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Board approves UMR as TPA and accepts benefits strategy that may shift many employees to Tier‑1 network
Summary
Trustees voted to approve UMR as the district’s third‑party administrator and accepted a benefits strategy that favors a Nexus ACO Tier‑1 approach to achieve projected savings; trustees sought more detail on a pacing deficit (~$1.3M) and impacts on employees.
Elmbrook trustees approved UMR as the third‑party administrator for the district’s self‑insured health insurance plan and accepted a recommended benefits strategy intended to reduce costs for the 2025 plan year.
Staff and consultants presented three plan-design options and recommended Option 1—focused on a Nexus ACO and a Tier‑1 provider emphasis—on the basis that it would produce the greatest savings consistent with budget objectives. The benefits consultant acknowledged the district presently faces a projected deficit in the plan (discussed as roughly $1.3 million at the time of the meeting with potential variance), and said the district is pacing about $15.7 million in total plan cost through June 30. One strategy—narrowing to a smaller Tier‑1 network—could affect an estimated 30% of employees, who might face higher out‑of‑pocket costs if they remain with some current primary‑care providers outside Tier‑1. Staff said tiering would include education, choice for employees, and continuation of Tier‑2 benefits that still pay better than out‑of‑network.
Trustees asked for more time to review pharmacy‑benefit managerial outcomes (PBM carve‑outs and OptiMed results were discussed), stop‑loss reimbursements, and the timing for implementing network changes to make systems ready before open enrollment. The board approved the TPA selection and accepted the benefits strategy; staff will notify UMR, configure systems for a narrower Tier‑1 setup and provide an employee education plan before open enrollment.
