Title: Health Care Coverage for You and Your Family!
1Health Care Coverage for You and Your Family!
2Agenda
- Who is eligible to enroll
- Plan options and whats new
- Cost of health coverage
- How to enroll
- Enrollment support
- Questions
3Who 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
4Employees 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.
5Eligible 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)
6Newborns
- 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
7PPO Plan Options
8Whats 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
9PPO 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
Need to locate a Network Provider?
www.trs.state.tx.us/trs-activecare www.bcbstx.com/
trs
10Plan Overview
ActiveCare 1 ActiveCare 2 ActiveCare 3
Deductible (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 20 for primary 30 for specialist
Illustrates benefits when network providers are
used. Non-network benefits are also available
see Enrollment Guide for more information.
11Plan Overview
ActiveCare 1 ActiveCare 2 ActiveCare 3
Preventive 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 25 for primary 35 for specialist 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) 20 for primary 30 for specialist 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.
12Blue CareConnection
- Health and Wellness Programs
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.
1324/7 Nurseline
New!
Advice anytime. Round-the-clock health and the
wellness advice from licensed professionals
- Advice isnt 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 nights
rest
1-800-581-0368
24/7
Available in English and Spanish
14Personal Health Manager
New!
- 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
15Ask-A Online Advisor
Expert advice at your fingertips.Our Ask-A
feature is here to help.
Ask the experts. Expert advice from licensed
professionalsvia the Personal Health Manager
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 SECURE Receive a response within
one business day
16Blue PointsSM Incentives
ActiveCare 1, 2 and 3 plan participants and their
covered dependents accumulate Blue PointsSM in
the Personal Health Manager.
Stay motivated. Earn 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!
17Weight 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
Weight Management Program Support for a Healthier
You
Tobacco Cessation Program Support for members who
want to quit
- Personalized Lifestyle Management Support
- Counseling and coaching with licensed Wellness
Coaches - Motivational toolkit
- 24/7 Nurseline
- Referrals when appropriate
18Expecting? Special Beginnings Program
1-800-462-3275
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
19Live ChatSecure Online Customer Service
New!
- 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)
20What if I Have Questions?
- Personalized Service
- Call 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
21Blue Access for MembersOnline Member Management
Tool
- 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
22Prescription Drugs
23Your 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
24Your Medco Prescription Drug Plan
- Medco has its own mail-order pharmacy Medco By
Mail which delivers medications to your home at
a lower cost - Medcos 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
25Specific Rx Benefit Information
- If you are taking a long-term medication, filling
your prescriptions through Medcos 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, Medcos 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
26Prescription 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 100 of the discounted cost at the time of purchase 80 will be reimbursed by Blue Cross and Blue Shield of Texas after deductible 15 35 60 15 35 55
Medco by Mail (up to 90-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 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.
27Prescription Drug Benefits
ActiveCare 2 and 3 Applying the Deductible Example 1Claim cost less than 50 Deductible
Total Cost Deductible Applied Copay Deductible Remaining
First Fill 37 37 37 13
Second Fill 37 13 13 copay 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
28Prescription Drug Benefits
ActiveCare 2 and 3 Applying the Deductible Example 2Claim 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.
29Information 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
30My Rx Choices Your online savings tool
- Lower 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. Youll to take
a moment to register before using this service.
You can also call 1-866-355-5999.
31My 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.
32My Rx Choices
Medco can facilitate on generic equivalents
received through mail order
33My Rx Choices
Members may print a kit to discusslower-cost
alternatives with their doctor
34More about Your Rx Benefits
- 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
35Medco 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
36HMO Plan Options
37FirstCare
38FirstCare Health PlansService Area
92 counties across Texas
39FirstCare 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
40FirstCare 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
41FirstCare Health PlansWhats 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
42FirstCare Health PlansWhats 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
43FirstCare Health Plans
Benefit Copay
PCP 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
44FirstCare Health Plans
Prescription Drugs Prescription Drugs Prescription Drugs
Retail (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
10,000 maximum prescription benefit per person
per plan year
Excludes insulin and allergy serum Not subject
to 10,000 benefit maximum
45FirstCare 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
46Legacy Health Solutions
47Legacy Health SolutionsService Area
18 counties West Texas
48Legacy Health Solutions
- 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
49Legacy Health Solutions
- 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
50Legacy Health SolutionsWhats 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
51Legacy Health Solutions Claim Messaging
52Legacy Health SolutionsPharmacy Savings Messaging
3,835.46
1,235.55/yr
Potential Savings
How to Save Talk to your doctor about switching
from Nexium to Prilosec OTC or another comparable
drug.
Print Report
53Legacy Health Solutions Web Tools
- Best in class tools to help members understand
and manage their health and health care finances
54Legacy Health Solutions
Benefit Copay
PCP office visit 20
Specialist office visit 35
Preventive care PCP 20 / Specialist 35
Outpatient surgery facility 300
Inpatient hospital 300 per day (5-day maximum)
Emergency room 150 (waived if admitted)
Urgent care 25
Out-of-pocket maximum 3,000 (individual) 9,000 (family)
55Legacy Health Solutions
Prescription Drugs Prescription Drugs Prescription Drugs
Retail (up to 30-day supply) Mail Order (up to 90-day supply)
Generic 8 16
Preferred Brand 35 70
Non-Preferred Brand 200 or 50 of charges, whichever is less N/A
Injectable Prescription Drugs - 25 of charges
56Mercy Health Plans
57Mercy Health PlansService Area
- 4 Texas counties
- Webb
- Jim Hogg
- Zapata
- Duval
58Mercy Health Plans
- No claim forms
- No lifetime maximum
- No preexisting condition limitations
59Mercy Health Plans
- Low out-of-pocket expense
- Emergencies covered anywhere
- Case management
- Diabetes mellitus
- Hypertension
- Asthma
- Other chronic diseases
- CuraScript Injectable Program
60Mercy 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
61Mercy 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
62Mercy Health PlansWhats 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
63Mercy Health Plans
Benefit Copay
PCP/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)
64Mercy Health Plans
Prescription Drugs Prescription Drugs Prescription Drugs
Retail (up to 30-day supply) Mail Order (up to 90-day supply)
Generic 10 20
Preferred Brand 25 50
Non-Preferred Brand 45 90
Infertility drugs are covered at 50 2,000
maximum prescription drug benefit per person per
plan year
65Scott White Health Plan
66Scott and White Health PlanService Area
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
68Scott and WhiteNew Cancer Treatment Center
Temple Campus
First phase of work is underway Estimated
completion date is 1QTR 2009
69Scott and White Health PlanExpanding Network of
Providers
- Hospital Additions
- Hillcrest Baptist Medical Center/Waco
- Grimes St. Joseph Hospital/Navasota
- Physician Group Additions
- SW Wells Branch Clinic March 2008
- Kings Daughters Clinic March 2008
- SW 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
70Scott and White Health PlanWhats 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
71Scott and White Health Plan
Benefit Copay
Deductible 0
PCP/Specialist office visit 25
Preventive care 25
Outpatient surgery facility 100
Inpatient hospital 200 per day (1,000 maximum)
Emergency room 100 (waived if admitted)
Urgent care 40
Out-of-pocket maximum 3,000 maximum per individual 6,000 maximum per family
72Scott and White Health Plan
Prescription Drugs Prescription Drugs Prescription Drugs
Retail (up to 34-day supply) Mail Order (up to 90-day supply)
Rx Deductible None None
Generic 5 10
Preferred 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
year If a brand-name prescription is dispensed
when a generic is available, enrollee pays 50 of
brand-name cost
73Scott and White Health PlanOnline Wellness Tools
- 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
www.trs.state.tx.us/trs-activecare
74Valley Baptist Health Plans
75Valley Baptist Health PlansService Area
- Rio Grande Valley
- Counties
- Cameron
- Hidalgo
- Starr (partial)
- Willacy
- Provider Network
- More than 780 providers
- 11 hospitals Valley-wide
76Valley Baptist Health Plans
- No deductibles or coinsurance
- No claim forms
- No lifetime maximum
- No preexisting condition limitations
- Predictable costs
77Valley Baptist Health Plans
- Free diabetic supplies available
- Worldwide emergency care
- Locally owned and operated in the Rio Grande
Valley by Valley Baptist Health System
78Valley Baptist Health Plans
- 99 member satisfaction (employer group survey)
- 97 of our providers would recommend our plan to
their patients (provider survey)
79Valley Baptist Health Plans
- PCP will refer you to a specialist
- No referral needed for a designated OB/GYN
- Case management services for diabetes mellitus
80Valley Baptist Health PlansWhats New for
2008-2009
- No plan changes
- Approximately 8.5 premium increase
81Valley Baptist Health Plans
Benefit Copay
PCP office visit 25
Specialist office visit 35
Preventive care 25 PCP/35 Specialist
Outpatient surgery facility 250
Inpatient hospital 300 per day (1,500 maximum)
Emergency room 150 (waived if admitted)
Urgent care 25
Out-of-pocket maximum 3,000 maximum (individual) 6,000 maximum (family)
82Valley Baptist Health Plans
Prescription Drugs Prescription Drugs Prescription Drugs
Retail (up to 30-day supply) Mail Order (up to 90-day supply)
Generic 15 30
Preferred Brand 25 50
Non-Preferred Brand 45 90
83Cost for Health Coverage
84Coverage Categories
- Employee Only
- Employee and Spouse
- Employee and Child(ren)
- Employee and Family
85Monthly Costof Coverage
Page 35 of the Enrollment Guide
86Application 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
87How to Enroll
88How to Enroll
- 2 Complete an Enrollment Application and Change
Form - Available in the Enrollment Guide
- Also available online
3 Sign, date and submit form to your Benefits
Administrator
1 Choose your health plan
89How 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
90Can 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 theres 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
91Cafeteria 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
92Are 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
93Important 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
94Your 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
96Enrollment 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
97Questions