The state offers health insurance coverage to both active and retired school employees.

Active employee health insurance (TRS-ActiveCare)
The state plan for active employees, currently provided through Blue Cross/Blue Shield, has four levels of coverage ranging from catastrophic coverage to benefits equal to the state employee plan offered by the Employee Retirement System (ERS). A new level of coverage with a higher deductible has been added to comply with federal guidelines. ActiveCare 1-HD is similar to ActiveCare 1 coverage, but has a deductible of $2,300 per contract compared to $1,150/$3,000 per individual/family. Rates approved by the TRS Director's council for 2009-10 represent a 4.5 percent increase over the 2008-09 rates.

TCTA-initiated language passed in the 2007 legislative session requires districts not participating in the state plan to make available their health insurance policies at each campus and/or on the district website.

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. The term “eligible employees” includes part-time employees working at least 10 hours per week, but excludes 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 at least $150 per month per employee.

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. Retirees (including those who return to active service) are not included in the state plan but have access to the TRS-Care program.

A school employee married to another school employee can decide whether to be treated under the district health insurance plan as the primary employee or a dependent.

Districts choosing not to participate must still provide access to a plan comparable to that provided to state employees. The funding arrangement ($75 per month per employee from the state and at least $150 per month per employee from the district) will still apply.

Portability of insurance/continuing coverage
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. TCTA-initiated legislation passed in 2007 requires that districts continue to provide insurance coverage and funding through the summer months for employees who resign after the end of the instructional year. A 2009 TCTA-initiated law prohibits TRS from opting out of federal law that requires coverage of pre-existing conditions, thus maximizing portability between private sector/local district coverage and TRS-ActiveCare.

Coverage options
TRS has approved four HMOs 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 website. 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 and those in several West Texas counties can choose the Scott & White Health Plan.

Retiree health insurance (TRS-Care)
Details of the state’s health care coverage for retirees are available at the TRS website.

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.

Highlights of Blue Cross/Blue Shield Plan Designs for 2009-10

Updated: 09/29/09