Health Care Coverage for You and Your Family!

Health Care Coverage for You

and Your Family!Welcome

2

Agenda

• Who is eligible to enroll• Plan options and what’s new• Cost of health coverage• How to enroll • Enrollment support• Questions

3

Who is Eligible to Enroll?

To be eligible for TRS-ActiveCare coverage, you must:• Be employed by a participating district/entity and

– Be an active, contributing TRS member or– Be employed 10 or more regularly scheduled

hours each week

Health care coverage for public school employees and their families

4

Employees NOT Eligible to Enroll

• State of Texas employees or retirees• Higher education employees or retirees• TRS retirees, receiving or who declined

coverage under TRS-Care

These individuals are not eligible to enroll for TRS-ActiveCare coverage as employees, but they can be covered as a dependent of an eligible employee.

5

Eligible Dependents

• Spouse (including a common law spouse)• Unmarried children under age 25

– Natural child– Adopted child– Stepchild– Foster child

• Other eligible dependents listed in Enrollment Guide– Grandchildren (unmarried)

– Disabled children (unmarried, of any age)

6

Newborns

• Covered the first 31 days if employee has coverage• To continue coverage, employee must add

newborn within 60 days after the date of birth• However, an employee has up to one year after the

newborn’s date of birth if:– Employee has “employee and family” or “employee and

child(ren)” coverage at the time of birth and at the time of enrollment

ActiveCare 1, 2 and 3

PPO Plan Options

8

What’s New for 2008-2009?

ActiveCare 1, 2 and 3• No premium increase • No benefit changes • Emphasis on health and

wellness New plan features available April 1, 2008

– Blue Care Connection – 24/7 Nurseline – Personal Health Manager (PHM)

online health and wellness resource– Live Chat secure, online real-time

access for customer service inquiries

9

PPO Network for ActiveCare 1, 2 and 3

Largest PPO network in the state Includes over 50,000

physicians and over 400 hospitals in Texas

Available in all 254 Texas counties

Advantages to using network providers Receive highest level of benefits No claims to file No balance billing

www.trs.state.tx.us/trs-activecarewww.bcbstx.com/trs

Need to locate a Network Provider?

10

Plan Overview

ActiveCare 1 ActiveCare 2 ActiveCare 3Deductible(individual/family)

$1,100/$3,000 $500/$1,500 None

Out-of-Pocket Maximum(individual/family)

$2,000/$6,000 $2,000/$6,000 $1,000 per individual

Coinsurance(Plan pays/participant pays)

80%/20% 80%/20% 80%/20%

Office Visit Copay 20% after deductible

$25 for primary$35 for specialist


Illustrates benefits when network providers are used. Non-network benefits are also available; see Enrollment Guide for more information.

11

Plan Overview

ActiveCare 1 ActiveCare 2 ActiveCare 3Preventive Care• Routine physicals*• Well-woman exams*• Routine mammograms *• Eye exams*• Well-baby exams• Immunizations• Hearing exams• PSA screenings• Colorectal screenings• Osteoporosis screenings

* Services limited to one per person per plan year

$0 copay up to $500 per person,

per plan year

Remaining charges subject to deductible

and coinsurance


Includes all preventive care services billed

with an office visit by a network doctor

Coinsurance applies when no office visit is

billed or when services are

performed outside the office

(deductible waived)


Includes all preventive care services billed

with an office visit by a network doctor

Coinsurance applies when no office visit is

billed or when services are performed outside

the office(no deductible)

Illustrates benefits when network providers are used. Non-network benefits are also available; see Enrollment Guide for more information.

TRS-ActiveCare is administered by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Texas provides claims payment services only and does not assume any financial risk or obligation with respect to claims.

Blue CareConnection®

Health and Wellness Programs

13

Advice anytime.Round-the-clock health and the wellness advice from licensed professionals

24/7 Nurseline

Advice isn’t just neededfrom 9 to 5.24/7 Nurseline is here to help.

• Nurses provide health advice and information about high fevers, earaches, cuts and bruises and more

• Audio health library on topics such as kicking the smoking habit and ways to get a good night’s rest

Available in English and Spanish

24/7 1-800-581-0368

New!

14

Personal Health ManagerNew!

Your online wellness experience begins here: www.bcbstx.com/trs

• Take a Health Risk Assessment

• Improve your health with the “Eat Right” nutrition planner

• Create a fitness plan to suit your personal health goals and needs with “Get Fit”

Click on the Personal Health Manager iconon Blue Access® for Members

15

Ask the experts.Expert advice from licensed professionalsvia the Personal Health Manager

“Ask-A” Online Advisor

Expert advice at your fingertips.Our “Ask-A” feature is here to help.

Ask a Trainer, Dietitian orLife Coach: Send questions about fitness, nutrition, or managing stress.

Ask a Nurse:Interact online with a Blue Care Advisor on non-emergency, health-related questions using the secure “Ask a Nurse” feature.

CONFIDENTIAL AND SECUREReceive a response within one business day

16

Stay motivated.Earn Blue PointsSM in the Personal Health Manager

Blue PointsSM Incentives

ActiveCare 1, 2 and 3 plan participants and their covered dependents accumulate Blue PointsSM in the Personal Health Manager.• Complete designated health

and wellness activities

• Report completed activities in the Personal Health Manager

• Track your available balance

• Redeem earned Blue PointsSM for a variety of items!

17

Weight Management ProgramSupport for a Healthier You

Tobacco Cessation ProgramSupport for members who want to quit

Weight Management and Tobacco Cessation

Self-Paced Approach• Online tools and resources via the Personal Health Manager

• Secure e-mail outreach to keep members on track

Personalized Lifestyle Management Support• Counseling and coaching with licensed Wellness Coaches

• Motivational toolkit• 24/7 Nurseline• Referrals when appropriate

18

Expecting? Special Beginnings® Program

Special Beginnings is a confidential, full-featured program helping you to better understand and manage your pregnancy.

• A pregnancy risk assessment to determine the risk of your pregnancy and provide you with close monitoring through a series of follow-up calls from an experienced obstetrical nurse.

• A welcome packet full of congratulatory gifts including:

– Baby bath and soap samples– Cleansing cloths– Nursing pads– Coupons for baby products

• Magazines that help you learn more about pregnancy and parenting

1-800-462-3275

19

Live ChatSecure Online Customer Service

• Send inquiries to customer service via e-mail

• Immediate access to BCBSTX customer advocates

• Available Monday – Friday, 7 a.m. to 10 p.m. (CT)

New!

20

What if I Have Questions?

Personalized ServiceCall the TRS-ActiveCare customer service team for:• Claim questions/status• Network provider information• Membership and eligibility • Medical coverage questions• Inquiries (telephone and e-mail)• ID card requests• Transition of care information• Help with online tools! Customer Service

1-866-355-5999

21

Online member management tool.• Check claim status, view

and download EOBs (Explanations of Benefits)

• Order additional ID cards, and print temporary ID

• Send secure e-mail messages to BCBS Customer Advocates

• Monthly health articles

• Links to health information and wellness tools and resources

Blue Access® for MembersOnline Member Management Tool

Prescription DrugsActiveCare 1, 2 and 3

23

Your Medco Prescription Drug Plan

• Your TRS-ActiveCare health plan has two prescription drug components– Blue Cross and Blue Shield of Texas manages your

medical plan expenses, including prescription drug expenses under ActiveCare 1

– Medco manages your prescription drug plan expenses for ActiveCare 2 and 3

24

Your Medco Prescription Drug Plan

• Medco has its own mail-order pharmacy – Medco By Mail – which delivers medications to your home at a lower cost

• Medco’s mail-order pharmacies fill about 2 million prescriptions per week through a highly automated process that is 99.9997% accurate and is 23 times more accurate than a retail pharmacy*

* “Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice”; Nov. 2007, Pharmacology, a peer-reviewed journal of the American College of Clinical Pharmacy

25

Specific Rx Benefit Information

• If you are taking a long-term medication, filling your prescriptions through Medco’s mail-order pharmacy provides several benefits:– You receive a 90-day supply of your medication at a lower copay– You have access to Specialist Pharmacists who receive additional

training in conditions such as asthma, diabetes, heart disease and more– While retail pharmacists know the medications you fill at one pharmacy,

Medco’s Specialist Pharmacists have a complete view of all of your medications so they know if there are potential safety issues and will contact you and your doctor to discuss these issues

• You have access to specialist pharmacists whether you fill your prescription at a retail pharmacy or at Medco By Mail

• Your medication questions can be answered by calling 1-866-355-5999

26

Prescription Drug Benefits

ActiveCare 1 ActiveCare 2 ActiveCare 3

Drug Deductible(per person, per plan year)

Subject to $1,100 plan year deductible

$50 $50

Retail Short-Term(up to 30-day supply)Generic/Preferred Brand/Non-Preferred Brand

100% of the discounted cost at

the time of purchase; 80%

will be reimbursed by Blue Cross

and Blue Shield of Texas after deductible

$10$25*$45*

$10$25*$40*

Retail Maintenance(after second fill, up to 30-day supply)Generic/Preferred Brand/Non-Preferred Brand

$15$35*$60*

$15$35*$55*

Medco by Mail(up to 90-day supply)Generic/Preferred Brand/Non-Preferred Brand

$20$62.50*

$112.50*

$20$62.50*$100*

* If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Non-network benefits are also available; see Enrollment Guide for more information.

27


ActiveCare 2 and 3: Applying the DeductibleExample 1—Claim cost less than $50 Deductible

• Once the deductible is satisfied, the member pays the applicable copay • Member-paid cost differences between a brand-name drug and a

generic equivalent do not apply to the deductible• Member cost share will not exceed the cost of the medication

Total Cost

Deductible Applied Copay Deductible

Remaining

First Fill $37 $37 $37 $13

Second Fill $37 $13 $13 + copay $0

28


ActiveCare 2 and 3: Applying the DeductibleExample 2—Claim cost more than $50 Deductible

Total Cost

Deductible Applied

Copay Deductible Remaining

First Fill $100 $50 $25 $0

Next Fill $100 $0 $25 $0

• Once the deductible is satisfied, the member pays the applicable copay • Member-paid cost differences between a brand-name drug and a generic

equivalent do not apply to the deductible• Member cost share will not exceed the cost of the medication.

29

Information Resources

• TRS Web site – www.trs.state.tx.us/trs-activecare– Pharmacy Benefit Highlights– List of maintenance medications– FAQs– Download forms

• Medco Member Web site – www.medco.com– Prior Authorization List– Formulary Information– Locate a Participating Pharmacy– Health and Wellness Information– My Rx Choices® / Price a Medication– Online Ordering– Download forms

• Customer Service Number 1-866-355-5999 • Benefits Booklet

30

My Rx Choices® Your online savings toolLower your cost for prescriptions with My Rx Choices• Features include:

– Personal assessment of cost-saving opportunities based on your prescription plan and medications that you or covered family members take on an ongoing basis.

– Best-value alternatives based upon greatest cost savings to you presented in order from highest value to member

– Brand-to-generic and retail-to-mail compare options available– Easy-to-understand explanations of complicated concepts– The average amount saved by My Rx Choices users is $294!

• Your doctor knows which medications are right for you but you may not know how much they cost. My Rx Choices provides you with available lower-cost options so that you and your doctor can make the most informed decisions based on health and cost.

• Simply visit www.medco.com/save. You’ll to take a moment to register before using this service. You can also call 1-866-355-5999.

31

My Rx Choices Available through Customer Service or on www.medco.com

• The My Rx Choices home page allows the user to:- Select a patient (pre-

populated with all covered household members)

- Select a drug to compare from a pre-populated list of prescriptions for the user.

• Your potential savings are clearly presented.

32

My Rx Choices

Medco can facilitate on generic equivalents received through mail order

33

My Rx Choices

Members may print a kit to discusslower-cost alternatives with their doctor

34

• Refill your medication at www.medco.com when you use Medco By Mail

• Sign-up for “Refill Reminders” at www.medco.com

• Speak to a specialist pharmacist about the medications you are taking for a specific condition

• Send e-mails to Customer Service and to Medco pharmacists through the Medco member Web site

More about Your Rx Benefits

35

Medco Tour of Champions

• An endorsement campaign featuring six Olympic gold medalists – each with a chronic or complex condition

• Promotes Specialist Pharmacists as providing a higher level of care for people with chronic and complex conditions like asthma and diabetes

• Campaign runs through 12/08

HMO Plan Options

2008-2009 Plan Year

FirstCare

HMO Plan Option

38

FirstCare Health PlansService Area

92 counties across Texas

39

FirstCare Health Plans

• No claim forms• No preexisting limitations• Emphasis on preventive health care• No referrals required• Extensive provider network

– Local hospitals and doctors– Nationwide network through Texas True Choice

and PHCS (outside Texas)• Worldwide emergency care

40

FirstCare Health PlansMember Satisfaction

• Timely Customer Service – Minimum automation; calls answered in Lubbock, Texas– Limited wait time to talk to a live representative

• High member satisfaction for claims processing (90%)

• Web site accessibility for information 24 hours a day

• Regional offices in Abilene, Amarillo, Lubbock and Waco to serve local communities

41

FirstCare Health PlansWhat’s New for 2008-2009

• $400 deductible – not applicable on most office visit services; see Plan Summary

• Out-of-pocket maximum reduced to $3,500 per person• $100 copay on radio-nuclide stress test• $100 copay on non-pregnancy ultrasound tests• $40 copay on bone mass measurement test• Limited dental-related services have a maximum allowance of

$10,000• External prosthetics devices have a lifetime maximum

allowance of $10,000• 10% copay on preferred diabetic testing supplies• No copay on preferred glucose monitors• Premium increase of approximately 9.9%

42

FirstCare Health PlansWhat’s New for 2008-2009

• 24/7 NurseLine available– Access a Registered Nurse with your medical

questions• Staying Healthy Questions• Minor Injuries• Routine Illnesses• Medication Questions• Understanding Your Treatment Options• Access Their Web site (www.healthforums.com)

– Health Assessments– Health Topics

1-800-981-7912

43


Benefit CopayPCP office visit $20 (no deductible)

Specialist office visit $40 (no deductible)

Preventive care $20 (no deductible)

Outpatient surgery facility $150

Inpatient hospital $150 per day ($750 maximum)

Emergency room $100 (waived if admitted)

Urgent care $40

Out-of-pocket maximum $3,500 per member

44


Prescription DrugsRetail

(up to 30-day supply)Mail Order (up to 90-day supply)

Generic $15 $45

Preferred Brand $30 $90

Non-Preferred Brand $50 $150

Self-Injectable and High Technology Drugs *† 20% 20%

*Excludes insulin and allergy serum †Not subject to $10,000 benefit maximum

$10,000 maximum prescription benefit per person per plan year

45

FirstCare Health PlansMember Portal

• Link from the TRS-ActiveCare Web site for easy access to:– Change PCP– Request ID Cards– Print temporary ID Cards– Change address– Check status of claims– Check status of authorizations

HMO Plan Option

Legacy Health Solutions

47

18 counties West

Texas

Legacy Health SolutionsService Area

48

• HMO Network Expansion– 389 Physicians in Legacy HMO Network– Added physicians of West Texas Medical Associates to our HMO

• Members like HMO features– Predictable medical expense– No deductibles– No coinsurance– Coverage for preexisting conditions– No referrals needed for specialists

• In CAHPS Customer Satisfaction Survey, members ranked Legacy HMO in 93%

• Local management means timely feedback for participant questions, concerns, medical appointments


49

• Emergencies covered anywhere• 24 Hour Nurse Hotline• Health Advisory Tools customized to each member• Online Personal Health Record• Out-of-area care for dependents• LHS network has 349 physicians representing over

43 specialties throughout West Texas• Disease and case management for chronic

conditions


50

Legacy Health SolutionsWhat’s New for 2008-2009

• $300 copay per day for inpatient hospital($1,500 maximum per admission)

• $300 copay for outpatient hospital

• $3,000/$9,000 out-of-pocket maximum per individual/family

• $150 copay for emergency room care within 48 hours (copay waived if admitted)

• $35 copay for preferred brand-name drug(retail; up to 30-day supply)

• $70 copay for preferred brand-name drug(mail; up to 90-day supply)

• Premium increase of approximately 5%

51

Legacy Health Solutions Claim Messaging

52

Legacy Health SolutionsPharmacy Savings Messaging

$3,835.46

Potential Savings: $1,235.55/yrHow to SaveTalk to your doctor about switching from Nexium to Prilosec OTC or another comparable drug.

Print Report

53

Legacy Health Solutions Web Tools

• Best in class tools to help members understand and manage their health and health care finances

54

Benefit CopayPCP office visit $20

Specialist office visit $35

Preventive care PCP $20 / Specialist $35


Inpatient hospital $300 per day (5-day maximum)


Urgent care $25

Out-of-pocket maximum $3,000 (individual)$9,000 (family)


55


(up to 30-day supply)Mail Order (up to 90-day supply)

Generic $8 $16


Non-Preferred Brand$200 or 50% of

charges, whichever is less

N/A

Injectable Prescription Drugs - 25% of charges


Mercy Health Plans

HMO Plan Option

57

Mercy Health PlansService Area

4 Texas counties:Webb Jim HoggZapataDuval

58

Mercy Health Plans

• No claim forms• No lifetime maximum• No preexisting condition limitations

59

Mercy Health Plans

• Low out-of-pocket expense• Emergencies covered anywhere• Case management

– Diabetes mellitus– Hypertension– Asthma– Other chronic diseases

• CuraScript Injectable Program

60

Mercy Health Plans

• Mercy Health Plans ranked #1 on Consumer Assessment Health Plans Survey (CAHPS)* on the following:– How people rated their plan– How people rated their health care– How people rated their doctor– How people rated their specialist– How people rated the efficiency and helpfulness of

customer service

* Office of Public Insurance Council

61

Mercy Health PlansReferrals

• To visit a specialist, a PCP referral is required; however, referrals are not required for the following:

– Women may self refer to a designated OB/GYN – Ophthalmologist/optometrist (annual eye exam)– Orthopedic surgeon– Dermatologist

• No benefits available for non-emergency care outside the network or for a specialist visit without a referral from a PCP

62

Mercy Health PlansWhat’s New for 2008-2009

• Office visit copay changes from $10 to $20• 10% coinsurance for inpatient, outpatient and

diagnostic services• Prescription drug copays change from:

– Retail• $5 to $10 generic• $20 to $25 preferred brand (formulary)• $35 to $45 non-preferred brand (non-formulary)

– Mail Order• Copays = 2x retail copays

• Approximately 10% premium increase

63

Mercy Health Plans

Benefit CopayPCP/Specialist office visit $20

Preventive care $20

Outpatient surgery facility 10% coinsurance

Inpatient hospital 10% coinsurance, after $500 plan year deductible

Emergency room $50 (waived if admitted)Urgent care $25

Out-of-pocket maximum $1,000 maximum (individual)$2,000 maximum (family)

64

Mercy Health Plans


(up to 30-day supply)Mail Order

(up to 90-day supply)

Generic $10 $20



Infertility drugs are covered at 50%$2,000 maximum prescription drug benefit per person per plan year

HMO Plan Option

Scott & White Health Plan

66

Scott and White Health PlanService Area

Somervell

ErathHill

Bosque

Coryell

Bell

BurnetLlano

Blanco

Hays

Williamson

Regional Office

Milam

Falls

Travis

Caldwell

Bastrop

Lee

Burleson

Robertson

Leon

Madison

Walker

Grimes

Brazos

Washington

AustinWaller

LampasasSan Saba

Hamilton

Mills McLennan

Scott & White Approved TRS Service Area

Waco

Temple

Georgetown College Station

32 counties across Texas

67

Scott and White Health Plan

• Named one of the Highest Ranked Health Plans in Texas by U.S. News & World Report (2007) for the third year in a row

• No claim forms, no deductibles• Coverage for preexisting conditions• Worldwide emergency care• Direct access to OB/GYN and ophthalmology• Regional customer service centers in Georgetown,

Temple, Bryan/College Station and Waco• 24-hour Nurse Advice Line 1-800-975-6612

68

Scott and WhiteNew Cancer Treatment Center – Temple Campus

First phase of work is underway

Estimated completion date is 1QTR 2009

69

Scott and White Health PlanExpanding Network of Providers

• Hospital Additions– Hillcrest Baptist Medical Center/Waco– Grimes St. Joseph Hospital/Navasota

• Physician Group Additions– S&W Wells Branch Clinic – March 2008– King’s Daughters Clinic – March 2008– S&W Salado Clinic – September 2008– Expansions/additions proposed in 2008 for Williamson, Travis and

Bastrop counties

• Pharmacy Additions– SWHP Canyon Creek Pharmacy – Temple – April 2008– SWHP Salado Pharmacy – September 2008

70

Scott and White Health PlanWhat’s New for 2008-2009

• Prescription benefit maximum– Increasing from $2,000 to $3,000 per person

• Diabetic test strips– Preferred brand $5– Non-preferred brand $25

• Home infusion therapy benefit– $100 per day – $500 maximum copayment per course of treatment

• Premium increase of approximately 9%

71


Benefit CopayDeductible $0

PCP/Specialist office visit $25

Preventive care $25


Inpatient hospital $200 per day ($1,000 maximum)


Urgent care $40

Out-of-pocket maximum $3,000 maximum per individual$6,000 maximum per family

72


Prescription Drugs

Retail (up to 34-day supply)

Mail Order (up to 90-day supply)

Rx Deductible None NoneGeneric $5 $10Preferred Brand $25 $50

Non-Preferred Brand lesser of $50or 50% copay

lesser of $100or 50% copay

Non-Formulary greater of $50 or 50% copay N/A

$3,000 maximum benefit per person per plan yearIf a brand-name prescription is dispensed when a generic is available, enrollee pays 50% of brand-name cost

73

• Succeed® – Health risk appraisal• Breathe® – Smoking cessation• Balance® – Weight management• Relax® – Stress management• Nourish® – Nutrition• CareTM for Your Back – Back pain management• CareTM for Your Health – Healthy living program• OvercomingTM Depression – Depression management

Scott and White Health PlanOnline Wellness Tools

www.trs.state.tx.us/trs-activecare

Valley Baptist Health Plans

HMO Plan Option

75

Valley Baptist Health PlansService Area

• Rio Grande Valley • Counties

– Cameron– Hidalgo– Starr (partial)– Willacy

• Provider Network– More than 780 providers– 11 hospitals Valley-wide

76


• No deductibles or coinsurance• No claim forms• No lifetime maximum• No preexisting condition limitations• Predictable costs

77


• Free diabetic supplies available • Worldwide emergency care• Locally owned and operated in the Rio Grande

Valley by Valley Baptist Health System

78


• 99% member satisfaction (employer group survey)• 97% of our providers would recommend our plan to

their patients (provider survey)

79


• PCP will refer you to a specialist• No referral needed for a designated OB/GYN• Case management services for diabetes mellitus

80

Valley Baptist Health PlansWhat’s New for 2008-2009

• No plan changes• Approximately 8.5% premium increase

81


Benefit CopayPCP office visit $25

Specialist office visit $35

Preventive care $25 PCP/$35 Specialist


Inpatient hospital $300 per day ($1,500 maximum)


Urgent care $25

Out-of-pocket maximum $3,000 maximum (individual)$6,000 maximum (family)

82



(up to 30-day supply)Mail Order

(up to 90-day supply)

Generic $15 $30



2008-2009 Plan Year

Cost for Health Coverage

84

Coverage Categories

• Employee Only• Employee and Spouse• Employee and Child(ren)• Employee and Family

85

Monthly Costof Coverage

Page 35 of the Enrollment Guide

86

Application to Split Premium

• Married couples working for different participating entities may “pool” funds

• Optional

• Requires an Application to Split Premium form to be completed by both employees and both employers

2008-2009 Plan Year

How to Enroll

88

How to Enroll

2 Complete an Enrollment Application and Change Form•Available in the Enrollment Guide

•Also available online

1 Choose your health plan

3 Sign, date and submit form to your Benefits Administrator

89

How to Enroll

• If you do not wish to make changes to your current health benefit plan, you do not need to submit an enrollment application form– You will be enrolled in the same plan you

selected for 2007-2008 at the same level of coverage

• To decline coverage: You must complete and submit a form – even if you have declined coverage before

90

Can Changes in Coverage Be Made After Your Application Has Been Submitted?

• Changes can be made up to the end of your enrollment period• Plan choices will remain in effect through August 31, 2009

unless there’s a special enrollment event such as: – Marriage or divorce– Birth, adoption or placement for adoption of a child– A child marries or reaches age 25– A court order to provide health coverage for an eligible child – Loss of coverage

• Changes must be made within 31 days after the event date (special rules apply to newborns)

• New application must be submitted for any change

91

Cafeteria Plan Vendor(s)

• Making a change through the Section 125 vendor does not automatically generate a change to coverage under TRS-ActiveCare

• All changes to TRS-ActiveCare must be signed, dated and submitted on an Enrollment Application and Change Form

92

Are There Preexisting Condition Exclusions?

• Pre-x does not apply to employees that initially enroll when the district/entity begins participating in TRS-ActiveCare or to new hires who enroll within 31 days after their actively-at-work date

• If covered at any time since 2002, pre-x may apply if employee is hired by another participating district/entity (or rehired by same district/entity) unless gap in coverage is less than 63 days and the employee has proof of prior creditable coverage

• A 12-month pre-x condition waiting period may apply due to:– A special enrollment event – A future plan enrollment period (to be determined by TRS for each plan

enrollment period)– A transfer to another participating district/entity (or rehire) if the employee

or any covered dependent has any remaining preexisting waiting period or a gap in coverage greater than 63 days

• Pre-x waiting period may be reduced by creditable coverage

93

Important NoticeSupplemental Coverage• TRS does not offer or endorse any supplemental

coverage for any of the health coverage plans available under TRS-ActiveCare

• To obtain information about any coverage that claims to be a companion or supplement to any TRS-ActiveCare plan, employees should contact:– The organization making such offering and/or – The Texas Department of Insurance (TDI)

http://www.tdi.state.tx.us or the TDI Consumer Helpline (800) 252-3439

94

Your TRS-ActiveCare ID card will be mailed to your home• ActiveCare 1, 2 and 3

– New ID cards will not be issued to current participants unless changing plans; new enrollees will receive new cards

• HMO plans – All HMO participants will receive

new cards (except for Scott and White Health Plans)

– Each individual covered under the plan will receive a card

95

Enrollment Support

Dedicated Customer Service• ActiveCare 1, 2 or 3 1.866.355.5999

(Blue Cross and Blue Shield of Texas and Medco) • FirstCare Health Plans 1.800.884.4901• Legacy Health Solutions 1.877.410.2432• Mercy Health Plans 1.800.617.3433• Scott and White Health Plan 1.800.321.7947• Valley Baptist Health Plans 1.800.829.6440

96

Enrollment Support

Available Online • Enrollment guide (English

and Spanish)• Downloadable forms

(enrollment application, split premium, claim form, etc.)

• Provider locator• Frequently asked questions

www.trs.state.tx.us/trs-activecare

Thank you for attending

Questions

Health Care Coverage for You and Your Family!

Documents

eligible employee

health advice

trsactivecare coverage

roundtheclock health

blue shield of texas

children coverage

nonnetwork benefits

eligible dependentsspouse