Evergreen Park ESD 124 announces medical plan changes, special open enrollment and dependent-audit timeline

Erica Mendoza, a benefits consultant with Gallagher, told Evergreen Park ESD 124 employees during a recorded special enrollment session that changes to the district’s medical plans will take effect July 1, 2024, and that the Educational Benefit Cooperative (EBC) will conduct a dependent‑eligibility audit Oct. 1–Nov. 15.

Mendoza said the special enrollment covers medical plans only and permits employees to enroll, waive coverage, switch among plan options, or add or drop dependents during the window. “You can switch between plan options and you can add or drop dependents,” she said, adding that changes outside this period require a qualifying life event such as birth, marriage or loss of coverage.

Why it matters: the plan design changes alter member cost-sharing and how deductibles and out-of-pocket limits apply. Mendoza and co-presenter Brian Franz, also of Gallagher, walked through the new High‑Deductible Health Plan (Plan H), the HMO changes and prescription tiers so employees can decide which plan best fits their needs.

Plan H (HDHP) changes and key numbers
Mendoza said the district has introduced separate in-network and out‑of‑network deductibles and out-of-pocket limits on Plan H. Key figures presented were an individual deductible of $1,800, an individual‑plus‑one deductible of $3,600 and a family deductible of $3,800. Out-of-pocket limits were listed as $3,600 for individuals, $5,600 for individual‑plus‑one and $7,600 for families. Mendoza said the plan will pay 90% in‑network after the member meets the deductible (the member pays 10%), with the plan covering 100% once the out‑of‑pocket maximum is reached.

HMO and copay changes
Mendoza said the HMO plan’s emergency‑room copay will increase from $50 to $150, though that copay is waived if the member is admitted to the hospital. Office visit copays were described as changing from $10 to $20 for primary care physicians and to $40 for specialists.

Prescription benefits and mail‑order
The presenters described prescription tiers as preferred generic $5, non‑preferred generic $15, preferred formulary $30, non‑preferred formulary $50 and specialty $75. The presentation’s transcript shows a likely transcription error for the non‑preferred specialty tier; Gallagher materials provided during the session will be the authoritative source for exact specialty copays. Presenters also explained that a 90‑day mail‑order supply is billed as two months’ cost (pay for two months, receive three months).

PPO plans and premium credit
Franz said PPO plans E and G will not change. Employees who switch plans effective July 1 will receive a credit for amounts they paid Jan. 1–June 30, but the credit is a manual process: employees must contact Blue Cross (the number on the back of the ID card) to request carryover credit and wait for it to post in the Blue Access for Members (BAM) portal.

Dependent eligibility audit and next steps
Mendoza said the EBC is initiating a dependent‑eligibility audit to confirm covered dependents meet plan requirements. Employees will receive emails and letters with instructions and may submit required documentation via mobile or website app; Impact Interactive will administer the audit. Mendoza warned that dependents who cannot be verified will be removed from district coverage effective Jan. 1, 2025, and said those dependents will not be offered COBRA. The district is working to publish alternative coverage resources for affected dependents.

HSA eligibility and plan mechanics
Franz explained that Plan H is HSA‑eligible if the individual has no disqualifying coverage: no health FSA, no first‑dollar coverage under another plan (for example, a spouse’s non‑HDHP), not enrolled in Medicare and not claimed as someone else’s tax dependent. He noted employees enrolled in an FSA must wait until 2025 to open and contribute to an HSA.

Member resources and value‑added programs
The presenters reviewed Blue Cross Blue Shield and EBC resources available to members, including the BAM portal and provider finder, the Well onTarget wellness portal and BluePoints rewards, fitness program tiers, a 24/7 nurse line, Learn to Live digital mental‑health tools, Teladoc telemedicine (no cost for PPO/HMO, a copay for HDHP members), chronic‑disease coaching (formerly Livongo, now part of Teladoc Health), identity‑protection services (InfoArmor) and the EBC Navigate well‑being portal.

Contacts and follow‑up
Mendoza said Shannon Cusack will be available at district buildings over the next two weeks to answer enrollment questions and that the presentation deck and flyers will be shared with staff. The session was recorded and, per the host, the recording will be posted to YouTube the following day.

What was not decided
No formal motions, votes or policy adoptions were taken during the presentation; the session served to explain plan changes and next steps. Employees seeking plan documents, exact specialty copays or vendor forms were directed to the follow‑up materials and to contact Blue Cross or Shannon Cusack for assistance.