Joint Insurance Committee

By The City of Oklahoma City Office of the City Clerk at 3:56 pm, Feb 25, 2026 March 4 6  CITY OF OKLAHOMA CITY JOINT INSURANCE COMMITTEE AGENDA and MEETING NOTICE DATE: March 04, 2026 TIME: 8:30 a.m. PLACE: 420 W Main Ste 110, Oklahoma City, OK 73102 Basement Conference Room AGENDA: I. Call to Order II. Approval of Minutes September 10, 2025 --No December 2025 Meeting III. Information from Vendors IV. Information from Employee Benefits Division V. Items from Committee Members VI. Adjournment  10 June 1 Overall Plan Performance (Actives & Retirees) Loss Ratios: YTD plan-wide loss ratio: 94.9% (compared to 84.1% YTD prior year). Variance attributed to EPO plan integration and claim maturity. Historical Context: Prior year had immature claims due to new EPO population. Stop Loss Claims Tracking 2025 YTD: 2 claimants have exceeded the ISL deductible. 2024 YTD Comparison: 9 claimants over stop loss last year. Financials: $240,000 in stop loss reimbursements received so far in 2025, compared to $1.3 million in the prior year. Expectations: Projected to remain under stop loss for 2025. Annual marketing for stop loss carriers is underway as a due diligence step, Enrollment and Claims Trends Plan Enrollment: Stable; little change in the number of enrollees. Claims: Gross and net claims were reviewed. Per-enrollee annual claims cost rising, but in line with national trend. Anticipation of further cost escalation into 2026-2027, especially for pharmacy. Medical and Pharmacy Cost Split Current Split: 60% medical / 40% pharmacy (actives). Considered average for this population. Monthly Performance: Only two months in 2025 have had loss ratios exceeding 100%. Actives vs. Retirees Performance Active Employees: Loss ratio: 92% (prior year: 77%). 2 stop-loss claimants in active population. July claims spike attributed to EPO integration. Overall trend aligns with projections and market expectations. Retirees: Ongoing loss ratios above 100% for over two years (currently 106%). -cost/stop-loss claims. No stop loss reimbursements for retirees. Per-enrollee claim costs appear lower than actives, but largely because most retirees are Medicareeligible (true underlying costs are higher). Cost Mitigation Strategies for Upcoming Year Population Health Programs Summary: Four mitigation concepts were presented, with two population health program highlights: 1. Hinge Health: Musculoskeletal health program. Conservative, exercise/therapy-based (not medication-focused). Employee cost: $0 (prevention claim). Runs through health claim; intended ROI of “even” or possibly 2:1 or higher. Potential to reduce reliance on medications and improve outcomes. 2. Teladoc: Chronic condition management (diabetes, cardiovascular health, hypertension). Runs through the medical claim, no additional RFP needed. Implementation: Both programs available via Blue Cross partners for easier integration. Other programs may be considered upon committee suggestions. Pharmacy Program Adjustments Prior Authorizations Current State: No prior auth for many medications, especially GLP1s (diabetic/weight loss drugs). Proposed Change: Add prior auth for GLP1s and other high-cost drugs. Guardrails would limit use to clinically appropriate patients (e.g., type 2 diabetes, sleep apnea if covered,not strictly for weight loss). Physicians already accustomed to prior auth process; minimal member impact expected. -label prescribing and unnecessary costs. Potential Impact: Data revealed approx. 10% of population on GLP1s; concern some are prescribed for non-covered (i.e., weight loss) purposes. Prescription Drug List Changes Current state: Open drug list (all drugs mostly covered). Proposal: Move to a “Balanced” drug list (fewer covered drugs, with some high-cost brands removed if generics exist). Rationale: Savings potential. Employee/member impact depends on overlap/disruption. Sample Impact: similar insulins covered), with exceptions possible for medical necessity. Co-pay structure: Flat dollar co-pays by tier (not %). Assistance: Rx Sourcing Programs Summary: Use third-party services to source high-cost specialty drugs (cash-only, Canadian, European pharmacies). Legal/Compliance: FDA previously prohibited (enforcement less strict now); legal/compliance implications under review. Local Example: Fire department has adopted this, reporting large savings. Member Impact: disruption but minimal ongoing impact. Health & Pharmacy Plan Design Discussion Plan Options: Actives: Standard PPO and EPO (one plan each). Retirees: Two plan options (standard vs. another). Discussion: Consideration of high/low (deductible/out-of-pocket) plan options for actives. Potential for negative selection (healthy employees self-selecting cheapest plan, undermining risk pool). Administrative complexity considered. HSA plans mentioned as option elsewhere. General support for employee choice but caution regarding long-term impact to plan health. Process for coverage exceptions: Would be available for unique medical needs (e.g., insulin pump compatibility). Proposed Meeting Dates for 2026 March 4, 2026 June 3, 2026 September 2, 2026 (week before Labor Day) December 2, 2026 No objections to proposed dates. Open Enrollment Dates & Plan Changes Active Employees Onsite Enrollment: October 27–31, 2025, at the convention center (vendors present). Virtual Option: Via American Fidelity. Self-Kiosk Enrollment: Reduced post-enrollment corrections. Plan Guide Distribution: Expected around October 10, 2025. Retirees Open Enrollment: October 21–22, 2025, at Will Rogers Center. Plan Guide Distribution: Aiming for early October 2025 to meet Medicare disclosure deadline (before Oct.15). Dental Plan Enhancements Missing tooth clauses removed. Preventive cleanings no longer count toward annual maximum. Annual maximums for low plan: $1,000, increasing by $100 per year of continuous enrollment (capping at $1,300 after 3 years). If coverage lapses and reinstates, resets to base maximum. Purpose: More value for employees/retirees and encourages preventive care. Long-term Disability (LTD) Plan Changes Current: Only 180-day waiting period; no Short-Term Disability previously. New Option: Add 30-day waiting period option (acts like STD). Rationale: balance. Employee Paid: Both options remain employee- Carrier: American Fidelity. Upcoming: RFP for all ancillary products (including LTD) for plan year 2027. Other Discussions Co- - pays. Examples of real employee/retiree scenarios discussed (e.g., needing to switch insulin brands, pharmacy substitution practices). Emphasis on not mandating generic substitution if medical need is demonstrated. Action Items 1. Monitor Stop Loss Market: Continue annual RFP-like comparison for stop loss pricing to ensure competitiveness and, if out-of-line, initiate formal RFP. 2. Track Emerging Stop Loss Claims: Ongoing monitoring until end of the year for potential new high-cost claimants. 3. Review Population Health Program Options: Further exploration of Hinge Health, Teladoc, and other chronic care management programs— partnerships. 4. Assess Pharmacy Plan Adjustments: - cost drugs. Evaluate disruption and cost savings for possible switch to Balanced Drug List. Legal review of potential Rx sourcing for specialty medications. 5. Finalize and Communicate Open Enrollment Details: Ensure guidebooks and communications distributed per deadlines. 6. Implement Dental and Disability Plan Changes: Update systems and communications for new rules and Follow-up Points / Future Meetings 2026 Meeting Dates: As above; no concerns raised. Ongoing: - label use expansion. Next Steps: Routine monitoring of retiree loss ratios and impact of new plan design elements. 2027 Ancillary Product RFP: Set reminder for RFP issuance for plan year 2027. Adjournment: Meeting adjourned at 9:20 AM.  AGENDA ITEM III. Information from Vendors  AGENDA ITEM IV. Information from Employee Benefits Division City of Oklahoma City Joint Insurance Committee March 2026 LOCKTON COMPANIES | 1 Health Plan Performance 2025 Plan Year (January December) Executive Summary On an all-plans combined basis; the plan is running at 101.6% loss ratio (funding vs. expenses). The Active EPO plan is running with YTD expenses to budget/accrual ratios of 91.4% while the PPO Plan is running at 127.0%. The Retiree plans are running at 108.1%. Projected Per Employee Per Year (PEPY) cost for Actives is $21,758 (in December 2024, it was $20,057). An 8.2% increase. Active enrollment increased 5% from the prior plan year. Active plans had 10 claimants over $350k stop loss deductible, for a total reimbursement of $2,519,458. Retiree plans had 2 claimants over $350k stop loss deductible, for a total reimbursement of $46,333. LOCKTON COMPANIES | 4 Active Per Employee Per Year (PEPY) Month over Month Comparison Current Active PEPY through December is $21,758 LOCKTON COMPANIES | 7 Performance Overview Actives Only LOCKTON COMPANIES | 8 Performance Overview Retirees Only LOCKTON COMPANIES | 9  Pharmacy Trends Data through Q3 (January - September 2025) LOCKTON COMPANIES | 11 Biosimilars What Are They? Key points: Biosimilars matter because they offer the same clinical A biosimilar is a medication that is highly similar to an effectiveness as high-cost existing FDA-approved biologic drug (called the biologic drugs at a fraction of the price often 15% to 80% less. differences in safety, purity, or effectiveness. Recent example is Humira While only 1 2% of members typically use specialty drugs, they Stelara has a biosimilar coming to market next year account for over 50% of total Think of it like a generic for biologics but because pharmacy spend for many employer and public health plans. biologics are complex and made from living cells, rigorous testing to ensure they work the same way as As more biosimilars enter the the original drug. market, they create opportunities for health plans to reduce specialty drug spending without compromising patient outcomes. A clear adoption strategy, including managing rebates and preventing brand leakage, is key to capturing these savings. LOCKTON COMPANIES | 12 Opportunity for Future Savings Biosimilar Strategy: Humira (brand): List price historically around $6,000 per month After rebates from AbbVie (often 50 60%), the net cost to the plan can drop to about $2,800 per prescription. Humira biosimilars: Some launched with list prices 55 86% lower than Humira (as low as $1,000 $2,500 per month). However, rebates on biosimilars are much smaller, so the net cost after rebates often ends up unless the PBM formulary strategy favors biosimilars. Example scenario: Savings: Key takeaway: Plans only realize meaningful savings if they prioritize low-list-price biosimilars and adjust rebate strategies, because PBMs often structure contracts to favor high-rebate brands over low-cost biosimilars. LOCKTON COMPANIES | 13 Hinge Health Program through BCBSOK New for 1/1/2026 Hinge Health is covered by to eligible members with certain qualifying conditions. covers 100% of the cost of your program. Your care team includes a dedicated physical therapist who will help fine tune your care plan and conduct virtual physical therapy sessions if needed. Members who are treated for chronic pain (pain that lasts or recurs for 3+ months) get 1-on-1 coaching and support from a certified health coach. Your care team includes a dedicated physical therapist who will help fine tune your care plan and conduct virtual physical therapy sessions if needed. Members who are treated for chronic pain (pain that lasts or recurs for 3+ months) get 1-on-1 coaching and support from a certified health coach.  AGENDA ITEM V. Items from Committee Members AGENDA ITEM VI. Adjournment