Number
260550
Version
SUBSTITUTE 1
Reference
Sponsor
THE CHAIR
Title
A substitute resolution authorizing the implementation of the UnitedHealthcare NexusACO program for the City of Milwaukee health plan.
Analysis
This resolution authorizes the Department of Employee Relations to implement UnitedHealthcare’s NexusACO network for the City’s medical plan effective January 1, 2027. The plan maintains broad provider access while establishing tiered cost-sharing inpatient and outpatient facility services and is projected to reduce the City’s annual medical-plan costs by approximately $4.3 million.
Body
Whereas, The City of Milwaukee offers its employees and retirees a medical plan administered by UnitedHealthcare and currently operates on the Choice/Choice Plus network; and
Whereas, The NexusACO network is substantially the same as the City’s current network, except that certain providers are designated as Tier 1, including, in the Milwaukee area, Advocate Aurora Health, Froedtert & the Medical College of Wisconsin, and Children’s Wisconsin; and
Whereas, Based on the City’s 2025 claims experience, approximately 82 percent of medical-plan spending was either with a Tier 1 provider or for a service not subject to tiering; and
Whereas, Members may continue to receive care from their current providers regardless of tier, and certain services, including mental health and substance-use treatment, urgent and emergency care, laboratory services, radiology, and ambulance services, will be covered at the Tier 1 benefit level regardless of the provider’s tier; and
Whereas, NexusACO requires each member to be assigned a primary care physician for administrative purposes, but the City’s plan will not require a referral to see a specialist or other physician, and members may continue to see a physician of their choosing; and
Whereas, The proposed plan design retains the City’s current deductibles, out-of-pocket maximums, and professional-service coinsurance, except that inpatient and outpatient facility services will be tiered, providing an 80 percent coinsurance benefit after the deductible at Tier 1 network facilities and a 60 percent coinsurance benefit after the deductible at non-Tier 1 facilities; and
Whereas, UnitedHealthcare estimates that the transition to NexusACO could reduce medical-plan costs citywide by 6.4 percent to 7.1 percent, and by 6.6 percent to 7.3 percent for the Milwaukee market, while the City uses a more conservative estimate of approximately 4 percent in annual savings, or approximately $4.3 million, based on 2025 medical-plan spending, for budgeting purposes; now, therefore, be it
Resolved, By the Common Council of the City of Milwaukee, that the Employee Relations Benefits Director is authorized to implement the UnitedHealthcare NexusACO network as the network for the City's medical plan, effective January 1, 2027, consistent with the plan design described in the September 8, 2026 correspondence from the Employee Benefits Director; and, be it
Further Resolved, That the Department of Employee Relations is directed to notify all affected employees and retirees of the change in network and plan design before the January 1, 2027 effective date, including information on Tier 1 and Tier 2 providers and the process for confirming or updating an assigned primary care physician.
Requestor
Department of Employee Relations - Molly King
Drafter
Addis Zewdie
LRB181917-1
09/11/2026