Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Employee Insurance topic
No spam. Unsubscribe anytime.
Insurance consultant presents renewal options, flags pharmacy-driven claim volatility and self-funding alternative
Summary
Valley Risk Consulting presented April claims data showing high pharmacy-driven costs and presented alternatives: Blue Cross renewal (big increase), HMO proposals, and a self-funded model with a $125,000 credit from United as a possible structure to reduce long-term expense growth.
Roger Garza of Valley Risk Consulting briefed the commission on June 3 about employee health-plan claims trends, renewal proposals and possible plan structures as the city approaches its renewal window.
Garza summarized recent claims: he reported April 2025 medical paid at roughly $117,023 with total claims in that month near $151,000, and he said pharmacy expenses and a small number of very-high-cost claimants (oncology cases) drove most of the volatility. "It could be one person... it's really the confinement part where people spend $300,000 to $500,000 in that first week," Garza said.
He reviewed renewal proposals from current carriers. Blue Cross and Blue Shield presented a fully funded renewal that included a proposed price increase (a best-and-final offer that still represented a sizeable increase); Garza said the Blue Cross offers involved deductible increases that he and staff found undesirable for employees. Garza also described HMO options and a competitive United proposal that included a $125,000 credit incentive.
Garza advocated examining self-funded options to give the city more control of plan design and long-term cost, while cautioning that self-funding requires administrative structure and a stop-loss policy to limit catastrophic exposure. He noted network considerations: Nava (NAP) Medical Center was not in one national network mentioned and would require negotiation or supplemental arrangements to preserve local access.
What happens next: Garza said consultants will run financial scenarios for fully funded and self-funded models and present recommendations at a future meeting so the commission can select a renewal path before the plan's effective date.
