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The state plan provides three levels of coverage, ranging from catastrophic coverage to benefits equal to the state employee plan offered by the Employee Retirement System (ERS). Rates approved by the TRS Board of Directors for 2006-07 represent no change from the 2005-06 rates.
ActiveCare 1 |
ActiveCare 2 |
ActiveCare 3 |
|
Coverage Category |
Rate |
Rate |
Rate |
Employee only |
$249 |
$331 |
$446 |
Employee and spouse |
$566 |
$753 |
$1,014 |
Employee and child(ren) |
$396 |
$527 |
$710 |
Employee and family |
$623 |
$828 |
$1,115 |
| * Rates and benefits under locally provided plans or state-approved HMOs will vary. | |||
Funding
All districts and eligible employees, regardless of whether they are participating in the state plan, are included in the funding contributed for school employee health insurance. “Eligible employees” include part-time employees working at least 10 hours per week, but exclude retirees who have returned to employment in the school. The state provides $75 per month for each employee for health insurance coverage, and districts must contribute $150 per month per employee. In addition, most employees will receive “pass-through” funding from the state that can be used toward health insurance coverage.
- Part-time employees (defined as employees working less than 30 hours per week) receive $250.
- Professional staff (primarily administrators and other central office employees) do not receive a supplement.
- The remaining employees receive a $500 supplement.
Important note: House Bill 1, passed in May 2006, converted the $250/$500 supplement to salary; it is technically no longer a health insurance supplement. TRS has determined that the $500 will be subject to the TRS-required contribution and will be included in the salary on which the retirement annuity will be calculated.
Participation
All school districts are eligible to participate in the statewide plan. Participation for districts with 500 or fewer employees is mandatory; those that are self-funded or participating in a co-op/risk pool were given the opportunity to opt out when the program first began. Districts with more than 500 employees can opt in to the program.
Individual employees in participating districts may choose to waive coverage. If they obtain their own health insurance, the pass-through money can still be used for that purpose. Retirees (including those who return to active service) are not included in the state plan but have access to the TRS-Care program.
Legislation passed in the 2005 session allows a school employee married to another school employee to decide whether to be treated under the district health insurance plan as the primary employee or a dependent.
Districts choosing not to participate will continue to operate under the law that requires access to a plan similar to that provided to state employees. The funding arrangement ($75 per month per employee from the state, at least $150 per month per employee from the district, and the pass-through funding for the employee) will still apply.
Portability of insurance
Legislation initiated by TCTA and passed into law in 2005 requires that a school district not participating in the state plan must provide for portability of insurance coverage, an essential benefit for employees transferring from one school district to another. This will ensure that the plan could not refuse coverage for a pre-existing condition if the employee has had insurance under another qualifying plan for at least 12 months and applies for coverage under the district plan no more than 63 days after coverage is terminated under the former coverage.
Coverage options
TRS has approved five HMOs available as an option for employees in participating districts in certain parts of the state. The benefits offered under these HMOs are significantly different from those offered under the Blue Cross/Blue Shield plan, and details are available on the TRS Web site at www.trs.state.tx.us/TRS-ActiveCare/hmo_ratechanges_2006.pdf. Employees in the Panhandle and parts of North and West Texas can participate in FIRSTCARE; those in portions of the Rio Grande Valley can opt for Mercy Health Plans or Valley Baptist Health Plan; Central Texas employees can choose the Scott & White Health Plan; and several counties in West Texas are covered by Legacy Health Solutions.
Retiree health insurance (TRS-Care)
Details of the state’s health care coverage for retirees are available at the TRS Web site at www.trs.state.tx.us.
Eligibility requirements have changed in recent legislative sessions; employees retiring after Sept. 1, 2005, must meet the Rule of 80 or have at least 30 years of service credit to be eligible for TRS-Care.
TRS-Care participants will have a modified open-enrollment opportunity at age 65. This will allow retirees to choose a higher level of coverage in TRS-Care when they turn 65, if desired.
*Benefits and rates under locally provided plans or state-approved HMOs will vary.
