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, ...
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