Employee Health Insurance Benefits

City Council Agenda Item Report FROM:

Ryan Cummins, City Manager

MEETING DATE:

June 18, 2025

SUBJECT:

Employee Health Insurance Benefits for FY 25-26

DESCRIPTION: The City’s employee health insurance agent, Gallagher Benefit Services LLC (Gallagher), has provided the attached quotes for coverage for next fiscal year. The quote to renew the existing Priority Health HMO plan will result in a 14.94% increase, which equates to an annual change of $20,658.24. We aren’t alone in seeing significant percentage increases. State regulators approved the rate changes. Saugatuck Township’s quote showed their current plan increasing 13.2%. Fennville’s quote was a 14.3% increase. Kalamazoo Lake Sewer-Water Authority’s quote also showed an increase of 12.7%. The City Treasurer/Finance Officer and I have been meeting with Gallagher to discuss options to lessen our cost increase. We have also been comparing our existing benefits against nearby municipalities and running numbers on various options. At the workshop meeting, we will have a presentation on the recommendation for next fiscal year. BUDGET ACTION: None at this time. LEGAL REVIEW: Legal will be at your meeting for any questions you may have. SAMPLE MOTION: Workshop item.

Medical Benefit Comparison for City of Saugatuck - Copy Prepared by Julie James, Gallagher Benefit Services LLC 49453 (Saugatuck, MI, Allegan), Medical #1: PriorityHMO 500

Current

Renewal

Plan 1

Plan 2

Plan 3

Priority Health Priority Health Priority Health Priority Health Priority Health

Deductible Individual Family Coinsurance Coinsurance Individual Max Family Max

PriorityHMO Gold G50

PriorityHMO Gold G50

PriorityHMO Gold G10 - West MI Partners

PriorityHMO Gold G10

PriorityHSA HMO Gold G16 - West MI Partners

8/1/2024

8/1/2025

8/1/2025

8/1/2025

8/1/2025

HMO In-Network

HMO In-Network

HMO In-Network

HMO In-Network

HMO In-Network

$500 $1,000

$500 $1,000

$1,000 $2,000

$1,000 $2,000

$1,650 $3,300

20% $5,500 $11,000

20% $5,500 $11,000

20% $4,500 $9,000

20% $4,500 $9,000

20% Not Applicable Not Applicable

$8,500 $17,000

$9,100 $18,200

$8,150 $16,300

$8,150 $16,300

$4,500 $9,000

Annual Out of Pocket Max Individual Family Physician Office Services Preventive Care

No Charge

No Charge

No Charge

No Charge

No Charge

Primary Care

$30

$30

$20

$20

20% after deductible

Specialist

$50

$50

$50

$50

20% after deductible

Virtual Visit

$10

$10

$10

$10

$10 Copay after deductible

Behavioral Health

$25

$30

$20

$20

20% after deductible

Hospital Services

Urgent Care Emergency Room

$85

$85

$85

$85

20% after deductible

$250 Copay after deductible

$250 Copay after deductible

$250 Copay after deductible

$250 Copay after deductible

20% after deductible

Inpatient

20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible

Outpatient

20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible

Diagnostic Services

Imaging/CT/PET/MRI

$250 Copay after deductible

Labs

$35

X-Rays

$75

$250 Copay after deductible

$250 Copay after deductible

$250 Copay after deductible

20% after deductible

$35

$35

$35

20% after deductible

20% after deductible 20% after deductible 20% after deductible 20% after deductible

Rehabilitative Care

Chiropractic Speech Therapy Occupational and Physical Therapy Durable Medical Equipment Prescription Drugs Generic

$40

$40

$40

$40

$50 Copay after deductible $50 Copay after deductible

$50 Copay after deductible $50 Copay after deductible

$50 Copay after deductible $50 Copay after deductible

$50 Copay after deductible $50 Copay after deductible

20% after deductible 20% after deductible 20% after deductible

50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible

$5/$35

$5/$35

$5/$35

$5/$35

Preferred Brand

$80

$80

$75

$75

Non-Preferred Brand

$95

$95

$90

$90

$5/$35 Copay after deductible $65 Copay after deductible $85 Copay after deductible After deductible, 20% $250 max After deductible, 20% $450 max 4

Preferred Specialty

20%/$250 max

20%/$250 max

20%/$250 max

20%/$250 max

Non-Preferred Specialty

20%/$450 max

20%/$450 max

20%/$450 max

20%/$450 max

Employee Count

Employee + Spouse Count

Employee + Children Count

Family Count

Total Number of Employees

Monthly Total Premium

$11,524.64

$13,246.16

$11,900.14

$13,084.39

$10,792.14

Annual Total Premium

$138,295.68

$158,953.92

$142,801.68

$157,012.68

$129,505.68

Current

Current

Current

Current

14.94% $20,658.24

3.26% $4,506.00 Tier 2 Benefits include higher member cost share

13.53% $18,717.00

-6.36% ($8,790.00) Tier 2 Benefits include higher member cost share

Compared To Annual Change (%) Annual Change ($)

Generated 5/22/2025 3:15:04 PM

Medical Benefit Comparison for City of Saugatuck - Copy Prepared by Julie James, Gallagher Benefit Services LLC 49453 (Saugatuck, MI, Allegan), Medical #1: PriorityHMO 500

Current

Renewal

Plan 4

Plan 5

Plan 6

Priority Health Priority Health Priority Health Priority Health Priority Health PriorityHMO Gold G50

PriorityHMO Gold G50

8/1/2024

8/1/2025

8/1/2025

8/1/2025

8/1/2025

HMO In-Network

HMO In-Network

HMO In-Network

HMO In-Network

HMO In-Network

$500 $1,000

$500 $1,000

$2,500 $5,000

$1,650 $3,300

$2,000 $4,000

20% $5,500 $11,000

20% $5,500 $11,000

0% Not Applicable Not Applicable

20% Not Applicable Not Applicable

0% Not Applicable Not Applicable

$8,500 $17,000

$9,100 $18,200

$5,000 $10,000

$4,500 $9,000

$6,950 $13,900

No Charge

No Charge

No Charge

No Charge

No Charge

$30

$30

0% after deductible 20% after deductible 0% after deductible

Specialist

$50

$50

0% after deductible 20% after deductible 0% after deductible

Virtual Visit

$10

$10

0% after deductible

Behavioral Health

$25

$30

0% after deductible 20% after deductible 0% after deductible

$85

$85

0% after deductible 20% after deductible 0% after deductible

$250 Copay after deductible

$250 Copay after deductible

0% after deductible 20% after deductible 0% after deductible

Deductible Individual Family Coinsurance Coinsurance Individual Max Family Max

PriorityHSA HMO PriorityHSA HMO PriorityHSA HMO Gold G251 Gold G16 Gold G201

Annual Out of Pocket Max Individual Family Physician Office Services Preventive Care

Primary Care

$10 Copay after deductible

0% after deductible

Hospital Services

Urgent Care Emergency Room Inpatient

20% after deductible 20% after deductible 0% after deductible 20% after deductible 0% after deductible

Outpatient

20% after deductible 20% after deductible 0% after deductible 20% after deductible 0% after deductible

Diagnostic Services

$250 Copay after deductible

$250 Copay after deductible

0% after deductible 20% after deductible 0% after deductible

Labs

$35

$35

0% after deductible 20% after deductible 0% after deductible

X-Rays

$75

Imaging/CT/PET/MRI

20% after deductible 0% after deductible 20% after deductible 0% after deductible

Rehabilitative Care

Chiropractic Speech Therapy Occupational and Physical Therapy Durable Medical Equipment Prescription Drugs

$40

$40

$50 Copay after deductible $50 Copay after deductible

$50 Copay after deductible $50 Copay after deductible

0% after deductible 20% after deductible 0% after deductible 0% after deductible 20% after deductible 0% after deductible 0% after deductible 20% after deductible 0% after deductible

50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible

20%/$450 max

20%/$450 max

Employee Count

$5/$35 Copay after deductible $70 Copay after deductible $90 Copay after deductible After deductible, 20% $250 max After deductible, 20% $450 max 4

Employee + Spouse Count

Generic

$5/$35

$5/$35

Preferred Brand

$80

$80

Non-Preferred Brand

$95

$95

Preferred Specialty

20%/$250 max

20%/$250 max

Non-Preferred Specialty

$5/$35 Copay after deductible $65 Copay after deductible $85 Copay after deductible After deductible, 20% $250 max After deductible, 20% $450 max 4

$5/$40 Copay after deductible $80 Copay after deductible $100 Copay after deductible After deductible, 20% $250 max After deductible, 20% $450 max 4

Employee + Children Count

Family Count

Monthly Total Premium

Total Number of Employees

$11,524.64

$13,246.16

$11,986.81

$11,989.42

$12,472.78

Annual Total Premium

$138,295.68

$158,953.92

$143,841.72

$143,873.04

$149,673.36

Current

Current

Current

Current

14.94% $20,658.24

4.01% $5,546.04

4.03% $5,577.36

8.23% $11,377.68

Compared To Annual Change (%) Annual Change ($)

Generated 5/22/2025 3:15:04 PM