Medical Plan Updates
Important Updates about
Our Medical Plans
Effective July 1, 2026
Why the Changes Were Made
The changes to the medical benefit design will help the consortium maintain the strong cost stability it has achieved over the past several years. The consortium has consistently kept medical plan cost increases below general market trends, and these updates will help sustain long-term stability.
The cost increase from 2020 to 2025 is an annual rate of just 3.7%. This is well below the trend in the overall marketplace of 7% to 9%. This is a great track record, and these changes will help it continue.
| OC2 Changes: Brief Summary | |
| Out-of-network deductible No deductible for in-network care. |
$1,500 Individual (increase) |
| Primary Care Services doctor visit | $15 copay (decrease) |
| Emergency room (in and out-of-network) Waived if admitted to the hospital. |
$175 copay (increase) |
| Urgent Care | $35 copay (increase) |
| Teladoc mental health virtual visits | $0 copay (decrease) |
| All other OC2 benefits remain the same. | |
| OC3 CHANGES: Brief Summary | |
| Out-of-network deductible | $2,200 Individual / $4,400 Family (increase) |
| Out-of-pocket maximum for family (out-of-network) | $20,000 Family (decrease) |
| Inpatient hospital per admission | $400 copay (increase) |
| Outpatient surgery | $300 copay (increase) |
| Emergency room (in and out-of-network) Waived if admitted to the hospital. |
$175 copay (increase) |
| Urgent Care | $50 copay (unchanged) |
| Teladoc mental health virtual visits | $0 copay (decrease) |
| All other OC3 benefits remain the same. | |
| NEW OC4 PLAN: Highlights Please check with your HR office to determine if this plan is being offered to you. |
|
| In-network deductible | $2,800 Individual / $5,600 Family |
| Out-of-network deductible | $6,000 Individual / $12,000 Family |
| Coinsurance | 0% in-network / 50% out-of-network |
| In-network out-of-pocket maximum | $5,600 Individual / $11,200 Family |
| Out-of-pocket maximum for out-of-network services | $12,000 Individual / $24,000 Family |
In network preventative care does not require any employee cost share and does not apply to the plan deductibles.
Your out-of-pocket costs are lower, and you get greater value by selecting in network services.
Only medical plans are changing.
The prescription drug benefit manager will continue to be CVS Caremark. Prescription drug benefits continue to follow the agreements in place between your bargaining unit and your school entity/Board of School Directors. Your HR office or Benefits Coordinator will provide this information as part of open enrollment. Our plan administrator will remain Aetna.
OC1 and the Point‑of‑Service (POS) plan will sunset on June 30, 2026.
Other Key Changes
- Deductibles Moving to a Plan‑Year Cycle
The deductible period will change from a calendar year to a plan year. Now your deductible will accumulate from July 1 to June 30 of the following year. This change was made to match the way the Consortium plans operate. - New 4th‑Quarter Deductible Carryover
There is a new 4th-quarter deductible carryover feature.
In-Network Services incurred from April to June will count toward the next plan year’s In-Network deductible. - Special One‑Time Transition for OC3 Members
There will be a one-time transition feature for Members currently enrolled in the OC3 plan, in regard to In-Network amounts. For July 1, 2026, OC3 members will receive deductible credit for any In-Network amounts accumulated from January through June 2026.
Your New Benefits Guide!
A new tool called ALEX will be available to help you compare medical plans. By answering a few simple questions, ALEX makes it easier to under stand your options and estimate potential costs— so you can choose with confidence. A link to Alex featuring plan costs for your school entity and bargaining unit will be sent to you from your HR department.