Employee Benefits

The District has covered 27% in premium increases over the last several years, in addition to an 8% increase for the 2026 plan year. The cost of insurance will likely continue to rise due to matters beyond our control, such as market trends, inflation, and large claims. However, the District will continue to do what it can to mitigate the impact of these increases on employees while following collective bargaining agreements. 

No, that issue has nothing to do with being self-insured. Dentists add and drop insurance providers depending on patient load, ease of use, reimbursement rates, and other factors.  

Your out-of-pocket maximums, copays, and deductibles paid this calendar year will be carried over when we change insurance programs. This change would happen effective 10/1/2025. 

Yes, generic prescriptions will still be free at Costco pharmacies.  

UCLA is covered by our current plan. In-network and out-of-network rules still apply as they would with our current plan.  

The District is staying with Anthem as our health insurance carrier. If your provider currently takes your insurance, then your provider will still be able to take you as a patient when we switch insurance programs.  

Yes. Please note that deductibles, coinsurance, and copays may still apply. 

Yes, the Teledoc Health service remains available to everyone. Please note that deductibles, coinsurance, and copays may still apply. a

No, workers comp is managed through a separate Joint Powers Agreement (JPA) .

FSA & DFSA would stay with American Fidelity. 

Yes, your individual medical information is private. District staff will have no access to individual medical information. 

Midi focuses on women’s health. We do not have utilization data on Midi and although there may be other programs available that focus on women’s health, we intend to keep Midi. 

The initial contract with Parteo and BRMS will be one year, however it will likely require more time to determine if the transition was “successful”. But we can always return to SISC or a similar JPA program if things do not work out as planned. 

Distric staff will not be reviewing medical records. Chronic condition and wellness management is a added benefit through BRMS and would be employee driven can help employee groups be healthier. District management will have access to overall utilization data that can be used to offer more focused programs. 

This has been an ongoing discussion in the benefit advisory group. HUB and Pareto have presented to the group as well. All employee groups are represented on the benefit advisory groups with the intent that they disseminate information as it is received.

For now, none. Plan choices currently remain the same. 

There is a stop-loss/reinsurance policy in place through Pareto via Sunlife Financial. 

No, it’s not individually rated. AHC is still rated as a whole group and durable medical will continue. 

A grievance is a response to a collective bargaining contract violation, so unless  a contract violation occurs, the grievance process doesn’t apply.  BRMS and Anthem do have an appeals process for claims if needed.  

You will receive a new ID card with an updated ID number that will need to be provided to your doctor(s).

By being self-insured, we hope to be able to add additional value-added products for our members use. Currently, SISC does not provide the District with utilization data of value-added programs.  Moving forward, the goal is to utilize data to update our value-added programs to better suit the District’s needs.  

Pareto is an employer collective, which is a group of employers sharing the claims risk and managing the stop loss insurance. BRMS is the third-party benefit administrator responsible for the day-to-day administration of our medical benefits. HUB is our local insurance broker.

There is no health benefits negotiation team; changing benefit administrators does not require negotiations. This transition has been facilitated by a Benefit Advisory Group alongside a small group of District management. 

At the time of the town hall, a contract had not been signed.  Yes, we would likely be able to go back to SISC or another similar JPA or program if the new program does not work out as planned. 

The District has covered 27% in premium increases over the last several years, with an 8% increase for the 2026 plan year. The cost of insurance will likely continue to rise due to matters beyond our control, such as market trends, inflation, and large claims. However, the District will continue to do what it can to mitigate the impact of these increases on employees along with following collective bargaining agreements. 

Yes, your medical history will live with your physicians and with Anthem.  

We will be part of a risk pool with Pareto Health and be backed by additional stop-loss insurance for large claims. We will also receive our initial investment with SISC back, which will be held in a health benefit reserve fund. 

As the Benefits Coordinator, Pam Blanchard is always available for questions.   

Self-funded health insurance groups in California are primarily regulated by the Employee Retirement Income Security Act (ERISA). While the California Department of Insurance (CDI) and Department of Managed Health Care (DMHC) regulate fully-insured health plans, self-insured plans are largely exempt from state insurance laws. The U.S. Department of Labor, through its Employee Benefits Security Administration (EBSA) enforces ERISA.

The “risk shield” is the protection we get from Pareto and the stop-loss contracts they  provide. We have a guaranteed rate cap on all our stop-loss renewals. A laser is the identification of a certain high cost member which a stop-loss carrier can make an employer pay more claims for. The “no new laser” provision prohibits the stop-loss carrier from ever implementing a higher charge on a specific employee due to higher claims. The District is going into Pareto with no “lasers” and will never receive a new laser going forward due to being a part of Pareto.  

Yes, the open enrollment will still be in July and the change will take effect in October.  

No. We are already self-insured through SISC, so nothing changes by moving to Pareto and BRMS from a legal perspective. 

Your out-of-pocket maximums, copays, and deductibles paid this calendar year will be carried over when we change insurance programs. This change will happen effective 10/1/2025. 

Yes, there are local organizations who self-insure with Pareto, BRMS, and  HUB. They are all large, well respected organizations. We have reached out to some of the local companies who self-insure with these groups, and they have provided encouraging feedback.

No. BRMS will be the main claims administrator and HUB will work with the District as our broker. All three entities have entirely different roles and will have little to no impact to employees.  

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