Consultant proposes 9.46% health insurance increase, GLP‑1 carve‑out and MRI copay changes for 2027
July 22, 2026 | Walworth County, Wisconsin
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Walworth County’s benefits consultant reviewed plan performance through the first four months of the 2026 plan year and proposed rate and design changes for 2027.
“Right now through the first four months of the 2026 plan year, we’re about 101%,” the consultant said. Based on trend assumptions, he presented an aggregate medical increase projection of 9.46% for 2027 — roughly a $1.6 million increase to the county’s medical budget — and said the dental plan is running hotter (about 108%) with a dental rate increase recommendation of 14.9%, approximately $107,000 in additional cost.
The consultant outlined several plan‑design recommendations: carve out GLP‑1 medications used exclusively for weight loss into a partner program (Trio Health) with a proposed $150 copayment per fill and health‑coach support, while members taking GLP‑1s for specified disease states (diabetes, cardiovascular disease, sleep apnea, kidney disease) would continue on the traditional pharmacy plan. He also recommended adding a $250 copay for non‑emergency MRIs performed in a hospital setting and continuing a $200 incentive for employees who use a freestanding imaging center (MH Imaging). The presentation cited approximate MRI price differences — hospital MRIs between $4,000 and $6,000 versus about $650 at MH Imaging — as a rationale for the incentive.
On HSA plan changes, staff said the HSA deductible must be increased to meet 2027 IRS minimums; the transcript contained an unclear figure for the deductible, so the exact dollar amount was not specified in the meeting record. Staff also noted that Gail’s Law will require first‑dollar coverage for supplemental and diagnostic breast imaging effective Jan. 1, 2027, and that coverage for those services will be added to county plans to ensure compliance.
The board discussed access to the GLP‑1 program and imaging incentives. The consultant said employees can access the program without prequalification and that health coaching is available by phone, video or text. A board member suggested increasing the imaging incentive if the county adds a $250 copay for hospital MRIs.
Staff emphasized that the presentation represents projections for budget submission and that figures may change before the final budget is filed.
“Right now through the first four months of the 2026 plan year, we’re about 101%,” the consultant said. Based on trend assumptions, he presented an aggregate medical increase projection of 9.46% for 2027 — roughly a $1.6 million increase to the county’s medical budget — and said the dental plan is running hotter (about 108%) with a dental rate increase recommendation of 14.9%, approximately $107,000 in additional cost.
The consultant outlined several plan‑design recommendations: carve out GLP‑1 medications used exclusively for weight loss into a partner program (Trio Health) with a proposed $150 copayment per fill and health‑coach support, while members taking GLP‑1s for specified disease states (diabetes, cardiovascular disease, sleep apnea, kidney disease) would continue on the traditional pharmacy plan. He also recommended adding a $250 copay for non‑emergency MRIs performed in a hospital setting and continuing a $200 incentive for employees who use a freestanding imaging center (MH Imaging). The presentation cited approximate MRI price differences — hospital MRIs between $4,000 and $6,000 versus about $650 at MH Imaging — as a rationale for the incentive.
On HSA plan changes, staff said the HSA deductible must be increased to meet 2027 IRS minimums; the transcript contained an unclear figure for the deductible, so the exact dollar amount was not specified in the meeting record. Staff also noted that Gail’s Law will require first‑dollar coverage for supplemental and diagnostic breast imaging effective Jan. 1, 2027, and that coverage for those services will be added to county plans to ensure compliance.
The board discussed access to the GLP‑1 program and imaging incentives. The consultant said employees can access the program without prequalification and that health coaching is available by phone, video or text. A board member suggested increasing the imaging incentive if the county adds a $250 copay for hospital MRIs.
Staff emphasized that the presentation represents projections for budget submission and that figures may change before the final budget is filed.
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