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City review outlines Vienna's high‑deductible plan, HRA structure and broker fees
Summary
The Schwindeman Agency walked the council through Vienna’s medical plan design: a Highmark high‑deductible PPO with a $6,000 individual deductible and an HRA that reduces employee out‑of‑pocket exposure to about $1,750; council asked for historical contribution data and discussed spousal limitations and broker compensation.
Mark Schwindeman of the Schwindeman Agency presented a detailed review of the City of Vienna’s employee benefits and renewal process, saying the agency markets the city’s benefits each year and provides ongoing employee resources.
Schwindeman described the medical coverage as a high‑deductible PPO with Highmark Blue Cross: an individual deductible of $6,000 and a family deductible of $12,000, with an embedded individual limit and a maximum out‑of‑pocket of $9,200 for a single enrollee (double for family). He gave specifics: a $25 office visit copay for primary care and specialists, $40 urgent care copays, an emergency room charge after the deductible with a $150 copay, and prescription copays of $15 for a 34‑day supply and $45 for a 35–90 day supply.
Key to the plan design is the city’s Health Reimbursement Arrangement (HRA). Schwindeman explained the mechanics with numbers: “the employee pays the first $400, the employer funds the next $4,002.50, then the employee pays the remaining $1,350,” which he said results in an effective out‑of‑pocket cost for major medical services of roughly $1,750 for an employee under the combined design.
Council members raised whether the city’s coverage qualifies as credible coverage for federal requirements; Schwindeman confirmed it does. The council debated a spousal limitation or surcharge for employees whose spouses have alternative employer coverage. Schwindeman and other commenters cautioned that in a small group of roughly 63 active plan members the city risks adverse selection if it excludes or surcharges dependents; that can lead to higher future premium increases.
Members requested historical contribution and premium data going back multiple years and asked for modeling of phased employee contribution scenarios. Schwindeman said he could provide projections; the mayor said he would not support measures that would unduly penalize employees’ access to benefits. Schwindeman also disclosed his agency’s compensation: $25 per employee per month on health insurance (unchanged since 2011) plus standard commissions on ancillary products, and said commissions are billed separately to the city.
Next steps: staff will gather historical contribution data and the agency will prepare modeling for different employee‑contribution scenarios ahead of formal budget decisions.
