Joint Peace Officers/County Benefits Committee Meeting - July 29, 2026

Agenda

• Meeting Details
  Vendor Topics of Discussion
  2027 Benefit Plan Renewals
• Time: 11:00 – 11:30 am
  Additional Topics: Review 2027 Benefit Plan Renewals
  Attendees: Committee

Minutes

Attendance and Minutes

Voting Members Present: Steve Gaytan; Rachel Forslund; Ben Wiley; Billie Hurley

Voting Members Not Present: N/A
Consultant: Joe Bober, Mercer; Morgan Hoffman, Mercer

Non-Voting: Heather Pedersen; Cynthia Kodachi

Joe Bober reviewed the renewal projections for the POA health plans using updated claims experience through June 2026. The presentation focused on current plan performance, projected 2027 costs, renewal budget recommendations, employee contribution impacts, and discussion of the carrier recommendations. 

Claims Experience Review

Mercer presented current medical and pharmacy experience through June 2026.

Key observations included:

• The combined rolling 12-month medical and pharmacy loss ratio is approximately 100%, indicating claims are generally tracking with the current budget. 
• The Personal Option continues to experience higher utilization, with a rolling 12-month loss ratio of approximately 116%. 
• The Open Option is performing more favorably, with a rolling 12-month loss ratio of approximately 95%. 
• One large claimant exceeded the $250,000 stop-loss threshold during the year, contributing significantly to Personal Option claims. 
• Dental claims are running slightly above expectations (approximately 107% rolling 12-month loss ratio), while the fully insured VSP vision plan remains within expected levels. 

2027 Renewal Projection

Mercer explained that the renewal projection assumes:

• Medical administration through Aetna 
• Pharmacy benefits through OptumRx 

The renewal projection includes:

• Medical and pharmacy trend assumptions 
• Expected reductions in covered lives 
• Pharmacy rebate improvements 
• Administrative fees 
• Estimated stop-loss costs 

Based on these assumptions:

• Projected overall medical budget increase: 7.5% 
• Recommended dental budget increase: 11.7% 

Mercer noted that although claims are relatively stable, national medical inflation, prescription drug trend, and stop-loss costs continue to place upward pressure on future budgets. 

Employee Contribution Examples

Mercer reviewed projected employee contributions under several carrier scenarios.

Aetna + OptumRx

Using Mercer’s recommended combination:

• Overall self-funded budget increase: 7.5% 
• Kaiser renewal increase: approximately 6.8% 
• Employee premium increases remain relatively moderate. 

Joe Bober explained that changes in enrollment by tier affected the Personal Option more significantly this year because there are proportionally more employee-family enrollments than in prior years. As a result, Personal Option premiums increase more than Open Option premiums despite the overall budget increase remaining 7.5%. 

Regence and Moda Scenarios

Mercer also modeled costs if Regence or Moda were selected.

Because of weaker provider discounts:

• Regence would require approximately a 21.8% self-funded budget increase. 
• Moda would require approximately a 21.1% increase. 

Mercer emphasized that these higher costs are driven primarily by provider reimbursement discounts rather than administrative fees. 

Benefit Design

Steven Gaytan asked whether changing carriers would affect plan benefits.

Joe Bober confirmed that:

• Copays  
• Deductibles  
• Out-of-pocket maximums 
• Covered services 

would remain substantially the same regardless of carrier.

He noted that only minor administrative differences may exist because of each carrier's claims processing systems (for example, hearing aid administration), but members should experience essentially the same plan design. 

Discussion Regarding Aetna

Ben Wiley shared concerns based on feedback received from approximately 150 POA members who responded to a member survey.

Primary concerns included:

• Negative perceptions of Aetna from current and former users. 
• Difficulty finding providers willing to accept Aetna. 
• Alternative care reimbursement. 
• Maintaining access to Providence physicians. 

Mercer Response

Joe Bober explained that Mercer specifically negotiated these concerns with Aetna.

Aetna agreed to:

• Continue Clackamas County's current alternative care approach. 
• Reimburse alternative care providers using billed charges rather than low contracted reimbursement schedules. 
• Maintain the current member experience for chiropractic, massage therapy, and acupuncture services. 

Joe also explained that:

• The County's plans are self-funded, so Aetna is paid only fixed administrative fees. 
• Claims costs are driven primarily by provider network discounts rather than insurance premiums. 
• Aetna's stronger provider discounts produce lower overall claim costs while maintaining comparable benefits. 

Mercer noted that alternative care was the primary disruption identified across all carriers and that this issue had been addressed before making its recommendation. 

Providence Network

Ben Wiley also asked whether Providence physicians would remain accessible under Aetna.

Joe confirmed that:

• Providence and Aetna currently have a multi-year provider agreement. 
• Providence physicians are presently considered in-network under Aetna. 
• While provider contracts can change over time, Mercer does not anticipate disruption under the current agreement. 

Key Takeaways

• Current claims experience supports an overall projected 7.5% medical budget increase for 2027. 
• Mercer continues to recommend Aetna for medical administration and OptumRx for pharmacy based on projected savings and provider discounts. 
• Regence and Moda would require budget increases exceeding 21% because of less favorable provider discounts. 
• POA leadership expressed significant concern regarding member perception of Aetna, particularly surrounding alternative care reimbursement and provider access. 
• Mercer stated these concerns have been addressed through negotiated provisions preserving the County's current alternative care reimbursement model and confirmed that Providence providers remain in-network under Aetna's current agreement. 

Adjournment

There being no further business, the meeting was adjourned following completion of the scheduled agenda items.