Change to TRS Active Care

1
Change to TRS Active Care

• April 2006

2
Agenda

• Purpose of Meeting/Introductory Remarks
• Steve West, Assistant Superintendent / Finance
  Operations

• TRS Active Care Presentation
• Sheri Sides, Assistant Superintendent / Human
  Resources

• Open Enrollment Procedures
• Melissa Page / Benefits Specialist

• Review of Voluntary Products
• Financial Benefit Services

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Implications of Transition

• Eliminate Alternate Plan
• Eliminate Self-Funded Health Dental Plans
• Transition to TRS Plan is Permanent
• One-time shortened deductible and Out-of-Pocket
  expense period
• January August 31, 2006 (AISD Self-Funded Plan)
• September 1, 2006 August 31, 2007 (TRS
  ActiveCare)
• Insured Dental Plans
• Network Access Plan (similar to Self-Funded
  Dental)
• DHMO

4
Allen ISD Claims Contributions History
Projections Since July 2002
5
General Fund Recap of Expenditures per Student
2006/07
6
2005/06 Allen ISD Self-Funded Rates
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2006/07 TRS Active Care Rates
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Current Dental Plan Rates
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Guardian Dental Rates
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2005/06 Benefits Committee Members
Honey Gray Vaughan Elementary Lorraine Milstead
Allen High School Kay Simms Boyd
Elementary John Holley Anderson Elementary Pam
Fitchner Reed Elementary Lori Pryor Curtis
Middle School Stacia Butler Green
Elementary John Steele Dillard Center Sonja
Olf Story Elementary Andrea Brooks Ford
Middle School Vivien Addington Service
Ctr/Student Nutrition/Transportation Janice
Rogers Rountree Elementary Dianna Bass Norton
Elementary Cora Jackson Lowery Freshman
Center John Ashcraft Bolin Elementary Julie
DeLeon Kerr Elementary Lee Ann Parsons Marion
Elementary Bobbi Taylor Ereckson Middle
School Kim Kelsey Boon Elementary Steve
West Administration Sheri Sides Administration M
elissa Page Administration
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Enrollment

• Open Enrollment May 1 31, 2006
• Open Enrollment is designated as the only time an
  employee can add coverage, drop coverage, or
  change benefit selections in any way. The only
  exception is in the event an employee becomes
  eligible due to a family status change/qualifying
  event.
• 2006/07 Enrollment Booklet will soon be available
  for distribution to employees

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Enrollment

• Every employee must complete a new Benefit
  Election Form each year, even if
• There are no benefit selection changes
• The employee does not wish to participate
• in AISD benefits.
• Benefit selections will not be carried over from
  the 2005-06 benefit year.

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Enrollment

• Online Benefit enrollment is available by going
  to www.allenisdbenefits.com and using the
  instructions included in the employee benefit
  enrollment booklet.
• Enrolling agents from Financial Benefit Service
  (FBS) will be available at each campus again this
  year to help anyone who would like assistance
  with completing the online enrollment process.

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Enrollment

• Changes made during our open enrollment period
  will be effective September 1, 2006. (Current
  benefit selections will be in effect through
  August 31, 2006.)
• Deductions for the current benefits will continue
  to be made from paychecks through August, 2006.

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Website ResourcesBlue Access for Members

• Available to ActiveCare 1, 2 and 3 enrollees
• Blue Access for Members link on home page of
  TRS-ActiveCare Web site
• Check the status of a claim
• Confirm who is covered under the plan
• View and print detailed claim information
  (Explanation of Benefits)
• Opt-out of receiving paper copies of their
  Explanation of Benefits
• Sign up to receive email notifications of new
  claim activity
• Request a new or replacement ID card or print a
  temporary member ID card
• Access to health and wellness information from
  Mayo Clinic

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Website Resources General

• TRS Active Care Rules
• http//www.trs.state.tx.us/TRS-ActiveCare/trsactiv
  ecare.rules.htm
• TRS-ActiveCare Frequently Asked Questions (FAQs)
• http//www.trs.state.tx.us/FAQs.htm 
• Allen ISD Benefits Page
• http//www.allenisdbenefits.com/

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Plan Information

• TRS Active Care
• Guardian Dental Plan

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Whats New for 2006-2007?Recap

• No premium rate increase for ActiveCare 1, 2 or 3
  PPO plans
• ActiveCare 1
• Plan year deductible increased from 1,000 to
  1,050 per individual
• ActiveCare 2 and ActiveCare 3
• No plan changes
• Network growth
• Over 45,500 doctors and 400 hospitals in PPO
  network
• Effective January 1, 2006, Scott White doctors
  and hospitals joined the Blue Cross and Blue
  Shield of Texas PPO network and are now network
  providers for the ActiveCare 1, 2 and 3 plans

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Employees Eligible to Enroll
Active contributing TRS member?
You may be eligible
If Yes
If No
Regularly work 10 or more hours per week?
You may be eligible
If Yes
If No
You are not eligible
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Eligible Dependents

• Spouse (including a common law spouse)
• Unmarried (including divorced) children under age
  25
• Natural child
• Adopted child
• Stepchild
• Foster child

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More Eligible Children

• An unmarried child under the legal guardianship
  of the employee
• An unmarried child in a regular parent-child
  relationshipwith the employee
• The child's primary residence is the household
  ofthe employee
• The employee provides at least 50 of the child's
  support
• Neither of the child's natural parents resides in
  that household
• The employee has the legal right to make
  decisions regarding the child's medical care
• An unmarried grandchild whose primary residence
  is the household of the employee and who is a
  dependent of the employee for federal income tax
  purposes

22
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
  newborns 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

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More Eligible Dependents

• Unmarried children (any age) mentally retardedor
  physically incapacitated
• Siblings over age 25 or parents are not the
  children of an employee and do not meet the
  definition of an eligible dependent
• Any other dependents required to be covered under
  applicable law

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Network vs. Non-Network Providers

• Network Providers
• Receive highest level of benefits
• No claims to file
• No balance billing
• Non-Network Providers
• Receive non-network level of benefits
• Must file own claims
• May be billed for charges exceeding allowable
  amount

Effective January 1, 2006, Scott White doctors
and hospitals joined the Blue Cross and Blue
Shield of Texas PPO network and are now network
providers for the ActiveCare 1, 2 and 3 plans
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PPO Features ActiveCare 1, ActiveCare 2 and
ActiveCare 3

• Administered by Blue Cross and Blue Shield of
  Texas and Medco
• No primary care physician (PCP) required no
  referrals required to see a specialist
• Select any provider for care within the PPO
  network or outside the network
• When you receive care inside the network, you
  receive the highest level of benefits
• When you receive care outside the network, you
  still have coverage but you may pay more of the
  cost
• Worldwide coverage for emergency and
  non-emergency care

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Coverage Outside Texas

• BlueCard PPO Program
• (for enrollees living or traveling outside of
  Texas)
• More than 85 percent of all doctors and hospitals
  contract with Blue Cross and Blue Shield Plans
• Outside of the U.S., you have access to doctors
  and hospitals in more than 200 countries
• Network level of benefits
• Claims filed by providers
• No balance billing

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Preauthorization Required

• All inpatient hospital stays
• Treatment of all serious mental illness, mental
  health care and chemical dependency
• Home health care
• Hospice
• Skilled nursing facility
• Home infusion therapy

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Special Beginnings Prenatal Program

• Available now to ActiveCare 1, 2 and 3 plan
  participantsat no cost
• Program is available from pregnancy through six
  weeks after delivery
• Helps mothers take better care of themselves and
  their babies
• Assesses pregnancy risk level and provides close
  monitoring through a series of calls from an
  experienced obstetrical nurse
• Call 1-800-462-3275 to enroll or ask questions
  about the program

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Disease Management Programs ActiveCare 1, 2 and
3 PPO Plans

• Voluntary programs available now to ActiveCare 1,
  2 and 3 plan participantsat no out-of-pocket
  cost
• Designed for those diagnosed with
• Asthma
• Diabetes
• Congestive heart failure
• Coronary artery disease
• Metabolic syndrome ( high blood pressure, high
  cholesterol)
• Lower back pain
• End stage renal disease

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Disease Management Programs

• Enrolling in a program can help
• Decrease the intensity and frequency of symptoms
• Enhance self-management skills
• Minimize missed days at work
• Enrich quality of life
• Claims and pharmacy data review,
  preauthorization prior to a hospitalization or a
  physician referral are some of the factors that
  help determine if a disease management program is
  right for the plan participant
• Blue Cross and Blue Shield of Texas will notify
  doctor by letter if it finds that the plan
  participant would benefit by enrolling in a
  program
• Call 1-800-462-3275 to enroll

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Disease Management Programs

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Deductibles (Plan Year)
Deductible The amount of out-of-pocket expense
that must be paid for health care services before
becoming payable by the health care plan
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Coinsurance
Coinsurance The percentage of medical expenses
that you and the health plan share
34
Office Visit Copay
Copayment (Copay) The amount paid at the time of
service for certain medical services and
prescription drugs copays depend on whether the
doctor is primary or a specialist Specialist
Any physician other than a family practitioner,
internist, OB/GYN, and pediatricians
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Preventive Care
Copayment (Copay) The amount paid at the time of
service for certain medical services and
prescription drugs copays depend on whether the
doctor is primary or a specialist Specialist Any
physician other than a family practitioner,
internist, OB/GYN or pediatrician
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Out-of-Pocket Maximum(excludes copays and
deductibles)
Out-of-Pocket Maximum When you reach your
plans of out-of-pocket maximum, the plan then
pays 100 of any eligible expenses for the rest
of the plan year.
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Prescription Drug Benefits Overview

• Retail pharmacy program
• Medco by Mail
• Retail maintenance drug list
• Copays
• Prior authorization
• Online technology
• Medco by Mail tips
• Savings Advisor

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Prescription Drug Benefits Whats New

• No plan changes, no copay changes
• Retail Pharmacy ProgramActiveCare 2 and
  ActiveCare 3No changes
• Retail copays for maintenance medications
• First two fills of maintenance medication at
  retail
• short-term copay
• Third (3rd) fill of maintenance medication at
  retail
• copay increase
• Retail copays for short-term medications did not
  change
• Mail order copays did not change
• Separate 50 drug deductible per family member
  for ActiveCare 2 and ActiveCare 3 did not change

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Prescription Drug Benefits
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Prescription Drug Benefits
Note When using a non-network pharmacy, you must
pay the entire cost and submit a claim form to
Medco. You will be reimbursed the amount that
would have been charged by a network pharmacy,
less the required copayment.
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Prescription Drug Benefits
Note When using a non-network pharmacy, you must
pay the entire cost and submit a claim form to
Medco. You will be reimbursed the amount that
would have been charged by a network pharmacy,
less the required copayment.
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Prescription Drug Benefits

• 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

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Prescription Drug Benefits

• 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

44
Prescription Drug Benefits

• ActiveCare 2 and 3 Member pays the difference
• You pay the difference if a brand-name
  prescription is dispensed when a generic is
  available
• You pay the generic copay plus the difference in
  cost between the brand-name prescription and what
  the cost would be if the generic drug had been
  purchased, regardless of doctor DAW (Dispense As
  Written)

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Dental Plan Guardian
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Dental Plan Guardian