Orange County Public Schools

A: The district has not increased premiums in three years, but inflation has increased the cost of medical services and prescription drugs. In order for our self-insured plan to remain solvent as determined by the Florida Office of Insurance Regulation, the OCPS health plan must maintain sufficient funds to cover claims for 60-days, which is approximately $41 million. In order to comply with this provision, we need to make plan and premium changes to the existing plans. Without changes, the current health plan may have to dissolve, forcing the district to move to a more costly insurance carrier.

A: The school board contributes over $190M per year for employees’ health insurance; however, since 2020 the district has contributed an additional $100M to the Employee Benefits Trust to ensure solvency of the health plan. Of the $100M, $67M was paid from the General Fund, while $33M was paid with ESSER funds designated for COVID-related expenses. These ESSER funds have been exhausted.

A: The school board will increase the contribution by $1,266 per employee per year. For the 2023-2024 plan year, the district contributes $9,289 per employee per year. The contribution will increase June 30, 2024, to $10,555 per employee per year. The district contributes over $190M in recurring dollars annually for employee health coverage which will increase by another $26M beginning June 30, 2024. 

In order to offset the impact of necessary healthcare premium increases, the district’s $103.5 million salary proposal reflects the highest single-year increase in history.

A: The increase will depend on the plan selected. The chart below shows the current deduction for the 2023-2024 plan year and the new deduction beginning June 30, 2024.

A: Yes, the SureFit plan (Plan D) will remain a $0 premium plan for employee-only coverage.

A: Employees can determine plan enrollment from your Cigna member card. The plan code is located in the upper-right corner of your Cigna ID Card. Employees can also visit the Benefits Sections of the OCPS Employee Self-Serve SAP portal. Plan enrollment is listed under Participation Overview/Enrolled Benefits.

A: Yes, during the April/May Annual Enrollment period, you can change your plan to the no-premium plan (Plan D SureFit) beginning June 30, 2024.

A: The Employee Wellness Program (EWP) provides offerings that allow employees to improve their health and well-being while reducing health care costs. There are programs directly related to disease states including pre-diabetes, diabetes, cancer and chronic conditions – such as Thrive, Livongo, etc.

SurgeryPlus is a supplemental benefit made available to OCPS Cigna members at no additional cost. The benefit offers a lower-cost and high-quality member experience with a focus on positive outcomes for non-emergency surgical procedures. This program provides savings to the OCPS health plan that are passed on to the employee.

A: The copayments for primary care providers (PCP) will be reduced to $15 on all four plans. Also, the copayments for virtual visits through Cigna’s MD Live program will be reduced from $10 to $0. The medical out-of-pocket maximum for in-network coverage will be reduced from $6,500/individual to $4,500/individual and from $13,000/family to $9,000/family. The out-of-network coverage on Plan B will retain the current out-of-pocket maximums of $9,000/individual and $18,000/family. All plans will implement Mental Health Parity effective Oct. 1, 2023, with the current copayments and coinsurance remaining the same; however, the current limitations for outpatient visits and autism coverage will be eliminated.

A: Mental Health Parity requires insurance benefits have the same coverage for mental health and behavioral health coverage as any other medical condition. In 2010, the district opted-out of complying with the Mental Health Parity Act; however the Consolidated Appropriations Act 2023 requires the district’s health coverage comply with mental health parity effective Oct. 1, 2024.

Cigna has offered to add enhanced behavioral health coverage effective Oct. 1, 2023, which would comply with Mental Health Parity. With the Cigna proposal, the current copayments and coinsurance will remain the same; however, Cigna will eliminate limits on outpatient visits and annual and lifetime maximums on autism. The plan changes will not affect the 2023-2024 premiums.

Both OCCTA and OESPA signed a Memorandum Of Understanding (MOU) to implement plan enhancements; therefore, the district’s health plan will comply with Mental Health Parity effective Oct. 1, 2023.

A: For a comparison of health plans and coverage from other nearby school districts, click here.