Latest news with #IndividualCoverageHealthReimbursementArrangement
Dominion Post
12-06-2025
- Business
- Dominion Post
Mon Commission grappling with soaring insurance costs
MORGANTOWN — 'This is just not sustainable.' Monongalia County Commissioner Tom Bloom lamented that the annual increases in the cost of group employee health insurance is on a trajectory that will consume an untenable percentage of the county's overall budget in the near future without intervention. On Wednesday, the commission approved a proposal from Highmark Blue Cross/Blue Shield that comes with a 20.48% cost increase to the county when it takes effect Aug. 1. All told, the percentage increase absorbed by the county will total just over $1 million. Commissioner Sean Sikora explained that the final agreed-upon number was actually negotiated down significantly from Highmark's opening offer, which would have kept everything unchanged from the current plan — except the cost, which would have jumped 34.8%. In order to bring the percentage down, the commission agreed to raise employee deductibles from $6,000 single/$12,000 family to $7,000/$14,000. That disclosure was followed by a commitment from the commission to cover all employee deductibles at a potential maximum cost of $900,000. There will be a change on the employee end. Co-insurance — the percentage of a medical bill the patient pays after meeting the deductible — will increase from 10% to 20%. 'Really, that's the only negative impact to the employees,' Sikora said. 'There's two positive impacts. One, they're not getting a premium increase when there is one — a significant one. Two, they're not having to pay any deductible, which previously they had to pay $750 or $1,500.' Sikora explained that the county, like many other public and private entities, is facing what's known as the 'group plan dilemma' in which costs rise higher and higher while the level of satisfaction – either from employees, employers or both – falls. Embedded within the group plan concept is the inevitability that a small number of individuals will push costs up for everyone. It was explained that the offer Highmark first presented to the county was predicated on the fact that the company paid out 23% more than it collected in premiums in the current cycle. 'The problem we're dealing with is our experience in claims is what's driving our cost. There's nothing we can do about that. It's really just what they call in the industry the 'group dilemma.' Having these group plans, if we put it out to bid or we ask for a new proposal, we're paying for our experience. All that information is known and all that information is out there. We have a small portion of our participants that account for nearly 50% or 60% of all our claims, and those aren't going away.' While the commission opted to move forward with the Blue Cross/Blue Shield proposal, the insurance discussion isn't over. The body recently heard a pitch regarding ICHRA, or Individual Coverage Health Reimbursement Arrangement, through which employees would work with a consultant to select their own health plan options from various insurance carriers and the commission would reimburse employees tax-free for premium costs up to a defined amount. As it stands, the commission is looking at an overall insurance spend of approximately $6 million in a $43.6 million budget. That's up from about $4.9 million. Based on recent history, there's no indication the county won't be back in this position a year from now. 'And that's just not realistic. That's not acceptable. We have to look at other options,' Bloom said.
Axios
27-04-2025
- Business
- Axios
Healthee lands $50M to streamline benefits
Health benefits navigation startup Healthee raised $50 million in Series B funds led by Key1 Capital. Why it matters: This is one of several recent bets on benefits tech, as investors seek AI-native tools for legacy HR pain points. Follow the money: The capital gives Healthee roughly four years of runway, per CEO Guy Benjamin, who says he expects the company will raise again in about three years. Previous investors Fin Capital, Glilot Capital Partners and Group11 joined the raise. How it works: Based in New York City, Healthee uses AI to help employees navigate health and benefits options. A core offering is Zoe, an AI assistant designed to decode dense insurance terms and recommend care options based on personal needs and plan coverage. It can answer questions like "Is this lab in-network?" or "What's left on my deductible?" Customers include Instacart, SiriusXM and Celonis. "We leverage LLM models," says Benjamin. "It's like ChatGPT for benefits." Inside the room: Healthee didn't set out to raise this round, per Benjamin; Key1 approached the company based on its traction. Stunning stat: Half of employees said they wish they were more informed about their company's benefits, per a 2023 MetLife survey. Reality check: While Healthee's growth and backers are strong signals, the health benefits space is crowded — with legacy players and other AI startups vying for employer attention. For example... Thatch, a startup helping employers offer Individual Coverage Health Reimbursement Arrangement (ICHRA) to employees, earlier this month raised $40 million in Series B funds from Index Ventures, Andreessen Horowitz, General Catalyst, and others. Auxa Health, another benefits navigation startup, last year collected a $5.2 million seed from backers including Zeal Capital Partners and AlleyCorp. The bottom line: Investors are betting that AI-powered simplicity can power better benefits navigation, but company success will depend on sustained user engagement and measurable outcomes.
Chicago Tribune
12-03-2025
- Health
- Chicago Tribune
Porter County commissioners dole out latest round of opioid settlement funds to nonprofits
Five Porter County entities will receive a portion of this year's $125,000 in Opioid Settlement money. The county's Opioid Settlement Funds Committee began taking applications for the awards in January and made its recommendations to the Porter County Board of Commissioners at its meeting Tuesday morning. Commissioner Barb Regnitz, R-Center, explained it was agreed five recipients would be selected so as not to create an undue burden in the process. Duneland Schools will receive $10,000 for student education and prevention, as well as developing a diversion program for students who have been affected by the crisis. Moraine House, Portage Recovery Association, and Three20 Recovery will each receive $25,000. Moraine House will use the money for house repairs and remodeling. Three20 Recovery will use the money for music, art, fitness, nutrition and faith initiatives to 'continue to try to remove barriers and meet people where they're at,' said executive director Allen Grecula. Similarly, the Portage Recovery Association will use the money to flesh out a variety of all-inclusive services at its new facility. 'To give them all of these tools to go forward is beyond amazing,' said director Jake Monhaut. The Caring Place will receive $40,000 to aid its women's recovery program. Porter County will receive approximately $336,000 per year between 2022 and 2038. The county sets aside $200,000 of that to pay the salaries and benefits of the two social workers at the Porter County Sheriff's Department. After the five annual awards, a small balance remains in reserve. The state's opioid settlement and litigation page on states that at the height of the opioid crisis in 2012, 112 opioid prescriptions were being written for every 100 Hoosiers. In other business, the commissioners gave General Insurance Services permission for its advisory panel to explore the possibility of the county adopting an Individual Coverage Health Reimbursement Arrangement (ICRA) for the 1,100 to 1,200 employees and dependants that it insures. GIS Employee Benefits Advisor Candace Arvin explained to the commission that there are long lead times for implementation of any changes and now is a good time to simply understand what else is available in terms of employee health insurance. Regnitz said the switch this year to a health savings account-based plan for employees was already a big shift for the county and it should do nothing more than explore at this point. Board of Commissioners President Jim Biggs, R-North, told Arvin, 'You've got to figure out how to get more aggressive with our plan because it's only going to get more expensive.' Regnitz praised GIS for keeping the county's health insurance cost increases below industry averages. 'But they have another gear, Barb,' Biggs insisted.
