MONTICELLO – The Legislature unanimously voted on October 15 to change employee health insurance plans from fully insured, fixed monthly premiums to self-insurance plans.

County Manager Joshua Potosek said the move gives the county more control over spending without changing the structure of employee benefits. He acknowledged that a self-insurance plan would shift financial liability from Anthem, the county’s health insurance provider, to the county, but noted that “a lot of upstate counties do this.”

“We’re currently in a fully insured plan,” said Potosek, “which means regardless of how much our employees are utilizing those services, [the county] pays a fixed monthly premium.” He explained that in a self-insurance plan, the county only pays claims on its actual usage.

“What happens if you need surgery?” asked District 7 Legislator Joseph Perrello. Potosek explained that the county would pay the cost of a claim up until the $150,000 stop-loss cap, after which the insurance company pays the balance.

Perrello cited concerns over the aging population of Sullivan County residents and shared an anecdote about a friend who needed a back surgery that cost $1.2 million.

“There’s an ability to control cost more with this,” said Potosek. “There’s lower fees but it does shift the risk of it to the [county].”

When Perrello asked who was going to monitor the self-insurance plan, Potosek said, “We have a TPA (Third Party Administrator).”

According to the website of TPA Collective Health, “Outsourcing to a TPA like Collective Health can be an attractive option for organizations looking to take advantage of the significant cost savings associated with self-insuring their healthcare plans.”

“Nothing is really changing in terms of the structure and what benefits are being paid, networks, or pharmaceuticals,” Potosek said. He explained that the county will get an insurance bill through the TPA on a weekly basis based on the county’s usage.

“Healthcare is unaffordable,” District 5 Legislator Cat Scott said. “We spend almost $43 million [yearly] on healthcare for our employees.”

Potosek said the county would have seen a 36.2% increase for the fully insured plan this coming year; while the new self-insurance plan is a proposed 25% increase in health insurance spending in the tentative 2027 budget.

“I think [this will] help control costs,” said District 1 Legislator Matt McPhillips. “We [have to] do something here.”

“Globally, something’s got to change with health insurance, period,” said Potosek. “We don’t even know what the NYSHIP (New York State Health Insurance Program) increase is going to be yet, if that goes up 15%, the family plan will be $50,000… the cost increases are unsustainable.”