Board hears steep 2026 health-insurance renewal; staff proposes plan changes and spousal coverage language

The Sycamore School District on Monday heard a detailed presentation on the proposed 2026 employee health-insurance renewal that showed a sharp rise in claim costs and prompted staff to recommend plan changes to limit the district's exposure.
Stacy Smith, the district's benefits coordinator, told the board the district's claims had worsened over the last year: the number of plan members with claims exceeding $50,000 rose to 77 from 48 the prior year; the plan paid roughly $17 million in a prior period and was at about $22 million year to date. She said carriers initially proposed increases above 40 percent for the district.
To reduce the projected premium spike, the district and the insurance committee recommended several changes, which Smith summarized: remove coverage of GLP-1 drugs when prescribed solely for weight loss (coverage would continue for medically indicated uses such as diabetes), increase some pharmacy copays by $10 for a mail order tier (from $25/35/55 to $35/45/65), raise nonemergency emergency-room copays (the presentation proposed doubling to $300 for nonemergency ER visits), and adopt spousal-coverage language that would require a spouse offered employer coverage to enroll in that employer's plan as primary with the district plan as secondary.
"We wanted to illustrate why we have a rate increase at all," Smith said, citing rising specialty-drug costs and a small number of very large claimants. She said Blue Cross Blue Shield initially presented a 52 percent renewal that ultimately narrowed in negotiations but remains substantially higher than recent trends.
Board members asked for the underlying claims data and for staff to continue negotiating with carriers and union groups. Staff said open enrollment and dependent eligibility verification this fall would produce final enrollment numbers and that the district expects to return to the board with options in January. Smith and consultants also described education and case-management efforts carriers and the district will use to try to curb utilization.
No final change to benefits or a contract was adopted at the meeting. Board members agreed by consensus to have staff bring back more detailed options after open enrollment and after further discussions with union representatives.