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District proposes insurance design changes, on-site clinic and stop‑loss savings to hold premiums flat
Summary
Business officials reported a 0% increase to employee premiums for 2025–26, citing several plan design changes, a new provider ACO tiering arrangement, pharmacy edits and an onsite clinic arrangement intended to control costs; administration said stop‑loss procurement also yielded anticipated savings
District finance staff presented a summary of the recommended employee health-insurance plan design for the 2025–26 year and said the administration expects to hold employee premiums at a 0% increase.
Business officials described a multi-pronged approach: maintain the current UMR provider relationship while joining a local Nexus ACO that creates tiered provider networks (tier 1 including Aurora, Froedtert and other local providers), refine the pharmacy formulary to exclude weight‑loss medication when used only for elective weight loss, promote generic substitutions when appropriate, and introduce an onsite district clinic available to employees and their dependents. Administration said these steps, together with competitive stop‑loss procurement, are expected to yield significant savings and keep overall premium costs flat for 2025–26.
The administration noted the district is self‑funded and uses stop‑loss insurance to protect against very large individual claims; staff reported nine current high‑cost claimants above $75,000 and said the stop‑loss RFP produced competitive pricing and expected stop‑loss savings of roughly $312,000. Business officials also said two claimants had previously generated repetitive high costs and that vendors proposed pricing "with no lasers" for the stop‑loss contract.
On the clinic, staff said the district plans to partner with an existing local clinic (operated in partnership with the county/Aurora) to provide same‑day visits and low‑cost options for routine care, and to promote Teladoc virtual visits for after‑hours needs. The clinic will be available to employees, dependents and retirees; administration said it expects the clinic to reduce out‑of‑pocket and plan costs for minor, frequent services.
Administration cautioned the board that while these measures are designed to hold premiums steady, some members of the bargaining unit or retirees may see different out‑of‑pocket impacts depending on provider choice and pharmacy use. Business staff said they will continue member education on network tiers, generic options and clinic use to realize plan savings.
