Strategic Modifications to Employee Insurance Plans for 2027
In anticipation of a projected winter storm, the Department of Employee Trust Funds (ETF) has transitioned its services to virtual formats starting Monday, March 16. Members can also use the drop box outside the facility for assistance. This strategic move ensures continuity while accommodating weather disruptions.
The Group Insurance Board has approved several modifications to cost-sharing arrangements for the 2027 plan year, addressing rising expenses and evolving plan utilization trends. In a session held March 13, following discussions from February 25, the Board directed the ETF to further examine cost-sharing and plan design changes. They will assess drug savings through the Access Guidance Services (AGS) program, and provide cost estimates for GLP-1 anti-obesity medications (AOMs).
ETF collaborated with Navitus Health Solutions, their pharmacy benefit manager, and Segal Consulting, the Board’s actuary, to address inquiries from Board members. Authorized changes include adjustments to pharmacy benefits cost-sharing structures, projected to decrease expenses by approximately $29.3 million. These evaluations incorporated comprehensive industry research and feedback from program participants and employers regarding out-of-pocket costs.
Under the updated plan designs, members of the largest group programs will experience modest increases in emergency room copays, deductibles, and out-of-pocket expenses. However, Level 1 drug copays and maximum out-of-pocket expenses for in-network medical services within non-High Deductible Health Plans will be eliminated. These strategic revisions aim to realign GHIP plan designs with those of surrounding states, curtail premium growth, improve care utilization, and sustain a balanced benefit structure for members and sponsors.
Starting January 1, 2027, AOMs will be included under a separate cost-sharing tier for non-Medicare participants, with a set copay of $200. The AGS program, effective July 1, 2026, will allow non-Medicare members on high-cost medications to apply manufacturer copay assistance toward their overall cost sharing and out-of-pocket expenditures. Navitus Health Solutions estimates that the AGS implementation could save approximately $28.5 million for 2024 and 2025.
Looking forward, the Board plans to set the 2027 rates at its forthcoming meeting on May 21, 2026, ensuring strategic planning and proactive cost management. This initiative underlines the Board’s commitment to regulatory compliance and cost efficiency, enhancing the overall sustainability of the insurance programs administered by ETF.