Subject:
Title
Approval of Group Health Plan Design Changes
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Fiscal Impact:
Implementing the 2027 group health plan design changes recommended by the Employee Benefits Insurance Advisory Committee (EBIAC) is estimated to have a net financial impact of approximately $4.65M - $6.85M, dependent on utilization, to the County's self-insured group health plan, effective January 1, 2027.
Dept/Office:
Human Resources
Requested Action:
Recommendation
It is requested that the Board of County Commissioners:
1) Approve the 2027 group health plan design changes recommended by the Employee Benefits Insurance Advisory Committee (EBIAC); and
2) Authorize staff to evaluate piggybacking the City of Orlando's competitive solicitation for Pharmacy Benefit Manager (PBM) Administrative Services (RFP26-0046) and enter into negotiations with the selected firm, Southern Scripts, LLC d/b/a Liviniti LLC. Anticipated effective date: January 1, 2028.
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Summary Explanation and Background:
The County's group health plan is self-insured and, under Florida Statute 112.08, must complete annual actuarial projections. Based on a 9% combined medical and pharmacy trend, the 2027 projections if increases are not approved are as follows:
National cost trends have outpaced this rate over the past two years, averaging 9.4% for medical care and 10.7% for pharmacy (9.8% combined). To protect the plan's financial health while limiting the impact on members, staff and the EBIAC reviewed claims data to identify where costs could be reduced without reducing the quality of care.
The largest cost driver is facility spend (hospital system fees), which made up 58% of medical spend in 2025. Where a service is performed makes a significant difference in cost. For example, a CT or MRI averages $3,400 at a hospital outpatient facility versus $500 at a free-standing radiology center. Outpatient surgery averages $28,400 at a hospital facility versus $3,400 at a free-standing surgical center.
This data, along with the County's benefits consultant's trend and financial analysis, was presented to the EBIAC on 07/24/2026 to guide plan design decisions and protect the plan's long-term sustainability. The Committee's recommendations are summarized below.
1. New Pharmacy Benefit Manager (PBM), effective January 1, 2028.
The City of Orlando recently completed a competitive procurement (RFP26-0046) and selected Liviniti as its new PBM. Consistent with County piggyback procedures, staff recommends exploring the option of using same contract. Liviniti offers greater pricing transparency and cost-saving tools not available through the County's current PBM, including expanded access to clinical programs such as manufacturer patient assistance programs, voluntary international sourcing, and the CostPlus Drugs platform. These options are expected to lower plan costs and reduce, or in some cases eliminate, employee out-of-pocket pharmacy costs.
Fiscal Impact: Estimated annual savings of approximately $1,500,000 beginning in 2028.
2. Changes to the EPO Plan.
The EPO plan is the County's lowest-cost option, covering approximately 15% of the plan's membership,. EPO members currently choose between the Cigna and UMR networks. The EBIAC recommends:
• Removing the Cigna EPO option (UMR EPO only)
• Requiring EPO members to use the Lantern Surgical Network for elective bone and joint procedures
Fiscal Impact: Estimated savings of $200,000.
3. Medical Deductibles and Hospital Facility Cost Share.
The EBIAC recommends changes as shown below:
The purpose of these changes is to encourage members to use lower-cost settings of care. Preventive services remain fully covered. Members already have access to preferred providers for advanced imaging and outpatient surgery for $125 copay, and a new option, Green Imaging (described below), will expand these choices for members. The same $400 copay change will also apply to emergency room visits to encourage use of urgent care, virtual care, or primary care instead of the ER for non-emergencies. The $400 co-pay is waived if a member is admitted to the hospital following an ER visit.
Fiscal Impact: Estimated savings of $1,800,000.
4. Green Imaging Network (Voluntary Option).
The EBIAC recommends adding Green Imaging, an independent network offering most imaging services at significantly lower cost. Members who choose Green Imaging pay nothing out of pocket and receive concierge scheduling. Green Imaging as a network of more than 5,000 providers nationwide, 16 locations across Brevard County.
Fiscal Impact: 67% savings on the plan's top five imaging exams. Estimated annual savings range from $300,000 at 10% utilization to $2,500,000 at 90% utilization.
5. Lantern Infusion Network (Voluntary Option).
The EBIAC recommends expanding the County's existing Lantern network, currently used for elective surgeries, to include infusion services as a voluntary option. Members who use this network pay nothing out of pocket incentivizing them to utilize independent and home infusion providers.
Fiscal Impact: Estimated savings of $50,000 at 10% utilization.
6. Increase Employee Contributions to Group Health Premiums.
Since 2022, the County has increased its employer contribution annually, while employee premiums saw only modest increases in 2023 and 2025. Brevard County's employee premiums, especially for dependent coverage, remain well below those of neighboring counties and other Central Florida public entities. To help close this gap while remaining competitive, the EBIAC recommends the modest monthly premium increases. Given the plan design changes described above, no increase is recommended for the EPO plan.
Retiree and COBRA rates to participate in the group health program will increase by 9%.
Fiscal Impact: Estimated additional annual revenue of approximately $2,106,656.
Clerk to the Board Instructions:
Please provide a copy of the Clerk's Memo to Human Resources.