Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Employee Benefits topic
No spam. Unsubscribe anytime.
McAllen ISD narrows employee medical offering, board approves GLP coinsurance at 20%
Summary
Trustees approved consolidating the district’s self-funded medical plans into a single basic plan and adopted a 20% coinsurance contribution for certain GLP medications after amendment; vote passed 4–2.
The McAllen Independent School District Board of Trustees on Sept. 23 voted to move from three self-funded medical plan options to a single basic plan and to add a coinsurance tier for certain GLP-class pharmacy drugs. Trustees approved the final motion with an amendment setting the GLP coinsurance at 20 percent; the motion passed 4–2.
Administration’s benefits director, Andy Silva, presented the recommendation and emphasized that the district would not raise employee monthly contributions or change core medical cost-sharing (deductibles, copays or out-of-pocket maximums) as part of the final recommendation. "There is no recommendation to increase the contributions the employees contribute on a monthly basis toward their medical benefits," Silva said.
Silva and benefit consultants recommended discontinuing the higher-cost ‘high’ and ‘state’ plans while continuing the basic plan and adding a pharmacy coinsurance tier to address rapid cost growth in certain specialty drugs, including some GLP-1 and diabetes medications. Silva said the district expects pharmacy costs to rise if new indications for medications (such as Wegovy/semaglutide for metabolic indications) expand access and that a coinsurance tier helps "future-proof" the plan.
Trustees and staff discussed support options and manufacturer copay assistance. Board legal counsel and administration emphasized that the district is the plan fiduciary and that switching third-party administrators (TPAs) is an administrative change rather than a change of insurance carrier; claims adjudication must follow the district’s plan document. Roger Garza noted the board remains the plan fiduciary and the administrator acts under the district’s instructions.
After discussion, Trustee Haddad moved to adopt the recommendation but set the GLP coinsurance at 20 percent (rather than the 30 percent initially proposed); the motion passed 4–2. Administration said the revised design, combined with a recent mail-order program and outreach to manufacturer assistance programs, would reduce the fund’s projected deficit and limit the district’s projected net cost.
