County benefits staff and brokers told the Glynn County Board of Commissioners on Oct. 6 that the county intends to change its health‑plan design for 2026 by moving toward a direct contracting model with Southeast Georgia Health System managed through Nomi Health and administered by a proposed third‑party administrator, ASR.

John Laguey of MSL Benefit Group (presenting for the county broker) and Scott Williams of Nomi Health outlined the rationale: they said direct contracting can produce deeper provider discounts, reduce patient out‑of‑pocket barriers to care (Nomi proposed a 0‑deductible, 0‑copay design inside a tier‑1 network), and decrease claims paid under the large regional carrier arrangement.

The presenters said the county has used Anthem Blue Cross Blue Shield as administrator for years and that a switch to direct contracting is not possible under the current Anthem contract. For 2026 the county plans to use ASR as third‑party administrator, maintain a broad PPO network as a secondary (tier 2) option, and operate a tier‑1 network comprised of Southeast Georgia Health System facilities and providers. Presenters said pharmacy would remain carved out with the county’s current vendor (described at the meeting as RASI/Veracity in different remarks), and that stop‑loss renewal pricing is still being finalized; early stop‑loss indications showed a possible 15% increase under the existing carrier (Voya) with a more competitive option nearer 4%.

Benefits staff presented claims data: over an Aug. 2023–July 2025 two‑year period the county paid just over $6.4 million in claims to Southeast Georgia Health System; presenters projected approximately a 27% reduction in those payments under the Nomi/Southeast Georgia arrangement compared with the Anthem pricing — roughly a $1.7 million reduction by simple math — and estimated overall budgetary impact in preliminary figures would be about a 3% increase versus current budget assumptions once administrative and stop‑loss changes were included.

Under the proposed design, employees who obtain care inside the tier‑1 Southeast Georgia/Nomi network would face no deductible or out‑of‑pocket costs except for emergency‑room and urgent‑care copays (presenters said the ER copay would be $500 and urgent care $45). Outside the tier‑1 network, employees would go to the broader PPO with typical coinsurance (presenters described an 80/20 arrangement for out‑of‑network PPO access in one slide). Presenters also said they expect tier‑1 utilization to rise and modeled a conservative 10% increase (they noted some markets see 15–20% increases in tier‑1 utilization).

Commissioners asked clarifying questions about copays, lab vendors (Quest/LabCorp), pharmacy carve‑outs and stop‑loss pricing; staff said they will return to the board with firm stop‑loss quotes once September claims data completes the renewal cycle. No formal action was taken; staff said final contract and stop‑loss terms would be presented to the county for approval at a later meeting.