The 2025–2026 health plan year has been one of the most challenging in recent history, with healthcare costs continuing to rise at record levels nationwide. To ensure the long‑term stability of your health benefits, the Berks County School Districts Health Trust is making several updates to how the plan is funded and how certain benefits are structured.
These changes are designed to help the Health Trust continue providing reliable, high‑quality coverage today and in the future.
How the Health Plan Is Being Stabilized
To address rising medical and prescription costs, participating school districts are increasing their overall funding of the Health Trust for the 2026–2027 plan year (July 1, 2026 – June 30, 2027).
This includes:
A one‑time, Trust‑wide funding contribution made by school districts
An increase to monthly health plan funding levels
For the first time in over 10 years, adjustments to member co-pays
These funding changes help strengthen the Health Trust so it can continue paying claims, managing risk, and supporting member benefits despite ongoing cost pressures. While most of the increase occurs at the employer level, they are geared to reduce the need for more significant benefit reductions in the future if trend rates don’t increase above current market cost trend conditions.
What’s Changing for Members on July 1, 2026
In addition to increased employer funding, some member cost‑sharing amounts will change beginning July 1, 2026. These updates are targeted and intended to balance plan affordability with continued access to care.
Medical Co‑Pay Changes
Co-Pay | Current | Effective July 1, 2026 |
|---|---|---|
Primary Care Visits | $15 | $25* |
Specialist Visits | $30 | $40 |
Urgent Care Visits | $40 | $75* |
*Please note that co-pays for St. Luke’s Primary Care (both dedicated and open centers) will have a $0 copay. St. Luke’s Care Now Urgent Care Centers will also remain at $0, but the visit runs through Capital Blue Cross insurance as a claim.
Additional Updates:
The following services will have visit limits implemented:
Manipulation Therapy (Chiropractic) – 30 Visit Annual Limit
Home Health – 30 Visit Annual Limit
Inpatient Rehab – 30 Visit Annual Limit
Physical Therapy and Occupational Therapy – 60 Combined
Visits Annual Limit
The Trust will introduce the SWORD virtual physical therapy program as of
8/1/2026, offering convenient, no-cost access to care.
Prescription Drug (RX) Changes
Prescription Drug Type | Current (30-day/90-day) | Effective July 1, 2026 |
|---|---|---|
Generic Medications | $5/$10 | $10/$20 |
Brand Preferred Medications | $35/$70 | $40/$80 |
Brand Non-Preferred Medications | $70/$140 | $80/$160 |
The Health Trust has also approved the 90 DayMyWay program, which implements 90-day fills for eligible maintenance medications for added convenience and cost savings.
Why These Changes Are Necessary
Healthcare inflation is being driven by higher utilization, increased hospital pricing, and rapidly rising specialty drug costs. By combining additional employer funding with measured plan design changes, the Berks County School Districts Health Trust is working to:
Maintain a high-level plan (platinum/gold rated) with comprehensive
coverage
Protect access to care
Attempt to mitigate the risk of more disruptive changes in future years
Looking Ahead
Additional plan design options, including deductible‑based plans and PPO tiered structures, will be reviewed later in 2026. Any future changes will be communicated clearly and well in advance of implementation.
Over the next few months, the Trust will be offering a series of voluntary virtual information sessions so members can learn more about Qualified High-Deductible Health plans. A separate communication with more details on SWORD and 90 DayMyWay will be sent out in May.
We understand that changes to benefits and costs can be difficult. Thank you for your continued trust and partnership. If you have questions, please contact your school district’s benefits office for additional information.
If you have additional questions about your coverage or need help navigating your benefits, please contact Capital Blue Cross Member Services via phone at 866-802-4761 or visit the portal at capbluecross.com.