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,...
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