Increase to Plan Year Deductible

Currently, the Individual Deductible is $300 and the Family Deductible is $600. Effective 9/1/2026 the Individual Deductible will increase to $350 and the Family Deductible will increase to $700.

• Only inpatient and outpatient hospital charges, as well as charges from an ambulatory surgical center apply towards the Plan Year Deductibles
• Once the Individual Deductible is met, the individual will have no further out of pocket expenses for in-network covered charges from an inpatient or outpatient hospital or ambulatory surgical center. The plan year runs from 9/1 through 8/31
• Only 2 members of a family need to meet their Individual Deductible to satisfy the Family Deductible. Once the Family Deductible is met, all members of the family will have no further out of pocket expenses for in-network covered charges from an inpatient or outpatient hospital or ambulatory surgical center
• Individual and Family Deductibles count towards the Individual and Family Out of Pocket Maximums

Return of $35 Copay for Imaging Services at Radnet and California Medical Imaging (CMI)

On 8/31/25 the Direct Contracting agreement for imaging services at Radnet and CMI facilities terminated due to the fact our new PPO Network, Anthem Blue Cross, offered lower fee schedules for imaging services than the Direct Contract. Although the contract terminated, the plan continued to waive copays for plan members until the EBC could reconvene and make a decision to maintain or waive the copays. Effective 9/1/2026 copays for imaging at Radnet and California Medical Imaging will be reinstated at $35.

Increase to the Emergency Department Copay

Currently the Emergency Department Copay is $200. Effective 9/1/2026 the Emergency Department Copay will increase to $250.

• If a patient is present in the Emergency Department but is then admitted to the hospital, there will be no Emergency Department copay as the $350 deductible would then apply (unless already met)
• In-Network Emergency Department Copays count towards the Individual and Family Out of Pocket Maximums

Exclusion of GLP-1 Medications for Weight Loss Only

Currently the plan covers GLP-1 medications for weight loss only up to a $5,000 Lifetime Maximum. Effective 9/1/2026 the plan will no longer cover GLP-1 medications for weight loss only.

• GLP-1 medications will remain available for members with a diagnosis of Diabetes
• The District has implemented the Rx Savings Plus program through CVS, at no cost to the plan, which will provide significant savings on GLP-1 medications for members who have met their $5,000 Lifetime Maximum. See examples below of member costs for GLP-1 medication for weight loss using the Rx Savings Plus program once it is effective on 4/1/26

• Please see the Rx Savings Plus flyer included in this mailing for additional information on how members can save money on prescriptions not covered under the plan as well as over the counter medications and supplements

Increase to Copay When a Hospital is Used for Labwork, Imaging, and Physical Therapy

Effective 9/1/2026 when hospitals are utilized for laboratory, imaging and physical therapy services members will be charged a $70 instead of the $35 copay.

• The $70 copays applies when the hospital bills using a clinic location. If the hospital bills using an outpatient hospital location, the deductible would then apply (unless already met)
• Copays do not apply during inpatient hospital stays as the deductible would then apply (if not already met)

6.2% Increase to Active Employee Premiums

Effective 9/1/2026 active employee premiums will change as follows:

• Employee premiums are automatically deducted from an employee’s paycheck before federal and state income taxes are calculated. This allows for employees to pay for their premiums with pre-tax dollars, reducing their taxable income and tax liability. In most cases, the change an employee will see on their paycheck will be less than the actual increase in their premium noted above
• Retiree Premiums will not be affected by this 6.2% increase and will continue to be calculated in accordance with Governing Board Policy No. 4154, 4254, 4354. The new rates for retiree premiums will be available on 8/1/2026