How the Health Benefits Work
Health benefits are, with salaries, the cost the Board names first when it explains the outsourcing and the contract offer: “salaries and health benefits. These costs comprise more than 70% of our budget and these costs rise from year to year” (Superintendent’s letter, April 29, 2026, p. 2). This page sets out, from the district’s own records and the state’s, what the district buys, what it pays, what its employees pay, what the law requires of it, and what is happening to the state plan it is often compared with. The last two sections take up questions residents have been asking about alternatives, including the question of doing without insurance for everything but catastrophe. Those sections are the ledger keeper’s assessment and are marked as such; the rest is record. Nothing here is legal or financial advice.
The spring 2026 proposals on this subject (Module 5, written before the budget passed) are kept as an archive. This page supersedes them where they differ and will be updated as records arrive.
What the district buys
West Orange is not in the state’s School Employees’ Health Benefits Program (SEHBP). It buys medical and prescription coverage through the School Health Insurance Fund (SHIF), a joint self-insurance fund of New Jersey school districts, with Aetna as the medical carrier, Express Scripts for prescriptions, and Delta Dental for dental. The district’s 2026-27 budget summary lists “Insurance Coverages and Benefits: School Health Insurance Fund” under shared services (User Friendly Budget, p. 10), and the Board approves the fund’s renewal rates each June.
The district offers four medical plans. Two are the plans state law requires every district to offer, the New Jersey Educators Health Plan (NJEHP) and the Garden State Health Plan (GSHP), in SHIF’s “equivalent” versions. Two are older plans, an “Open Access $10/$20” plan and a high-deductible plan with a health reimbursement account (HDHP-HRA). The monthly premiums the Board approved for the current and the previous school year, for an employee alone and for a family (the minutes also give parent-and-child and two-adult rates):
| Plan | Coverage | 2025-26 | 2026-27 | Change |
|---|---|---|---|---|
| Open Access $10/$20 (Aetna) | Single | $1,474 | $1,710 | +16.0% |
| Family | $4,347 | $5,057 | +16.3% | |
| HDHP-HRA (Aetna) | Single | $1,109 | $1,325 | +19.5% |
| Family | $3,279 | $3,917 | +19.5% | |
| NJ Educators Health Plan (Aetna) | Single | $1,252 | $1,391 | +11.1% |
| Family | $3,703 | $4,116 | +11.2% | |
| NJ Garden State Health Plan (Aetna) | Single | $1,110 | $1,243 | +12.0% |
| Family | $3,281 | $3,674 | +12.0% | |
| Prescription, standard (Express Scripts) | Single | $268 | $340 | +26.9% |
| Family | $747 | $949 | +27.0% | |
| Prescription, Educators and Garden State plans | Single | $236 | $285 | +20.8% |
| Family | $657 | $795 | +21.0% | |
| Dental, high option (Delta) | Single | $54.50 | $56.14 | +3.0% |
| Family | $187.52 | $193.15 | +3.0% |
Sources: June 16, 2025 minutes, pp. 17-19 and June 16, 2026 minutes, pp. 23-25, “Health Benefits Costs” for each school year, rates effective July 1. The table is reproducible from the two PDFs with a short script.
Medical and prescription together, the Educators plan costs $1,676 a month for one employee and $4,911 a month for a family in 2026-27, which is $20,112 and $58,932 a year, up 12.6% from 2025-26. The Open Access plan with the standard prescription plan costs $2,050 and $6,006 a month, $24,600 and $72,072 a year, up 17.7% and 17.9%. The “nearly 18%” increase in health benefits reported in April (The Digest, April 13, 2026, no source given) matches the Open Access line; the district’s blended increase depends on how many staff are in each plan, which is not published.
In the budget. The 2026-27 budget’s “Personal Services-Employee Benefits” line is $40,348,140, against $35,087,587 budgeted for 2025-26 and $30,904,458 spent in 2024-25, a rise of 15.0% in one year and 30.6% in two (User Friendly Budget, p. 5). That line covers all benefits, not health alone, though not the pension and Social Security the state pays on the district’s behalf; the same document puts employee benefits at 38.45% of salaries for 2026-27, against 31.21% the year before (p. 9). On May 4, 2026 the Board added $797,076 to the budget as a “Health Care Costs adjustment” under N.J.S.A. 18A:7F-38(d), the provision that lets a district raise its tax levy above the 2% cap for health cost increases, “to pay for the additional increases in health care premiums” (minutes, p. 7).
How many employees are enrolled in each plan and tier, what the district paid in premiums net of employee contributions, and who the district’s broker is and how it is paid are not in any published record found so far. Since September, the paraprofessionals employed through EduStaff are the agency’s employees, and whatever coverage they are offered is the agency’s; what the district paid for its own paraprofessionals’ coverage in 2025-26 is part of the $3 million question on What the District Said.
What an employee pays
Under Chapter 44 (P.L. 2020, c.44), an employee enrolled in the Educators plan or the Garden State plan, or a district’s equivalent of either, pays a percentage of salary rather than a share of the premium. The percentage rises with salary and with the coverage tier, and the salary used is capped at $125,000. From the state’s 2026 contribution chart for the Educators plan (Division of Pensions and Benefits; the Garden State plan’s percentages are about half of these):
| Base salary | Single | Parent and child | Employee and spouse | Family |
|---|---|---|---|---|
| Up to $40,000 | 1.7% | 2.2% | 2.8% | 3.3% |
| $40,001 to $50,000 | 1.9% | 2.5% | 3.3% | 3.9% |
| $50,001 to $60,000 | 2.2% | 2.8% | 3.9% | 4.4% |
| $60,001 to $70,000 | 2.5% | 3.0% | 4.4% | 5.0% |
| $70,001 to $80,000 | 2.8% | 3.3% | 5.0% | 5.5% |
| $80,001 to $90,000 | 3.0% | 3.6% | 5.5% | 6.0% |
| $90,001 to $100,000 | 3.3% | 3.9% | 6.0% | 6.6% |
| $100,001 to $125,000 | 3.6% | 4.4% | 6.6% | 7.2% |
| Above $125,000 | $4,500 | $5,500 | $8,250 | $9,000 |
Set against the district’s 2026-27 rates, a paraprofessional earning $30,000 with family coverage on the Educators plan would pay $990 a year toward a premium of $58,932; the district pays the other $57,942. A teacher at the median base salary on the May 4 reappointment list, $111,038 (How the Pay Works), pays $3,997 a year for single coverage against a $20,112 premium, or $7,995 for family coverage against $58,932; the district pays $16,115 or $50,937. Because the employee’s share is fixed to salary, a premium increase on these plans falls entirely on the district.
What a paraprofessional cost. In 2025-26, the last year the paraprofessionals were district employees, the Educators plan with prescriptions cost $1,488 a month for one employee and $4,360 for a family, $17,856 and $52,320 a year. A paraprofessional earning $30,000 paid $510 or $990 of that and the district paid the rest: about 58% of her salary for single coverage and about 170% for family coverage, before the district’s share of pension and payroll taxes. Whether a given paraprofessional was eligible turns on the hours threshold in the union agreement, which is not public, and how many took which tier is not published. The arithmetic is nonetheless what makes health coverage most expensive, relative to pay, for the lowest-paid staff, and it is the line an outsourcing decision reaches first. What the district paid for the group’s coverage, and what EduStaff offers in its place, are what items 7 and 1 of OPRA-001 ask for.
Employees in the older plans contribute under the earlier law, Chapter 78 (P.L. 2011, c.78), which sets the share as a percentage of the premium rising with salary to 35% for those earning $110,000 or more with family coverage, or $95,000 or more with single coverage (the schedule is reproduced in Chapter 44, section 4). At those rates, family coverage on the Open Access plan with prescriptions would cost such an employee about $25,000 a year, against about $8,000 on the Educators plan. That difference is why enrollment statewide has moved to the new plans: in the state program, 81% of active subscribers were in the Educators or Garden State plan in 2026, up from 59% in 2024 (mid-year presentation, March 2026, p. 8). Which plans West Orange staff are in is not published.
What the same coverage costs elsewhere. The national average employer premium in 2025 was $9,325 for single coverage and $26,993 for family coverage, with workers paying 16% and 26% of it (KFF Employer Health Benefits Survey, 2025). The district’s Educators plan premium is 2.2 times the national average for both tiers. The comparison is rough: New Jersey’s medical prices are high, the Educators plan is a national-network plan with $10 and $15 copayments, and a school workforce is older than the national average. It is the scale of the number that matters for everything below.
Waiving coverage. For public employers in the state health programs, for county colleges, and for counties and municipalities, state law lets an employee “who is eligible for other health care coverage” waive the employer’s plan, lets the employer pay the employee for doing so at its own discretion and outside collective bargaining, and since P.L. 2010, c.2 caps the payment: it “shall not exceed 25%, or $5,000, whichever is less, of the amount saved by the employer” (the 2010 law, sections 11, 17, and 18; the Division of Local Government Services explains the calculation in Local Finance Notice 2016-10). The state’s guidance names coverage “through a spouse or domestic partner” as the example of other coverage, and for districts in the state program the state’s administration manual (October 2026, p. 5) requires “other employer-provided health care coverage”. None of those statutes names a board of education outside the state program, and no statute that does has been found for this page. For West Orange, then, whether waivers are paid, how much, and what counts as other coverage rest on the Board’s own policy and the union agreement, neither of which has been seen; the $5,000 figure used below is the cap the comparable statutes set, taken as the working assumption. How many employees waive is not published.
The law, and what changes at the end of 2027
Three state laws set the frame. Chapter 2 (P.L. 2010, c.2) was the first statewide requirement that public employees contribute to their health coverage, at 1.5% of base salary. Chapter 78 (P.L. 2011, c.78) replaced that with a share of the premium, phased in over four years, from 3% to 35% depending on salary and tier (Division of Pensions and Benefits). Chapter 44 (P.L. 2020, c.44) created the Educators and Garden State plans for school employees and moved their contributions back to a percentage of salary.
For a district outside the state program, Chapter 44 says (section 5):
- It “shall offer to its employees, and their dependents if any, the equivalent of the New Jersey Educators Health Plan” from January 1, 2021 “and for each plan year thereafter”, and the equivalent of the Garden State Health Plan from July 1, 2021, “regardless of any collective negotiations agreement”.
- Employees hired after the law took effect “shall be enrolled by the employer” in one of the two, and stay there “until December 31, 2027”, unless they waive coverage.
- “No new health care benefits plans, other than those specified in paragraph (1) of this subsection, shall be added by the employer from January 1, 2021 through December 31, 2027 unless the provisions of any collective negotiations agreement entered into before or after the effective date of this act, P.L.2020, c.44, result in additional premium cost reductions.” Plans that existed before the law may continue.
- “The level of benefits in the equivalent New Jersey Educators Health Plan and the equivalent Garden State Health Plan offered by the employer shall remain unchanged until December 31, 2027.”
- “Commencing January 1, 2028 and for each plan year thereafter”, both the level of benefits and the employee contributions for those plans “may be modified in accordance with collective negotiations agreements”.
So what ends on December 31, 2027 is the freeze: the fixed plan designs, the fixed contribution schedule, the mandatory enrollment of new hires, and the bar on adding plans. The duty to offer the two plans has no end date in the text. Education lawyers describe the law as “set to expire on December 31, 2027” (Chasan Lamparello Mallon & Cappuzzo, November 13, 2025), and the teachers’ union says it “expires at the end of 2027” (NJEA); in practice both mean that from 2028 health benefits for school employees return to the bargaining table, plan by plan and district by district. The current West Orange agreement expired on June 30, 2025 and a successor is in fact-finding (How the Pay Works); its health benefits article is not public.
Two things are moving in Trenton. The union-backed S4438/A5285, the “Public School Employees’ Health Benefits Trust Act”, introduced June 8, 2026, would create a new trust for school employees’ coverage; it is in the Senate State Government committee. Separately, Governor Sherrill reached an agreement with 17 unions of state employees on September 2, 2026 that waives increases in state employees’ contribution rates for 2027 and committed to a working group on the State Health Benefits Program by October 1 (Governor’s office); the State Health Benefits Program Reform Working Group was launched on October 1 with a first meeting on October 16 (announcement). The announcements name vendor contracting, premium-contribution structures, plan design, and participation rules as its topics. They do not mention Chapter 44 or school districts, and the 2027 freeze is for state employees, not school employees.
The state plan and the pool
The SEHBP is the comparison the district is most often asked about, and it is in trouble of its own. For 2026 the state’s actuary, Aon, recommended and the program adopted a 31.9% increase for active school employees, 27.9% on medical and 58.6% on prescription premiums (Plan Year 2026 analysis). The 2026 Educators plan rate for one employee, medical and prescription together, is $1,313.89 a month (2026 rate sheet). For 2027 Aon recommended a further 34.4%, 32.4% on medical and 45.5% on prescriptions, with premiums set 15.9% above expected claims to repay a $70 million temporary transfer the Legislature authorized in June 2026 (P.L. 2026, c.28) and to begin rebuilding a reserve projected to be below zero at the end of 2026 (Plan Year 2027 analysis, pp. 3-7). The commission that sets the rates deadlocked on July 27, August 19, and September 3; on September 18 the Division of Pensions and Benefits warned districts that if the deadlock continued “the SEHBP will not be an option for providing health benefits by employers to their employees starting January 1, 2027” (memo). The increase was approved on September 25 over the votes of the three union-appointed commissioners; a Treasury spokesman said “Chapter 44 established the current SEHBP plan structure and froze plan design of all SEHBP plans through the end of 2027” (New Jersey Globe, September 25, 2026).
Aon’s reports describe why. Active membership in the school employees’ plan was 116,525 in early 2026 against 133,616 assumed when the 2026 rates were set, a 12.8% drop, and Aon writes that “significant enrollment declines over the past two years, as Local Education employers opt out of the SEHBP for available lower cost coverage, has likely increased the risk pool remaining in the plan” (mid-year presentation, pp. 4-5). The 2027 rates carry an “anti-selection” load of 4.75% “to reflect the increased risk of employers choosing to leave the plan”, with the note that “even this level of anti-selection may be insufficient if attrition from the plan is significant”, and assume active enrollment falls another 8.75% in 2027. Inside the plan the same sorting happens between plans: employees in the Educators plan are on average 8 years younger than those in the older PPO plans, and those in the Garden State plan 14.8 years younger. On the claims side, prescription spending on weight-loss drugs rose 83.5% in 2025, Zepbound was the plan’s single largest drug by spend and Wegovy, Mounjaro, and Ozempic were all in the top five, specialty drugs for inflammatory conditions rose 21%, and outpatient and specialist-physician costs rose 12% and 17% (Plan Year 2027 analysis, cost drivers section). The spring essay on the limits of local self-reliance is about exactly this problem.
Two comparisons follow, each with a caveat. The state’s 2026 Educators plan rate for one employee, $1,313.89, is 22% below the district’s SHIF rate for the same plan design in the year from July 2026, $1,676; but the state rate is a single statewide rate for calendar 2026 and the district’s is its own fund’s rate for a later twelve months, and the state’s 2027 rates, once posted, will be about a third higher. The law requires every district to “examine all available group options for insurance policies and participate in the most cost-effective plans as a condition of receiving State Aid” (N.J.S.A. 18A:55-3, as cited by the State Auditor, p. 6); the auditor found in December 2025 that Perth Amboy had not done so and could have saved $49.1 million over five years by joining the state plan, and that its broker was taking undisclosed commissions. Whether and when West Orange last made that comparison is a records question. The fund the district belongs to has its own finding: the State Comptroller reported in September 2025 that SHIF paid about $36 million over five fiscal years to a program manager and an affiliated brokerage that “function as one entity”, without the conflict-of-interest disclosures the law requires (Office of the State Comptroller, September 9, 2025).
Questions residents are asking
This section and the next are the ledger keeper’s reading of the records and the law, offered for discussion. They are not legal advice, and corrections are welcome.
“Why can’t a teacher buy a plan on Get Covered New Jersey and have the district pay for it?” Three rules stand in the way. First, an employer that pays or reimburses premiums for individual policies outside a compliant arrangement runs an “employer payment plan”, which federal guidance since 2013 treats as a group health plan that fails the Affordable Care Act’s market rules, with an excise tax of $100 a day per employee (IRS). The compliant form is an Individual Coverage Health Reimbursement Arrangement (ICHRA), under which an employer sets a fixed contribution and employees buy their own individual policies, including catastrophic plans. But an employer may not offer the same class of employees both an ICHRA and a traditional group plan; it can split classes only along lines the regulation lists, such as full-time against part-time or salaried against hourly, with minimum class sizes (45 CFR 146.123). An optional reimbursement beside the existing plan for every teacher is not available. (A House bill in 2025 would have written ICHRAs into the tax code under a new name, “CHOICE Arrangements”; that part was dropped from the law signed on July 4, 2025, so the name has no legal standing.) Second, Chapter 44 requires the district to offer the Educators and Garden State plans and, through 2027, bars adding others. Third, a teacher who is offered affordable coverage at work cannot receive the federal premium tax credit on the marketplace, so the individual price is the full price.
“The district pays $5,000 to people who waive. Is that right?” The statutes for other public employers cap the payment at the lesser of 25% of what the employer saves or $5,000, and leave it to the employer whether to pay anything; no statute for a board outside the state program has been found, and the Board’s own policy has not been seen. Taking $5,000 as the working figure, the arithmetic residents have done is sound as far as it goes. A single teacher at the median salary costs the district $16,115 a year on the Educators plan; if she waived and the district paid the full $5,000, the district would keep $11,115 and she would have $5,000 toward an individual plan, which for a 40-year-old in New Jersey in 2026 averages $451 a month for the cheapest bronze plan, $545 for the benchmark silver, and $700 for the cheapest gold (KFF), before the 19.8% average increase the state announced for 2027 (Department of Banking and Insurance, October 15, 2026). Two things the arithmetic leaves out. The waiver requires other coverage, and whether an individual policy qualifies here is the Board’s policy to say. And the people for whom this is a good trade are the ones who can buy cheap coverage: the young, the healthy, and those with a spouse’s plan. Each one who leaves takes a below-average claim out of the district’s pool and leaves the average higher for the renewal. That is the mechanism Aon describes for the state plan, one level down.
“Chapter 44 expires next year.” The freeze ends on December 31, 2027; the duty to offer the two plans does not. From 2028, benefit levels and contributions for those plans become negotiable. The bill that would replace the structure, S4438, is in committee.
“The Governor has a council on this.” The working group announced on October 1 is for the State Health Benefits Program and comes out of an agreement with state-employee unions. School districts and Chapter 44 are not named in its charge.
“The insurers peel the cheaper districts out of the state plan, and the pool spirals.” Aon’s own language is that employers “opt out of the SEHBP for available lower cost coverage” and that the remaining pool is riskier. Nothing in the record shows a pool that is not rising: the state plan 31.9% and 34.4% in two years, the district’s fund 11% to 27% by line this year, the individual market 16.6% this year and 19.8% next (Department of Banking and Insurance). A one-year saving from moving people between pools is a one-year saving.
Going without insurance, except for catastrophe
The keeper’s assessment, continued.
The question underneath the others is whether the money has to go through insurance at all. The district pays $20,112 a year to insure one employee on its main plan, and $58,932 for a family, before anyone receives any care. National health spending in 2024 was $15,474 per person, counting the old and the sick (CMS); the average employer premium for one person was $9,325. The idea residents have raised is to spend the premium money on care directly, through local clinics and direct arrangements with providers, and buy insurance only against the catastrophic event. Here is what the law and the prices allow, first for one person and then for the district.
For one person, this is legal now and getting easier. A catastrophic plan is an individual-market plan whose deductible equals the year’s out-of-pocket maximum, $10,600 in 2026 and $12,000 in 2027, with preventive care and at least three primary care visits a year covered before the deductible (HealthCare.gov). Until this year it was limited to people under 30 or with a hardship or affordability exemption, and only 1,719 of the 509,192 people who chose a 2026 plan on Get Covered New Jersey chose one (enrollment snapshot, p. 7). A federal rule effective July 20, 2026 extends the hardship exemption to anyone whose income is below 100% or above 250% of the poverty line, so that people aged 30 and older who hold the exemption can enroll in catastrophic coverage, and lets insurers sell catastrophic plans with terms of up to ten years (CMS fact sheet on the 2027 payment rule). Every full-time teacher on the West Orange guide is above 250% of the poverty line (about $39,000 for one person under the 2025 guidelines), so from the enrollment that opens November 1, 2026 the age limit no longer applies to them. Since January 1, 2026, bronze and catastrophic plans count as high-deductible plans for a health savings account, and a direct primary care membership costing up to $150 a month for one person or $300 for a family neither disqualifies the account nor fails as an expense it can pay (IRS Notice 2026-05; the limits are in the 2025 federal budget law).
The prices. Two carriers sell catastrophic plans in New Jersey for 2026, at base monthly rates of $266.64 (Oscar) and $401.48 (Horizon) for a 21-year-old, multiplied by an age factor: 1.278 at 40, 2.230 at 55, 3.000 at 64 and over (Department of Banking and Insurance 2026 rate sheet). A 40-year-old pays $341 or $513 a month; a 55-year-old $595 or $895. A direct primary care practice in West Orange lists adult membership at $99 a month, children at $39, a $99 enrollment fee, and a family maximum of $250 a month (directory listing; not verified by this ledger). So a healthy 40-year-old on her own could hold a catastrophic plan and a primary care membership for about $440 a month, $5,280 a year, with a worst-case year of about $15,900 if she hit the deductible. The district pays $20,112 for her coverage now.
The arithmetic holds until it doesn’t. One ongoing prescription changes it: a weight-loss drug is $349 a month at the manufacturer’s cash price and more at list, a specialty drug for an inflammatory condition is far more, and under a catastrophic plan all of it is below the deductible. A family multiplies the premium by each member and the deductible to $21,200. At 55 the catastrophic premium alone is $595 to $895 a month before any care. And the employee cannot take the district’s money with her: on the working assumption above, the most the district would pay her for leaving is $5,000, and only if its policy counts an individual plan as other coverage, so on the Educators plan she pays $3,997 a year for coverage with $10 and $15 copayments, and on her own she would pay $5,280 for coverage with a $10,600 deductible. For one person the district’s plan is the better deal because the district pays 80% of it. The saving in the thought experiment is the district’s, not hers, and the district cannot hand it over.
For the district, “no insurance” is not an option; a different plan is. A public employer with more than fifty full-time employees must offer minimum essential coverage to at least 95% of them or pay $3,340 per full-time employee (less thirty) in 2026 and $3,780 in 2027, and the coverage must be affordable, meaning the employee’s share for self-only coverage is no more than 9.96% of household income in 2026, and must cover at least 60% of expected costs, or the employer owes $5,010 for each employee who gets subsidized marketplace coverage instead (Rev. Proc. 2025-26; Rev. Proc. 2025-25; 2027 amounts). A self-funded plan the district sponsors counts; a plan at a catastrophic level of coverage may not meet the 60% test. Chapter 44 then requires the district to keep offering the Educators and Garden State plans with their benefit levels unchanged through 2027, and bars adding a plan before then unless a negotiated agreement produces “additional premium cost reductions”; whether a clinic or a primary care membership paid by the district is a “health care benefits plan” under that bar is a legal question this page cannot answer. From 2028 the benefit levels and the contributions become negotiable with the union, whose members at the top of the salary guide are the oldest and would carry the most risk under a high-deductible design.
Within those limits, the idea has a long record under another name. The district is already in a self-insurance fund: SHIF pools its member districts’ coverage, with Aetna providing the network and administering the plans, so the district’s premium is largely its share of the fund’s claims and costs, not an insurer’s margin. What employers who go further have done is to buy the predictable care directly and insure the rest. Rosen Hotels in Orlando has self-funded since 1991, runs its own clinic, contracts directly with a hospital system and a pharmacy, and says it spends about $5,500 per covered employee for 5,700 people, less than half the national average; the figures are the company’s (Florida Trend, 2018). Montana’s state employee plan set hospital payments as a multiple of Medicare rates in 2016 and an independent analysis found $47.8 million in savings over three years (NASHP). The state program itself offers its members a direct primary care program, Marathon Health, with no membership fee and no copayments, inside the existing plans (Division of Pensions and Benefits), which shows the model can live inside Chapter 44 as a feature of a plan rather than a new one. None of these is a New Jersey school district, and none has been priced for one.
What such a design can reach, and what it cannot, is visible in Aon’s breakdown of where a school employee’s medical dollar goes: in 2025, about $131 a month per member on inpatient care, $307 on outpatient care, and $391 on physicians and other professionals, with specialist physicians the largest and fastest-growing line, and on the prescription side weight-loss drugs alone at 22% of what the plan paid (mid-year presentation, pp. 9-10). A clinic and direct contracts work on the professional and outpatient lines, the first several thousand dollars of each person’s year. They do not change what a hospital charges for a stay or what a drug company charges for Zepbound, which is where the increases are coming from.
The honest summary, in the keeper’s view: catastrophic-only coverage with direct primary care is feasible for a healthy individual, now more than before, and it is the wrong unit for a district. An employer of this size has to offer qualifying coverage, has no lawful way found here to move its contribution to individuals beyond a waiver payment, and would watch its pool age if the healthy left. The version the law could accommodate from 2028 is a negotiated redesign of the district’s own plan: self-funded as it already is, with a higher deductible, direct primary care and direct contracts for the care that can be bought in blocks, and insurance for the rest. That changes how the first part of each person’s care is bought. It does not touch the part that is breaking the pools, and anyone proposing it should say so. A version that reaches beyond district employees to the community would need a vehicle other than a school district’s insurance fund, and that is a different page.
Looking to 2028
The keeper’s assessment, concluded. Written down so that it is on the table before the agreement that will be in force on January 1, 2028 is signed.
What opens, and through whom. From January 1, 2028 the statute lets the benefit levels and employee contributions of the two required plans be “modified in accordance with collective negotiations agreements” and lets the district offer other plans “as may be required” by such an agreement. The duty to offer an Educators-type plan remains; its contents and price become bargaining subjects. The agreement being negotiated now, in fact-finding since August 2026, is the one that will be in force on that date, so any 2028 redesign has to be written into its health benefits article, as a reopener or a dated change. The equivalence rule also cuts the other way: whatever the state’s plan design committee does to the Educators plan after 2027, or whatever a successor law imposes, reaches SHIF’s equivalent plans and West Orange with it.
What a state reform could realistically deliver. The working group’s topics are the ones on which other public-employee plans have shown partial, measurable results, none of them a rebuilt health system:
- Hospital payment caps as a multiple of Medicare. Oregon’s state employee plan has paid its large hospitals no more than 200% of Medicare since October 2019; studies put the saving at about $107 million in the first 27 months (Milbank Memorial Fund, 2024) or about $50 million a year, with hospitals’ margins little changed (Brown University School of Public Health, December 2025). Montana’s version is above.
- Pharmacy benefit contracting and drug coverage design. North Carolina’s state employee plan stopped covering GLP-1 drugs prescribed for weight loss on April 1, 2024, after a 4-3 board vote, while keeping them for diabetes; the drugs had cost it about $102 million in 2023 (Associated Press via WLOS). In New Jersey that choice belongs to the state’s plan design committee, whose designs are frozen through 2027, and by equivalence it would reach West Orange.
- Direct primary care inside the plan, centers of excellence and site-of-care rules, and eligibility audits. Each buys a few years of lower trend. None stops it.
The weight-loss drugs and the community’s choice. If the Educators plan stops covering these drugs for weight loss after 2027, as other public plans have, the bridge for people who need them medically would be local: a hardship fund, the manufacturers’ cash prices, and time. The core patents on semaglutide are reported to run to about 2032, with later formulation patents that could delay generics further (Healthline). That is the trade-off the spring essay on the limits of local self-reliance describes, and it is a decision a community can make openly; the law does not now let one district make it alone.
Families and older employees. The catastrophic approach fails them in two different ways. For older people it is price: at the age factor of 3.0 that applies from 64, the two catastrophic plans cost about $800 and $1,200 a month for one person, before a deductible they are likelier to meet. For families it is risk. Two 40-year-olds and two children on the cheaper catastrophic plan would pay about $1,100 a month, $13,000 a year, against a family deductible of $21,200, so a worst year is about $34,000. That is still below the $58,932 the district pays for family coverage, which is why the idea keeps looking attractive from the payer’s chair; from the family’s chair it turns a fixed $7,995 into $13,000 plus $21,200 of exposure, with none of the district’s $50,937 following them. The design works only if the employer funds the gap, which is the self-funded plan with a district-funded account described above, and the people it protects least are the ones at the top of the salary guide.
The options that remain, in the keeper’s view. Three, each partial and each lawful:
- A negotiated redesign of the district’s own plan from 2028: self-funded as it is, with a higher deductible, a district-funded account, direct primary care, and direct contracts or reference pricing for the care that can be bought in blocks. Under Chapter 44 employees are insulated from premium growth, so the district would have to buy their stake in the savings; that is the negotiation.
- The pool question under N.J.S.A. 18A:55-3, asked every year and in public: whether SHIF, the state program, or another fund is the most cost-effective, with the broker’s compensation disclosed.
- A community vehicle outside the school fund, such as a township-level direct primary care arrangement or a purchasing coalition of local public employers for hospital contracts. The school fund law does not provide it; it would be its own project, and How Services Could Work sets out what it might look like and what has been tried before.
What this page does not know yet
- Enrollment by plan and coverage tier, and what the district paid in premiums net of employee contributions, for 2025-26 and 2026-27.
- The Board’s waiver policy, and how many employees waive.
- Who the district’s broker or consultant is, how it is paid, and what it was paid.
- When the district last compared its coverage with the state program and other options under N.J.S.A. 18A:55-3, and what the comparison found. Residents refer to a broker’s presentation to the Board in May 2026; it has not been found online.
- The health benefits article of the 2020-2025 agreement, and whether the Board’s current proposal touches health benefits.
- What EduStaff offers the paraprofessionals it employs, and what the district paid for their coverage before July 2026.
- The state plan’s 2027 rates by plan, once posted.
Each is a records question. No request for these has been filed yet; when one is, it will appear on Records Requests.