Monroe City Council approves modest funding increase for employee health and cafeteria plans

Monroe City Council on Feb. 11 approved a recommended 3% funding increase to the city's self-funded health and cafeteria plans for fiscal year 2025—26, with no change to employee contributions and no benefit changes beyond an IRS-required adjustment to Health Savings Account (HSA) plan deductibles.

The funding request, presented by Lisa Jensen, the city's human resources director, and Mark Broward of Mark3 Employee Benefits, sought a modest budget increase to maintain the plan's conservative funding posture. Mark Broward said the plan has been conservatively run and that claims have averaged about 3.8% per year on the claim side. "From a net cost basis we only think that the net costs are going to go up about 1 and a half percent," Broward told the council.

Why it matters: Monroe's health plan is self-funded, meaning the city pays administration and claims costs and carries stop-loss insurance for high-cost claims. Broward described a larger purchasing block negotiated with Blue Cross for stop-loss coverage that, he said, produced savings and a sizeable distribution back to participating employers: "We anticipate about $4,000,000 of coming back, which is completely unique in the market," he said. He also said the city's transition of stop-loss coverage to a Blue Cross block helped reduce the city's stop-loss costs.

Plan performance and employee health screenings: Broward said the plan has remained within budget and has seen normal year-to-year claim fluctuations driven by high-cost conditions such as oncology and specialty pharmacy. The council then heard a detailed report on the city's 2024 biometric screening results from Jessica Bridges, health promotion coordinator for Piedmont Pharmaceutical Care Network (PPCN). Bridges said PPCN has delivered screening services for the City since 2020 and that participation in 2024 was the highest since 2016, with 579 participants of about 631 eligible employees, spouses and retirees.

Bridges summarized participation and clinical trends: about 75% of those screened met the premium-incentive threshold through biometric points or alternatives; the waist-measurement incentive (employees only) was achieved by roughly 69% of participating employees; hypertension measures trended down, while A1C and some lipid measures have increased since 2016. Bridges noted the city's chronic-condition programs that began July 1, 2024, are in early stages: the diabetes-management program was at about 50% of budget and 30% of eligible enrollment, and the medical weight-management program had reached 100% of its budget.

Council action and next steps: A council member moved to approve the renewal expectation and options for the health plan and cafeteria plan, authorizing the city manager to execute necessary documents; the motion passed. The administration will return to council in coming weeks with any proposals for integrating plan administration and pharmacy under Blue Cross and with additional details on projected distributions and plan management opportunities.

Context and limits: Bridges and Broward emphasized that the HSA deductible change is driven by IRS rules and is outside staff control; Bridges also noted all screening data are reported in aggregate and protected under HIPAA. The presentation included recommendations to continue conservative funding while pursuing integration opportunities with Blue Cross to improve coordination and cost management.

The council did not change employee contributions as part of this action and directed staff to bring further integration proposals and any required budget items back to the council for review.