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Middleton staff brief council on proposed employee health-plan change for FY26
Summary
City benefits consultant presented a comparison of the city's current health plan and a pooled/triple-A alternative; staff will plan employee communications beginning February and return with a formal action item when rates and enrollment details are finalized.
City benefits staff and a benefits consultant presented options to the Middleton City Council for employee health plans for fiscal year 2026, including a move to a pooled association plan described as a “triple A” option that staff said could lower costs and expand benefits.
Lindsay, the benefits consultant, told the council the association plan would bundle employee assistance and administration services and could reduce the city’s net cost after accounting for the current health reimbursement arrangement. “When we add in the cost of the health reimbursement arrangement that you currently have… that’s where those overall savings on the second page come into play,” the consultant said.
Nut graf: Council members asked about enrollment rules, eligibility and how the change would affect employees’ paychecks and deductibles. Staff said the earliest implementation would be October 2026 and emphasized additional enrollment communications and a required employee application process.
Details and concerns: Staff said the pooled plan’s overall premium appeared lower for most enrollment tiers and that dental and vision costs were largely comparable. The consultant said the association has taken steps to control costs, including a pass-through pharmacy-benefit manager, and reported positive feedback from other local employers who have joined the plan. Staff warned one change: the current stipend tied to the city’s health reimbursement arrangement would end if the city moves to the association plan.
Eligibility and enrollment: Staff said employees without TRICARE or Medicare would be required to enroll in the association plan if the council adopts it. The consultant said the association plan is a qualified health plan with no preexisting-condition exclusions. Staff noted rates could change based on the city’s employee health history and that a final decision would follow additional analysis and employee engagement in 2025.
Next steps: Council directed staff to continue planning outreach; staff said communications to employees would begin in February and a formal action item would be returned when final rates and enrollment mechanics are available.
