiers.
• Negative employee spouse premium exampleCommissioners clarified how employee-spouse tier pricing works when the spouse rate is lower than the employee-only rate.
• Potential $10 negotiation on all tiersThe presenter noted that the $10 employee-only rate reduction might be squeezed into other tiers.
• Family tier employee cost analysisA commissioner calculated the monthly family premium under Non-Stop.
• Carrier preference assessmentThe presenter asked commissioners which plan option they preferred among Curative, United Healthcare, and United Healthcare with Non-Stop.
• Curative network size concernCommissioners discussed whether Curative's smaller network was a significant barrier.
• Family tier rate negotiation strategyThe presenter described how to negotiate the Curative family tier rate downward.
• Immediate negotiation actionThe presenter stepped out to call the carrier and attempt live rate adjustments.
• Service network coverage and geographic radiusPresenters demonstrated the geographic scope of available providers under the proposed plans, discussing service areas and provider density.
• Employee premium impact comparison: Curative vs. United Health PlusPresenters analyzed cost differences between the two plan options, highlighting specific premium increases for single parents covering children.
• Health coaching and medication management benefitsPresenters discussed the value of health coaching services and prescription cost optimization available under the new plans.
• Curative website and provider search functionalityPresenters demonstrated the user-friendly features of the Curative plan website for locating in-network providers.
• First Health Network coverage confidencePresenters expressed comfort with the breadth of available providers under the First Health Network that underlies Curative.
• United Healthcare rate reduction negotiationNegotiators secured a 2% discount on United Healthcare plans along with additional family tier reductions.
• Cost shifting and internal employee subsidy optionsPresenters explored whether savings could be redistributed to offset employee premium increases in certain tiers.
• Claims payout analysis and employee utilizationCounty finance staff reviewed actual health claims payments through the first three months of the benefit year.
• Nonstop plan discount application and family tier reductionPresenters clarified how the negotiated discounts apply specifically to the nonstop family tier while other tiers remain unchanged.
• Single parent employee impact and current rate comparisonPresenters analyzed the financial burden on single parents with children under renewed rates compared to current coverage.
• Curative transition credit and year-one savings analysisPresenters calculated county-level financial impact of selecting Curative, including one-time credits and multi-year rate guarantees.
• Budget allocation strategy for health plan savingsCounty officials discussed how to apply health plan savings or additional appropriations to the budget.
• Rate comparison: Curative versus United Healthcare with nonstopPresenters presented detailed rate scenarios comparing the two finalist plans across family compositions.
• Employer contribution model for premium offsetPresenters discussed alternative strategies used at other employers to absorb rate increases and protect employees.
• Curative plan trade-offs: out-of-pocket costs and Zoom requirementPresenters summarized key plan design features and their implications for employee health spending.
• Doctor network transition and acceptance uncertaintyPresenters cautioned that not all current providers will accept the new plans, requiring employees to potentially change doctors.
• Scott and White / Blue Cross contract statusPresenters flagged an upcoming contract negotiation that could affect network availability for employees.
• Melissa's plan preference and recommendationThe benefits administrator summarized her assessment of both finalist plans for the county's employee population.
• Single parent employee cost impact under United planPresenters quantified the specific monthly premium increase single parents with children face under United Healthcare.
• Blue Cross network uncertainty and employee doctor concernsEmployees and officials discussed uncertainty about current providers' participation in the proposed plans.
• Curative plan premise and premium stabilityPresenters reiterated core Curative plan features emphasizing no premium increase and zero-deductible option.
• Budget consideration: employee count and staffing levelsCounty officials discussed how current and projected staffing affects health insurance budget requirements.
• Senate Bill 22 and employee count adjustmentStaff clarified how pending legislation affects employee count calculations for budget purposes.
• County budget headcount and actual enrollment reconciliationFinance staff clarified the difference between budgeted headcount and actual insurance-enrolled employee counts.
• Possibility of increased plan uptake with richer benefitsPresenters discussed the likelihood that a more generous plan could increase employee enrollment rates.
• Employee count and budget calculation for CurativeStaff recommended budgeting for 340 employees under Curative and calculated resulting cost projections.
• Curative annual cost with employee count adjustmentFinance staff calculated total annual Curative cost including the additional employee count buffer.
• County staffing levels and budget stability observationLeadership reflected on the staffing situation in relation to historical budget patterns.
• Waiting period policy and enrollment timingCounty officials addressed whether waiting periods are controlled by the insurance plan or the employer.