Don Calderon, the district’s director of risk management and employee benefits, and Dustin Keen, senior benefits consultant with the Garren Group, told the Martin County School Board on Jan. 7 that the district’s health-plan claims are driving a high renewal offer from Florida Blue.

Calderon introduced the presentation and said the district is starting to receive renewal offers for the 2025–26 benefits year. Keen reviewed claims for the July 1, 2023–June 30, 2024 plan year and told the board the plan was up roughly 19 percent last year, “or roughly $3,000,000,” driven mostly by high-cost claimants — defined in the presentation as members with more than $75,000 in claims in a plan year. The number of high-cost claimants rose about 24 percent, and Keen said 61 percent of those members were expected to continue into the current plan year.

Keen said removing high-cost claimants from the calculation produced an underlying trend of about 4.6 percent, but the overall rolling loss ratio remains elevated: "Last plan year, you're at about a 104%. This current plan year, you're at a 103%," he said. The district’s consultants modeled renewal scenarios and reported a range: the consultant’s independent projection called for roughly a 20 percent increase, while Florida Blue’s initial “not to exceed” for medical came in at 32 percent.

Board members questioned details behind spikes in certain lines of coverage. Keen told the board inpatient claims increased about 64 percent and outpatient claims about 29 percent; pharmacy costs rose because higher‑cost medications came to market. He also highlighted positive trends: wellness screening utilization and virtual visit use were higher than Florida Blue’s overall book of business and telemedicine utilization was up (telehealth up 11–18 percent), which the consultants said can reduce costly ER and urgent‑care utilization.

On other lines, consultants gave starting negotiation points: dental at a 5 percent not‑to‑exceed with an 84 percent loss ratio; district‑paid life insurance showed no increase for the district portion but large percentage increases for dependent and retiree supplemental lines driven by very high loss ratios. Long‑term disability had a 19 percent not‑to‑exceed and the employee assistance program was presented at a 41 percent increase due to 16 percent higher claims than expected.

After the presentation the board gave staff and the Garren Group direction to issue a request for proposals for medical coverage. The consultants said an RFP could be posted immediately, with responses due Feb. 12, an initial shortlist presented the first week of March, finalists negotiated mid‑March and a final recommendation brought to the board for action on March 25 if the schedule holds. Board members asked staff to build flexibility into the timetable so carriers could include February and March claims in best‑and‑final offers and suggested staff combine a workshop and meeting back‑to‑back if necessary to meet decision deadlines.

Board members also discussed continuity of communications to employees about the district’s incentives for the high‑deductible health plan and the 0‑premium employee‑only option and suggested continued efforts to shift enrollment where appropriate to help mitigate cost pressure.

The board did not take a formal, roll‑call vote during the workshop. Staff took direction: issue the RFP for medical coverage and work with the consultants to try to extend the data window for best‑and‑final proposals; return recommended contract language and any calendar adjustments to the board in March. No final contract was awarded at the meeting.