Larimer County to switch third‑party administrator and offer new zero‑deductible plan for 2026

Larimer County benefits staff announced on Sept. 4 that the county will change medical third‑party administrators from Meritain to UMR (UnitedHealthcare) and replace its current Choice and Standard plans with a new Surest zero‑deductible, variable co‑pay plan for the 2026 benefit year. Jennifer Whitener, benefits manager for Larimer County, said new ID cards will be mailed in December and the Surest plan’s provider/cost lookup site will be available in October prior to open enrollment, which runs Oct. 27–Nov. 7.

The change matters because most county claims are with UCHealth and the county prioritized a vendor with stronger contracted rates in Northern Colorado. Whitener said the move aimed to slow rising plan costs and to meet a county budget requirement that limited departmental premium increases to about 3%.

Under the Surest zero‑deductible plan, members pay a single co‑pay for a bundled service that accumulates toward an out‑of‑pocket maximum of $5,000 for single coverage and $10,000 for family coverage. Whitener described the plan as a “variable co‑pay plan” that uses a UnitedHealthcare “care rating” (1–10) combining quality and cost metrics to set co‑pay tiers. “What’s nice about this plan is that you will know the cost for the service you’re going to receive before you go,” Whitener said, adding that the Surest app and website will allow members to compare providers and see the co‑pay for a given provider and service in advance.

Whitener gave examples used to determine care ratings: complication and readmission rates for surgical procedures, use of imaging and diagnostic tests for acute conditions, diabetes‑related outcomes for primary care management, and measures around maternity outcomes such as cesarean rates and NICU use. She said care ratings and associated co‑pays are set annually and “will not change during the course of the year.”

Key benefit changes described by staff: - Network and vendor: third‑party administrator changes from Meritain to UMR; the county will use UnitedHealthcare Choice Plus network. Whitener said major local providers including UCHealth, Banner and Family Care Center will remain in network. - Plan offerings: the Choice and Standard PPO plans will be discontinued; employees will choose between the Surest zero‑deductible co‑pay plan or the existing high‑deductible health plan (HDHP). The HDHP will continue with higher deductibles of $3,400 single / $6,800 family and unchanged HSA employer contributions. - Cost structure: Surest has no deductible or coinsurance; co‑pays vary by provider care rating (examples given: office visit co‑pays will range roughly $20–$105 depending on rating). Teladoc, the wellness clinic and preventive services remain $0 co‑pay. Urgent care co‑pay on Surest is $60; emergency room co‑pay is $650; out‑of‑network mental health visits are $160; out‑of‑pocket maximums are $5,000 single / $10,000 family. Whitener said a maternity bundle example ranged from $900–$2,000 in the demo. - Bundling: Whitener said the plan “bundles all related services into a single co pay,” meaning a single co‑pay covers services for a procedure even when multiple providers are involved; if a related test or service occurs on a separate date or location, a separate co‑pay could apply. - Programs ending or changing: several customized benefits will end Dec. 31 because they cannot be administered on the Surest platform. Whitener said the county will discontinue the Health Care Blue Book rewards and programs, the $500 lifestyle education benefit, previously negotiated $0 co‑pay arrangements (Banner MD Anderson $0, Family Care Center $0, and eight free physical therapy visits at Colorado In Motion), doula coverage and sensory deprivation therapy. She emphasized the named providers remain in network but will no longer necessarily retain prior $0 co‑pay arrangements. - Continued or unchanged benefits: prescription drug coverage remains with CVS; the Virta Health diabetes management program will continue and EAP (CompSex/Employee Assistance Program) will remain, including six free counseling sessions per issue; vision (VSP) remains unchanged. Dental premiums will increase slightly for employee+1 and employee+2+ tiers; single dental coverage remains no cost. - Wellness and incentives: the county will continue the wellness rate discount for 2026 ($480 per eligible employee and an additional $480 if a spouse completes requirements). Whitener reminded staff that the deadline to complete requirements for the 2026 wellness discount is Sept. 30. - Open enrollment and implementation tasks: open enrollment will run Oct. 27–Nov. 7; Surest’s actual care ratings and co‑pays will be loaded into the Surest site in October; staff will receive training, recorded webinars, FAQs and campus office hours. Whitener said benefits staff are proactively reaching out to commonly used massage and acupuncture providers to encourage them to join the UnitedHealthcare network. - Wellness clinic staffing: the county plans to add a third physician assistant and another medical assistant to clinic staff to reduce access delays; to offset that cost the county will eliminate counseling services provided through the county clinic and transition those patients to Family Care Center.

Whitener and her colleagues answered several participant questions during the webinar. She said prior authorizations remain required for surgical procedures and that existing prescription prior authorizations with CVS will persist until their normal expiration; Medicaid may be used as secondary insurance but the county plan will pay as primary. When asked why the county left UMR previously, Whitener explained that the county evaluates its TPA on a five‑year cycle and selected the vendor with stronger local contracting at the time of the previous evaluation; for 2026 she said UMR/UnitedHealthcare offered the most favorable contracted rates with UCHealth.

County cost context and budget rationale Jennifer Glover (presenter identified as Jen) said the county’s annual per‑employee contribution toward health premiums is $15,480. Whitener and Glover said the county’s health plan has grown from about $25 million to $35 million in recent years and that claims have exceeded collected premiums and reserves in the previous two years; those budget pressures were the principal driver for the plan design and vendor changes.

Questions raised by staff and clarifications provided Participants asked about mental health provider access, out‑of‑network coverage, ambulance co‑pay and the ER co‑pay jump. Whitener acknowledged the ER co‑pay is higher under Surest and said the plan design intends to steer non‑emergency care to lower‑cost options such as urgent care and telehealth. She confirmed mental health visits will have a $15 in‑network co‑pay on Surest but will be in‑network only (out‑of‑network mental health remains available at $160). Massage and acupuncture will remain a $25 co‑pay but will require in‑network providers; Whitener said the most‑utilized massage provider, Height of Health Massage, has applied to the UnitedHealthcare network. She also confirmed ambulance co‑pay is $375 and that inpatient admission replaces ER co‑pay if the ER visit results in admission.

What to expect next Benefits staff said the county will publish a new benefits booklet in early October, post webinar recordings on the county benefits page, and notify employees when the Surest site with Larimer‑specific ratings is live. Staff invited employees to request 1:1 appointments, to submit provider contact details for outreach, and to bring questions to scheduled department meetings and campus office hours.

Ending Whitener closed by acknowledging the change will be significant for some employees and asked staff to use the forthcoming resources; she said benefits staff would continue outreach and support through the open enrollment period.