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AGENDA ITEM REVIEW FORM |
3.A.
Special Employee Benefit Trust Board Meeting
- Meeting Date:
- 05/11/2026
- Department Head:
- Adela Cortez
- Submitted By:
- Maria Barajas Gutierrez, Human Resources Coordinator, Human Resources Department
ITEM:
Discussion and possible action on any and all matters regarding the Employees' Health Benefits Plan. (Dave Madden, CBIZ Account Executive)
SUMMARY:
This presentation provides an overview of the Employees’ Health Benefits Plan performance during Fiscal Year 2025-26, along with the proposed renewal and funding projection for Fiscal Year 2026-27.
During the current fiscal year, the plan experienced several high-cost claims that significantly impacted the renewal cost of stop loss insurance with our current carrier with an increase in liability of $1 million laser for a specific member. To date, three claims have exceeded the policy deductible of $100,000.
We marketed the stop loss policy, and the most favorable offer was submitted by Symetra with a Stop Loss Laser set at $800,000.
For FY 2026–27, projected total claims are approximately $4,062,843, with fixed costs of $1,278,840, resulting in a total funding requirement of $5,341,683. To meet the projected funding needs, a 25.04% increase in funding rates is recommended.
Additionally, it is recommended to expand medical and dental benefits on the Mexico Plan. The proposed coverage will include:
- Mexico Plan
- Dental
- Increase Annual Maximum benefit from $1,125 to $1,500
- Consider adding adult orthodontic coverage.
- Medical
- Expand Nutrition services beyond the minimum requirements mandated by the ACA.
- Implement a referral requirement and establish visit limits with a maximum of 15 visits per calendar year.
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO APPROVE SWITCHING STOP LOSS INSURANCE CARRIER TO SYMETRA.