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Triple option, HMO and direct‑primary‑care considered; vendors warn underwriting could raise renewal
Summary
Presenters offered options including a triple‑option (co‑pay, HMO, HDHP), which could force re‑rating and raise the city’s renewal to about 20%; an HMO showed a possible 5% discount and a direct primary care (DPC) option could replace the co‑pay plan but has geographic/access limitations.
Presenters described several plan‑design alternatives intended to reduce the headline increase: Option 1 would increase HDHP deductibles (moving individual deductible from $5,000 to $6,000 and raising OOP max to $8,000), while Option 2 would keep the HDHP unchanged and raise the PPO out‑of‑pocket maximum to $6,000. Gallagher said combining the two plan changes could reduce the renewal to just over 7 percent but likely would require underwriting rerating.
Heather Von Gotten said a triple option—adding an HMO alongside the co‑pay and HDHP—was newly available but would reduce guaranteed monthly contributions and could increase the city’s renewal from ~12% to ~20% in underwriting. She added the HMO showed about a 5% discount from PPO on paper but that the triple‑option structure changes the underwriting math. Von Gotten also noted the pool will remove Jardiance effective Aug. 1 (Lakeway currently has no members using that drug). “The triple option must be a co‑pay plan, an HMO, and a high deductible health plan,” she said, and the council was warned that adding plans can dilute monthly contributions and affect rates.
