Sweetwater council approves switch to Blue Cross HMO for city-offered health plan; keeps Ameritas for dental and vision

The Sweetwater City Council on Aug. 12 approved moving the city’s employer-paid health plan to a Blue Cross HMO and keeping Ameritas as the city’s dental and vision carrier.

The council’s action follows a presentation by Nancy (staff member), who said Blue Cross was the only insurer to submit a bid for the city’s health coverage and that the carrier’s renewal would place projected costs at about $2.785 million — roughly 10.4% above the city’s current annualized run rate if no plan changes are made. Nancy recommended moving to Blue Cross’s Blue Essentials HMO and noted under the HMO the city would offer the HMO plan at no charge while employees could “buy up” to a PPO by paying an additional premium.

Nut graf: The change is intended to reduce the city’s projected claims costs. Blue Essentials, Nancy said, includes virtually all acute care hospitals in Texas and a large share of primary care and specialist providers; the HMO structure requires employees to choose a primary care physician (PCP) and obtain referrals for specialty care. Nancy said Blue Cross underwriters estimated the HMO could reduce claims by about $245,000 annually if all members switched, but she cautioned full savings are unlikely because some employees would choose the PPO buy-up.

Council members moved and seconded a motion to adopt the HMO as the city’s primary health plan and to maintain Ameritas for dental and vision. The motion carried on a voice vote. The council directed staff to meet with employees to explain the HMO and PPO options, collect plan elections, and assist employees who choose the HMO in selecting PCPs.

Nancy described the proposed buy-up costs as a two-tier structure: $125 per month for employee-only PPO buy-up and $310 for employee-plus-dependents, figures she said came from conventional rate equivalence underwriting. She also said Aetna reviewed the request but declined to quote, a common outcome when underwriting indicates much higher rates.

Council member Lisa (staff member) spoke in favor of selecting the HMO to save money. Trent Poindexter (staff member) was present during the presentation and answered implementation questions. The council did not change the city-paid structure for dental and vision; Nancy presented alternative quotes that would reduce employee-paid premiums but recommended deferring to staff judgment about provider networks.

Ending: The move to the Blue Cross HMO takes effect after staff completes employee meetings and enrollments; employees who select the HMO must designate PCPs as part of the enrollment process. The council did not specify a retroactive date for coverage changes in the public discussion.