Town Council Panel Presses Broker On Health Plan Costs

Town Council · Meeting of February 24, 2026

New Canaan's Town Council committee grills the school district's health broker over insurance costs and bidding. The Board of Education committee heard that the self-funded health plan is projected to cost about $21.8 million in claims and fees for 2026-27, or roughly $34,835 per employee before drug rebates. Administrative fees paid to third-party administrator Sigma are projected at $543,000, down from $583,000.

Council member Kim pushed for a competitive bid process, saying it's about showing residents "we're doing the best that we can to get the best price," while Brian and consultant Joe said any carrier decision belongs to the Board of Education, not the council. Last year, 63 members, 4.24 percent of enrollment, drove 43.4 percent of the plan's $17.65 million in net claims. No votes were taken.

In the full story:

• The complete report — 751 words

Source: the Town Council meeting of February 24, 2026, reported from the official video recording and transcript.

The Full Article

NEW CANAAN — February 24, 2026 — The Town Council's Board of Education committee spent nearly an hour Tuesday questioning the school district's health insurance broker over administrative fees, claims trends and whether New Canaan should seek competing bids after roughly 15 years with the same claims administrator.

The committee heard that the district's self-funded health plan is projected to cost about $21.8 million in claims and fees for the 2026-27 plan year, or roughly $34,835 per enrolled employee, before drug rebates are applied. Council member Kim raised the possibility of putting the plan out to bid, but Board of Education staff member Brian and the district's benefits consultant, identified only as Joe, said that decision rests with the Board of Education, not the Town Council.

The Full Story

New Canaan's Board of Education has been self-insured for years, meaning the district, not an insurance company, is directly liable for employee health claims up to a $300,000 stop-loss threshold per claimant. Sigma serves as the plan's third-party administrator, processing claims and running the provider network, while Sunlife currently provides stop-loss coverage after the district previously used Voya. Broker Joe told the committee that administrative fees are projected at $543,000 for the 2026-27 plan year, down from $583,000, reflecting a drop in enrollment. He said Sigma earns no margin on claims themselves and returns 100 percent of prescription drug rebates to the plan each quarter.

Kim pressed for more scrutiny of the arrangement, asking whether an audit had ever examined gross claims against net claims paid. Brian said the district last commissioned a claims audit in 2019, covering claims from September 2017 through February 2019, which found accuracy above 99 percent and only minor errors, mostly involving unapplied coordination-of-benefits credits worth a few thousand dollars. He said the audit itself cost roughly $50,000 and did not generate savings anywhere close to that amount. Brian said he and Joe have already requested an updated quote and plan to bring it to the Board of Education's resources committee for a cost-benefit discussion.

Joe told the committee the district is running about $1.9 million, or roughly 31 percent, under its expected claims total for the current plan year, though he cautioned that figure will likely rise as more employees hit their deductibles later in the year. Last year, the plan's net claims totaled $17.65 million, with 63 members, or 4.24 percent of the roughly 1,486 enrolled, driving 43.4 percent of total cost through high-dollar claims over $50,000. The district's single largest claim so far this year stands at $221,000, well below prior years that saw individual claims as high as $2.1 million.

On whether to seek competing bids, Brian and Joe said the carrier and the claims administrator are effectively the same entity in any bid scenario, and that Sigma, Anthem, Cigna and United are the only realistic options for a municipal group in Connecticut. Joe said the district could request both self-funded and fully insured proposals but cautioned that switching carriers would be disruptive to roughly 1,400 covered members, particularly around prescription drug networks.

"In Connecticut, there is no significant discount advantage for any one carrier." — Joe, benefits consultant

"Whether it's Sigma, Anthem, whoever else is the administrator, the bulk of the cost is the claim cost, and that's not going to change because that's based on experience." — Brian, Board of Education staff

"It's just something to give the appearance to the public and the residents and the taxpayers that we're doing the best that we can to get the best price." — Kim, Town Council member

Why It Matters

The Board of Education's self-funded health plan represents one of the district's largest and most volatile budget lines, with claims and fees projected near $21.8 million for 2026-27. Whether to bid out the plan's carrier, seek a new claims audit, or move toward a fully insured model are decisions that ultimately belong to the Board of Education, not the Town Council, but the committee's questions signal continued pressure to justify staying with Sigma after roughly 15 years. Any changes would affect the roughly 1,400 employees, retirees and dependents covered by the plan, particularly around provider networks and prescription drug formularies. The district expects to revisit its claims projections again in March, ahead of a Town Council vote on the final budget.

Key Motions & Votes

No formal votes taken at this meeting.

Source

Town Of New Canaan: Town Council meeting, February 24, 2026