Agenda 09/23/2025 Item #16E 2 (BA to Fund 5017 (Group Health and Life Insurance), to pay health and pharmacy claims expenditures for the remainder of FY 2025.)9/23/2025
Item # 16.E.2
ID# 2025-3472
Executive Summary
Recommendation to approve a Budget Amendment to Fund 5017 (Group Health and Life Insurance), to pay health and
pharmacy claims expenditures for the remainder of FY 2025.
OBJECTIVE: To transfer funds from Insurance Reserves to Group Health Insurance Claims in Fund 5017 (Group
Health and Life Insurance) to ensure sufficient resources are available to cover health and pharmacy claims expenditures
for the remainder of FY 2025.
CONSIDERATIONS: The Board of Commissioners sponsors a partially self-funded Group Health Insurance Plan for
the County Manager’s Agency employees and the participating Constitutional Officer Agencies. The County utilizes the
services of Willis Towers Watson as its consulting benefits brokerage and actuarial firm. Claims under the program are
adjudicated through the County’s third-party claims administration company, Allegiance Benefit Plan Management, Inc.
Reinsurance or “Stop Loss” coverage is purchased through SunLife to protect the Plan against catastrophic claims.
Utilization Review, Concurrent Stay, Managed Care, and Provider Network services are provided through Community
Health Partners, Inc. The Risk Management Director is the Plan Administrator for the Plan.
Pharmacy claims and costs, particularly for specialty medications, continue to rise each quarter, while catastrophic
medical claims increased 25.5% last quarter. A single specialty drug accounted for more than 20% of total spending in
the first half of the plan year, further compounding overall inflationary pressures in medical and pharmaceutical costs.
These factors have driven an unanticipated surge in plan expenses, making a budget amendment necessary to safeguard
the plan’s financial stability.
Fund 5017 (Group Health and Life Insurance) maintains reserves to comply with Florida Department of Insurance
statutory funding requirements to protect against unforeseen events such as those described above. An additional
$3,000,000 from the reserve fund is requested to cover the cost of group health and pharmacy claims through the end of
FY 2025. This recommendation has been reviewed by the County’s Benefits and Actuarial Consultant, Willis Towers
Watson, with their concurrence. Funds may only be used for health and pharmacy claims expenditures and cannot be put
towards any other purpose. Unspent funds, if any, will be returned to Fund 5017, Reserves for Insurance.
This item supports the strategic plan by promoting fiscal stewardship and sound budget oversight.
FISCAL IMPACT: A budget amendment is requested to move $3,000,000 in Fund 5017 (Group Health and Life
Insurance), from Reserves (5017-919010-99630) to Operating (5017-121640-645920). The health claims budget for FY
2025 is currently $52,944,151. The requested budget amendment will increase the claims budget by approximately
5.7%, raising it to $55,944,151. Fund Reserves will remain sufficient to meet statutory requirements.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated with this action.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, raises no legal issues and
requires a majority vote for approval. -JAK
RECOMMENDATIONS: To approve the attached Budget Amendment to Fund 5017 (Group Health and Life
Insurance), to pay health and pharmacy claims expenditures for the remainder of FY 2025.
PREPARED BY: Sonja Sweet, Risk Manager, Human Resources
ATTACHMENTS:
1. Sept 2025 BA Request for 5017 3M REV
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