Benefits Review Committee - Aug. 20, 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 20, 2026

Voting Members Present

Cheryl Bell, Nancy Bush, Rachel Forslund, Paula McDonald, Sandra Montoya, Greta Nickerson, Ron Wierenga, Jon Santana, Nybelle Caruso, Alex Gonzalez, Cynthia Boettcher, Liane Kinne, Nathan Boles, Bob Skinner, Brandon Paullin, Katie Alexander

Voting Members Not Present

Philip Mason-Joyner, Denim Schneider, Niki Edge

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 confirmed that the committee had quorum. She introduced Liane Kinne as a new represented panelist joining the BRC. Rachel Forslund also advised that the vacant non-represented position would remain unfilled for the remainder of the current BRC season, with the expectation that it could be filled for the following year.

Voting: Approval of Meeting Summaries for 7/23, 7/30, 8/6 and 8/13

Motion made by Greta Nickerson to approve the minutes as submitted
Motion was seconded by Cheryl Bell

Yay/Nay Count: 16 Yes, 0 Abstention, 0 Nay 

The committee voted unanimously to approve all four meeting summaries. Toni confirmed that the summaries would be finalized and posted.

2027 Medical, Pharmacy, Dental, and Vision Plan Design: Aetna Transition and Mercer Review of Updated Plan Design Options

Joe Bober reviewed updates requested at the prior meeting and presented three plan-design alternatives, along with the no-plan-change scenario that was still under consideration at the beginning of the discussion. 

Joe explained that the committee was seeking approximately $1.6 million in savings to bring the overall medical renewal increase closer to the County's target. Option 1 continued to focus on deductible and out-of-pocket maximum changes. Option 2 included those changes plus office-visit copay changes and coverage for GLP-1 medications for weight loss. The new Option 3 was very similar to Option 1 but used the lower $2,500 Kaiser out-of-pocket maximum.

Joe noted that the four-tier contribution amounts for non-represented employees were the same between Options 1 and 3 because the difference between those options was limited to the Kaiser out-of-pocket maximum. The change did, however, affect represented employees because of the resulting change in the overall rate.

GLP-1 Coverage: Available Information and Remaining Questions

Joe reported that Mercer had consulted with pharmacists regarding the potential longer-term return on investment associated with GLP-1 coverage. He stated that there was not yet enough substantiated experience to determine the long-term savings or return on investment. Mercer expected an initial increase in costs if the benefit were added because members who are not currently using the medications could begin treatment, with utilization potentially leveling off over time. Actual experience would provide better information in future years.

Paula McDonald asked whether Mercer could provide a subject-matter expert to explain the medical uses and potential benefits and drawbacks of GLP-1 medications, including uses beyond weight loss. Joe said Mercer could look into identifying someone who could provide that information, although he noted that the committee was approaching the end of its decision timeline.

Morgan Hoffman explained that the existing Providence approach to GLP-1 coverage involved requirements such as physician prescribing, ongoing weight-related check-ins, and obtaining the medication through a standard pharmacy rather than a compounded or online pharmacy. Joe indicated that the future Optum pharmacy arrangement would likely have similar controls, although the final requirements had not yet been confirmed.

Employee Feedback and Member Polling

The committee discussed the employee feedback that had been gathered since the prior meeting. Alex Gonzalez reported that his group had conducted a survey during a very short response window. Liane Kinne reported 266 responses from approximately 900 eligible members. The results were 105 responses favoring no plan changes, 84 favoring the GLP-1 option, and 77 favoring a simpler deductible and out-of-pocket maximum approach.

Alex explained that the short timeframe made it difficult to fully communicate the alternatives and obtain feedback on the newly presented Option 3. He also noted that additional informal feedback had continued to arrive after the survey closed. Nathan Boles said he would like another opportunity to poll members using simplified information and the updated options.

Brandon Paullin reported that an AFSCME poll received 40 responses. He said the three leading preferences were no changes, Option 1, and the GLP-1 option, although the response period was also limited.

Cynthia Boettcher supported allowing additional time for member feedback, noting that some employees had misunderstood the earlier poll and believed they were voting only on Kaiser. She favored giving members another opportunity to review the complete set of updated options.

Financial Impact of the No-Plan-Change Scenario

Greta Nickerson emphasized that the committee needed to consider both employee feedback and the financial impact of each alternative. She noted that under a no-plan-change scenario, every employee enrolled in the plans would experience a premium increase, while deductible and out-of-pocket changes would primarily affect members who incur enough claims to reach those thresholds.

Rachel Forslund clarified that the County must have its 2027 plan design decision made 120 days before the plan takes effect, which places the deadline at August 31. She explained that if the committee did not make a plan-design change, the status quo would remain in place and the higher no-change renewal rates would apply.

Bob Skinner asked about the County's financial exposure under the no-change scenario. Joe explained that the County's contribution structure means that the County would absorb the applicable increase for non-represented employees up to its contribution limit, with the remaining increase affecting employee contributions. The committee discussed the implications for both the County budget and employee premiums.

Straw Poll Process and Results

After discussion of the available alternatives, the committee conducted an informal straw poll to gauge current preferences. Corey Falls explained that the first poll allowed one vote per member and was non-binding.

In the first straw poll, no-plan-change received 0 votes, Option 1 received 3 votes, Option 2 received 7 votes, and Option 3 received 6 votes.

Alex Gonzalez requested a second straw poll that would allow members to select more than one option, explaining that some members could reasonably support more than one alternative. Corey conducted the second poll using the same four alternatives.

The results of the second straw poll were 0 votes for no plan changes, 7 votes for Option 1, 10 votes for Option 2, and 10 votes for Option 3. The committee understood that this second poll allowed multiple selections and therefore was not a direct ranking of the options.

Voting: Removal of No-Plan Change option from consideration

Motion made by Bob Skinner to remove the no-plan-change option from consideration for the current year in order to narrow the alternatives. 
Motion seconded by Greta Nickerson and Sandra Montoya

Discussion: Members discussed the pros and cons of removing the no-change alternative from consideration while also recognizing the significant premium impact if it remained.

The committee approved the motion unanimously. The no-plan-change option was therefore removed from consideration for the current year.

Yay/Nay Count: 15 Yes, 0 Abstention, 0 Nay

Discussion of Final Alternatives and Option 3

Following the removal of the no-plan-change scenario, the committee continued discussing Options 1, 2, and 3. Alex Gonzalez observed that Options 1 and 3 were similar in structure and asked members whether there was a strong preference between them. Greta Nickerson explained that Option 3 had been useful for understanding the effect of a lower Kaiser out-of-pocket maximum but expressed concerns about the additional premium impact created by the change.

Sandra Montoya asked why a separate Kaiser deductible change shown in the Mercer materials did not appear as a stand-alone plan option. Alex explained that the item had been included to illustrate the potential savings from that individual change, rather than as a separate packaged alternative.

The committee discussed the need to simplify the information being communicated to employees and represented groups. Members also recognized that the BRC's remaining timeline was short and that the final plan-design decision would need to be made at the next scheduled meeting.

Voting: Motion to Finalize Plan Design at the August 27 Meeting

Motion made by Alex Gonzalez to postpone the final plan-design vote from August 20 to August 27, with August 27 serving as the hard deadline for the final decision. 
Motion seconded by Cynthia Boettcher 

During discussion, members questioned whether the motion was necessary because the committee's existing deadline already required a decision by the end of August. With the committee rapidly approaching the end of the meeting and quorum becoming a concern, Alex withdrew that motion.

Voting: Motion to remove Option 3 from consideration

Motion was made by Alex Gonzalez to remove Option 3 from consideration for the current year and proceed with Options 1 and 2 as the remaining alternatives for consideration. Motion seconded by Sandra Montoya

The committee confirmed that quorum remained, and the motion passed.

Yay/Nay Count: 10 Yes, 1 Abstention, 2 Nay 

The motion passed and Option 3 was removed from consideration, leaving Options 1 and 2 as the alternatives to be evaluated for the final plan-design decision.

Next Steps:

• Mercer will continue to provide information and clarification regarding the financial impacts of Options 1 and 2, including the plan-design changes, employee contributions, and represented/non-represented impacts.
• The committee members will continue gathering and reviewing employee and represented-group feedback on Options 1 and 2 before the final decision.
• Mercer will continue to investigate available information regarding GLP-1 coverage, including utilization and longer-term financial implications, to the extent time permits.
• The no-plan-change option has been removed from consideration for the current year.
• Option 3 has been removed from consideration for the current year. Options 1 and 2 remain for further discussion and final consideration.
• The committee will make its final 2027 plan-design decision at the next scheduled BRC meeting on August 27, 2026, consistent with the applicable decision deadline.
• Toni McGarvey will finalize and post the approved meeting summaries for July 23, July 30, August 6, and August 13.

Adjournment

Toni McGarvey noted that the meeting had reached the end of its scheduled time and that the committee had completed its business. The meeting was adjourned at approximately 3:32 p.m. 

The next BRC meeting is scheduled for Thursday, August 27, 2026, when the committee is expected to finalize the 2027 plan-design decision.