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Edinburg CISD staff recommend UnitedHealthcare as new health-plan third-party administrator
Summary
District staff recommended moving the self-funded health-plan administration from Blue Cross Blue Shield to UnitedHealthcare after a multi-vendor RFP and claim repricing; staff said UnitedHealthcare's network covers 99.9% of current providers and will allow more plan-design flexibility ahead of an Oct. 1 open enrollment.
Dustin Garz, the district's insurance manager, told the board the administration recommends selecting UnitedHealthcare as the third-party administrator (TPA) for the district's self-funded health plan following an RFP process.
"So the administration will be recommending moving to UnitedHealthcare," Garz said as he reviewed committee rankings. Garz said four TPAs submitted proposals, and the district conducted claim repricing that showed similar costs among the top-ranked vendors. He told trustees that UnitedHealthcare's network includes 99.9% of the providers the district currently uses, a key factor in the recommendation.
The committee that evaluated proposals included Garz, Miss Felix and Amado Tejrino (committee names were presented by staff). Garz said staff will negotiate contract language with the recommended vendors and return a finalized package to the board at the Aug. 11 meeting so changes can be implemented before open enrollment.
Board members asked about timing and contract terms. Garz said the recommended changes would be implemented Jan. 1 if approved and that the district treats major insurance items as annual renewals and monitors performance, noting the health plan represents roughly $53,000,000 in annual spend.
If the board approves the recommendation at a future meeting, staff said they will begin implementation work — building files, aligning plan-language and conducting employee education sessions ahead of the Oct. 1 open enrollment start.
