County staff recommend 4-tier health premiums; committees endorse plan design and ask HPS for clarifications

Walworth County staff recommended shifting the county's self-funded health plan to a four-tier premium structure and adjusting plan parameters for 2026; the county committees endorsed the recommendation as input for the administrator's budget while requesting additional clarification from Health Payment Systems (HPS) on member payment plans and communication.

Josh Pollock and consultant Jesse (Hausman) presented analysis showing an overall projected premium increase of 9.85 percent driven by rising claims and several high-cost claimants; staff recommended a phased move to a four-tier premium structure (employee only, employee + child(ren), employee + spouse, family) to better align premiums with actuarial cost ratios.

Josh Pollock explained HPS's role as the county's provider network and billing intermediary and summarized HPS's member payment options: "they offer the convenient payment plan, up to 24 months of 0 interest," he said, adding staff would meet with HPS to review member complaints received by the county.

Staff outlined key changes under the recommendation: an average 9.85 percent increase across plans to match projected claim costs; a move to four tiers so employees with only children or only spouses are not subsidizing larger family coverage; and an adjustment to high-deductible health plan (HDHP) minimum deductibles so the plan remains HSA-qualified (federal 2026 minimum: $1,700 single / $3,400 family). The staff presentation showed example impacts: single coverage would rise roughly 10 percent on the traditional plan and 7.5 percent on the HDHP; employee-plus-child coverage would decrease slightly; employee-plus-spouse coverage would be held near current family levels; and full-family premiums would rise by roughly 19 percent in year one of the change.

Committee members asked about alternative networks, provider access and whether HPS billing practices created collection problems for members. Pollock said HPS negotiates deeper discounts and pays providers promptly, which reduces overall claim cost, but acknowledged the county has received complaints about HPS customer service and payment-plan implementation and that staff would re-engage HPS to seek clarifications.

The committee motion to endorse the staff recommendation for inclusion in the county administrator's 2026 budget was made and seconded; the motion carried. Staff said final premium and plan-design decisions will be finalized through the formal budget process and during open enrollment, and that administrative communications would emphasize options including the HDHP/HSA choice.

What happens next: staff will meet with HPS to review member complaints and payment-plan availability, finalize actuarial calculations for the budget, and return with final recommended premium rates as part of the administrator's 2026 budget presentation.