2010-2011 Plan Year Effective September 1, 2010

2

Your TRS-ActiveCare ID card will be mailed to your home

Enroll by May 19 to receive ID card by September 1

ActiveCare 1-HD, 1, 2 and 3 – All enrollees, including existing plan participants, will receive

new ID cards – New! Separate cards for medical and prescription drugs

• Blue Cross and Blue Shield of Texas

• Medco

PPO Medical PlansActiveCare 1-HD, 1, 2 & 3 Plans

4

PPO Network for ActiveCare 1-HD, 1, 2 and 3

Network

There is no need to:– Select a Primary Care Physician– Obtain referrals for specialist care

Receive the highest level of benefits:

– Pay less for care– No balance billing

No claim forms– Provider files claim for you

Non-Network: You pay more of the cost

of out-of-network benefits– Higher deductibles,

coinsurance

You may need to file your own claim

You could be balance billed for amounts over allowed amount

Always verify provider network status

New for 2010-2011: The allowable amount for non-contracting providers

will be limited to 50% of billed charges

5

PPO Plan Overview (Network Level of Benefits)

Plan Features ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Deductible (individual/family)

$2,400/$2,400 $1,200/$3,000 $500/$1,500 None

Out-of-Pocket Maximum

(does not include deductibles)

$3,000/$5,000 $2,000/$6,000 $2,000/$6,000 $1,000 per individual

Coinsurance

(Plan pays/participant pays)

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

New Deductiblesfor 2010-2011 (per IRS rules)

ActiveCare 1-HD and ActiveCare 1

6

PPO Plan Overview (Network Level of Benefits)

Services ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Office Visit Copay 20% after deductible $30 for primary

$50 for specialist

$20 for primary

$30 for specialist

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

$30 for primary

$50 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)

New Copaysfor 2010-2011ActiveCare 2

7

ActiveCare 1-HD vs. ActiveCare 1Plan Features ActiveCare 1-HD ActiveCare 1

Meets IRS definition of High Deductible Health Plan

Yes, for all coverage categories

(employee only, employee and spouse, employee and

child(ren) and employee and family)

Yes, for employee-only coverage

No, for other coverage categories

Deductible$2,400 for employee only

$2,400 for family

$1,200 per individual

$3,000 per family

Maximum Coinsurance $3,000 for employee only

$5,000 for family

$2,000 per individual

$6,000 per family

Out-of-Pocket Maximum

(includes deductibles)

$5,400 for employee only

$7,400 for family

$3,200 per individual

$9,000 per family

Monthly Premium CostLower premium than

ActiveCare 1in all coverage categories

except employee and family

Higher premium than ActiveCare 1-HD in all

coverage categories except employee and family

New for 2010-2011: Deductible and out-of-pocket maximum amounts increased per IRS guidelinesNew for 2010-2011: Deductible and out-of-pocket maximum amounts increased per IRS guidelines

8

Important:

Bariatric surgery procedures for weight loss, such as lap band and gastric bypass, must be performed at one of the Blue Distinction Centers for Bariatric Surgery or the procedure will not be covered by TRS-ActiveCare

Blue Distinction Centers for Bariatric Surgery

List of Blue Distinction Centers for Bariatric Surgery is subject to change

Refer to the Doctors and Hospitals section of the Web site, www.bcbstx.com/trs or call Customer Service for most current list

How to Enroll

2010-2011 Plan Year

10

Enrollment

Enrollment Periods for 2010-2011 Plan Year:– April 21,22,23 (HISD Spring Enrollment)– August date TBA (HISD Summer Enrollment)

Preexisting condition exclusion applies to those that previously declined coverage; may be reduced by prior creditable coverage

All employees must attend enrollment to:– Change TRS-ActiveCare plan option– Add or drop dependents– Cancel and/or decline coverage– Enroll for TRS-ActiveCare coverage with a different

participating district/entity – Change name or address or correct date of birth or Social Security number

11

Eligible Dependents

Spouse (including a common law spouse)

Unmarried children under age 25– Natural child– Adopted child– Stepchild– Foster child

Other eligible dependents listed inEnrollment Guide– Grandchildren (unmarried)

– Disabled children (unmarried, of any age)

12

Special Eligibility Situations

If employee and spouse both work for a participating district/entity:

– A spouse may be covered as an employee or as a dependent of an employee

– Only one parent can cover dependent children

A child (under age 25) employed by a district/entity and a contributing TRS member cannot be covered as a dependent

The child must be covered as an employee If the child is not a contributing TRS member, the child

may be covered as a dependent

13

Preexisting Condition Waiting Period and Creditable Coverage

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

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 of 63 or more consecutive days

Pre-x waiting period may be reduced by creditable coverage

Exception: If a participant has been covered by TRS-ActiveCare at any time since 2002, pre-x may apply if employee is hired by another participating district/entity (or rehired by same district/entity)

2010-2011 Plan Year

Cost for Health Coverage

15

Monthly Costfor Coverage

See page 27 of Enrollment Guide

$225 in district/entityand state funds to help pay for coverage

16

Cost of Coverage (Cont’d)

Employee and family coverage for ActiveCare 1-HD is more expensive than ActiveCare 1 because the deductible and out-of-pocket maximum amounts for family are less and the plan may begin paying 100% benefits sooner

PPO Plans ActiveCare 1-HD ActiveCare 1

Coverage Category Your Cost Your Cost

Employee Only $37 $72

Employee and Spouse $417 $452

Employee and Child(ren) $184 $249

Employee and Family $615 $521

Family Deductible $2,400 $3,000

Family Out-of-Pocket Maximum

$7,400 $9,000

17

Cost of Coverage (Cont’d)

New Copays for 2010-2011 (Active Care 2) $30 for an office or preventive care visit for primary and $50 for specialist.

PPO Plans ActiveCare 2 ActiveCare 3

Coverage Category Your Cost Your Cost

Employee Only $171 $308

Employee and Spouse $676 $988

Employee and Children $405 $625

Employee and Family $766 $1,109

Family Deductible $1,500 None

Family Out-of-Pocket Maximum

$7,500 $1,000 per individual

18

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 employers

19

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, 2011 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

20

Newborns

Covered first 31 days if employee has coverage

Must add newborn within 60 days after the date of birth or up to one year after the 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

Not necessary to wait for newborn’s Social Security number

– Submit application without SSN to enroll– Re-submit another form after SSN is issued

21

Online member management tool Check claim status, view claim

summaries and print EOBs (Explanations of Benefits)

Order additional ID cards, and print temporary ID

Monthly health articles Links to health information

and wellness tools and resources, including the Personal Health Manager

Send secure e-mail messages to BCBS Customer Advocates available Monday thru Friday, 7 a.m. to 10 p.m. (CT)

Blue Access® for Members

Available online

Enrollment Video Application Form Enrollment GuideBenefits Booklet

24/7 Nurseline, Lifestyle and

Condition Management and

Special Beginnings phone numbers

www.bcbstx.com/trs

23

Blue Care Connection®

Whether you decide to skip fast food, quit smoking, or walk more, every day decisions can have a positive impact on your health; Blue Care Connection offers guidance at every level of health

Complex / CatastrophicWell Members Low- Risk Moderate- Risk High-Risk

< < < Wellness > > >

Total Care Approach to Health and Wellness

24

Condition Management

• Support from Blue Care Advisors—clinical professionals who can help you manage chronic health conditions such as: asthma, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disorder and other health conditions

• Understanding and following your physician’s orders

• Review medications, side effects, compliance, refills and current services

• Establish goals with you and caregivers, scheduling follow-ups as appropriate

If you have a chronic condition, we offer support.

1-800-462-32751-800-462-3275

25

Self-Paced Approach

• Online program and resources available in the Personal Health Manager

• Secure e-mail outreach to keep members on track

Lifestyle Management Support

• Counseling and coaching with licensed Wellness Coaches

• 24/7 Nurseline

• Referrals when appropriate

Tobacco Cessation and Weight Management

1-800-462-32751-800-462-3275

26

Special Beginnings®

Special Beginnings helps expectant mothers and their babies get off to a healthy start by providing prenatal and postnatal health education and guidance at no additional cost

Once enrolled in the program, plan participants receive:

• Pregnancy risk assessment and ongoing communication/monitoring

• Educational material covering pregnancy and infant care topics

• Frequent, personal contact with program staff from early pregnancy through six weeks after delivery

• Assistance in managing high-risk conditions such as gestational diabetes and preeclampsia

Program components are available in English and Spanish

1-888-421-77811-888-421-7781

27

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 1-800-581-03681-800-581-0368

28

Personal Health Manager (PHM)

Your online wellness experience begins with the Personal Health Manager

Features include: Lifestyle Management tools:

Weight Management Tobacco Cessation Fitness and Nutrition Plans Stress Reduction

Health Risk Assessment

“For Your Health” features Blue PointsSM Rewards “Ask-A” feature – health and

wellness questions via secure e-mail

Online health encyclopedia Interactive symptom checker

29

Personal Health Manager – Home Page

Use the Interactive Symptom Checker

Read the latest health news, search for specific health topics or explore the prescription drug index

Ask a Question to a certified Nurse, Trainer, Dietitian or Life Coach

Access MemberCare Profile

Take a Health Risk Assessment

Read secure messages

Review member alerts

Explore topics in the Health Information and Care Center

30

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 Secure – Receive an e-mail response within one business day

31

Receive Personalized report and next steps:

• Report provides member with summary of health risks and areas where they could improve

• Recommended ‘next steps’ and suggestions to make positive changes to your lifestyle.

Health Risk Assessment – Easy To Use

Complete the assessment in as little as10 to 15 minutes

Choose your assessment topic:

• Health & well-being*

• Sleep

• Stress management

• Nutrition

• Fitness & physical activity

• Back & joint health

*We recommend completingthe Health & Well-beingassessment first.

1 2 3

32

Health Risk Assessment (HRA)

A Health Risk Assessment helpsassess your health risks, interests and readiness to change Examines your overall health

and well-being

Provides a detailed report with overall health and well-being score and sub-scores for: Medical health, job satisfaction,

life load, risk and lifestyle, mood, nutrition, sleep, stress, pain and body weight

Recommends areas for improvement

Confidential and secure (results are not shared with employers)

Be informed about your overall health and well-being

Earn Blue PointsSM

33

Stay motivated.Earn Blue Points in the Personal Health Manager

Blue PointsSM Incentives

TRS-ActiveCare PPO plan participants and their covered dependents accumulate Blue Points 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 Points for a variety of items!

Prescription DrugsActiveCare 1-HD,1, 2 & 3

35

Your Medco Prescription Drug Plan

Medco administers your prescription drug plans on behalf of TRS– ActiveCare 1-HD, 1, 2, and 3 plans

Benefit includes both a retail and mail component

Medco has its own mail-order pharmacy – Medco By Mail – where specialist pharmacist focus on compliance and lower cost options for the patient, and the automated filling system ensures the prescription is filled accurately.*

• 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

36

Prescription Drug Benefits - Network Level

Features ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Drug Deductible(per person, per plan year)

Subject to plan year deductible

Subject to plan year deductible

$50 $50

Retail Short-Term(up to 30-day supply)

Generic/Preferred Brand/Non-Preferred Brand

20% coinsurance

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.

37

Specific Rx Benefit Information

Retail pharmacies are ideal for acute (short-term) and new medication you may be trying for the first time

In compliance with SB 0704, 81 (R) Texas Legislature, TRS will make available through Medco a retail maintenance network effective September 1, 2010.  Retail pharmacies who choose to participate in this network will be able to dispense up to a 90-day supply of medication.  Please contact Medco customer service for more information on pharmacies that may choose to participate in the retail maintenance network. Medco is in the process of soliciting this network. We will not know which pharmacies will choose to participate until later this summer.

38

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 can receive up to a 90-day supply of your medication at a lower copay

– Prescriptions are delivered directly to you and you can order refills online and check the status of your orders

– You have access to specialist pharmacists

• Specifically trained in specific conditions

• Review all of your incoming prescriptions for potential safety issues and will contact you and your doctor to discuss any issue

– Medco only buys medication from the most reputable suppliers

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

39

My 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 the medications you use

• Print a kit to help your doctor better understand the economic impact of different medication alternatives

• Alternative medications are based upon greatest cost savings to you presented in order, starting with the highest value

• Brand-to-generic and retail-to-mail comparisons are shown

• The average amount saved by My Rx Choices® users is $294!

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

You have to shop your benefit. Prices can vary at different retail pharmacies

40

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 within a household (pre-populated with all under age 18 dependents and spouse information will be shown if authorization has been given)

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

Your potential savings are clearly presented

Members may print a kit to discuss with their doctor

Generic alternatives are provided

41

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– Order Medco By Mail refills– Download forms– Medco widget

Customer Service 1-866-355-5999 Benefits Booklet

42

Customer Service

1-866-355-5999

What if I Have Questions?

Call TRS-ActiveCare customer service 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!

Personalized Service

Thank you for attending