Don Calderon, the district’s director of risk management and employee benefits, and consultants from the district’s benefits advisor presented a mid‑year update on employee medical coverage after the district moved coverage to Cigna on July 1, 2025.

Gabrielle Swain summarized claims experience through November 2025 and reported a rolling 12‑month loss ratio of about 92% and a first five‑month year‑to‑date loss ratio of roughly 94%, with October and November running above 100% in recent months. “So 94 percent including that is a pretty high number from what we would like to see,” she said.

Dustin Keen said the RFP negotiated a not‑to‑exceed 10% rate cap for year two; under a standard underwriting renewal the district’s claims profile might call for an increase near 20% but the contract language limits next‑year increases to 10%. Consultants presented two rating approaches: a 10% across‑the‑board increase or siloed plan rating that would apply different increases by plan (examples shown with higher increases for the largest‑enrollment plan and a lower increase for the high‑deductible plan).

Presenters noted plan enrollment distribution drives the claims picture: approximately 65% of enrollment is in the OAPIN plan (formerly an HMO) but that population accounts for around 80% of claims, while about 30% of employees are in the high‑deductible plan and account for roughly 12% of claims. Board members and consultants discussed using incentives to shift enrollment toward the high‑deductible plan, expanding wellness efforts and evaluating a clinic to shift utilization out of the health plan.

Options discussed included negotiating plan design to preserve an employee‑only $0 premium option, siloing plan rating by experience, pursuing a clinic (consultants estimated clinic build-out costs in the ~ $1,000,000 range for the district’s size) and considering hybrid self‑insured models with stop‑loss. Consultants said a rough 60‑day reserve benchmark would put self‑insurance reserve needs in the low millions (presented informally as a ballpark figure of approximately $3.5 million), and they offered to produce side‑by‑side fully insured and self‑insured cost comparisons at renewal.

Several trustees emphasized employee concerns about the high out‑of‑pocket exposure of a high‑deductible plan and asked the administration to examine financial impacts for families and options to preserve affordability. Staff said they would return with updated renewal recommendations and additional claims months for more precise negotiation.