Health Care Coverage for You and Your Family!
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Transcript of Health Care Coverage for You and Your Family!
Health Care Coverage for You
and Your Family!Welcome
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Agenda
• Who is eligible to enroll• Plan options and what’s new• Cost of health coverage• How to enroll • Enrollment support• Questions
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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
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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.
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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)
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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
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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
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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?
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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
$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.
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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
$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.
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
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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!
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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
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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
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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!
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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
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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
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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!
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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
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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
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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
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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
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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
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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.
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Prescription Drug Benefits
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
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Prescription Drug Benefits
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.
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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
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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.
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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.
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My Rx Choices
Medco can facilitate on generic equivalents received through mail order
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My Rx Choices
Members may print a kit to discusslower-cost alternatives with their doctor
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• 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
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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
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FirstCare Health PlansService Area
92 counties across Texas
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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
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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
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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%
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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
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FirstCare Health Plans
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
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FirstCare Health Plans
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
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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
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18 counties West
Texas
Legacy Health SolutionsService Area
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• 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
Legacy Health Solutions
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• 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
Legacy Health Solutions
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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%
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Legacy Health Solutions Claim Messaging
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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
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Legacy Health Solutions Web Tools
• Best in class tools to help members understand and manage their health and health care finances
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Benefit CopayPCP 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)
Legacy Health Solutions
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Prescription DrugsRetail
(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
Legacy Health Solutions
Mercy Health Plans
HMO Plan Option
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Mercy Health PlansService Area
4 Texas counties:Webb Jim HoggZapataDuval
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Mercy Health Plans
• No claim forms• No lifetime maximum• No preexisting condition limitations
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Mercy Health Plans
• Low out-of-pocket expense• Emergencies covered anywhere• Case management
– Diabetes mellitus– Hypertension– Asthma– Other chronic diseases
• CuraScript Injectable Program
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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
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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
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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
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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)
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Mercy Health Plans
Prescription DrugsRetail
(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
HMO Plan Option
Scott & White Health Plan
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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
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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
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Scott and WhiteNew Cancer Treatment Center – Temple Campus
First phase of work is underway
Estimated completion date is 1QTR 2009
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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
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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%
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Scott and White Health Plan
Benefit CopayDeductible $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
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Scott and White Health Plan
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
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• 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
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Valley Baptist Health PlansService Area
• Rio Grande Valley • Counties
– Cameron– Hidalgo– Starr (partial)– Willacy
• Provider Network– More than 780 providers– 11 hospitals Valley-wide
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Valley Baptist Health Plans
• No deductibles or coinsurance• No claim forms• No lifetime maximum• No preexisting condition limitations• Predictable costs
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Valley Baptist Health Plans
• Free diabetic supplies available • Worldwide emergency care• Locally owned and operated in the Rio Grande
Valley by Valley Baptist Health System
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Valley Baptist Health Plans
• 99% member satisfaction (employer group survey)• 97% of our providers would recommend our plan to
their patients (provider survey)
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Valley Baptist Health Plans
• PCP will refer you to a specialist• No referral needed for a designated OB/GYN• Case management services for diabetes mellitus
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Valley Baptist Health PlansWhat’s New for 2008-2009
• No plan changes• Approximately 8.5% premium increase
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Valley Baptist Health Plans
Benefit CopayPCP 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)
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Valley Baptist Health Plans
Prescription DrugsRetail
(up to 30-day supply)Mail Order
(up to 90-day supply)
Generic $15 $30
Preferred Brand $25 $50
Non-Preferred Brand $45 $90
2008-2009 Plan Year
Cost for Health Coverage
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Coverage Categories
• Employee Only• Employee and Spouse• Employee and Child(ren)• Employee and Family
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Monthly Costof Coverage
Page 35 of the Enrollment Guide
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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