Benefits Review Committee - Aug. 13, 2026

Agenda

Topics of Discussion

• Approval of prior meeting minutes
• Renewal Update and Discussion

1:30 – 1:40 pm General Business:

• Attendance
• Introductions
• Minutes from Prior Meetings

1:40 – 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 August 13, 2026

Voting Members Present

Cheryl Bell, Nancy Bush, Rachel Forslund, Phillip Mason-Joyner, Sandra Montoya, Greta Nickerson, Jon Santana, Ron Wierenga, Nybelle Caruso, Alex Gonzalez, Cynthia Boettcher, Pablo Oropeza, Denim Schneider, Nathan Boles, Niki Edge,Bob Skinner, Katie Alexander

Voting Members Not Present

Paula McDonald, Brandon Paullin

Minutes: Toni McGarvey

Facilitator: Corey Falls and Rachel Forslund

Consultant: Joe Bober and Morgan Hoffman of Mercer

Opening / Housekeeping

Toni McGarvey opened the meeting and advised that previously circulated minutes would be addressed later in the meeting so the committee could devote the initial portion of the meeting to the substantive plan-design discussion. Rachel Forslund introduced Pablo Oropeza as a new BRC member who would be filling in for the remainder of the current BRC season. Toni also reported that there was one non-represented vacancy remaining on the roster.

2027 Medical, Pharmacy, Dental, and Vision Plan Design: Aetna Transition

Mercer Review of Plan Design Options

Joe Bober began by reviewing the plan-design information previously presented and introduced a new exhibit requested at the prior meeting. The first scenario represented no plan changes. The presentation then reviewed the previously modeled options for Kaiser and the Providence Personal and Open Options, along with the two primary packaged approaches that had been discussed previously.

Option 1 continued to focus primarily on deductible and out-of-pocket maximum changes. The more comprehensive. Option 2 incorporated most of the available plan-design levers and included GLP-1 coverage for weight loss, resulting in an overall increase.

Joe then reviewed a new single-page exhibit that placed the current benefits, proposed changes, and rates together so committee members could more easily compare the alternatives. Information was displayed for the Personal and Open Options, including the four-tier rates for non-represented employees and the composite rates applicable to represented employees.

Financial Estimates and Long-Term Impact of GLP-1 Coverage

Rachel Forslund asked Joe to clarify that the rates shown for the Aetna options with GLP-1 coverage were estimates rather than guaranteed costs. Joe confirmed that all of the modeled plan changes are best estimates based on prior claims experience and other available data. Actual utilization may be higher or lower, and actual results will vary from the estimates.

Greta Nickerson asked how the addition of GLP-1 coverage could affect future renewals. Joe explained that the following year's renewal would be based on the prior 12 months of actual claims and utilization. If utilization of a newly added benefit is higher than projected, the higher utilization would affect the next renewal calculation. Conversely, lower utilization could result in a lower impact. He emphasized that this same utilization-based process applies to other plan changes as well.

Alex Gonzalez asked whether Mercer had experience with other employer groups that had added GLP-1 coverage for weight loss and whether there was enough history to evaluate year-over-year effects. Joe stated that GLP-1 coverage is a frequent topic among employer groups but that he personally had limited experience with groups that had already adopted the benefit. He indicated that Mercer could conduct additional research. Joe also explained that the pharmacy trend assumption used in the analysis would generally be approximately two percentage points higher when a group includes GLP-1 coverage for weight loss.

Motion to Remove GLP-1 Coverage from the Current Discussion

Sandra Montoya made a motion to remove GLP-1 coverage options from the BRC's discussion for the current 2026 BRC cycle. Sandra explained that the County was already undertaking a significant transition from Providence to Aetna and that she believed it would be useful to simplify the decision-making process by evaluating the carrier transition separately from the additional uncertainty associated with adding GLP-1 coverage for weight loss.

Greta Nickerson seconded the motion. 

During discussion, Greta explained that she had spoken with numerous coworkers and groups and was concerned about adding another significant unknown at the same time the County was changing carriers. She emphasized that her concern was primarily financial and related to the potential for utilization to increase after the benefit was introduced. She also noted that the committee could revisit the subject in a future year with more actual utilization data.

Cynthia Boettcher opposed removing the issue from consideration. She stated that she was hearing strong support from the employees she represents for adding the coverage and that employees' experiences with GLP-1 medications could involve broader health and quality-of-life considerations beyond weight loss. Cynthia argued that the committee should continue discussing the benefit rather than postponing the issue primarily because of the carrier transition.

Alex Gonzalez asked about the methods other members were using to gather employee feedback. He explained that his group had conducted a more formal survey and that the feedback he received favored maintaining the current plan design, although he remained interested in obtaining additional information about the potential long-term effects of GLP-1 coverage. Joe agreed to investigate whether Mercer had additional experience or data that could help answer those questions.

Voting: GLP-1

The committee proceeded to a formal vote after discussion.

Motion made by Sandra Montoya to remove GLP-1 coverage from consideration for the current BRC cycle. 

Motion was seconded by Greta Nickerson

Yay/Nay Count: 6 Yes, 3 Abstention, 8 Nay 
As a result, GLP-1 coverage remained on the table for the committee's continued consideration.

Following the vote, Sandra asked whether the result meant that the committee would now consider only covered or existing benefits. Greta and Alex clarified that the vote did not eliminate any other plan-design options; it simply meant that GLP-1 coverage would remain available for consideration rather than being removed from the discussion. The committee could ultimately select an option that did not include GLP-1 coverage.

Employee Feedback and Alternative Care

Alex Gonzalez reported that his members had been surveyed regarding the plan options. The strongest feedback he had received favored maintaining the status quo for the year, apart from the necessary transition from Providence to Aetna. He asked other committee members what they were hearing from their represented groups.

Katie Alexander reported that alternative care was a particularly important issue among the employees she had heard from. She also reported that employees generally viewed GLP-1 coverage as an issue where more time and data would be helpful. Katie asked how Aetna would handle alternative-care services under the County's new arrangement.

Joe explained that the County had specifically negotiated with Aetna to preserve the existing approach to alternative care. Under the arrangement, qualifying alternative-care services would continue to be covered at billed charges rather than being subject to the ordinary in-network/out-of-network discount structure. The member would pay the applicable cost share, such as the plan's copay, and the County would pay the remaining billed charge.

Several members emphasized that alternative care had generated significant employee concern because of prior difficulties involving provider participation and payment arrangements. Greta Nickerson stated that employees were already researching whether their current providers would participate with Aetna and expressed concern that employees could become alarmed if they looked at Aetna's public website and saw information that did not reflect the County's special arrangement.

Joe confirmed that employee education would be important because Aetna's public website may display ordinary network information that does not fully explain the County's special self-funded arrangement. He stated that the County's arrangement would continue to provide the negotiated coverage at billed charges regardless of whether the alternative-care provider was in or out of Aetna's standard network.

Denim Schneider asked for clarification about providers who may be reluctant to accept Aetna because of concerns about reimbursement. Joe reiterated that qualifying alternative-care services would be covered at billed charges under the County's arrangement.

Alex Gonzalez asked whether the special alternative-care arrangement would be specifically reflected in contract language and employee communications. He emphasized that employees had lingering concerns from prior experiences with alternative-care administration and that clear communication would be important to prevent confusion during the transition.

Aetna Transition and Plan Naming

Rachel Forslund reminded the committee that if GLP-1 coverage were ultimately added to Aetna, it would also need to be added to Kaiser so that the benefit would be available consistently across the applicable medical options. She also cautioned employees against relying too heavily on the Aetna public website before the County's plan designs are finalized. Aetna would be developing a County-specific benefits microsite and network information after receiving the final plan design.

Alex asked whether the County had decided what to call the Personal and Open Options after the carrier transition. Rachel said the County expected to have more information the following week but believed the existing plan names could likely be retained. Joe explained that Aetna network terminology would still appear in some materials, but the County's plan names—such as Personal Option and Open Option—could likely continue.

Greta raised a related concern about whether retaining the existing names might create unnecessary confusion if Aetna uses different terminology. She suggested that, because the County was already changing carriers, this might be an opportunity to adopt Aetna's terminology rather than maintaining a permanent crosswalk between old and new names. The issue was left for further consideration.

Request for Additional Employee Input

Cynthia Boettcher requested that the committee allow another week for members to communicate with their represented employees before taking an official vote on a plan option. As the largest represented group, she wanted more information before making a formal recommendation or voting.

Straw Polling Process

Because several members were new to the BRC, the committee paused to review the purpose and process of a straw poll. Corey Falls explained that a straw poll is an informal, non-binding method for determining where committee members are leaning based on the information available at that time. He emphasized that a member could change their position later when additional information was available and a formal vote was conducted. The facilitator could ask an open-ended question and use raised hands or verbal responses to gauge the group's position. 

Straw Poll of Plan Options

The committee discussed whether additional plan-design combinations should be modeled before conducting a straw poll. Cynthia expressed interest in seeing more combinations similar to the alternatives historically presented in prior years. Greta focused on the benchmarking information and emphasized the importance of maintaining competitive benefits while avoiding unnecessarily high deductibles.

Rachel explained that the options Mercer had presented were selected because they represented the plan-design levers most likely to produce a meaningful reduction in the renewal increase. Smaller changes, such as adjustments to emergency-room copays, would generally have a much smaller financial impact than changes to deductibles or out-of-pocket maximums. Joe confirmed that Mercer could price additional combinations if the committee identified specific changes it wanted to examine.

Bob Skinner noted that in prior years the committee generally reviewed three options, conducted a straw poll, and then narrowed the field. Joe acknowledged that, in addition to Options 1 and 2, the committee could also treat no plan changes as a third alternative.

The committee conducted an informal straw poll. Option 1 initially received five (5) votes. Option 2 received eight (8) votes. Option 3, no plan changes, received ten (10) votes. 

Discussion of the Straw Poll Results

Nathan Boles observed that the results appeared to highlight the continuing question of whether the committee wanted to include GLP-1 coverage. Alex agreed that the results suggested members were concentrated toward the two ends of the range: maintaining the status quo or considering the more comprehensive package that included GLP-1 coverage and additional plan-design changes.

Sandra Montoya shared a separate analysis she had developed to show the proposed changes in both dollar and percentage terms. She explained that viewing the changes as percentages helped demonstrate the magnitude of some of the proposed increases. Sandra stated that these larger immediate cost exposures were a major reason she favored no plan changes despite understanding that premiums would increase.

Alex commented that the straw poll appeared to show little interest in the middle ground of simply raising deductibles and out-of-pocket maximums—the approach the committee has often used in previous years. 

Bob Skinner expressed concern about the no-change option because of its impact on represented employees' monthly premiums. Joe showed the modeled composite premium impacts for represented employees. Under the no-change scenario, the estimated monthly cost increase was substantially higher for represented employees, with the percentage increases varying by plan. Bob emphasized that represented employees tend to include lower-paid County employees and that significant premium increases could discourage employees from obtaining preventive care.

Joe noted the important distinction between premium increases and plan-design changes: a premium increase affects everyone enrolled in the plan, whether or not they use medical services, while a deductible or out-of-pocket change primarily affects employees who incur enough claims to reach those thresholds.

Cynthia Boettcher offered a different perspective, noting that employees who choose the Open Option are knowingly selecting a richer and more expensive plan. She stated that employees may be willing to pay a higher monthly premium in exchange for broader coverage and choice, and that the committee should consider that employee preference when evaluating the options.

Request for a Moderate Plan-Design Option

Greta Nickerson proposed that the committee consider a middle-ground option rather than limiting the discussion to no changes or the comprehensive Option 2. She suggested modeling a package that would make more moderate increases to deductibles and out-of-pocket maximums for Kaiser and the Aetna plans, while leaving office-visit and other copays unchanged and excluding GLP-1 coverage from that particular package.

Joe confirmed his understanding that the requested model would involve only deductible and out-of-pocket maximum changes, would leave the copays unchanged, and would not include GLP-1 coverage. He agreed to price that alternative for the next discussion.

The committee also discussed whether the Open Option deductible could be increased further to bring it closer to the Personal Option. Joe explained that increasing the Open Option deductible could reduce the overall cost but would make the two plans more similar. Rachel noted that the difference in out-of-pocket exposure between the plans could also become smaller.

Joe explained that the Personal and Open Options historically reflected a 'base and buy-up' structure, with the Open Option designed as the richer plan and therefore carrying higher employee contributions. The committee recognized that the structure has historical roots and would need to be considered when evaluating changes.

Next Steps

• GLP-1 coverage will remain on the table for continued BRC discussion after the motion to remove it from consideration failed.
• The committee will continue gathering feedback from represented and non-represented employee groups before any final plan-design vote.
• Mercer will continue to investigate available experience or data from other employer groups that have added GLP-1 coverage for weight loss, including potential effects on future utilization and renewals.
• Joe Bober will model a more moderate plan-design alternative requested by Greta Nickerson: moderate deductible and out-of-pocket maximum changes, no changes to the discussed copays, and no GLP-1 coverage in that particular scenario.
• The committee will continue to evaluate the financial and employee-impact differences between no plan changes, the broader Option 2 package, and additional alternatives that Mercer may model.
• County Benefits staff will continue working with Aetna on the County-specific plan design, network information, benefits microsite, employee education, and communications.
• The County will provide clear communication regarding the special alternative-care arrangement with Aetna so employees understand that qualifying alternative-care services will continue to be covered at billed charges under the County's arrangement.
• The committee will continue to consider whether the Personal Option and Open Option names should remain the same or be changed to align more closely with Aetna terminology.
• Members who will be unavailable for the following week's meeting were asked to notify Toni McGarvey so the committee can confirm that quorum will be maintained.
• Members were encouraged to send questions or requests for additional information to Toni or the Benefits team as soon as possible so Mercer can prepare information for the next meeting.

Adjournment

Toni McGarvey announced that the meeting had reached its scheduled end and reminded members that quorum would be particularly important for the next meeting. Members were asked to communicate any scheduling conflicts and to submit requests for additional information in advance so the Benefits team could alert Joe and Mercer. 

The meeting was adjourned at approximately 3:31 p.m., with the next meeting scheduled for the following Thursday, August 20, 2026.