Insurance review: district weighs GHC provider disruption, self‑funding not financially viable now
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Summary
The Human Resources Committee reviewed responses to an insurance request for information and was told self‑funding would raise plan costs roughly 26.7%; remaining fully insured options narrowed to Group Health Cooperative (GHC) with provider disruption or Dean Health with higher cost but continuity of providers.
District staff told the Human Resources Committee they received limited responses to a request for information about 2025–26 employee health coverage and that the available offers narrowed the district to two practical fully insured options and several self‑funding proposals.
"The best of these offers...would be an increase in district costs or plan costs...of 26.7%," said Brian, the staff presenter, summarizing replies from self‑funded administrators and local carriers. He said most national carriers and several local carriers declined to respond; among self‑funded respondents, BenefitMall, Lucent, Prairie States and AMPS replied, while some major carriers declined to bid.
In fully insured comparisons, staff said Group Health Cooperative (GHC) offered lower first‑year costs but would require employees to switch providers and use GHC’s clinic network, which is based in Madison. Dean Health’s proposal would preserve current provider relationships but at a higher cost. District staff asked both organizations about a dual‑choice model; GHC would allow it without raising first‑year rates, while Dean required that both plans be offered at the same employee cost, which staff said would force the district to raise the GHC rate to Dean's level and result in a materially larger district contribution — the district estimate was that this approach could push budgeted contributions from a 5% increase to nearly 13% at the district level.
Staff reported they asked self‑funded respondents about separating pharmacy benefits, stop‑loss arrangements, multi‑year pricing and reporting. The presenter said the committee prioritized preserving the district’s independent employee wellness clinic and wanted multi‑year projections rather than one‑year promotional pricing.
Committee members asked that staff collect employee feedback on tradeoffs — lower premiums versus keeping current providers — and said the insurance committee would meet in early April to prepare a recommendation. The insurance committee’s recommendation is scheduled to go to the full board at the April 14 regular meeting, and staff said they would overlap employee education and open enrollment with final board action.
Staff also noted that plan rate firms provided year‑two pricing that narrows the first‑year difference between options; however, employees who switch to GHC could see a larger percentage increase in their costs from year one to year two if GHC rates increase in year two. Staff recommended collecting employee input via a brief survey with illustrative cost examples before finalizing the board recommendation.
