Benefits Review Committee - July 30, 2026

Agenda

Topics of Discussion

• Approval of prior meeting minutes
• Renewal Update and Discussion

1:30 – 1:45 pm General Business:

• Attendance
• Introductions
• Minutes from Prior Meetings (Approving 7/23)

1:45 – 2:30 pm Renewal Update and Discussion

Presenters:
Rachel Forslund, Benefits
Joe Bober, Mercer

Discussion: All Members

2:30 – 2:40 pm BREAK

2:40 – 3:30 pm Renewal Update and Discussion

Presenters:
Rachel Forslund, Benefits
Joe Bober, Mercer

Discussion: All Members

Minutes

Meeting Summary for July 30, 2026

Voting Members Present

Cheryl Bell, Nancy Bush, Rachel Forslund, Phillip Mason-Joyner, Paula McDonald, Sandra Montoya, Greta Nickerson, Nybelle Caruso, Alex Gonzalez, Cynthia Boettcher, Denim Schneider, Nathan Boles, Brandon Paullin, Bob Skinner

Voting Members Not Present

Ryan Miller, Jon Santana, Ron Wierenga, Tina Marie Sears, Niki Edge, Ezra Flaherty, Katie Alexander

Minutes: Toni McGarvey

Facilitator: Corey Falls and Rachel Forslund

Consultant: Joe Bober, Mercer

2027 Medical, Pharmacy, Dental, and Vision Renewal Projections

Discussion

Joe Bober presented Mercer’s preliminary projections for the 2027 employee benefits renewal. The analysis was based on current plan experience and assumed implementation of the recommended medical and pharmacy vendors beginning January 1, 2027. Specifically, the renewal projections assumed an Aetna medical network and OptumRx pharmacy benefit manager.

Mr. Bober reviewed year-to-date claims experience for the County’s medical, dental, and vision plans. Medical claims continued to be monitored against projected costs and included adjustments for enrollment changes, stop-loss reimbursements, and the 2026 plan design modifications to ensure claims were evaluated on a consistent basis before projecting future costs.

The 2025 claims were adjusted to reflect the 2026 benefit level so the historical claims could be compared consistently. After these adjustments, projected net claims were approximately $25.2 million.

The projection assumed a 7% medical trend and a 10% pharmacy trend, producing an overall blended medical and pharmacy trend of approximately 7.1%. Mercer also included a 1% margin because of continuing uncertainty related to claims processing and potential backlog associated with the Collective Health transition. With the assumed Aetna and OptumRx arrangement, OptumRx was projected to reduce costs by approximately 3% compared with the current pharmacy arrangement, while Aetna’s provider discounts were described as generally comparable to Providence’s.

Mercer explained that the carrier comparison used claims repricing. Each prospective carrier received the County’s claims data and independently repriced the claims based on its own contracted provider rates without seeing Providence’s allowed amounts or the other carriers’ results. This methodology was intended to provide an apples-to-apples comparison. Mercer noted that the repricing results showed Aetna favorably compared with Regence and Moda because of differences in provider discounts; the Regence and Moda claims would have to be increased by approximately 13% to reflect their contracted rates in the comparison.

Using the Aetna and OptumRx assumptions and no plan design changes, Mercer projected an overall medical increase of approximately 8.7% after applying the County’s 95/5 contribution structure. Mercer illustrated that the employee impact would vary depending on the plan and enrollment tier.

Dental and Vision Experience

Mercer reported that dental experience was running slightly below target overall, at approximately 97–98% of target year-to-date. The incentive plan was running at approximately a 90% loss ratio. The preventive plan was running somewhat higher, while the traditional dental plan had only about 42 participants, making its 113% loss ratio less credible because a small number of claims can materially affect the result.

Mercer recommended holding the current dental rates because the overall projection showed only a slight decrease and changing the rates would not provide a meaningful benefit. Vision remained under its fully insured arrangement. Mercer reiterated that Delta Dental and VSP would remain in place and would not be affected by the medical and pharmacy vendor transition.

Pharmacy Vendor Discussion

Cynthia Boettcher asked about the status of CVS Pharmacy versus OptumRx. Rachel Forslund clarified that no final decision had yet been made and that additional discussions were scheduled with the Board of County Commissioners. Joe Bober explained that OptumRx was being used in the preliminary projection because it showed slightly better pricing and less member disruption than CVS.

Medical Plan Names, Networks, and Transition Considerations

Cheryl Bell asked whether the current Open Option and Personal Option would continue under a new medical vendor. Mr. Bober explained that the County would likely continue to offer two plans that are substantially similar to the current options, although the plans could be renamed depending on the selected carrier. Alex Gonzalez recommended that open enrollment materials clearly identify the relationship between any new plan names and the former Providence plan names so employees can understand the equivalency during the transition. Rachel Forslund stated that the HRIS team was already considering ways to make the transition and plan equivalencies easier for employees to understand.

Heather Pedersen reported that the Board had reviewed cost and disruption comparisons and had raised questions similar to those raised by BRC members, particularly concerning alternative care. She stated that Aetna had indicated it could provide an approach similar to the County’s current Providence arrangement for alternative care, including paying claims as billed for applicable alternative-care diagnosis codes. She also confirmed that Providence providers were expected to remain in Aetna’s network.

Paula McDonald asked about out-of-network coverage for dependents attending school outside Oregon. Mr. Bober explained that the current Open Option includes out-of-network coverage and that this feature would continue. He also noted that Aetna is a national network, so covered members would have access to the Aetna network throughout the United States if Aetna is selected.

Contribution Modeling and Plan Design Options

Mercer reviewed projected contribution impacts for Aetna/OptumRx, Kaiser, Regence, and Moda. Without plan design changes, the overall increases would remain above the County’s 5% contribution limit. Mercer illustrated that the projected overall increase was approximately 8.7% with Aetna/OptumRx, compared with approximately 17.8% with Regence and 17.4% with Moda under the assumptions presented. Because the County is already at its 5% contribution limit, increases above 5% would generally be borne by employees under the represented employee contribution structure.

Mr. Bober explained that approximately $1.6 million in savings would be needed across the medical plans to bring the represented employee contribution increase down to the 5% level.

Mercer presented examples of potential plan design changes and their estimated savings. Mercer noted that increasing deductibles and out-of-pocket maximums generally provides a larger financial impact than smaller copay changes because the changes affect members who generate a larger share of claims. 

Mercer noted that increasing deductibles and out-of-pocket maximums generally provides a larger financial impact than smaller copay changes because the changes affect members who generate a larger share of claims. The committee also discussed coinsurance as another possible lever. Mr. Bober explained that increasing coinsurance could produce additional savings, but the savings would not equal the percentage increase because not all members use the plan and some members already reach their out-of-pocket maximum.

Bob Skinner asked that future exhibits show the percentage savings associated with each plan design change in addition to annual dollar savings. Mr. Bober agreed to add overall percentage impacts for the three plans and to provide packaged options that show how combinations of changes would affect rates and employee contributions.

The committee discussed the distinction between reducing the overall cost of benefits and shifting where the cost is paid. Greta Nickerson emphasized that plan design changes do not necessarily reduce the underlying cost of care; instead, they can shift costs from payroll contributions to deductibles, copays, or other member cost-sharing. The alternative is to leave plan design unchanged and have employees pay higher contributions. Mr. Bober agreed that the plan design decisions essentially determine where the additional dollars fall.

GLP-1 Coverage Discussion

The committee discussed whether to add coverage for GLP-1 medications used for weight loss. Mercer provided estimated coverage costs.

Greta Nickerson asked whether other public-sector employers were adding weight-loss GLP-1 coverage. Mr. Bober said that GLP-1 coverage is a frequent topic in employer benefits discussions, but he had not personally worked with a public or private group that had recently added weight-loss coverage under comparable circumstances, noting that many organizations are concerned about the additional cost.

Cynthia Boettcher asked whether the County could create a richer optional plan that included GLP-1 coverage so employees who wanted that benefit could select it and pay a higher contribution. Mr. Bober explained that the plan options could retain different levels of deductibles, copays, and out-of-pocket maximums, but he also noted that if GLP-1 coverage is added to Kaiser, Kaiser requires the coverage to be added to the self-funded plans as well. Therefore, the cost would need to be incorporated into the overall plan design and contribution modeling rather than isolated entirely to Kaiser.

Additional Plan Design Discussion

The committee asked whether deductible and out-of-pocket maximum amounts for individual and family coverage must remain in a fixed relationship. Mr. Bober stated that this would need to be confirmed with the selected carrier, but there are plans in the marketplace with different family-to-individual deductible relationships. He noted that increasing the family deductible can have a smaller financial impact because fewer members reach the family deductible.

Sandra Montoya asked whether reducing the number of medical plan choices could produce savings. Mr. Bober explained that the current two Providence plans and one Kaiser plan are a common structure for an employer of the County’s size and that the two Providence plans serve different needs, including one option with out-of-network coverage and a richer buy-up structure. Cynthia Kodachi added that Kaiser’s HMO structure is also a reason it is offered differently from the Providence plans.

Denim Schneider asked about provider disruption under Aetna. Mr. Bober explained that the majority of the identified Aetna disruptions involved alternative-care providers, particularly chiropractic providers. He reported that Aetna had agreed to an arrangement under which applicable alternative-care services would be covered as billed, regardless of whether the provider is in or out of network, which would substantially address the concern about disruption for those services.

Rachel Forslund asked whether plan design could be adjusted by mixing copays, coinsurance, visit limits, and other service-specific provisions. Mr. Bober stated that additional combinations could be explored, although the availability of specific designs would need to be confirmed with Aetna or the selected carrier. He agreed to review additional options while considering the financial impact on members and the savings generated.

Mercer also reviewed available information regarding how many members had reached deductibles and out-of-pocket maximums. Mr. Bober explained that the data were intended to help the committee understand how many members could be affected by proposed cost-sharing changes, while recognizing that year-to-year utilization can vary and that the 2026 deductible changes make direct comparisons more difficult.

Benchmarking and Future Modeling

Sandra Montoya asked whether the County’s deductibles were comparable with other public-sector employers. Mr. Bober stated that the County appeared to be approximately in the middle of the benchmark range. He offered to prepare an additional benchmarking slide for a future meeting so the committee could see the County’s position relative to other employers.

Mr. Bober agreed to return with two or three packaged plan design options that would approach the approximately $1.6 million savings target, including the resulting rates and employee contributions. He also agreed to add percentage impacts to the exhibits and to show how different combinations of plan changes would affect the overall contribution structure.

Committee Questions

• Members asked clarifying questions regarding the assumptions behind the Aetna and OptumRx projections, plan naming and equivalencies, alternative-care coverage, out-of-network access, the 95/5 contribution structure, the $1.6 million savings target, and the potential impact of various plan design changes.
• The committee discussed how deductible, out-of-pocket maximum, copay, coinsurance, and GLP-1 changes could affect both the County and individual employees. Members emphasized the importance of balancing savings with employee affordability and maintaining understandable plan choices.
• The committee requested additional modeling that packages multiple plan design changes together and shows both annual savings and percentage impacts, along with the resulting employee contribution rates.

Next Steps

• Mercer will prepare updated renewal modeling, including two or three packaged plan design options designed to approach the approximately $1.6 million savings target.
• Mercer will add overall percentage savings/impact figures to future exhibits and show the effect of proposed packages on rates and employee contributions.
• Mercer will continue evaluating plan design alternatives, including deductibles, out-of-pocket maximums, copays, coinsurance, and GLP-1 coverage, and will confirm carrier feasibility where necessary.
• Mercer will provide additional benchmarking information regarding deductibles and plan design for comparable employers.
• Staff will continue work on open enrollment communications and plan-name equivalencies so employees can understand how any new plans correspond to the current Providence options.
• Weekly BRC meetings will continue during August as the renewal and plan design cycle progresses. Members should advise staff of any anticipated absences because quorum may be required for future votes.
• Toni McGarvey will resend the presentation deck and distribute finalized meeting materials. Finalized minutes will be posted to the public-facing webpage rather than draft minutes.

Other Business

Minutes from the Benefits Review Committee meetings occurring on 7/9/2026 had been distributed prior for review. No edits or revisions were reported.

Motion made by Paula McDonald to accept and approve minutes from the July 9th BRC Meeting as written.

Motion was seconded by Sandra Montoya

Yay/Nay Count: 14 Yes, 0 Nay 
Motion passes unanimously to accept minutes as written

Adjournment

There being no further business, the meeting concluded at approximately 2:52 p.m.