The state offers health insurance coverage to both active and retired public school employees through TRS. Many districts offer local health insurance for active employees rather than the state plan.
TRS-ActiveCare is a health plan for eligible public-school employees and has multiple levels of coverage that employees can choose from. Enrollment in the most expensive plan, TRS-ActiveCare 2, is closed and continues to be limited to only those who were enrolled in plan year 2018-2019. TRS-ActiveCare is administered by Blue Cross Blue Shield with pharmacy benefits managed by Express Scripts.
Plan benefits, with rates based on region, can be found at https://www.trs.texas.gov/health-benefits/active-members/coverage/rates.
All districts receive state funding for school employee health insurance through the basic allotment. Districts receive the funding regardless of whether they participate in TRS-ActiveCare. Employees, including part-time employees working at least 10 hours per week, are eligible to participate in TRS-ActiveCare. In 2001, state law mandated the employer premium contribution be at least $225 per month per employee, referencing a state contribution of $75 per employee per month and district contribution of $150 per employee per month. Many districts contribute more.
All school districts are eligible to participate in TRS-ActiveCare. 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.
A school employee married to another school employee can decide whether to be treated under the district health insurance plan as a primary employee or a dependent.
Legislation initiated by TCTA requires a school district not participating in TRS-ActiveCare 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.
TRS-ActiveCare provides HMOs as an option for employees in a few participating districts based on geography. The benefits offered are significantly different from benefits in the self-funded TRS-ActiveCare plan, and details are available on the TRS website at: https://www.trs.texas.gov/health-benefits/active-members/coverage/plan-options.
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.
Details of the state’s health care coverage for retirees are available at www.trs.texas.gov/health-benefits/retiree-health.
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. TRS-Care also has options for both dental and vision coverage through MetLife.
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