WASHINGTON, Mo. — The Washington City Council voted unanimously Dec. 8 to accept staff recommendations to switch the city27s employee health plan to a self-insured model administered by UnitedHealthcare with UMR as third-party administrator and Smith Rx as the pharmacy benefit manager.

Scott Treffer, the benefits consultant who presented the proposal, told the council that carriers other than UnitedHealthcare declined to bid because the city27s loss ratio is about 120 percent and the plan currently includes four high-cost claimants. "We received an 18% increase on our dental," Treffer said, and for medical he reported "a 22% increase from United" while larger carriers declined to bid.

Treffer said two protections are required to make self-insurance viable: "you cannot have claims to be lasered out," meaning individual high-cost members would not be excluded, and the city must cap its reinsurance attachment points so its maximum exposure per claimant is limited. He described a $100,000 per-claimant reinsurance cap as the working example the council discussed.

The consultant outlined projected savings from pharmacy management and rebates. "On those top 25 prescriptions alone, we'll save $200,000," Trefffer said, adding that reclaiming manufacturer rebates and routing eligible prescriptions through Smith Rx and retail options such as Costco could reduce costs for both employees and the city.

Council members asked for clarifications about stop-loss structure, administrative burden and employee cost-sharing. Trefffer said UMR would act as the third-party administrator and that employees would continue to use the same provider networks; the plan would include daily claims visibility for staff (with HIPAA safeguards) and ongoing outreach for high-cost drug substitutions.

Tammy, who staff identified as the finance contact for questions, told the council the budget had already allowed for an increase and the city had budgeted for a roughly 10% rise in benefits costs. Trefffer acknowledged that some families could see higher payroll deductions. "From '25 to '26, a family will pay right around $1,000 more a year," a speaker noted in discussion; staff said that the buy-up plan participants—about 28 employees—may see a decrease in premiums while base-plan families could see increases depending on elections.

After additional discussion about quarterly reporting and the possibility of adjusting stop-loss attachment points at future renewals, an unidentified councilmember moved to accept the recommendation and a second was recorded. The motion passed by unanimous voice vote; no roll-call vote tally was recorded in the transcript.

The meeting closed after the vote. The council and staff said they would hold employee meetings and publish materials during open enrollment to explain changes, and Trefffer said he would return for open-enrollment sessions to answer employee questions.