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Group Insurance Commission approves FY26 plan design changes, including dental enhancements and new digital MSK tool
Summary
The Group Insurance Commission voted unanimously to approve fiscal year 2026 plan design recommendations, adopting several medical plan tweaks (including the Hinge Health musculoskeletal app and fertility benefit harmonization) and a switch in dental carriers that raises dental annual maximums and adds retiree preventive coverage.
The Group Insurance Commission voted unanimously on Feb. 16 to approve staff-recommended plan design changes that will take effect July 1 as part of the fiscal year 2026 plan year.
The changes approved include several medical plan adjustments and a set of enhancements to the dental plans tied to a carrier change. Vice Chair Bobby Kaplan presided over the meeting and the roll call vote was conducted by Andrew Stern, general counsel.
Commissioners approved incorporation of the Hinge Health musculoskeletal app through the Commission's CVS partnership, broader fertility benefit coverage by removing cycle limits so coverage is determined by medical necessity, and removal of session limits for nutritional counseling as a result of a mental health parity audit. Staff also said the commission will implement provisions stemming from the federal PACT Act, including targeted no-cost or reduced-cost coverage for certain cardiac medications and a continuity-of-care program for medications that move off the formulary; staff said specific heart conditions are still being determined.
On the dental side, the Commission accepted staff recommendations resulting from a recent procurement to move dental coverage from MetLife to Altus. As presented by Cameron McBean, director of vendor management, the active-member dental plans' annual maximum will rise to $1,750 from $1,500; the dental plan year will align with the GIC fiscal year rather than the calendar year; routine dental care for children under 13 will have no cost sharing when members use in-network providers; and retiree dental coverage will add adult orthodontia, an enhanced table of allowance, and no-cost preventive services for retirees who use in-network providers. Staff said the active plan participants will see a small premium reduction despite the enhancements, while retiree premium impacts will be minimal but vary by product type.
Executive Director Matt reported that staff will finalize details needed for rate-setting and that the commission will vote on final rates at a later meeting. He also reminded commissioners that annual enrollment runs April 2–May 1 and that benefit statements are available in the myGIC member portal; paper benefit forms have been mailed to members who have not registered for the portal.
During discussion, Commissioners asked for further cost estimates tied to recent legislative mandates and the new mandates' projected budgetary impact. Staff said actuaries are working on specific estimates and that the commission regularly provides technical feedback to the Legislature when mandates add cost or reduce plan flexibility. On the PACT Act implementation, staff said work with CVS and Willis Towers Watson is ongoing to identify which heart conditions and medications will receive the no-cost or reduced-cost coverage.
The motion on the plan-design package was moved and seconded; a roll call produced unanimous approval of those present (yes: 12; no: 0; abstain: 0). The commission recorded the motion as approving the "GIC staff's plan design recommendations as presented beginning in FY26 (effective July 1)."
