District updates employee benefit trust: new TPA, provider and pharmacy networks; programs targeted to cut claims
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Summary
Finance staff reported changes to the district's self-insured employee benefit trust for 2025–26, including a switch of third-party administrator and provider networks, dental self-insurance, and new cost-control programs with estimated savings.
At the Yuma Elementary District governing board meeting, a district benefits presenter identified in the meeting as Miss Walton provided an update on the employee benefit trust as of Aug. 28 for the 2025–26 year, describing administrative and network changes and initiatives the district expects will reduce health-care claims costs.
Miss Walton told the board the district changed third-party administrators from Aetna to Personify, moved its provider network to Blue Cross Blue Shield, and switched pharmacy administration to PharosRx (having moved away from CVS/Aetna arrangements). She also reported the district changed dental coverage from fully insured with MetLife to a self-insured arrangement; MetLife remained the provider network and TPA for dental services.
Miss Walton said the trust has contingency and stop-loss mechanisms in place and that the district had already paid substantial claim amounts for the 2024–25 plan year but expected some stop-loss recoveries once final claims are processed. She said the district moved trust funds into an interest-bearing account and continues to track revenue from district and employee contributions.
To lower costs, Walton described two programs the trust adopted for 2025–26: Garner, an online tool to direct employees to higher-performing, lower-cost providers (the presenter cited an estimated $48,000 in claim savings and said 37% of enrolled staff had registered so far); and PharosRx Navigator, a pharmacy program to obtain specialty and high-cost drugs outside the medical plan, with an estimated savings based on last year’s prescriptions of about $421,000.
Walton emphasized ongoing education and outreach: the benefits coordinator provides one-on-one training at campuses, hosts benefit-partner events before open enrollment, distributes newsletters, and chairs the district wellness committee. The presenter identified Julissa Rodriguez as the district benefits coordinator and said, “This person is Julissa Rodriguez, and she is a benefits coordinator. She does a great job.”
Board members asked clarifying questions about premium trends, district contributions, and claim drivers. Walton said recent increases in claims include some high-cost, acute cases; she noted that COVID-era reductions in medical utilization had depressed early claims numbers in 2020–21. No formal board action was taken; the presentation was an informational first read of benefit changes.