Sweetwater council moves city-paid plan to Blue Cross HMO, keeps Ameritas for dental and vision

The Sweetwater City Council voted Aug. 12 to make the Blue Cross Blue Essentials HMO the city-paid baseline health plan for employees and to continue using Ameritas for dental and vision coverage.

Nancy, who presented the procurement results, told the council Blue Cross was the only carrier to submit a health bid; Aetna reviewed the materials but declined to provide a quote. "If everyone in your plan was in the HMO, it would save about $245,000 in claims a year," Nancy said, adding that underwriting and real-world participation could reduce that figure.

Staff proposed that employees be offered a two-tier buy-up to retain a PPO: Nancy described an employee-only buy-up of $125 and an employee-with-dependents buy-up of $3.10 as the underwriting difference between the HMO and PPO conventional-rate equivalents, noting those figures were provided by underwriting.

Council members asked about provider networks and patient access; Nancy said the Blue Essentials network covers 100% of acute-care hospitals in Texas, about 98% of primary-care physicians and about 96% of specialists, and that employees choosing the HMO would need a primary care physician to coordinate referrals. Trent Poindexter shared a personal example of using a pediatrician referral for specialty care to illustrate the referral process.

After discussion, a motion to adopt the HMO as the city-paid plan and to continue Ameritas for dental and vision carried on a voice vote. Staff said they will meet with employees to explain plan differences and to collect initial plan selections and required primary care provider assignments for those who select the HMO.

The council did not schedule a separate second reading; staff will implement the enrollment and sign-up process with human resources and payroll.