A: Healthcare costs are rising nationwide, and Florida is seeing some of the steepest increases. At the same time, increased medical utilization and declining enrollment have reduced revenue flowing into the Employee Benefits Trust. These factors have created a critical financial challenge that must be addressed now to protect the long-term stability of employee benefits.

A: Retirees and their eligible dependents may continue coverage under the District’s health insurance plan until they become eligible for Medicare (typically at age 65). Retirees pay the full premium cost; however, premiums cannot exceed the amount charged to active employees for the same coverage.

Once eligible for Medicare, retirees transition off the District’s plan and may enroll in a Medicare Supplement or Medicare Advantage plan through the Florida School Retiree Benefits Consortium (FSRBC) or a provider of their choice.

A: The Employee Benefits Trust is how the District funds health insurance through a self-insured model. Rather than paying premiums to an insurance company, Board contributions and employee premiums are deposited into the Employee Benefits Trust.

A: Being self-insured allows the District to:

• Design benefits around District employees’ needs
• Avoid high administrative fees and premium taxes
• Offer programs and coverage options that many fully insured plans do not

This model helps keep benefits comprehensive and cost-effective.

A: Yes. The 16% raise over the last four years for highly effective teachers would not have been possible without the one-mill special millage. It also funds about 2,000 school-based instructional positions.

A: OCPS conducts a competitive review process to evaluate healthcare providers based on cost, quality, and overall value. Decisions are informed by independent analysis and input from multiple stakeholders to ensure employees receive the best combination of coverage, access, and affordability.

A: Yes. OCPS health plans provide access to broad networks of providers, including primary care physicians, specialists, hospitals, and urgent care centers across Central Florida. Plan options are designed to ensure employees can receive high-quality care close to home.

A: In an emergency, you should always go to the nearest emergency room. OCPS plans are designed to provide significant financial protection, with the majority of emergency care costs covered by the District, once deductibles are met. Any costs you are responsible for will count toward your annual out-of-pocket maximum.

A: Different plan options are designed to balance cost and flexibility. Some plans offer broader access, while others provide lower costs by focusing on specific provider networks. This approach gives employees the ability to choose the option that best fits their healthcare needs and budget.

A: Healthcare networks are structured to manage costs while maintaining quality care. Including every provider at the same level of coverage can significantly increase costs for employees and the District. OCPS carefully evaluates networks to ensure strong access while keeping benefits affordable and sustainable.

A: Healthcare costs are increasing nationwide. OCPS and the School Board take a long-term, responsible approach to ensure benefits remain strong and sustainable. Adjustments help preserve the plan’s overall value while continuing to provide comprehensive coverage and financial protection.

A: OCPS uses data-driven decision-making, independent analysis, and ongoing plan evaluation to manage costs. The District also maintains one of the lowest administrative cost structures 

A: Yes. OCPS continuously reviews plan performance, employee feedback, and market trends. This ensures benefits remain competitive, relevant, and responsive to the needs of employees and their families.

A: OCPS regularly evaluates potential enhancements to benefits, including plan design and coverage options. Any changes are carefully considered to balance employee needs, cost, and long-term sustainability.

A: OCPS works to ensure its benefits remain competitive with other districts across Florida. The District and School Board are committed to offering a strong total compensation package that supports both recruitment and retention.

A: Without changes, projections show the trust would require significant additional funding to remain solvent. This year alone, $86 million is being transferred from the General Fund to sustain the trust. Addressing this now helps prevent more disruptive changes later.

A: Projections show a minimum of $145 million in additional funding would be needed to sustain the trust for the upcoming year if no action is taken.

A: The Board has made extensive efforts over the past several years to absorb rising health insurance costs while prioritizing salary increases. Those options are no longer sustainable due to continued increases in healthcare costs beyond the District’s control.  

Since 2021, the District has transferred more than $264 million, largely from the General Fund, to cover these rising expenses. These funds alone could have been redirected to provide nearly $11,400 in bonuses for each benefitted employee. This figure does not include the Board’s substantial annual recurring contribution for employee health insurance, which totals $210 million today and is projected to increase to $230 million by FY27.

A: No decisions have been made. We're reviewing options to protect access to quality care, preserve the advantages of self-insurance, and minimize the financial impact on employees as much as possible.

A: Fully insured plans typically cost more and offer less flexibility. They also include higher administrative costs and premium taxes and would eliminate certain programs currently available through the District’s self-insured model.

A: Health insurance and salaries are directly connected. Rising healthcare costs consume recurring dollars that could otherwise be used for salary increases. Ensuring a sustainable benefits program helps preserve the District’s ability to invest in employee compensation.

A: No. Employers across the country, including many public and private organizations, are facing similar challenges due to rising medical costs, prescription prices and utilization trends. These pressures are part of a broader national healthcare environment.

A: The District has engaged in joint work sessions with CTA & OESPA and will continue bargaining discussions throughout the impasse. Teachers will receive ongoing updates with data, plan options and context to ensure transparency and informed participation.

A: The goal is to maintain a strong, sustainable benefits program that supports employees and their families, minimizes financial impact where possible, and ensures long-term stability for both benefits and compensation.

A: PeopleOne Health, Preventive Care and MD Live services are available outside the deductible. That means, employees and their dependents may pay nothing or a minimal copay to access these services—even if they have not yet met their deductible. All other covered services are subject to the plan’s deductible and coinsurance. For employees and family members enrolled in both a health insurance plan and P1H, P1H services continue to be offered at $0 out of pocket cost.

A: The District does not currently purchase Stop Loss coverage. This coverage is evaluated every two to three years to determine whether it is fiscally advantageous.

As part of the November 2024 Request for Proposal (RFP) for medical and pharmacy coverage, the District also requested quotes for Stop Loss coverage. Based on the projected premium costs, attachment points, and the District’s recent experience with high-cost claims, the analysis showed that the District would likely pay an exorbitant Stop Loss premium without receiving a financial benefit.

The stop loss quotes we received as part of the RFP were between $5M - $15M for stop loss coverage with a $1M deductible per claimant. The average high-cost claim was $190K.

A: The District releases a Request for Proposal (RFP) for benefits consulting services every five years. The current contract with the benefits consultant expires on September 30, 2026.

A: Yes, these services are important and ensure our employees and their dependents are able to access immediate support. The Employee Assistance Program (EAP) through Cigna is a confidential, first line support resource designed to help address personal or family challenges that may feel difficult to manage alone.

Through the EAP, individuals have access to up to five no cost counseling visits per issue. These visits are intended to provide short term support, guidance, and to help identify next steps. Common concerns supported through the EAP include:

• Stress and emotional well being
• Alcohol or chemical dependency concerns
• Marriage and family issues
• Work related challenges

The EAP is available to help individuals get support early and connect with additional resources, if needed. While it does not replace ongoing medical or long term treatment such as doctor visits, lab work, prescriptions, imaging, or extended therapy, this essential service plays an important role in support, referral, and care navigation.

A: PeopleOne Health (P1H) offers comprehensive, ongoing mental health and substance use support as part of its integrated care model.

• Through P1H, members have access to:
  • Unlimited talk therapy, available both in person at the Gore location and via telehealth
  • A wide range of no-cost, generic mental health medications
  • Support from licensed, on staff social workers who help coordinate care
• P1H primary care providers:
  • Actively diagnose, treat, and manage mental health conditions
  • Prescribe and manage medications when appropriate
• In addition, P1H social workers:
  • Coordinate mental health and substance use services
  • Connect members with both P1H based and community resources
  • Support ongoing care navigation and therapy coordination

For substance use disorders requiring specialized care, members can be referred to experienced physicians or specialists within the Cigna network, ensuring access to additional treatment.

A: This would significantly drive up overall health plan costs. Under the federal Mental Health Parity and Addiction Equity Act, coverage for behavioral health and substance use services must be comparable to coverage for medical services.

This means that if behavioral health services were excluded from the deductible, the same approach would need to apply to other medical services as well. Eliminating the deductible for behavioral health services alone is estimated to increase plan costs by approximately $11 million.