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Benefits office outlines plan design, high prescription costs and options for self‑funding
Summary
Jamie Brown told the committee the district maintains a fully insured medical plan (single deductible $3,200 with $800 HSA contribution; family deductible $6,400 with $1,600 HSA contribution) and that carriers' high medical‑loss ratios and specialty prescriptions are drivers of premium increases.
Jamie Brown, presenting for the benefits office, gave a high‑level briefing on Janesville School District health‑plan design, quarter‑one carrier reporting and renewal options for the 2025‑26 plan year.
Brown summarized the current plan design: single enrollees face a $3,200 deductible with an $800 district HSA contribution; family coverage carries a $6,400 deductible with a $1,600 district HSA contribution. Brown emphasized that premiums are fully insured today and that the medical‑loss ratio (MLR) — carriers' ratio of claims to premiums — has recently been high, contributing to premium increases. For July–Sept quarter reporting, Mercy reported a 91% MLR and Dean reported a 97% MLR; Mercy's enrollment on the district plan was about 778 and Dean's about 214 for the snapshot Brown presented.
Brown highlighted prescription spending as a cost driver and provided carrier lists of top prescriptions and counts. She said some specialty drugs (examples cited in carrier reports) are high‑dollar items and that the carriers provide different report formats; Brown is pursuing more comparable, carrier‑level data through the district broker.
On renewal strategy for 2025‑26, Brown said the benefits office is evaluating the feasibility of moving toward self‑funding but stressed that a transition would require multiple mitigation levers and multi‑year planning. Potential levers discussed include an incentive‑based wellness program (biometrics and chronic‑condition management), direct primary care models, pharmacy‑benefit management/prior‑authorization protocols, care navigation to steer members toward lower‑cost high‑quality providers, and near‑site clinics. Brown and other staff noted self‑funding shifts risk from the insurer to the district (the district would assume claims risk) and therefore requires careful budgeting and implementation of cost‑management strategies.
Board members asked for clearer, comparable carrier data and pressed for staff training on pharmacy navigation; benefits staff said a February training will cover strategies for employees to manage prescription costs. Brown said the benefits office will continue to request more detailed deductible‑by‑member reports from carriers, compare bids from national carriers and ETF plans, and return to the board with further analysis; any move to self‑funding would be phased and studied over multiple years.
