Franklin City committee approves 2026 employee benefit renewals, recommends stop‑loss and plan design changes

Scott Fuller, a broker with USI, told the Franklin City Administrative Committee on Oct. 20 that the city—s recommended 2026 employee benefit package would hold premium equivalents steady while adjusting plan design features to reduce risk and cost.

Fuller said the recommendation is "to renew with Symmetra, your current carrier, and increase the specific deductible ... from a 100 to a $110,000." He said that change would produce about $58,000 in annual savings for the city and would require six claimants over $110,000 before the change would be a net loss.

The packet presented to the committee showed other plan adjustments Fuller described as largely administrative or tied to federal rules: the high‑deductible health plan deductible must rise from $3,300 to $3,400 to match new IRS rules; the city—s Health Reimbursement Arrangement (HRA) would be adjusted on an equivalent basis; and staff recommended moving to a tiered Nexus ACO network because roughly 84% of plan members already use Nexus ACO providers. Fuller said the Nexus move would reduce costs about 8% for those members and allow the city to keep overall renewal costs at "no change," meaning no increase to premium equivalents or employee contributions for medical and the self‑funded dental plan.

Fuller recommended retaining the city—s third‑party administrator, UMR, and continuing with the pharmacy benefit manager Servu, which provided a three‑year pricing renewal that he said represents a reduction from 2025. He also recommended a biosimilar formulary for certain high‑cost specialty medications and discussed international sourcing options for pharmacy benefits. Fuller said NICE Healthcare, which provides primary‑care access including virtual and in‑home visits, would rise by $1 per member per month (about 2.6% in 2026).

On dental and vision, Fuller said the city—s Delta Dental self‑funded option would see no recommended change to premium equivalents; the smaller fully insured Care Plus dental HMO option would increase by about 10%, which Fuller said is an approximate $500 annual cost to the city. For life and disability coverage, Fuller recommended switching to the NIS plan endorsed by the League of Wisconsin Municipalities; he said that change would reduce rates roughly 12% and include a five‑year rate guarantee.

A committee member asked whether the NICE Healthcare option was voluntary; Fuller confirmed it is voluntary and that the city pays membership costs for employees who use it. Committee members asked whether employees had been given the renewal details; staff said open enrollment materials would be provided about Nov. 1 after formal approval. A motion to approve the 2026 employee benefit insurance renewals "as outlined, including health, dental, vision, life, long term disability, and NICE Healthcare plan adjustments," and to authorize the director of administration to finalize contracts, was made and approved by voice vote. The committee did not record a roll call; individual yes/no votes were not recorded in the meeting minutes.

Clarifying details discussed in the presentation included the change to the specific stop‑loss deductible (from $100,000 to $110,000), the HDHP deductible increase from $3,300 to $3,400 to meet IRS requirements, the estimate that 84% of members use Nexus ACO providers, an estimated 8% cost reduction for those claims under the Nexus network, the NICE Healthcare $1 per member per month increase, a roughly $58,000 annual savings estimate tied to the stop‑loss adjustment, and an estimated $500 annual city cost if employees remain on the Care Plus dental HMO option after the 10% premium increase.

The committee—s approval moves the renewals forward for implementation; staff were directed to finalize contracts and update the employee handbook to reflect plan design and vendor changes.