Teton County renews Allegiance benefits contract with new out-of-network fees

Teton County’s Board of County Commissioners on April 7 approved a 2026 Administrative Services Agreement (ASA) with Allegiance Benefit Plan Management, Inc. to continue administering the county’s self-funded employee health plan. The contract runs Jan. 1–Dec. 31, 2026 and automatically continues in 12-month periods unless changed under the agreement. (Board Meeting Staff Report and Attachments Packet)

In the staff report, county HR said the primary cost change is a 2.5% increase in administrative fees for 2026, estimated at about $4,380 and spread across per-employee-per-month fees in the agreement’s Appendix A. HR also flagged higher hourly charges for certain services the county “rarely” uses — including large case management ($115/hr to $175/hr) and care-management medical review work (doctor time $275/hr to $300/hr; nurse time $100/hr to $110/hr). (Board Meeting Staff Report and Attachments Packet)

The updated ASA also adds several new fee items tied to specific compliance or cost-management services. These include an out-of-network savings program fee set at 35% of “gross savings” (or 29% of net savings) realized per claim; a clarified scope and hourly rate for non-quantitative treatment limitation (NQTL) analyses ($450/hr); a new $1,800-per-year fee for each eligibility data “feed” (in addition to existing eligibility-file fees); and “site of care” milestone fees for moving infusion drugs to lower-cost settings, with fees that can total up to $15,000 per member per drug over two plan years (with a first-year cap of $10,000). (Board Meeting Staff Report and Attachments Packet)