Teton commissioners to OK 2026 Allegiance admin deal for self-funded health plan

Teton County commissioners are scheduled to approve a 2026 Administrative Services Agreement with Allegiance Benefit Plan Management, Inc. at their April 7 meeting, continuing Allegiance’s role as third-party administrator for the county’s self-funded employee welfare benefit plan. The staff report says the 2026 administrative fee rose 2.5%—about $4,380—spread across per-employee-per-month fees in the agreement’s Appendix A. (Board Meeting Staff Report and Attachments Packet)

Beyond the base admin-fee bump, the packet lists multiple fee and scope changes. Those include higher hourly rates for large case management ($115/hr to $175/hr) and medical-review work (doctor: $275/hr to $300/hr; nurse: $100/hr to $110/hr), plus new language for an out-of-network savings program charging 35% of gross savings (29% of net savings) per claim. The agreement also adds/clarifies compliance-related work on “NQTL” analysis at $450/hr, and adds a $1,800-per-year fee for each eligibility feed (on top of existing eligibility-file fees). (Board Meeting Staff Report and Attachments Packet)

A newly described “Site of Care” program would trigger milestone fees tied to moving certain infusions to a new site: $5,000 after the first successful infusion, $5,000 after the second, with a $10,000 cap per member in the first plan year and up to $15,000 per member per drug over two plan years if savings continue. County HR told commissioners most of the add-on fee categories are “rarely used,” but the agreement’s pricing is described as guaranteed from Jan. 1, 2026 through Dec. 31, 2028. (Board Meeting Staff Report and Attachments Packet)