Sentara faces competition for James City health insurance admin contract
Plus, Virginia Cat Festival, citizen police academy and water use restrictions
James City County could soon decided to switch the company that manages health insurance for the 1,128 employees and retirees eligible for coverage under its plan. While the County is self-insured, meaning it pays employee medical claims directly rather than buying a policy from an insurance company, it currently partners with Sentara Health Plans to administer the plan on its behalf; Delta Dental of Virginia handles dental. Now, other companies have a chance to compete for the job as proposals for services are due in August. If the County picks a new plan administrator, the change would take effect July 1, 2027.
The County budgeted for an 9.0% increase in health insurance rates and a 2.5% increase in dental insurance rates in the FY2027 Adopted Operating Budget, though the plan administrators receive only a portion of the total budget. As part of the Request for Proposal (RFP), which was posted in June, the County provided a slew of aggregated data, which included overall views of past claims, enrollment numbers, and provider usage records. Each bidder is expected to show its own pricing and how its provider network would have paid the County’s past claims.
Coverage and Cost
The current plan covers most employees and retirees eligible for coverage, according to supplemental documents.
1,128 employees and retirees are eligible for coverage, and of those, 909 are enrolled in a medical plan while 219 have waived it
Monthly premiums range from $746 for an employee-only high-deductible plan to $2,609 for family coverage under the traditional plan, with the County covering most of that cost
How Employees Use Care
Claims data shows a clear pattern in how employees seek treatment, according to data included in the RFP.
Family practice accounts for the largest share of primary care providers (286), followed by pediatrics (98) and internal medicine (78)
Nearly 2,000 specialist visits were logged, led by behavioral health (275), radiology (224), anesthesiology (180), Ob/Gyn (157), and orthopaedics (120)
Combined primary care and specialist providers are concentrated in Newport News (498), Williamsburg (451), Richmond (325), Norfolk (270), and Hampton (186)
Sentara Health Plans, based in Virginia Beach, currently covers close to one million members across Virginia through commercial, Medicare, and Medicaid products. As the County reopens the contract, different companies may bid on different parts of the plan, such as medical coverage, prescription drugs, dental, or the health savings account program, according to the RFP.
The chosen provider will be expected to process claims, keep accurate records, issue ID cards, and offer strong customer service so employees can resolve issues directly. Winning companies must also follow federal health privacy laws, control costs on expensive hospital stays, run chronic disease management programs, and guarantee no employee loses coverage during the transition.
In addition to increased health care costs, the FY2027 Adopted Operating Budget provides a 4.0% salary raise to eligible county employees, effective July 1, 2026. This cost of living increase, characterized as a living wage raise, requires $2.8 million in General Fund support. The initiative is designed to invest in current county workforce talent, support staff recruitment and retention, and ensure the county remains competitive during the hiring process. Looking ahead, the county has also set aside additional funding in the FY2028 Plan for a subsequent living-wage adjustment for staff.
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