Does the county do any coordination of benefits? If not, then the county should mandate that employees have only one health care for coverage. OR, they could mandate people opt out if covered by their spouses plan.

Unless things have changed in the past 4 or so years since I left County employment - the County is self-insured to some degree, and offers a cafeteria plan for health/medical coverage for most of their more tenured employees.

This provides a basic level of "benefits dollars" from which members can pick basic health/medical/optical and even life insurance plans - if said employee wishes to upgrade their coverages over the "basic levels" then they do so by augmenting that allowance with a pro-rated deduction from their paycheck.

With respect to "mandating that people opt out" - what if the spouse's employer has a similar mandate? (I am also curious if such a 'mandate' is even legal) Regardless, I believe that for the most part, employees hired since the early 2000's are pushed into a single coverage provider with larger deductibles, etc.

From what I am reading in the original post - this topic is regarding members of the legacy defined benefit pension program that also have "life time medical coverage" as part of their pension. This former employee appears to be suggesting that the County / Pension board offer a medical-coverage buy-out - which over the long term should help the County's pension funding obligations by reducing long term actuarial expenses related to life time medical coverage benefits.

Way back in the mid 90s when I hired in, I was part of the 1st round of medical/pension cut-backs and was pushed into a defined contribution pension with no retirement healthcare - as a result there was really no long-term incentive for me to remain with the County, so a few years ago, when a greener pasture opened up, I took my 13+ years of County experience with the prior 7 years of local experience to a different employer.