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Board hears modest 2026 health‑plan copay increases, ER surcharge to curb non‑emergency use
Summary
Benefits staff proposed small member cost‑sharing increases for 2026 to help restore the district’s targeted employer/employee cost split. The board heard planned $5 co‑pay increases on many office visits, a rise in emergency‑room co‑pay from $100 to $175, a $10 diagnostic lab fee and a higher flexible spending account limit.
Charles County Public Schools presented proposed changes to its employee health benefits for calendar year 2026 at the Oct. 14 meeting, asking the board to note staff recommendations approved by the health‑insurance committee and to authorize next steps in employee communication.
Christina Warner, benefits manager, said the district aims to maintain an employer/employee cost split of roughly 75/25 under negotiated contracts. Based on claims projections from the insurer, Warner said the projected cost of medical claims this plan year was rising. Rather than raise premium rates district wide, the health‑insurance committee recommended a modest increase in several member cost shares:
- A $5 increase to most office co‑pays (all co‑pays except emergency room visits), which Warner said would better align member cost share with projected claims. - Emergency‑room co‑pay increase from $100 to $175. Warner said the committee specifically adopted a larger rise for ER visits to discourage use of the ER for non‑emergency care and to direct members toward urgent care centers when appropriate. Emergency‑room co‑pays would still be waived if the member is admitted from the ER. - A $10 co‑pay for some diagnostic lab services that previously carried no co‑pay. - An increase in the health‑care flexible spending account maximum from $2,400 to $3,300 to give employees more pretax funds for out‑of‑pocket costs (the federal IRS maximum is higher, Warner said).
Warner noted the district has not raised co‑pays since FY2016 and said the proposal is intended to bring employee cost sharing closer to the plan’s target without raising the monthly premium. The committee supporting the move, Warner said, also recommended preserving no increase for retirees’ Medicare Advantage coverage this year.
Board members and union representatives asked staff to emphasize clear, timely communication so employees and retirees are not surprised by small changes to co‑pays and to highlight FSA tax benefits. Vice Chair Cramer and other board members urged robust outreach to employees, including retirees, and suggested practical materials (checklists and examples of when urgent care is appropriate) to reduce ER utilization.
Discussion vs. action: The board received the presentation and asked for robust employee communication. No formal change to plan design or premium rates was adopted on Oct. 14; staff said the committee’s recommendations would go through the district’s benefit‑adjustment process and be communicated to employees.
Why it matters: The proposed changes are modest but affect employee out‑of‑pocket costs and the district’s self‑insurance budgeting. The ER co‑pay increase is designed to lower high‑cost ER claims caused by non‑emergency visits, Warner said.
What’s next: Staff will finalize plan language and a communication schedule, and return with any formal plan adjustments or enrollment changes for required approvals before open enrollment.
