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2020-2021 TRS- Active Care Plan Highlights

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Benet
TRS-ActiveCare
Primary
TRS-ActiveCare HD
TRS-ActiveCare
Primary+
TRS-ActiveCare 2
In-Network Only In-Network Only Out-of-Network In-Network Only In-Network Out-of-Network
Diagnostic Labs*
Ofce/Indpendent Lab:
You pay $0
You pay 20%
after deductible
You pay 40%
after deductible
Ofce/Indpendent Lab:
You pay $0
Ofce/Indpendent Lab:
You pay $0
You pay 40%
after deductible
Outpatient: You pay
30% after deductible
Outpatient: You pay 20%
after deductible
Outpatient: You pay
20% after deductible
High-Tech Radiology
You pay 30% after
deductible
You pay 20%
after deductible
You pay 40%
after deductible
You pay 20% after
deductible
You pay 20% after
deductible + $100 per
procedure copay
You pay 40%
after deductible
+ $100 per
procedure
copay
Outpatient Costs
You pay 30% after
deductible
You pay 20%
after deductible
You pay 40%
after deductible
You pay 20% after
deductible
You pay 20% after
deductible ($150
facility copay per
incident)
You pay 40%
after deductible
($150 facility
copay per
incident)
Inpatient Hospital Costs
You pay 30% after
deductible
You pay 20%
after deductible
You pay 40%
after deductible
($500 facility
per day
maximum)
You pay 20% after
deductible
You pay 20% after
deductible ($150
facility copay per day)
You pay 40%
after deductible
($500 facility
per day
maximum)
Freestanding Emergency
Room
You pay $500 copay +
30% after deductible
You pay 20%
after deductible
+ $500 copay
You pay 40%
after deductible
+ $500 copay
You pay $500 copay +
20% after deductible
You pay $500 copay +
20% after deductible
You pay $500
copay + 40%
after deductible
Bariatric Surgery
Facility – You pay 30%
after deductible
Not Covered Not Covered
Facility – You pay 20%
after deductible
Facility – You pay 20%
after deductible ($150
facility copay per day)
Not Covered
Professional Services –
You pay $5,000 copay +
20% after deductible
Professional Services
– You pay $5,000
copay + 30% after
deductible
Professional Services
– You pay $5,000
copay + 20% after
deductible
(Only covered if
rendered at a BDC+
facility)
(Only covered if
rendered at a BDC+
facility)
(Only covered if
rendered at a BDC+
facility)
Annual Vision Examination
(one per plan year; performed
by an ophthalmologist or
optometrist)
You pay $70 copay
You pay 20%
after deductible
You pay 40%
after deductible
You pay $70 copay You pay $70 copay
You pay 40%
after deductible
Annual Hearing Exam
(one per plan year)
You pay $70 copay
You pay 20%
after deductible
You pay 40%
after deductible
You pay $70 copay You pay $70 copay
You pay 40%
after deductible
Revised 06/05/20
*Pre-certication for genetic and specialty testing may apply. Contact your Personal Health Guide at 1-866-355-5999 with questions.
Learn the Terms
• Premium: The monthly amount you pay for health care coverage.
• Deductible: The annual amount for medical expenses you’re
responsible to pay before your plan begins to pay its portion.
• Copay: The set amount you pay for a covered service at the time
you receive it. The amount can vary by the type of service.
• Coinsurance: The portion you’re required to pay for services after
you meet your deductible. It’s often a specied percentage of the
costs; i.e. you pay 20% while the health care plan pays 80%.
• Out-of-Pocket Maximum: The maximum amount you pay each
year for medical costs. After reaching the out-of-pocket maximum,
the plan pays 100% of allowable charges for covered services.
Compare Pricing for Common Medical Services
trs.texas.gov
What to Know
How to Calculate Your Monthly Premium
Total Monthly Premium
Your District and State Contributions
Your Premium
Calculate Your Monthly Premium
Ask your Benets Administrator for your district’s specic premiums.
This new year brings new opportunities to unlock your potential and take charge of your wellness.
After connecting with your district leaders to learn how we could enhance the quality of your coverage, we’re providing improved
pricing, more network choices, simplied coverage and a new plan with a lower premium and copays.
Welcome to the 2020-21 TRS-ActiveCare, where you can empower the best you.
ACTIVATE YOUR HEALTH:
TRS-ActiveCare Plan Highlights 2020-21
You can use the cost estimator tool on www.bcbstx.com/trsactivecare starting Sept. 1 to shop for
the best prices through different providers.
REMEMBER:
All TRS-ActiveCare participants have three plan options. Each is designed with the unique needs of our members in mind.
This plan is closed and not accepting new enrollees. If you’re
currently enrolled in TRS-ActiveCare 2, you can remain in this plan.
2020-21 TRS-ActiveCare Plan Highlights Sept. 1, 2020 – Aug. 31, 2021
TRS-ActiveCare 2
• Closed to new enrollees
• Current enrollees can choose to stay in plan
• Lower deductible
• Copays for many drugs and services
• Nationwide network with out-of-network coverage
• No requirement for PCPs or referrals
If you’re currently in TRS-ActiveCare 2, and you make no changes
during Annual Enrollment, you will remain in TRS-ActiveCare 2 next year.
Total Premium Your Premium
$937 $
$2,222 $
$1,393 $
$2,627 $
Plan Features
Type of Coverage In-Network Coverage Only In-Network Out-of-Network In-Network Coverage Only
Individual/Family Deductible $2,500/$5,000 $2,800/$5,600 $5,500/$11,000 $1,200/$3,600
Coinsurance You pay 30% after deductible You pay 20% after deductible You pay 40% after deductible You pay 20% after deductible
Individual/Family Maximum Out-of-Pocket $8,150/$16,300 $6,900/$13,800 $20,250/$40,500 $6,900/$13,800
Network Statewide Network Nationwide Network Statewide Network
Primary Care Provider (PCP) Required Yes No Yes
In-Network Out-of-Network
$1,000/$3,000 $2,000/$6,000
You pay 20% after deductible You pay 40% after deductible
$7,900/$15,800 $23,700/$47,400
Nationwide Network
No
Doctor Visits
Primary Care $30 copay You pay 20% after deductible You pay 40% after deductible $30 copay
Specialist $70 copay You pay 20% after deductible You pay 40% after deductible $70 copay
TRS Virtual Health $0 per consultation $30 per consultation $0 per consultation
$30 copay You pay 40% after deductible
$70 copay You pay 40% after deductible
$0 per consultation
Immediate Care
Urgent Care $50 copay You pay 20% after deductible You pay 40% after deductible $50 copay
Emergency Care You pay 30% after deductible You pay 20% after deductible You pay 20% after deductible
TRS Virtual Health $0 per consultation $30 per consultation $0 per consultation
$50 copay You pay 40% after deductible
You pay a $250 copay plus 20% after deductible
$0 per consultation
Prescription Drugs
Drug Deductible Integrated with medical Integrated with medical $200 brand deductible
Generics (30-Day Supply / 90-Day Supply)
$15/$45 copay; $0 for certain generics
You pay 20% after deductible; $0 for certain generics
$15/$45 copay
Preferred Brand You pay 30% after deductible You pay 25% after deductible You pay 25% after deductible
Non-preferred Brand You pay 50% after deductible You pay 50% after deductible You pay 50% after deductible
Specialty You pay 30% after deductible You pay 20% after deductible You pay 20% after deductible
$200 brand deductible
$20/$45 copay
You pay 25% after deductible ($40 min/$80 max)/
You pay 25% after deductible ($105 min/$210 max)
You pay 50% after deductible ($100 min/$200 max)/
You pay 50% after deductible ($215 min/$430 max)
You pay 20% after deductible ($200 min/$900 max)/
No 90-Day Supply of Specialty Medications
TRS-ActiveCare Primary TRS-ActiveCare HD TRS-ActiveCare Primary+
Plan summary
• Lower premium
• Copays for doctor visits before you meet deductible
• Statewide network
• PCP referrals required to see specialists
• Not compatible with health savings account (HSA)
• No out-of-network coverage
• Similar to current 1-HD
• Lower premium
• Compatible with health savings account (HSA)
• Nationwide network with out-of-network coverage
• No requirement for PCPs or referrals
• Must meet deductible before plan pays for non-preventive care
• Simpler version of the current Select plan
• Lower deductible than HD and primary plans
• Copays for many services and drugs
• Higher premium
• Statewide network
• PCP referrals required to see specialists
• Not compatible with a health savings account (HSA)
• No out-of-network coverage
If you make no changes during Annual
Enrollment, you’ll have the following plan...
Only employees that choose this new plan during Annual
Enrollment will be enrolled in it.
If you’re currently in TRS-ActiveCare 1-HD and you make no
change during Annual Enrollment, this will be your plan next year.
If you’re currently in TRS-ActiveCare Select and you make no
changes during Annual Enrollment, this will be your plan next year.
What’s New
• Primary plan with a lower premium
and copays
• Primary+ (formerly Select) decreased
premiums by up to 8%
• Broader networks of health care
providers
• Lower premiums for families with
children
* Available for all plans. See benets guides
for more details.
Leverage Your $0
Preventive Care*
• Annual routine physicals (ages 12+)
• Annual mammogram (ages 40+)
• Annual OBGYN exam & pap smear
(ages 18+)
• Annual prostate cancer screening
(ages 45+)
• Well-child care
(unlimited up to age 12)
• Healthy diet/obesity counseling
(unlimited to age 22; ages 22+ get
twenty-six visits per year)
• Smoking cessation counseling
(8 visits per year)
• Breastfeeding support (six per year)
• Colonoscopy
(ages 50+ once every ten years)
Did You Know
• Our provider search tool will be
available in June.
• Choosing a PCP helps you meet
your health goals faster.
• Generic medications save money!
Ask your provider if your medicine
has a generic.
Monthly Premiums
Employee Only $386 $ $397 $ $514 $
Employee and Spouse $1,089 $ $1,120 $ $1,264 $
Employee and Children $695 $ $715 $ $834 $
Employee and Family $1,301 $ $1,338 $ $1,588 $
Total Premium Total Premium Total PremiumYour Premium Your Premium Your Premium
Benet
TRS-ActiveCare
Primary
TRS-ActiveCare HD
TRS-ActiveCare
Primary+
TRS-ActiveCare 2
In-Network Only In-Network Only Out-of-Network In-Network Only In-Network Out-of-Network
Diagnostic Labs*
Ofce/Indpendent Lab:
You pay $0
You pay 20%
after deductible
You pay 40%
after deductible
Ofce/Indpendent Lab:
You pay $0
Ofce/Indpendent Lab:
You pay $0
You pay 40%
after deductible
Outpatient: You pay
30% after deductible
Outpatient: You pay 20%
after deductible
Outpatient: You pay
20% after deductible
High-Tech Radiology
You pay 30% after
deductible
You pay 20%
after deductible
You pay 40%
after deductible
You pay 20% after
deductible
You pay 20% after
deductible + $100 per
procedure copay
You pay 40%
after deductible
+ $100 per
procedure
copay
Outpatient Costs
You pay 30% after
deductible
You pay 20%
after deductible
You pay 40%
after deductible
You pay 20% after
deductible
You pay 20% after
deductible ($150
facility copay per
incident)
You pay 40%
after deductible
($150 facility
copay per
incident)
Inpatient Hospital Costs
You pay 30% after
deductible
You pay 20%
after deductible
You pay 40%
after deductible
($500 facility
per day
maximum)
You pay 20% after
deductible
You pay 20% after
deductible ($150
facility copay per day)
You pay 40%
after deductible
($500 facility
per day
maximum)
Freestanding Emergency
Room
You pay $500 copay +
30% after deductible
You pay 20%
after deductible
+ $500 copay
You pay 40%
after deductible
+ $500 copay
You pay $500 copay +
20% after deductible
You pay $500 copay +
20% after deductible
You pay $500
copay + 40%
after deductible
Bariatric Surgery
Facility – You pay 30%
after deductible
Not Covered Not Covered
Facility – You pay 20%
after deductible
Facility – You pay 20%
after deductible ($150
facility copay per day)
Not Covered
Professional Services –
You pay $5,000 copay +
20% after deductible
Professional Services
– You pay $5,000
copay + 30% after
deductible
Professional Services
– You pay $5,000
copay + 20% after
deductible
(Only covered if
rendered at a BDC+
facility)
(Only covered if
rendered at a BDC+
facility)
(Only covered if
rendered at a BDC+
facility)
Annual Vision Examination
(one per plan year; performed
by an ophthalmologist or
optometrist)
You pay $70 copay
You pay 20%
after deductible
You pay 40%
after deductible
You pay $70 copay You pay $70 copay
You pay 40%
after deductible
Annual Hearing Exam
(one per plan year)
$30 PCP copay
$70 specialist copay
You pay 20%
after deductible
You pay 40%
after deductible
$30 PCP copay
$70 specialist copay
$30 PCP copay
$70 specialist copay
You pay 40%
after deductible
Learn the Terms
• Premium: The monthly amount you pay for health care coverage.
• Deductible: The annual amount for medical expenses you’re
responsible to pay before your plan begins to pay its portion.
• Copay: The set amount you pay for a covered service at the time
you receive it. The amount can vary by the type of service.
• Coinsurance: The portion you’re required to pay for services after
you meet your deductible. It’s often a specied percentage of the
costs; i.e. you pay 20% while the health care plan pays 80%.
• Out-of-Pocket Maximum: The maximum amount you pay each
year for medical costs. After reaching the out-of-pocket maximum,
the plan pays 100% of allowable charges for covered services.
Compare Pricing for Common Medical Services
*Pre-certication for genetic and specialty testing may apply. Contact your Personal Health Guide at 1-866-355-5999 with questions.
trs.texas.gov
Revised 06/17/20
What to Know
How to Calculate Your Monthly Premium
Total Monthly Premium
Your District and State Contributions
Your Premium
Calculate Your Monthly Premium
Ask your Benets Administrator for your district’s specic premiums.
This new year brings new opportunities to unlock your potential and take charge of your wellness.
After connecting with your district leaders to learn how we could enhance the quality of your coverage, we’re providing improved
pricing, more network choices, simplied coverage and a new plan with a lower premium and copays.
Welcome to the 2020-21 TRS-ActiveCare, where you can empower the best you.
ACTIVATE YOUR HEALTH:
TRS-ActiveCare Plan Highlights 2020-21
You can use the cost estimator tool on www.bcbstx.com/trsactivecare starting Sept. 1 to shop for
the best prices through different providers.
REMEMBER:
TRS also contracts with HMOs in certain regions of the state to bring participants in those areas another regional plan option.
Remember that when you choose an HMO, you’re choosing a regional network.
Revised 06/17/20
2020-21 Health Maintenance Organization Plans and Premiums for Select Regions of the State
REMEMBER:
trs.texas.gov
Prescription Drugs
Drug Deductible $150 (excl. generics) $100 $150
Days Supply 30-Day Supply / 90-Day Supply 30-Day Supply / 90-Day Supply 30-Day Supply / 90-Day Supply
Generics $5/$12.50 copay $10/$30 copay $5/$12.50 copay ACA Preventative: $0
Preferred Brand 30% after deductible $40/$120 copay 30% after deductible
Non-preferred Brand 50% after deductible $65/$195 copay 50% after deductible
Specialty
15%/25% after deductible
(preferred/nonpreferred)
You pay 20% after deductible 15%/25% after deductible
(preferred/nonpreferred)
Immediate Care
Urgent Care $50 copay $75 copay $50 copay
Emergency Care
$500 copay after deductible You pay 20% after deductible $500 copay before deductible plus 25% after
deductible
Doctor Visits
Primary Care $20 copay $25 copay $20 copay
Specialist $70 copay $60 copay $70 copay
Plan Features
Type of Coverage In-Network Coverage Only In-Network Coverage Only In-Network Coverage Only
Individual/Family Deductible $950/$2,850 $500/$1,000 $950/$2,850
Coinsurance You pay 20% after deductible You pay 20% after deductible You pay 25% after deductible
Individual/Family Maximum Out-of-Pocket $7,450/$14,900 $4,500/$9,000 $7,450/$14,900
Total Monthly Premiums
Employee Only $551.10 $ $491.54 $ $534.42 $
Employee and Spouse $1,382.06 $ $1,182.52 $ $1,287.58 $
Employee and Children $883.50 $ $766.96 $ $835.68 $
Employee and Family $1,478.56 $ $1,258.52 $ $1,370.12 $
Central and North Texas
Scott & White Health Plan
Brought to you by TRS-ActiveCare
Blue Essentials - South
Texas HMO
Brought to you by TRS-ActiveCare
Blue Essentials - West Texas HMO
Brought to you by TRS-ActiveCare
You can choose this plan if you live
in one these counties: Austin, Bastrop,
Bell, Blanco, Bosque, Brazos, Burleson,
Burnet, Caldwell, Collin, Coryell, Dallas,
Denton, Ellis, Erath, Falls, Freestone,
Grimes, Hamilton, Hays, Hill, Hood, Houston,
Johnson, Lampasas, Lee, Leon, Limestone,
Madison, McLennan, Milam, Mills,
Navarro, Robertson, Rockwall, Somervell,
Tarrant, Travis, Walker, Waller, Washington,
Williamson
You can choose this plan if you live
in one these counties: Cameron,
Hildalgo, Starr, Willacy
You can choose this plan if you live in one these
counties: Andrews, Armstrong, Bailey, Borden,
Brewster, Briscoe, Callahan, Carson, Castro,
Childress, Cochran, Coke, Coleman, Collingsworth,
Comanche, Concho, Cottle, Crane, Crockett, Crosby,
Dallam, Dawson, Deaf Smith, Dickens, Donley,
Eastland, Ector, Fisher, Floyd, Gaines, Garza,
Glasscock, Gray, Hale, Hall, Hansford, Hartley,
Haskell, Hemphill, Hockley, Howard, Hutchinson,
Irion, Jones, Kent, Kimble, King, Knox, Lamb,
Lipscomb, Llano, Loving, Lubbock, Lynn, Martin,
Mason, McCulloch, Menard, Midland, Mitchell,
Moore, Motley, Nolan, Ochiltree, Oldham, Parmer,
Pecos, Potter, Randall, Reagan, Reeves, Roberts,
Runnels, San Saba, Schleicher, Scurry, Shackelford,
Sherman, Stephens, Sterling, Stonewall, Sutton,
Swisher, Taylor, Terry, Throckmorton, Tom Green,
Upton, Ward, Wheeler, Winkler, Yoakum
Total Premium Total Premium Total PremiumYour Premium Your Premium Your Premium
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2020-2021 TRS- Active Care Plan Highlights

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Completed 2 January 2022

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