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Board approves 2026 health‑insurance changes and incentives tied to new Innovia/Enovia clinic
Summary
The board approved modifications to the district employee health plan for Jan. 1, 2026, including added urgent‑care and emergency‑room copays, adjusted out‑of‑pocket maximums, a spousal surcharge for spouses with employer coverage, and a conditional HSA deposit tied to clinic use.
The board approved proposed changes to the Wisconsin Rapids public school employee health insurance plan effective Jan. 1, 2026. The changes were presented by benefits consultant Jen Corte of M3 and discussed with district staff.
Key approved modifications (effective 01/01/2026 unless noted): - Maintain the Signature plan employer/employee premium split (district pays 85%, employees pay 15%). - Reduce the district’s exposure on the Freedom plan by capping the district contribution at the 2025 dollar amounts for single and family coverage; employees would pay the additional premium required if they remain on Freedom. - Add per‑visit copays that count toward the out‑of‑pocket maximum: $75 urgent care after deductible and $250 emergency room after deductible. These copays will limit the district’s projected rate increase by shifting some cost to point‑of‑service copays when used. - Raise the Signature plan maximum out‑of‑pocket to $2,500 single / $5,000 family (from $2,000 / $4,000) and the Freedom plan to $3,500 single / $7,000 family. - Add a spousal surcharge of $1,500 per year for a spouse covered on the district plan who has access to employer‑sponsored coverage and declines that coverage.
Clinic and HSA change: the board also approved a separate, related motion to maintain the district HSA deposit amount ($1,500 single / $3,000 family) but make the September half of the annual deposit contingent on the employee and any spouse (if applicable) completing an in‑person biometric/physical visit at Innovia/Enovia Health no later than July 31, 2026. The board debated and then approved that conditional HSA deposit in a second motion; supporters said the requirement is intended to encourage employee and spouse use of the new direct primary‑care clinic and to create early preventive care engagement.
Why it matters: the district’s medical‑loss ratio has been high (the consultant reported a 12‑month medical‑loss ratio near 120%), and the proposed design changes are intended to reduce premium increases and encourage use of the district’s new direct primary‑care partnership with Innovia/Enovia. The clinic offers no‑co‑pay visits, virtual care and on‑call access; Innovia has begun seeing patients in mid‑October and the district will host an open house Nov. 11.
Board discussion: trustees expressed concern about making part of the HSA contingent on clinic visits but agreed to split the HSA deposit decision into a separate motion so the main plan changes could proceed. Board members also asked about weekend clinic hours and access; M3 explained the clinic provides telehealth and on‑call availability outside standard hours but not routine Saturday/Sunday clinic openings.
Outcome and next steps: the board approved the plan design changes and the conditional HSA deposit. Staff will continue employee outreach, hold clinic open‑house events and monitor clinic utilization for future renewals.
