The state offers health insurance coverage to both active and retired school employees. Many districts offer local health insurance for active employees rather than the state plan.
The state plan for school employees has four levels of coverage. For 2022-23, enrollment in the highest level, ActiveCare 2, continues to be limited to only those who were enrolled in that level in the previous year. ActiveCare is administered by Blue Cross Blue Shield with pharmacy benefits managed by CVS Caremark. Full plan benefits can be found here.
All districts and eligible employees, regardless of whether they participate in the state plan, are included in the funding contributed for school employee health insurance (unless the employee has waived coverage). The term “eligible employees” includes part-time employees working at least 10 hours per week. The state provides $75 per month for each participating employee for health insurance coverage, and districts must contribute at least $150 per month per employee.
All school districts are eligible to participate in the statewide plan. Districts choosing not to participate must still provide access to health insurance. The funding arrangement ($75 per month per participating employee from the state and at least $150 per month per employee from the district) will still apply. Individual employees may choose to waive coverage.
Per a new law passed in 2021, districts participating in TRS-ActiveCare can choose to withdraw from the program; if they leave, they must remain out of ActiveCare for at least five years. Similarly, a district opting in to ActiveCare must remain in the program for at least five years. A district must make a decision by Dec. 31 to change its participation for the next plan year.
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. Pursuant to the U.S. Supreme Court’s ruling in Obergefell v. Hodges in June 2015, TRS extends spousal benefits to same-sex spouses.
Legislation initiated by TCTA requires a school district not participating in the state plan to provide for portability of insurance coverage, an essential benefit for employees transferring from one school district to another. This ensures that the employee cannot be refused 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. (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. The federal Patient Protection and Affordable Care Act passed in 2010 also restricts the ability of a health care plan sponsor to opt out of the provisions of federal law that ensure portability.)
Other TCTA-initiated legislation requires that districts provide insurance coverage and funding through the summer months for employees who resign after the end of the instructional year.
The TRS-administered plans are providing special COVID-related benefits, including free testing for many eligible enrollees. See https://tinyurl.com/4jfpp5dv for details.
TRS has approved three HMOs as an option for employees in participating districts. The benefits offered under these HMOs are significantly different from benefits in the ActiveCare Blue Cross Blue Shield plan, and details are available on the TRS website in the Active Members > TRS-ActiveCare section.
Employees in the Panhandle and parts of West and Central Texas can participate in West Texas: BCBSTX; those in portions of the Rio Grande Valley can opt for South Texas: BCBSTX; Central Texas employees and those in some Central and North Texas counties can choose the Baylor Scott & White Health Plan.
Details of the state’s health care coverage for retirees are available at trs.texas.gov. Beginning Jan. 1, 2018, a retiree who is age 65 and eligible for Medicare will be enrolled in a Medicare Advantage Plan with Medicare Part D prescription drug coverage. A retiree under age 65 will be enrolled in a high deductible plan. See trs.texas.gov for complete details. Due to a law passed in 2021, a one-time open enrollment opportunity will be provided to Medicare-eligible retirees who had voluntarily left TRS-Care between Jan. 1, 2017, and Dec. 31, 2019. Those choosing to re-enroll in the plan must do so by Dec. 31, 2023.
In June, state officials authorized use of $435 million from federal COVID-19 stimulus funds to ensure that no ActiveCare participants will see a base premium increase during the 2022-23 school year. This funding does not affect the state’s $75 per month contribution for health insurance.
Due to a new regional pricing model, premiums in some areas at worst remained flat, while those in some parts of the state decreased — significantly, in some cases. Districts may adjust their local contributions, as long as they continue to contribute at least $150 per month, which may affect the actual amount paid by employees. For details on ActiveCare rates for your region, click here.