In a pivotal meeting on September 22, 2025, Jefferson County officials discussed significant changes to their employee health insurance plan, focusing on the need to adjust both the aggregate and stop-loss coverage due to rising employee numbers and increasing claims.

The county's health insurance advisor highlighted that the current aggregate loss ratio stands at 108%, well above the target of 85%. This alarming figure indicates that the county is exceeding its maximum liability, prompting discussions on raising the aggregate limit to better align with the growing number of employees and the volume of claims being filed. The advisor noted that last year, the county faced an aggregate violation, resulting in a $280,000 refund, which underscores the financial implications of the current plan structure.

Key proposals included increasing the stop-loss deductible from $60,000 to $70,000, which could potentially lower the overall premium increase from 24% to 12%. This adjustment aims to balance the county's risk exposure while managing costs effectively. The meeting also explored various options for restructuring the health plan, including introducing a limited network option with Mountain View hospitals, which could offer better pricing due to lower reimbursement rates.

Officials expressed a consensus on the necessity of these changes, emphasizing the importance of aligning the health plan with current employee needs and claims trends. The discussions also touched on the potential for increased co-pays and deductibles to further manage costs, with suggestions to raise primary care co-pays from $30 to $40 and specialist co-pays from $60 to $80.

As the county moves forward, the anticipated adjustments aim to stabilize health insurance costs while ensuring adequate coverage for employees. The next steps will involve finalizing the proposed changes and preparing for open enrollment, where employees will be informed of their options and any new plan structures.