Gahanna officials told City Council on Aug. 25 they plan to leave the Central Ohio Healthcare Consortium and establish a standalone, self‑funded employee health insurance program starting Jan. 1, 2026. The administration recommends keeping UMR for medical administration and RxBenefits for prescription coverage while switching urgent care, wellness and employee assistance program vendors.

The change is intended to give the city “greater flexibility in vendor selection, transparency and claims management,” Director Berry said, and to “have complete governance over our own plan design and funding strategy instead of 1 vote of 12 in the consortium.” The benefits consultant NFP recommended the move following an RFP process and finalist interviews earlier this year.

The nut graf: City staff say the self‑funded model would not disrupt employees’ current provider networks, and forecast roughly $800,000 in minimum annual savings versus remaining in the consortium. Council agreed to place the two related resolutions on the consent agenda for the council’s next meeting.

Under the plan recommended to council, the city would:
- Keep UMR as the third‑party administrator for medical claims and RxBenefits/Express Scripts for pharmacy to avoid network disruption; staff said “there’ll be 0 disruption for employees.”
- Replace OSU urgent care with a virtual urgent care offered by First Stop Health (city‑funded access intended to reduce claim costs).
- Replace the OSU‑provided wellness platform with PeopleEQ/Wellness IQ, adding an app and engagement tools.
- Move employee assistance program (EAP) services to CURELINK, including a dedicated trauma‑informed line for first responders.

City staff and the NFP analysis presented an estimated 2026 premium impact of 0% increase for employees compared with an anticipated consortium increase of about 9% if the city stayed. Staff cited projected vendor savings: pharmacy up to 8.1% below consortium pricing, virtual urgent care estimated at roughly $13,000 per year versus a $270 per visit fee quoted by OSU urgent care, and wellness program savings of more than $10,000.

Council members asked about financial risk and program operations. Councilmember Schnetzer sought detail on actuarial oversight and reserves; Director Berry said NFP performs annual actuarial calculations per state code and recommends funding ranges for the city’s reserve, and that staff is working on how much to seed the self‑insurance internal service fund in the 2026 operating budget. Councilmember Schnetzer also asked about reinsurance; Berry said the city will purchase stop‑loss coverage with a recommended deductible of $100,000 so claims above that level would be reimbursed by stop‑loss.

Councilmembers asked whether urgent care would be solely virtual. Senior Deputy Director Weibensinger said the First Stop Health product is primarily virtual and partners with local providers for labs or imaging when needed; employees may still go to in‑person urgent care or an ER, but staff expects many employees to use the virtual option to avoid claims hitting the plan. On wellness, staff noted PeopleEQ offers a mobile app, points‑based engagement and an annual strategy review tied to biometric data.

Staff said all appropriations for the self‑insurance program will be included in the 2026 operating budget presented in October. The administration requested authorization for the mayor to execute related third‑party administrative and stop‑loss agreements and for the finance director to establish an internal service fund for self insurance. Council scheduled the two resolutions for the consent agenda at the next meeting.

Remaining questions staff flagged for future work include how much to seed the reserve fund to guard against early catastrophic claims and finalization of the stop‑loss carrier via RFP in August 2025. Director Berry and senior staff said they will return with implementation details during budget hearings and as agreements are finalized.

Less critical details: staff said the city transitioned ancillary benefits (dental, vision, life) to MetLife in 2024 and that the HSA plan design and contribution levels are budgeted to remain in place for 2026.