The county is now finishing its fourth year as a "self-insured" health-insurance provider. That means the county uses its own funds to pay all healthcare bills of its 448 employees and their 147 dependents.
Their estimated savings over the plan's first three years totals nearly
"After the first year, it got less scary, because it performed the way it should have performed, and you realize the amount of savings from not paying for Premera's administration and their profits," Mulhall said. "Now, I'm thinking I never want to look back."
County employees were insured through
Premera tracks the county's claims and costs and handles billing. It sends the county a weekly invoice for total costs. The county pays by money transfer.
By keeping Premera as a claims administrator, county employees' health plans all stayed the same. Employees' health cards still say "Premera," Mulhall said.
The county's health plans provide enviable coverage, even with today's exorbitant rates for all things medical.
Employees choose from zero,
In each plan, the county pays the employee's total premium cost. Employees pay the difference to include their spouse and/or children. The county pays the entire healthcare premium for jail and sheriff's office employees and their families.
In 2013, the first year under the self-insured system, the county saved
That was intentional, Mulhall said, to allow the county to build a healthcare fund that today totals about
"We are at a 100.4 loss ratio. Basically, everything coming in is going out," Mulhall said. "In self-insurance, you don't want to make or lose money."
Last year, the total healthcare cost savings was lower --
Premiums can also go higher, as needed, to sustain the fund. That hasn't happened much, so far.
In 2017, people insured through one of the insurance plans on the state's Affordable Care Act exchange are facing a 13-percent increase in premiums, Mulhall said. But
A "stop-loss" insurance policy is critical to the self-insured system, she says. It kicks in to cover healthcare costs that exceed
The county's annual healthcare savings figures already take the stop-loss insurance policy costs into account, Mulhall said.
The county had discussed self-insurance with its brokers over the years, Mulhall said, but always opted for one of the fully insured contracts offered by insurance companies.
That changed after Mulhall heard a presentation at a conference she was attending.
She added, "I'd always heard that doing it with less than 200 people is a risk. You have to have more healthy people paying in than sick people taking out. It's the law of large numbers. You have to have a larger number of insured people to have it make sense."
The county decided early on to include all its employees in the same insurance pool with the same insurance options, rather than provide different plans for different departments or union groups. This was a good call, according to their insurance broker.
"You feel you're more in control of your destiny, but at the same time you have more risk," Mulhall said. "It's stable and sustainable, and that's all you can ask for."
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