Cole County Commissioners on Oct. 28 approved renewing the county's stop‑loss (reinsurance) contract with Sun Life for the 2026 plan year and moved several related funding and employee‑cost decisions into the proposed 2026 budget. The renewal keeps the county's specific deductible at $85,000 and maintains a $1,000,000 aggregate umbrella and a contract provision that prohibits "lasering" (individual exclusions) at renewal.

The renewal vote was taken after a benefits consultant reviewed plan mechanics and renewal options. The consultant said Sun Life offered the most favorable market terms for continuity and contract protections, and that the county's stop‑loss premium for the $85,000 specific level renewed at roughly a mid‑single‑digit to low‑double‑digit increase on the fixed stop‑loss premium (presented in the packet as a 9.39% premium increase for the specific coverage). The consulting presentation showed an alternative option that would raise the specific deductible to $100,000 with a lower premium but would shift about $15,000 more per covered claim back to the county.

Why it matters: The county is self‑funded for medical and pharmacy and buys stop‑loss insurance to cap large claims. In recent months the county's health insurance fund balance has fallen to about $1.3 million and staff said the fund has been drawn down by roughly $100,000 per month. Actuarial guidance in the packet suggested a higher per‑employee set‑aside (the presentation cited ~$770.39 per employee) while the county currently sets aside about $694 per employee. County staff told commissioners that without action the fund's reserves could become uncomfortably low and that building the reserve is a budget priority.

What the commission approved and budget direction: Commissioners voted to
- renew stop‑loss and ancillary coverages with Sun Life at the renewal terms presented (renewal column), keeping the $85,000 specific deductible; the motion passed by voice vote;
- set the employee contribution for the PPO plan at $25 per pay period (a pretax payroll withholding) for 2026 and continue an employer HSA contribution (the presentation indicated an $80 monthly employer HSA deposit in the proposal); the motion passed by voice vote;
- absorb a 6% increase in dental premiums for employee coverage and continue paying the county's share of employee dental costs;
- transfer accumulated adult recreational marijuana revenue (presented in the packet as roughly $580,000) into the health insurance fund as a one‑time measure to stabilize reserves; the motion passed by voice vote.

Details and tradeoffs presented: The consultant explained the contract's mechanics: the specific deductible determines the county's exposure for any individual covered member (the county pays up to $85,000 per covered person under the current proposal), and the aggregate layer accumulates smaller claims toward an umbrella ceiling (the proposal included a $1,000,000 aggregate layer above the specific). The packet highlighted two important contractual protections: an unlimited lifetime maximum (consistent with federal rules) and a no‑new‑lasering provision at renewal (the carrier does not single‑out individuals at renewal with higher deductibles). The consultant also noted a contractual renewal cap (50%) and that Sun Life has been the most competitive option in the market comparisons included in the materials.

Numbers shown to commissioners: Packet figures presented the county's stop‑loss premiums and enrollment: 211 employee‑only census lines and 309 covered lives total. The stop‑loss premium at the $85,000 level was shown as roughly $1.384 million for the renewal scenario; an option raising the specific deductible to $100,000 produced a quoted premium near $1.267 million. Staff emphasized that raising the specific to $100,000 would reduce premium but increase the county's per‑claim exposure by roughly $15,000. The presenter also summarized that the actuarial "attachment" or budgeted set‑aside amount for claims (the packet cited about $770.39 per employee) exceeded the county's current per‑employee sweep of about $694.

HR and budget context: Debbie, identified in the meeting as a representative of HR leadership, told commissioners that medical and Rx costs have outpaced the county's payroll set‑asides and that the fund balance had fallen from a previously healthier level. Because reserves were declining, budget staff and HR included a 20% increase in the recommended per‑employee rate sweep in the initial proposed 2026 budget to move toward the actuarial suggestion; staff said that increase would raise the per‑employee sweep to approximately $858. County staff also warned that taking no action would risk continued balance depletion and greater pressure on general‑fund transfers in future years.

Cost‑containment discussion and wellness programs: Commissioners and staff discussed alternative containment tools, including greater use of a health‑department nurse practitioner clinic and participation in SmithRx and UMR care‑management programs. Staff said such programs can reduce cost when employees engage, but several commissioners and staff noted participation rates are inconsistent and behavior change is difficult to achieve. The meeting record shows staff will continue to promote existing programs and assess participation outcomes.

What the vote does not do: Commissioners did not change plan design other than agreeing to the renewal terms and the employee payroll contribution; they did not adopt the $100,000 specific deductible option. They also approved a one‑time transfer of marijuana proceeds to shore up reserves, but they did not commit to a permanent funding source beyond the budgeted rate changes; future budget decisions will revisit funding and design choices.

Selected quotes from the meeting:
"What we're paying out in medical and Rx is actually higher than the payroll that we're putting in there," Debbie (HR leadership representative) said, summarizing why staff recommended building reserves.
"They have a no new laser at renewal provision as part of this contract," Randy (staff member/consultant) said, describing a contract term the county sought to preserve because it prevents carriers from singling out specific insureds with higher deductibles at renewal.

Next steps and implementation notes: Staff said open enrollment materials and pricing communications must reflect the approved employee contribution before the county's open‑enrollment start (staff noted open enrollment begins Nov. 4). Budget staff will incorporate the 20% per‑employee sweep increase in the proposed 2026 budget documents and implement the one‑time marijuana fund transfer if the commission's formal budget actions remain consistent with the meeting vote.

Ending note: Commissioners framed the package as an effort to preserve employee benefits while rebuilding the insurance fund reserve; several commissioners warned the county will need ongoing monitoring and may need additional rate or design changes if medical and pharmacy costs continue to rise.