TCTA Survival Guide

Information contained in the printed TCTA Survival Guide is current as of Summer 2007, but is subject to change. To be sure what you are viewing is current, the date the information was posted or updated will be located at the bottom of each page. All legal material is for purposes of general reference only and is not a substitute for the advice of an attorney.

Health Insurance

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

TRS-ActiveCare	Funding	Participation
Portability of insurance/continuing coverage	Coverage options	Retiree health insurance (TRS-Care)
Highlights of Blue Cross/Blue Shield PPO Plan Designs for 2007-08

Active employee health insurance (TRS-ActiveCare)
The state plan for active employees 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 2007-08 represent a 7 percent increase from the 2006-07 rates.

	ActiveCare 1	ActiveCare 2	ActiveCare 3
Coverage Category	Rate	Rate	Rate
Employee only	$266	$354	$477
Employee and spouse	$606	$806	$1,085
Employee and child(ren)	$424	$564	$760
Employee and family	$667	$886	$1,193

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. “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 at least $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. The $500 will be subject to the required TRS 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. 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, at least $150 per month per employee from the district, and the supplemental funding for the employee) 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.

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 website at www.trs.state.tx.us/TRS-ActiveCare. 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 website.

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.

Highlights of BlueCross/Blue Shield PPO Plan Designs for 2007 - 08*

	ActiveCare1	ActiveCare 2		ActiveCare 3
Medical deductible				Network	Non-network
Individual	$1,100	$500		None	$500
Family	$3,000	$1,500		None	$1,500
Coinsurance (Plan pays after deductible	80% of network/60% of non-network charges	80% of network/60% of non-network charges		80% of network charges	60% of allowable charges
Office visit Primary/Specialist copay	Deductible and coinsurance	$25/$35 Deductible and coinsurance for non-network charges		$20/$30	Deductible and coinsurance
Emergency room	Deductible and coinsurance	$100 copay (waived if admitted) plus coinsurance		$100 copay (waived if admitted) plus coinsurance	Deductible and coinsurance
Hospital admission	Deductible and coinsurance	$100 per day, $500 maximum per admission, $1,500 plan year maximum plus coinsurance		$100 per day, $500 maximum per admission, $1,500 plan year maximum plus coinsurance	Deductible and coinsurance
Out-of-pocket maximum (in addition to deductible)
Individual	$2,000	$2,000		$1,000	$3,000
Family	$6,000	$6,000		None	None
Lifetime maximum	Unlimited	Unlimited		Unlimited	$1,000,000
Prescription drugs Deductible per person	$1,100	$50		$50
Retail - short term		Network	Non-network	Network	Non-network
Generic	Medical deductible and coinsurance (Discount card included)	$10	Must submit claim to Medco to receive reimbursement of the amount that would have been charged by a network pharmacy less the required copay.	$10	Must submit claim to Medco to receive reimbursement of the amount that would have been charged by a network pharmacy less the required copay.
Brand copay (preferred)		$25		$25
Brand copay (non-preferred)		$45		$40
Retail - maintenance (applies after two fills)
Generic	Medical deductible and coinsurance (Discount card included)	$15	Same as above	$15	Same as above
Brand copay (preferred)		$35		$35
Brand copay (non-preferred)		$60		$55
Mail Order
Generic	Medical deductible and coinsurance (Discount card included)	$20	n/a	$20	n/a
Brand copay (preferred)		$62.50	n/a	$62.50	n/a
Brand copay (non-preferred)		$112.50	n/a	$100.00	n/a

*Benefits and rates under locally provided plans or state-approved HMOs will vary.

Web posted: 08/02/07