Department
Finance
Requested Action (Identify appropriate Action or Motion, purpose, cost, timeframe, etc.)
title
Request approval of 2026 premium rates for the Medical and Pharmacy, Dental and Vision Plans effective January 1, 2026, through December 31, 2026.
body
Requirement for Board Action (Cite specific Board policy, statute or code requirement)
In accordance with Board Policy, benefit plan premiums are approved prior to the beginning of each plan year
Strategic Priority Area related to this item (If yes, note strategic priority area below)
Open and Responsible Government
Commission Districts Affected
All Districts ☒
District 1 ☐
District 2 ☐
District 3 ☐
District 4 ☐
District 5 ☐
District 6 ☐
Is this a purchasing item?
No
Summary & Background (First sentence includes Agency recommendation. Provide an executive summary of the action that gives an overview of the relevant details for the item.)
Scope of Work: Fulton County currently provides a combination of self-funded and fully-insured Medical & Pharmacy (Rx), Dental and Vision programs to approximately 3,800 employees, 3,500 retirees/beneficiaries, and their eligible dependents. Under a fully-insured funding arrangement, the insurance carrier pays claims from its own funds and sets premium rates to support expected claim payments. While under the self-funded arrangement, the carrier administers the plan, but claims are funded by the County. The Finance Department worked with Segal Consulting to complete the 2026 health plan renewals and premium rate projections.
2026 SELF-FUNDED RATE CHANGES
The funding rates for the self-funded plans require calculation using historical claims and enrollment data, to which actuarially sound methodologies and assumptions are applied, and costs and credits associated with administration of the plan are incorporated. Segal, our benefits consultant performed this exercise for 2026 on behalf of the County. Below are the proposed funding (premium) rate changes for 2026. These rates are set to support the expected costs generated by members enrolled in the plans.
2026 FULLY INSURED RATE CHANGES
Fully insured plans account for approximately 38% of the total medical and pharmacy costs. Our benefit consultants from Segal, assisted in this year’s procurement process and review of each vendor. The following are the proposed rates for each of the fully insured plans for 2026.
2026 VS 2025 PROJECTED HEALTH PLAN COST COMPARISON
2026 Projected Health Plan Cost
The expected total cost for all health plan offerings (Medical, Rx, Dental, and Vision) for 2026 is $115.1 million as shown below. This incorporates all renewal rate changes outlined above.
Community Impact: None
Project Implications: None
Community Issues/Concerns: None
Department Recommendation: The Finance Department request approval of 2026 health premium rates and funding as presented and summarized below for fully insured and self-insured plans:
Anthem (BCBS):
- 4.5% increase to Active and Pre-65 Retiree rates (HSA, POS, and HMO plans)
- 4.5% increase to Post-65 Retiree rates (Medicare HMO, Indemnity PPO, and PPO Plus plans)
Kaiser:
- 6.8% increase to HMO Active and Pre-65 Retiree rates
- 5.6% increase to Post-65 Senior Advantage Medicare rates
Aetna Dental:
- 1.0% decrease to the Dental HMO rates
- 7.0% increase for the Dental PPO rates
Humana MAPD:
- 2.3% increase to the Basic Medicare Advantage Plan rates
- 2.3% increase to the Enhanced (Buy-Up) Medicare Advantage Plan rates
- No change to the Vision PPO rates
These changes were carefully considered, weighing the financial impact to the plan as well as the financial and logistical impact to the member. Approval is needed to begin open enrollment planning including Employee Self-Service (ESS) enrollment system modifications and communications for the upcoming enrollment period scheduled from October 14th through November 1st for active employees and retirees. Employee and retiree information meetings will be held virtually, starting the week of September 30th.
Department Issues/Concerns: Item needs to be approved so that we may maintain timing for open enrollment which is set to start October 13 – October 24.
History of BOC Agenda Item: Has this item previously been before the BOC? Yes.
Contract & Compliance Information (Provide Contractor and Subcontractor details.)
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Exhibits Attached (Provide copies of originals, number exhibits consecutively, and label all exhibits in the upper right corner.)
Attachment I: 2026 Proposed Medical Premium Rates
Attachment II: 2026 Proposed Dental Premium Rates
Attachment III: 2026 Proposed Vision Premium Rates
Attachment IV: 2025 vs 2026 Medical Premium Rates Comparison
Attachment V: 2025 vs 2026 Dental Premium Rates Comparison
Attachment VI: 2025 vs 2026 Vision Premium Rates Comparison
Attachment VII: 2026 Medical & Rx Plan Designs Comparison
Attachment VIII: 2026 Proposed Fully Insured Medical Premium Rates
Contact Information (Type Name, Title, Agency and Phone)
title
Ray Turner, Interim Finance Director (404) 612-7737
Sabrinna McTier, Interim Deputy Director (404) 612-7646
Verna Thomas, Benefits Manager (404) 612-7639
Fiscal Impact / Funding Source
Funding Line 1:
426-999-P003-1560: Group Insurance Stabilization, General Fund, Administrative