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Elkhorn Area School Board approves dual‑choice health plan for 2026 to curb costs
Summary
The board voted Nov. 10 to offer employees a dual‑choice 2026 health plan: a Mercy Care HMO limited‑network fully insured option and a self‑funded option with EverPoint Elite and a Trilogy wrap. Consultants said the design should keep district budget pressure below about 6% while offering drug‑cost savings through new pharmacy programs.
The Elkhorn Area School Board approved a recommended redesign of employee health benefits for 2026 on Nov. 10, adopting a dual‑choice structure the district and its consultant said would limit budget increases while preserving access for staff.
USI consultant Scott Fuller told the board the district’s claims experience and pharmacy trendlines supported offering two options next year: a Mercy Care HMO as a fully insured, in‑network plan and a self‑funded tiered option that uses EverPoint Elite as the primary network with Trilogy Health as a secondary wrap. “So what we’re proposing is, a dual choice option plan,” Fuller said during the presentation.
Fuller reviewed recent claims history and pharmacy costs, saying pharmacy now accounts for roughly 20% of total claims and that doing nothing would have produced an actuarial projection of roughly an 11.6% increase to the benefits budget. He explained the Mercy Care option would have lower employee payroll deductions (a roughly 10% reduction from current contributions for those who select it) but would limit in‑network care to Mercy/Fort HealthCare/Watertown Regional providers; emergency care would still be covered consistent with federal requirements. The self‑funded alternative would carry slightly higher payroll deductions (around a 10% increase for employees who select it) but preserve broader provider access through tiered networks and out‑of‑network coverage at higher cost.
To address rising pharmacy costs, Fuller and staff proposed two targeted interventions for the self‑funded option: use of the federally enabled 340B procurement arrangements and an optional international sourcing program for certain high‑cost drugs. Fuller estimated the combination of those pharmacy programs could yield substantial savings, with projections in the low‑hundreds of thousands of dollars to as much as roughly $400,000–$500,000 depending on uptake.
Board members asked how the two options would affect employees who currently use providers outside the Mercy network and whether emergency care would be covered out of network. Fuller replied that the Mercy Care option intentionally narrows routine access to the Mercy network to reduce cost but that emergency care is covered under ACA rules and that staff who prefer broader provider choice could select the self‑funded option.
After discussion, a board member moved to approve the health insurance proposal as presented; the board approved the motion by roll‑call vote.
What happens next
District staff said open enrollment will proceed immediately: employees must choose an option or waive coverage by the stated deadline so new coverage can begin Jan. 1, 2026. Staff and the consultant emphasized employees should review their prescriptions and provider patterns before selecting a plan, because out‑of‑network cost exposure and available pharmacy savings will depend on each employee’s medications and providers.
