Resolution No. 25-112
PassedAuthorizing the Mayor or City Manager to contract with Amwins Group Benefits, LLC for medical and prescription drug coverage for the Medicare eligible retiree health plan at a set cost per member per month described in the attached exhibit as Alternative Medical Plan 5 for the plan year starting January 1, 2026.
Bill Details
Type:
Resolution
Introduced:
November 17, 2025
Passed:
November 17, 2025
Sponsor:
Joseph Jenkins
Full Text:
1 Resolution No. 25-112 - Authorizing the Mayor or City Manager to contract with Amwins Group
2 Benefits, LLC for medical and prescription drug coverage for the Medicare eligible retiree health
3 plan at a set cost per member per month described in the attached exhibit as Alternative
4 Medical Plan 5 for the plan year starting January 1, 2026.
5
6 Be it Resolved by the Council of the City of Charleston, West Virginia:
7
8 That the Mayor or City Manager is authorized to contract with Amwins Group Benefits, LLC for
9 medical and prescription drug coverage for the Medicare eligible retiree health plan at a set
10 cost per member per month described in the attached exhibit as Alternative Medical Plan 5 for
11 the plan year starting January 1, 2026.
Page | 3 of City of Charleston/Charleston Sanitary Board
2026 Retiree Medical & Rx Plan Renewal
2026 Renewal Summary:
City of Charleston and
Charleston Sanitary Board
PRESENTED BY:
Jim Ball
Amwins Group Benefits, LLC
Vice President, Sales
T: 704-749-2707
jim.ball@amwins.com
Page | 1
Page | 4 of City of Charleston/Charleston Sanitary Board
2026 Retiree Medical & Rx Plan Renewal
Renewal Summary
We are pleased to provide the 2026 Group Retiree Medical and Prescription Drug Program Renewal for the City of
Charleston/Charleston Sanitary Board. Other than the annual Medicare deductible and co-insurance adjustments for
Parts A, B, and D, the plan designs will remain unchanged for 2026. In addition to the current offering below we have
also included alternative medical insurance plans for you to consider. Please review the program details enclosed in
this summary.
As always, Amwins Group Benefits will continue to provide our extensive administrative services including:
Eligibility Management Program Administration
Annual and Monthly Enrollments List Billing
Retiree Communications Retiree Specialty Contact Center
Customer Service Ongoing Retiree Advocacy and Support
Medical Plan
Underwritten by: The Hartford Life and Accident Insurance Company
Effective January 1, 2026 – December 31, 2026
Plan 2025 2026 % Increase # of Lives
Post 65 $190.05 $275.57 45.00% 541
Pre 65 Medicare Eligible $241.50 $350.18 45.00% 23
Prescription Drug Plan
Underwritten by: Express Scripts Medicare
Effective January 1, 2026 – December 31, 2026
2025 2026 % Increase # of Lives
Custom 4 Tier $130.50 $137.80 5.59% 564
Overall Combined Program
2025 2026 % Increase # of Lives
Post 65 w/ Rx $320.55 $413.37 28.96% 541
Pre 65 Medicare Eligible
$372.00 $487.98 31.18% 23
w/ Rx
Amounts are inclusive of all services performed by Amwins Group Benefits, insurance premiums and non-insurance costs. Administration
services are provided by Amwins Group Benefits, LLC, a division of Amwins Group, Inc.
Page | 2
Page | 5 of City of Charleston/Charleston Sanitary Board
2026 Retiree Medical & Rx Plan Renewal
Retiree Program Plan Designs
Medical Plan
Underwritten by: The Hartford Life and Accident Insurance Company
Effective January 1, 2026 – December 31, 2026
Pre-65 Medicare Eligible Post-65
Deductible * Part B Deductible Part B Deductible
Coinsurance 20% 20%
Total OOP Max ** $300 $300
Lifetime Benefit Max Unlimited Unlimited
* Part B Deductible for 2026 has not been released yet (2025: $257)
** Includes Calendar Year Deductible
Prescription Drug Plan
Underwritten by: Express Scripts Medicare
Effective January 1, 2026 – December 31, 2026
Custom 4 Tier Custom 4 Tier
2026
(30 Day Retail) (90 Day/Mail Order)
Calendar Year Deductible $50
Tier 1: Generic $5 + 20% $10 + 20%
Tier 2: Preferred Brand 25% - $20 minimum, $95 maximum 22.5% - $40 minimum, $285 maximum
Tier 3: Non-Preferred Brand 25% - $35 minimum, $100 maximum 24% - $70 minimum, $300 maximum
Tier 4: Specialty 20% - $100 maximum 20% - $100 maximum
Catastrophic Coverage
$0 Copays
Out-of-Pocket Maximum: $2,100
Page | 3
Page | 6 of City of Charleston/Charleston Sanitary Board
2026 Retiree Medical & Rx Plan Renewal
Alternative Plan Options
Amwins is pleased to present alternative retiree medical plan options, underwritten by The Hartford Life and Accident
Insurance Company, Transamerica Life Insurance Company, and United American Insurance Company. These plans
offer coverage comparable to your current plan. Please review the plan summaries below for key details.
Retiree Medical Insurance Plan
Underwritten by: The Hartford Life and Accident Insurance Company / Transamerica Life Insurance Company /
United American Insurance Company
Effective January 1, 2026 – December 31, 2026
2025 2026
% Change # of Lives
(Hartford) (New Carrier / Plan)
Alt. Medical Plan 1
$190.05 $226.70 19.28% 541
The Hartford
Alt. Medical Plan 2 Post-65: $190.05 Post-65: 24.70%
$237.00 564
Transamerica* Pre-65: $241.50 Pre-65: (1.86%)
Alt. Medical Plan 3 Post-65: $190.05 Post-65: 8.92%
$207.00 564
Transamerica* Pre-65: $241.50 Pre-65: (14.29%)
Alt. Medical Plan 4 Post-65: $190.05 Post-65: 14.71%
$218.00 564
United American Pre-65: $241.50 Pre-65: (9.73%)
Alt. Medical Plan 5 Post-65: $190.05 Post-65: 4.18%
$198.00 564
United American Pre-65: $241.50 Pre-65: (18.01%)
*Residents of FL will be issued standard Plan G with age-banded rates.
Alternative Retiree Program Plan Designs
Alternative Retiree Medical Insurance Plan
Underwritten by: The Hartford Life and Accident Insurance Company / Transamerica Life Insurance Company /
United American Insurance Company
Effective January 1, 2026 – December 31, 2026
Alt. Med. 1 Alt. Med. 2 Alt. Med. 3 Alt. Med. 4 Alt. Med. 5
Part B Part B Part B Part B Part B
Deductible *
Deductible Deductible Deductible Deductible Deductible
20% to $300,
Coinsurance then 10% to OOP 20% 20% 20% 20%
Max
Total OOP Max ** $1,000 $300 $500 $300 $500
Lifetime Benefit Max Unlimited Unlimited Unlimited Unlimited Unlimited
* Part B Deductible for 2026 has not yet been released (2025: $257)
** Includes Calendar Year Deductible
Page | 4
Page | 7 of City of Charleston/Charleston Sanitary Board
2026 Retiree Medical & Rx Plan Renewal
Group Retiree Program Renewal Acceptance 2026
Please review and confirm the 2026 subsidy and billing summary. Please return the signed electronic copy to
holly.danca@amwins.com
Subsidy
2025 2026
All Members Handled by Client Handled by Client
Billing Mode
2025 Billing Mode 2026 Billing Mode
All Members List Bill List Bill
Please Confirm 2026 Medical Plan(s)
Alt. Medical Plan 1
Alt. Medical Plan 2
2026 Selection Keep current Medical Plans
Alt. Medical Plan 3
(Post-65 and Pre-65 Disabled)
Alt. Medical Plan 4
Alt. Medical Plan 5
Please be advised, we have reviewed the proposed plans, rates, subsidy levels, and billing modes and
communications. We authorize Amwins to mail these renewal communications to our retirees, advising them
of the 2026 changes.
Print Name Print Title
Signature Date
Page | 5
Page | 8 of Dear City of Charleston, WV,
Medco Containment Life Insurance Company and Medco Containment Insurance Company of New York (hereinafter referred to as “Express Scripts Medicare”) is pleased to continue
offering the Medicare Part D Employer Group Waiver Plan (EGWP) for 2026 as described in this renewal notice and in accordance with the terms and conditions of your current Express
Scripts Medicare Agreement (hereinafter “Agreement”).1 Please review the renewal notice and reach out to Amwins Group Benefits, LLC to review any further plan design changes by
October 15th, 2025. If there are no changes then your benefit, premium, and appropriate EGWP Enrollee communications will renew at the below specifications effective January 1,2026
and run through December 31,2026.
If you choose not to renew your EGWP benefit for the 2026 plan year, Express Scripts Medicare must be notified of your intentions to terminate in accordance with the timeframe required
within the Express Scripts Medicare agreement. Mid-year terminations are not permitted.
EGWP Benefit Design2: BXM42071
Pharmacy Retail Retail Maintenance Drug Program (MDP) Express Scripts Home Delivery
1-31 Day Supply (Mirrors Retail
Cost Share)
Day Supply Up to 31 Day Supply 32-60 Day Supply 61 to 90 Day Supply
32-90 Day Supply (Home Delivery
Cost Share)
Network: National Medicare
Standard Standard Standard Home Delivery
Performance Network
Generic* $5 + 20% $10 + 20% $10 + 20% $10 + 20%
Initial Preferred Brand 25% Min $20 Max $95 22.5% Min $40 Max $285 22.5% Min $40 Max $285 22.5% Min $40 Max $285
Coverage
Period
Member Cost
Share Non-Preferred Drugs 25% Min $35 Max $100 24% Min $70 Max $300 24% Min $70 Max $300 24% Min $70 Max $300
Specialty 20% Max $100 20% Max $100 20% Max $100 20% Max $100
Deductible $50 (Part D eligible drugs and Non Part D drugs contribute, Retail & Mail)
Member True Out of Pocket (TrOOP) $2,100
Catastrophic Coverage Member cost share post TrOOP is $0
Formulary Medicare Premier Access Open
Non Part D Drugs4 Covered; Non-Part D Covered Including All Lifestyles (ED-DL100080+QLL, Cosmetic-DL 100071, WL-DL100133+PA)
Part B and ESRD Drugs4 Not Covered
As defined by Express Scripts, Non-preferred Generics will be subject to the appropriate Generic Tier copay (excluding Specialty Tier Generics,
*Generic Definition* when applicable).
Utilization Management Program All PA, QLL & ST (Part D and applicable Non Part D/Part B), CMS Required, and High Risk edits
Compound Management Solution Compound Management Solution in place to mitigate compound drug abuse by means of inclusion and exclusion list
Federal Poverty Limits Standard Federal Poverty Limit (FPL) guidelines apply
Member cost share is capped at $35 for a one-month supply of each insulin covered by the plan and member cost share is $0 for Part D vaccines
Other5 covered by the plan as required by CMS.
Additional Benefits 0
*Please note that most specialty medications can only be dispensed up to a 31 day supply, or up to a 30 day supply if they are found on the Carelogic drug list (132368); Additionally, only medications in a
limited number of drug categories can be dispensed in less than a 35 day supply from Home Delivery including but not limited to diabetic supplies, state and federally controlled drugs, and a limited number of
other medications,; mail order pharmacy may update the list at their discretion; copays mirror Retail or Home Delivery unless state regulations apply. This plan participates in the Voluntary Generics Policy.
Standard Federal Poverty Limit (FPL) guidelines apply.
Data Class: Confidential Page | 9 of
This group Medicare Part D plan has additional benefits to enhance the Medicare Part D coverage, in accordance with the Centers for Medicare and Medicaid Services (CMS). Per CMS
regulations, the benefit enhancements are considered other health benefits and may require filing with and approval by the state Department of Insurance. Express Scripts Medicare may
offer this product or may offer this product in conjunction with a supplemental insurance company.6 The total premium amount consists of two distinct components as outlined below.
2026
Employer Group Waiver Plan Premium PMPM $113.72
Enhanced Insurance Premium PMPM $24.08
Total Member Premium Per Member Per Month (PMPM)7 8 $137.80
1The information in this renewal notice is subject to the Confidentiality provision in the Medicare Part D Employer/Union-Only Sponsored Group Waiver Plan Prescription Drug Policy.
2Required improvements to the plan designs will be incorporated as mandated by CMS.
4Some states require coverage for certain Non-Part D, Part B, and ESRD drugs. Above Program descriptions are available upon request.
5If an applicable state requirement has a lower member cost share cap for insulin that is deemed applicable to the supplemental product, the state requirement will apply.
6Express Scripts Medicare may offer this product or may offer this product in conjunction with one of the following supplemental insurance companies based on your plan’s situs state:
Companion Life Insurance Company, Companion Life Insurance Company of California, Niagara Life and Health Insurance Company or Pan-American Insurance Company.
7Express Scripts Medicare will comply with applicable state Department of Insurance requirements that are available upon request for the provision of a supplemental product to the Part D
plan. If any government action, change in federal or state law or regulation, change in the interpretation of any law or regulation, or any action by a pharmaceutical manufacturer has an
adverse effect on the pricing terms outlined in this renewal herein or if the above options are modified or the offering of proposed options are modified without express consent of Express
Scripts, then Express Scripts Medicare will have the right, upon notice, to modify these pricing terms. The parties agree that these pricing terms are subject to the Pricing Assumptions
noted8 below.
Express Scripts Medicare reserves the right to re-evaluate the proposed renewal in the event of a significant membership (504 lives) reduction to the extent that it materially
changes the average member morbidity enrolled within the plan."
Unless otherwise notified, the terms and conditions of this renewal notice are binding, accepted, and agreed to by the Plan and are hereby incorporated into your Agreement. In the event
that your organization has not accepted these terms and conditions or otherwise notified Express Scripts Medicare in writing in accordance with our Agreement by the timeframe required
within our Agreement, you shall be deemed to have accepted and agreed to the terms and conditions herein.
Print Name Signature
If you have any questions, please contact Amwins Group Benefits, LLC at 401-734-5980.
Sincerely,
Amwins Group Benefits, LLC
50 Whitecap Drive
North Kingston, RI 02852
401-734-5980
Data Class: Confidential Page | 10 of
FY 2026 Projected Cost – City Only
Revised Projection Scenarios – Alt. Medical Plan 4 & 5
July 2023 - June 2024 July 2024 - June 2025 July 2025 - June 2026
Projected Initial Proj Alt. Plan 4 Revised Proj Alt. Plan 5 Revised Proj
(Jul 25-Dec (Jan 26-Jun (Jan 26-Jun 26) (Jan 26-Jun 26)
(Jul 23-Jun 24) (Jul 24-Dec 24) (Jan 25-Jun 25) 25) 26) United American - $300 Ded United American - $500 Ded
Enrolled Post 65 Members 493 493 493 493 493 541 541
Hartford Monthly Rate * / United American ** $181.00 $181.00 $190.05 $190.05 $199.55 $218.00 $198.00
Enrolled Pre 65 Medicare Eligible Members 19 19 19 19 19 23 23
Hartford Monthly Rate * / United American ** $230.00 $230.00 $241.50 $241.50 $253.58 $218.00 $198.00
ESI Rx Monthly Rate for Pre 65 and Post 65 Members*** $130.50 $130.50 $130.50 $130.50 $130.50 $137.80 $137.80
Total Post 65 Rate $311.50 $311.50 $320.55 $320.55 $330.05 $355.80 $335.80
Total Pre 65 Medicare Eligible Rate $360.50 $360.50 $372.00 $372.00 $384.08 $355.80 $335.80
Total Projected Cost $1,925,028 $962,514 $990,595 $990,595 $1,020,080 $1,204,027 $1,136,347
Total Projected Annual Cost $1,925,028 $1,953,109 $2,010,675 $2,194,622 $2,126,942
1% 3% 12% 9%
* Initial projection assumed rate increase of 5% effective 1/1/2026
** Revised projections assumes the medical carrier will be United American effective 1/1/2026
*** ESI had the option of exercising an increase of up to 3% effective 1/1/2024 and 1/1/2025 which they declined. Additionally, it was expected that no rate increase would apply for the
period of 1/1/2026 through 12/31/2026, absent any legislative changes or actions by a pharmaceutical manufacturer causing an adverse effect on the pricing terms outlined in the prior
renewal. Recent changes introduced by the Inflation Reduction Act (IRA) are being cited as the reason for the rate increase effective 1/1/2026. While designed to lower drug costs for
Medicare beneficiaries, these changes fundamentally shift financial responsibility for prescription drugs to private plan sponsors and drug manufacturers which has resulted in higher costs
for Medicare Part D plans.
1
Page | 11 of Resolution No. 25-113
Introduced in Council: Adopted by Council:
November 17, 2025
Introduced by: Referred to:
Joseph Jenkins FinanceVote Summary
Consensus Score
100.0%
Near Unanimous
Yes
0
No
0
Total Votes:
0