Beverly Gossage

The meeting agenda included action items for the approval of the Membership Administration Portal (MAP) Eligibility System Contract and EAC Appointments. Discussion items covered the Open Enrollment Report, the Financial Report from Segal, setting the December 2026 HCC Meeting Date, and determining the next meeting date. The document also contains extensive financial reporting comparing budget versus actuals through October 2025, projecting future financial performance, analyzing claim trends, and detailing assumptions for HSA/HRA funding and actuarial values.

The meeting commenced with a call to order and an overview of the Health Care Commission's purpose and responsibilities. Key agenda items included the presentation and unanimous approval of bids for the Employee Assistance Program contract, resulting in a three-year award to ComPsych. A financial update summarizing data through year-end 2024 and key assumptions for projections was presented. Additionally, a review of GLP-1 Medication for Weight Loss was provided.

The Health Care Commission meeting included the approval of the map membership administration portal contract for three years. The commission also approved recommendations for seven new members and three reappointments to the EAC. Director Flory provided a detailed open enrollment report for Plan Year 2026, summarizing enrollment statistics for active employees, comparing plan elections (Plan A, C, J, N), and analyzing enrollment distributions between Aetna and Blue Cross Blue Shield. Discussions followed regarding the difference in coverage interpretation between the two carriers. The report also covered direct bill enrollment changes for non-Medicare and Medicare-eligible populations, including dental and prescription eyewear coverage elections. Finally, Segal representatives presented the financial report through October, projecting an ending reserve balance ahead of initial projections before accounting for a pharmacy settlement. The financial review detailed medical and pharmacy spending trends, noting increased GLP-1 spending, and projections through 2029. The commission also attempted to schedule the December 2026 meeting date.

The meeting included the approval of the minutes from the August 2025 meeting. A primary action item was the approval of a three-year contract with iTedium for the services and support of the Membership Administration Portal (MAP) eligibility system. The committee also addressed EAC Appointments, approving seven new members and the reappointment of three existing members based on recommendations. Furthermore, a report on Open Enrollment for Plan Year 2026 was presented, and the committee received an update on the 2025 financials through October.

The meeting included a detailed actuarial review covering 2025 actuals, portal training, and an updated multiyear projection for the health plan, noting a $12.6 million net income for 2025 influenced by a significant payment. Significant discussion centered on the operationalization of the prior authorization criteria for GLP1 anti-obesity medications, specifically concerning the implemented BMI threshold of 35 and the continuation of therapy requiring a 5% weight loss from the baseline. Concerns were raised regarding whether the implemented 5% maintenance rule matched the Commission's intent. Additionally, the Commission addressed the resignation of the HealthQuest Health Center's primary physician, outlining robust recruitment efforts and contingency plans involving a locum MD to prevent any lapse in coverage. Follow-up items were requested regarding the GLP1 continuation criteria, the cost-benefit analysis comparing a strict BMI stop versus rebate loss, and clarification on the remediation of the zinc rebate issue.