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Elmbrook staff outline 2025 benefits strategy; UMR TPA renewal, tiered network and screening changes considered
Summary
District staff recommended renewing the UMR third‑party administrator contract and presented three benefit strategies to close a budget gap: a Nexus ACO tiered network, expanded complete physical exams, and a specialty pharmacy carve‑out. Estimated annual savings range from hundreds of thousands to about $1 million depending on adoption and utilization shifts.
Elmbrook staff presented a multi-part approach to close a projected $1.5 million gap in the district’s employee health plan and keep long-term benefit costs manageable. The board heard a one-year TPA renewal recommendation and a slate of options for the 2025 benefit strategy.
Pam summarized the TPA renewal: UMR (a wholly owned subsidiary of UnitedHealthcare) manages the district’s self-funded plan. The renewal effective 09/01/2024 includes a pre-negotiated administrative fee increase of 4.2 percent; Pam said total spend for the TPA is $380,000 with wellness…
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