Holmen proposes 5.4% insurance premium rise, non-emergent ER penalty and other benefit adjustments

Holmen School District’s finance and human-resources team presented an annual employee-benefits renewal and recommended changes for the plan year beginning July 1.

Julie Homeman, Executive Director of Finance and Operations, and Janice Hura of the Insurance Center described the district’s self-funded cooperative model and reported a projected medical trend (≈9%) and prescription trend (≈13%), but recommended limiting the premium increase to 5.4% due to improved member engagement and lower-than-expected aggregate claims this plan year.

Key recommendations presented:

• Maintain the current employer/employee premium split at 85%/15% and continue employer HSA contributions and wellness bonus structure.

• Premium increase estimate: 5.4% (single coverage approximately $79.20/year; family coverage approximately $187.20/year). Staff said final premium impact will be confirmed at open enrollment.

• Introduce a targeted change to emergency-room cost-sharing: keep the $250 emergent ER co-pay but apply a $500 penalty for ER claims adjudicated by the TPA as non-emergent. Presenters emphasized appeal and review procedures through the TPA (Allegiance) and promised timely member support if a claim is miscoded.

• Recommend reducing annual chiropractic visit allowance from 30 visits to 20 to curb high utilization (894 visits and ~$81,000 plan cost in reporting period).

• Continue other plan features (deductibles, out-of-pocket maximums), add two voluntary vision plans through Delta Dental, and keep zero rate increases for life/LTD/STD coverages.

Staff stressed education and care-navigation efforts (neighborhood family clinic, virtual visits via Ricaro, AllOne Health mental-health access) to steer members to lower-cost options. The recommended renewal and proposed targeted changes will appear on the May 11 consent agenda for formal approval. Board members asked about EOB timing, appeals and impacts on families; staff described monitoring, monthly claim review and a plan to communicate changes proactively to employees.