Wachusett Regional School District outlines participant-funded health plan with district-funded debit cards to lower premiums

Wachusett Regional School District staff detailed on a recorded session how the district will shift to a participant funding arrangement (PFA) for employee health coverage beginning July 1, using savings from a higher-deductible Blue Cross Blue Shield New England base plan to fund debit cards that pay members’ out-of-pocket costs.

Bill, a district staff member who opened the meeting, said the change was presented to and selected by the district’s Public Employees (PE) committee, which includes union and retiree representatives. He framed the move as a response to rising insurance costs — “we are facing another increase of 9.1%” in premiums — and said the PFA option instead yields a roughly 7% premium decrease.

Justin Rosen, a representative of Reimbursement Specialist Incorporated (RSI), described the PFA model as “think of it as insurance for your insurance,” explaining that the district will buy a higher-deductible Access Blue New England Saver 2 base plan while preserving the same provider networks and drug formulary. "If you're on this gold or silver plan, you should never be paying anything to a doctor, to a pharmacist, to anybody out of your pocket until you've exhausted 100% of the funding on that debit card," Rosen said, summarizing how district-funded debit cards are used on a first-dollar basis to offset many routine costs.

How the tiers work

Under the design described by RSI and district staff, all PFA tiers share a $4,000 individual / $8,000 family deductible on the underlying Blue Cross plan. The gold option’s debit card offsets $3,500 of an individual deductible (or $7,000 for a family); the silver card offsets $3,000 individual ($6,000 family). The bronze option remains HSA-compliant: members are responsible for the first $2,000 individual / $4,000 family before district support applies, and members may continue HSA contributions.

Justin Rosen advised members that prescription drugs should be paid at time of service with the district-funded debit card, and that for other services members will receive a provider bill and an explanation of benefits (EOB) from Blue Cross; assuming the billed amount matches the EOB, the debit card can then be used to pay the contracted amount. He urged members to ask providers to bill insurance first and to contact RSI if claim amounts and EOBs do not match.

Cost and protections

Rosen and district staff noted that switching to the PFA avoids an estimated 9.1% premium increase and is intended to produce overall premium savings (the presenters described the net distribution of savings as roughly a 78% district / 22% employee split of the avoided cost). The Blue Cross plan’s out-of-pocket maximum was stated as $6,450; the district-funded debit card in the gold plan offsets the first $3,500 of that maximum, reducing worst-case member exposure.

Plan mechanics and elections

Vicki Chardier, the district’s supervisor of personnel services, and other staff emphasized enrollment mechanics: open enrollment was ongoing and closes May 8; employees must use Employee Navigator to enroll, while retirees should contact benefits staff directly (Deb Daer, benefits administrator). Debit cards will be mailed in sets of two by default, arrive in plain packaging, and additional cards can be requested.

Changes to FSAs and HSAs

Vicki said the district changed the FSA design: instead of a 75-day grace period at plan-year end, the FSA will allow a $680 rollover to the following plan year. Vicki also stated the HSA contribution limits for the bronze plan as $4,400 for individuals and $8,750 for families, with balances rolling year to year.

Vendor, funding and support

Regarding vendor stability and fund handling, Justin Rosen said RSI has administered these PFA-style programs since 1996 and that he has worked at RSI since 2017. Rosen clarified that RSI does not hold district deposits on its own balance sheet; funds backing the debit cards are held in a bank deposit account and drawn down as claims are paid. RSI charges an administrative fee to the district and offers a claims support team, available statedly 8 a.m.–6 p.m. Monday–Friday, to assist members with billing discrepancies.

Formulary and coverage notes

Katie Stewart, who works with the district’s insurance broker Risk Strategies, told attendees that the base plan and provider network remain the same under the PFA. She also confirmed a Blue Cross formulary change effective July 1: GLP-1 drugs used for weight loss (but not GLP-1s used to treat diabetes) were removed from the formulary; she recommended manufacturer assistance programs and third-party options for affected members.

Questions and next steps

Presenters said benefits counselors have been trained on the PFA and can answer most enrollment and coverage questions (with escalation to RSI, Blue Cross or HR as needed). Bill closed the session by thanking attendees, noting the presentation will be posted on the district website (wsd.net) with links to the PFA overview and plan documents, and reminding employees to make elections by May 8.

The district provided numeric examples and FAQs during the session; employees with specific billing or eligibility concerns were urged to contact RSI’s claims team, benefits counselors, or the HR office for one-on-one assistance.