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Williamson County

Presented by Charles Pareigis,

and Mike Henson

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Benefit Topics

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  • Dental RFP Results
  • Medical
    • Contract Discussions
    • Plan Design Changes
    • Premium Options

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Dental RFP Responses

  • Delta Dental- Incumbent
  • Cigna
  • Met Life
  • Ameritas – DQ Failed to complete the RFP requirements.
  • The Standard – DQ Failed to complete the RFP requirements.

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Dental Results

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Dental Recommendation

  • Cigna Total Network coupled with the Cigna DHMO. The DHMO will replace the Base Plan.
  • The DHMO will be free for the Employee and greatly reduced cost for EE+1 or Family.
  • Every employee who enrolls in the DHMO will save on dental plan claims and no ASO fee. Actual savings will be based upon the final enrollment percentage.
  • Cigna’s first 6 months of Admin Fees equals $147,000 in savings.
  • Cigna integration between medical and dental saves 1% of medical claims or an estimated $600,000 in savings.

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New Dental Premium �Equivalency Versus Current

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The Employee will save approximately 50% versus the current plan for EE+1 or family coverage.

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Cigna Medical Contract Review

  • Cigna included in the already approved Medical/RX proposal, significant savings for the RX program. There are no additional costs. The estimated savings are between $5 and $6 million on RX claims for 2026.
  • We negotiated with Cigna to include this provision effective on the date the contract was signed. This will save an estimated $2.5 million through the remainder of this year.
  • Total Estimated Savings from signed contract date to 12/31/26 is estimated at $7.5 million.

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Cigna GLP-1 Contract ROI Options

  1. Encircle RX
    • Targets the utilization of GLP-1 medications, providing more appropriate usage.
    • BMI of 32 or greater OR documented BMI of 27 or greater with 2 weight-related conditions.
    • Customers must enroll in Omada and actively engage with the monitored program, involving 4 weigh-ins and 4 app engagements within a rolling 30-day window.
    • Cost is $1.25 PMPM or $189,000 per year.
    • Estimated Net Savings of $1.3 million based on only $3.2 million in claims.
  2. Other options include eliminating GLP-1 for weight management. This would save approximately $5.2 million based on the most recent claims data.
  3. Another option is no plan change, and the costs for our current program will continue to escalate.

We are recommending Option 1.

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Pathwell Bone and Joint Contract Recommendation

  • Provides savings of up to 25% on Musculoskeletal surgeries to the plan as a result of better outcomes and a reduction in surgical costs.
  • Cost is $500 per year for each participant who enrolls in Pathwell.
  • Member benefits include:
    • $0 cost to the member for surgery for employees enrolled in the Deductible plan. HSA participants must meet their deductible first. This is a Federal Law.
    • 100% coverage for up to 5 PT visits.
    • $600 travel benefit if the participant travels more than 60 miles.

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Plan Design Deductible and �Out of Pocket Max Recommendations

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Plan Design Coinsurance Suggestions

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Or

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Employee Contribution Suggestions

  • Increase the cost of the Open Access Plan
  • Increase the monthly Surcharge by $15 to the Employee only cost and $30 to the EE+1 or Family levels for OAP only.
  • Between premium savings and claims savings due to migration to Local Plus, this will net approximately $1 million in additional savings with only 15% migration to Local Plus. Members enrolled in Local Plus have lower claims costs because the network reimbursement is lower.
  • The only premium cost change we are recommending will impact OAP-enrolled employees and dependents only.

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Employee Contribution Suggestions

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HSA Changes

  • The federal contribution limits are increasing by $100 for an individual and $200 for a family in 2026. No change to the $1000 catch-up contribution limit for employees who are age 55+
  • 2026 HSA Contribution Limits 
    • Self-Only Coverage: $4,400
    • Family Coverage: $8,750
    • Additional Catch-Up Contribution (Age 55+): $1,000

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Thank you for your time and attention.

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