City of Mauldin, South Carolina
In 2019 the City faced the same ~9%-a-year fully-insured renewal every municipality was on. Instead, IMA and the City moved to a self-funded, value-based plan. Six years later, actual spend held near $1.4M while the old path would have climbed to $2.56M — a gap measured in millions, with cost savings kept by the City rather than the carrier.
Cost held flat while the market climbed
By 2025, the fully-insured trend would have reached $2,555,594. The City budgeted $1,875,229 — and actually spent $1,423,374, landing $1,132,220 under trend in that year alone. The favorable experience flowed back to the City instead of the insurer.
Employees paid less, not more
Because the plan performed, the City never shifted cost onto its people. Monthly medical contributions are lower today than in 2019: Employee/Spouse down 15.4%, Employee/Children down 31.5%, Family down 5.0% — with Employee-Only coverage fully City-paid at $0 to the employee.
A richer benefit than a traditional plan
Under the value-based design, a member facing a $17,000 outpatient surgery pays a single flat copay of about $250 — versus $3,000–$3,400 (deductible plus 20% coinsurance) under a traditional plan. Across 174 surgeries from 2020–2026, members saved $203,517 — roughly $1,170 per surgery, every single time.
The engine: an on-site proactive MD clinic
No-copay primary care where employees work delivered 5,729 visits and $711,311 in total economic value — visit-cost savings, employee copay savings, and recaptured productivity — while catching issues early and intercepting high-cost claims before they hit the plan.
The ripple effect
Controlled healthcare cost made room for employee raises — merit pools and cost-of-living increases across FY2024–FY2027 — all while the City held its property tax rate flat.