2010-2011 Plan Year Effective September 1, 2010. 2 Agenda TRS-ActiveCare Program Highlights –Enrollment Summary –Facts and Figures 2010-2011 Health

2010-2011 Plan Year Effective September 1, 2010

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Agenda

TRS-ActiveCare Program Highlights– Enrollment Summary– Facts and Figures

2010-2011 Health Plan Options– ActiveCare 1-HD, 1, 2 and 3– HMOs

How to Enroll– Who is Eligible to Enroll– Cost of Coverage– Enrollment Support

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What is TRS-ActiveCare?

Established and signed into law in 2001 (Chapter 1579, Texas Insurance Code)Blue Cross and Blue Shield of Texas selected to

administer the program in January 2002 and 2008Medco selected as PBM in January 2002 and 2008Program effective date was September 1, 2002HMO options added in 2003

A statewide health care benefits program for employees of school districts, charter schools, regional educational service centers and other educational districts

Law authorizes funding levels to help employees pay for coverage

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Enrollment Summary (Employees by Plan, Jan. 2010)

FirstCare Health Plans 2.5% Scott & White Health Plan 1.9% Valley Baptist Health Plans 0.1%

237,107 Contracts (Employees) • 398,099 Members

PPO Medical PlansActiveCare 1-HD, 1, 2 & 3 Plans

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PPO Network for ActiveCare 1-HD, 1, 2 and 3

Network

There is no need to:– Select a Primary Care Physician– Obtain referrals for specialist care

Receive the highest level of benefits:

– Pay less for care– No balance billing

No claim forms– Provider files claim for you

Non-Network: You pay more of the cost

of out-of-network benefits– Higher deductibles,

coinsurance

You may need to file your own claim

You could be balance billed for amounts over allowed amount

Always verify provider network status

New for 2010-2011: The allowable amount for non-contracting providers

will be limited to 50% of billed charges

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PPO Plan Overview (Network Level of Benefits)

Plan Features ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Deductible (individual/family)

$2,400/$2,400 $1,200/$3,000 $500/$1,500 None

Out-of-Pocket Maximum

(does not include deductibles)

$3,000/$5,000 $2,000/$6,000 $2,000/$6,000 $1,000 per individual

Coinsurance

(Plan pays/participant pays)

80% / 20% 80% / 20% 80% / 20% 80% / 20%

New Deductiblesfor 2010-2011 (per IRS rules)

ActiveCare 1-HD and ActiveCare 1

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PPO Plan Overview (Network Level of Benefits)

Services ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Office Visit Copay 20% after deductible $30 for primary

$50 for specialist

$20 for primary

$30 for specialist

Preventive Care Routine physicals* Well-woman exams* Routine

mammograms* Eye exams* Well-baby exams Immunizations Hearing exams PSA screenings Colorectal

screenings Osteoporosis

screenings

* Services limited to one per person per plan year

$0 copay up to $500 per person, per plan year

Remaining charges subject to deductible and coinsurance

$30 for primary

$50 for specialist

Includes all preventive care services billed

with an office visit by a network

doctor

Coinsurance applies when no

office visit is billed or when services are performed

outside the office

(deductible waived)

$20 for primary

$30 for specialist

Includes all preventive care

services billed with an office visit by a

network doctor

Coinsurance applies when no

office visit is billed or when services

are performed outside

the office

(no deductible)

New Copaysfor 2010-2011ActiveCare 2

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ActiveCare 1-HD vs. ActiveCare 1Plan Features ActiveCare 1-HD ActiveCare 1

Meets IRS definition of High Deductible Health Plan

and offers opportunity to contribute pretax dollars into a Health Savings Account (HSA)

Yes, for all coverage categories

(employee only, employee and spouse, employee and

child(ren) and employee and family)

Yes, for employee-only coverage

No, for other coverage categories

Deductible$2,400 for employee only

$2,400 for family

$1,200 per individual

$3,000 per family

Maximum Coinsurance $3,000 for employee only

$5,000 for family


$6,000 per family

Out-of-Pocket Maximum

(includes deductibles)

$5,400 for employee only

$7,400 for family


$9,000 per family

Monthly Premium CostLower premium than

ActiveCare 1in all coverage categories

except employee and family

Higher premium than ActiveCare 1-HD in all

coverage categories except employee and family

New for 2010-2011: Deductible and out-of-pocket maximum amounts increased per IRS guidelinesNew for 2010-2011: Deductible and out-of-pocket maximum amounts increased per IRS guidelines

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Health Savings Account (HSA)

What is an HSA?– Special account owned by an individual and used to pay out-of-pocket

expenses (such as deductibles) or to grow as savings– May be funded by the employee, the employer or both– Portable, meaning the HSA funds always belong to the individual

Who is eligible? Per IRS rules, any adult can contribute to an HSA if he/she:

– Has coverage under an HSA-qualified high deductible health plan– Has no other first-dollar medical coverage– Is not enrolled in Medicare– Cannot be claimed as a dependent on someone else’s tax return

Does TRS offer an HSA?– No! But ActiveCare 1-HD qualifies as an HDHP for all coverage

categories and ActiveCare 1 qualifies for employee-only coverage

– Employees are not required to have an HSA to enroll in these plans

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Important:

Bariatric surgery procedures for weight loss, such as lap band and gastric bypass, must be performed at one of the Blue Distinction Centers for Bariatric Surgery or the procedure will not be covered by TRS-ActiveCare

Blue Distinction Centers for Bariatric Surgery

List of Blue Distinction Centers for Bariatric Surgery is subject to change

Refer to the Doctors and Hospitals section of the Web site, www.bcbstx.com/trs or call Customer Service for most current list

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Blue Care Connection®

Whether you decide to skip fast food, quit smoking, or walk more, every day decisions can have a positive impact on your health; Blue Care Connection offers guidance at every level of health

Complex / CatastrophicWell Members Low- Risk Moderate- Risk High-Risk

< < < Wellness > > >

Total Care Approach to Health and Wellness

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Condition Management

• Support from Blue Care Advisors—clinical professionals who can help you manage chronic health conditions such as: asthma, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disorder and other health conditions

• Understanding and following your physician’s orders

• Review medications, side effects, compliance, refills and current services

• Establish goals with you and caregivers, scheduling follow-ups as appropriate

If you have a chronic condition, we offer support.

1-800-462-32751-800-462-3275

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Self-Paced Approach

• Online program and resources available in the Personal Health Manager

• Secure e-mail outreach to keep members on track

Lifestyle Management Support

• Counseling and coaching with licensed Wellness Coaches

• 24/7 Nurseline

• Referrals when appropriate

Tobacco Cessation and Weight Management

1-800-462-32751-800-462-3275

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Special Beginnings®

Special Beginnings helps expectant mothers and their babies get off to a healthy start by providing prenatal and postnatal health education and guidance at no additional cost

Once enrolled in the program, plan participants receive:

• Pregnancy risk assessment and ongoing communication/monitoring

• Educational material covering pregnancy and infant care topics

• Frequent, personal contact with program staff from early pregnancy through six weeks after delivery

• Assistance in managing high-risk conditions such as gestational diabetes and preeclampsia

Program components are available in English and Spanish

1-888-421-77811-888-421-7781

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Advice anytime.Round-the-clock health and the wellness advice from licensed professionals

24/7 Nurseline

Advice isn’t just neededfrom 9 to 5.24/7 Nurseline is here to help. Nurses provide health advice and

information about high fevers, earaches, cuts and bruises and more

Audio health library on topics such as kicking the smoking habit and ways to get a good night’s rest

Available in English and Spanish

24/7 1-800-581-03681-800-581-0368

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Personal Health Manager (PHM)

Your online wellness experience begins with the Personal Health Manager

Features include: Lifestyle Management tools:

Weight Management Tobacco Cessation Fitness and Nutrition Plans Stress Reduction

Health Risk Assessment

“For Your Health” features Blue PointsSM Rewards “Ask-A” feature – health and

wellness questions via secure e-mail

Online health encyclopedia Interactive symptom checker

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Personal Health Manager – Home Page

Use the Interactive Symptom Checker

Read the latest health news, search for specific health topics or explore the prescription drug index

Ask a Question to a certified Nurse, Trainer, Dietitian or Life Coach

Access MemberCare Profile

Take a Health Risk Assessment

Read secure messages

Review member alerts

Explore topics in the Health Information and Care Center

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Ask the experts.Expert advice from licensed professionalsvia the Personal Health Manager

“Ask A” Online Advisor

Expert advice at your fingertips.Our “Ask A” feature is here to help.

Ask A Trainer, Dietitian orLife Coach:

Send questions about fitness, nutrition, or managing stress.

Ask A Nurse:

Interact online with a Blue Care Advisor on non-emergency, health-related questions using the secure “Ask A Nurse” feature.

Confidential and Secure – Receive an e-mail response within one business day

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Receive Personalized report and next steps:

• Report provides member with summary of health risks and areas where they could improve

• Recommended ‘next steps’ and suggestions to make positive changes to your lifestyle.

Health Risk Assessment – Easy To Use

Complete the assessment in as little as10 to 15 minutes

Choose your assessment topic:

• Health & well-being*

• Sleep

• Stress management

• Nutrition

• Fitness & physical activity

• Back & joint health

*We recommend completingthe Health & Well-beingassessment first.

1 2 3

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Health Risk Assessment (HRA)

A Health Risk Assessment helpsassess your health risks, interests and readiness to change Examines your overall health

and well-being

Provides a detailed report with overall health and well-being score and sub-scores for: Medical health, job satisfaction,

life load, risk and lifestyle, mood, nutrition, sleep, stress, pain and body weight

Recommends areas for improvement

Confidential and secure (results are not shared with employers)

Be informed about your overall health and well-being

Earn Blue PointsSM

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Stay motivated.Earn Blue Points in the Personal Health Manager

Blue PointsSM Incentives

TRS-ActiveCare PPO plan participants and their covered dependents accumulate Blue Points in the Personal Health Manager

Complete designated health and wellness activities

Report completed activities in the Personal Health Manager

Track your available balance

Redeem earned Blue Points for a variety of items!

Available online

Enrollment Video Application Form Enrollment GuideBenefits Booklet

24/7 Nurseline, Lifestyle and

Condition Management and

Special Beginnings phone numbers

www.bcbstx.com/trs

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Online member management tool Check claim status, view claim

summaries and print EOBs (Explanations of Benefits)

Order additional ID cards, and print temporary ID

Monthly health articles Links to health information

and wellness tools and resources, including the Personal Health Manager

Send secure e-mail messages to BCBS Customer Advocates available Monday thru Friday, 7 a.m. to 10 p.m. (CT)

Blue Access® for Members

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Customer Service

1-866-355-5999

What if I Have Questions?

Call TRS-ActiveCare customer service for:– Claim questions/status– Network provider information– Membership and eligibility – Medical coverage questions– Inquiries (telephone and e-mail)– ID card requests– Transition of care information– Help with online tools!

Personalized Service

Prescription DrugsActiveCare 1-HD,1, 2 & 3

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Your Medco Prescription Drug Plan

Medco administers your prescription drug plans on behalf of TRS– ActiveCare 1-HD, 1, 2, and 3 plans

Benefit includes both a retail and mail component

Medco has its own mail-order pharmacy – Medco By Mail – where specialist pharmacist focus on compliance and lower cost options for the patient, and the automated filling system ensures the prescription is filled accurately.*

• Medco’s mail-order pharmacies fill about 2 million prescriptions per week through a highly automated process that is 99.9997% accurate and is 23 times more accurate than a retail pharmacy

“Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice”; Nov. 2007, Pharmacology, a peer-reviewed journal of the American College of Clinical Pharmacy

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Prescription Drug Benefits - Network Level

Features ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Drug Deductible(per person, per plan year)

Subject to plan year deductible

Subject to plan year deductible

$50 $50

Retail Short-Term(up to 30-day supply)

Generic/Preferred Brand/Non-Preferred Brand

20% coinsurance

after deductible

$10

$25*

$45*

$10

$25*

$40*

Retail Maintenance(after second fill, up to 30-day supply)


$15

$35*

$60*

$15

$35*

$55*

Medco by Mail(up to 90-day supply)


$20

$62.50*

$112.50*

$20

$62.50*

$100*

* If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Non-network benefits are also available; see Enrollment Guide for more information.

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Specific Rx Benefit Information

Retail pharmacies are ideal for acute (short-term) and new medication you may be trying for the first time

In compliance with SB 0704, 81 (R) Texas Legislature, TRS will make available through Medco a retail maintenance network effective September 1, 2010. Retail pharmacies who choose to participate in this network will be able to dispense up to a 90-day supply of medication. Please contact Medco customer service for more information on pharmacies that may choose to participate in the retail maintenance network. Medco is in the process of soliciting this network. We will not know which pharmacies will choose to participate until later this summer.

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Specific Rx Benefit Information

If you are taking a long-term medication, filling your prescriptions through Medco’s mail-order pharmacy provides several benefits:

– You can receive up to a 90-day supply of your medication at a lower copay

– Prescriptions are delivered directly to you and you can order refills online and check the status of your orders

– You have access to specialist pharmacists

• Specifically trained in specific conditions

• Review all of your incoming prescriptions for potential safety issues and will contact you and your doctor to discuss any issue

– Medco only buys medication from the most reputable suppliers

You have access to specialist pharmacists whether you fill your prescription at a retail pharmacy or at Medco By Mail.Your medication questions can be answered by calling 1-866-355-5999

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Getting the right drug, to the right person, at the right time

Specialization and member engagement are critical components to controlling health care costs and driving quality clinical outcomes: Specialist pharmacist

Personalized medicine offering

Research-driven protocols

My Rx Choices®

Other available resources

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Personalized Medicine

What is it?– A science that examines the inherited variations in genes that dictate

drug response (whether a drug will be effective or safe)

– Personalizing drug therapy based on each patient's genetic variability

In 2009, TRS began providing this service toTRS-ActiveCare patients if both the doctor and patient wish to take the test

How patients metabolize drugs can have significant impacts on both medication choice and dosage

Testing consists of a cheek swab…what do you have to lose?

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High-level Process Flow

Identification Prescription comes in for a pharmacy claim for a

product with an associated test through the prescription. Fill the prescription, then…

Intervention

Cheek swab completed by patient and mailed to lab Lab processes test, sends results and interpretation to

physician and Medco TRC pharmacist Therapy change made if applicable

Communication

Contact physician for approval to test patient Contact patient to discuss program and test kit mailing 800 number provided for questions

Follow-up Monitor lab outcomes and

follow-up as needed

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My Rx Choices® Your online savings tool

Lower your cost for prescriptions with My Rx Choices®

– Features include:• Personal assessment of cost-saving opportunities based on your

prescription plan and the medications you use

• Print a kit to help your doctor better understand the economic impact of different medication alternatives

• Alternative medications are based upon greatest cost savings to you presented in order, starting with the highest value

• Brand-to-generic and retail-to-mail comparisons are shown

• The average amount saved by My Rx Choices® users is $294!

Simply visit www.medco.com/save. You’ll need to take a moment to register before using this service. You can also call 1-866-355-5999

You have to shop your benefit. Prices can vary at different retail pharmacies

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My Rx Choices® Available through Customer Service or on www.medco.com

The My Rx Choices® home page allows the user to:

– Select a patient within a household (pre-populated with all under age 18 dependents and spouse information will be shown if authorization has been given)

– Select a drug to compare from a pre-populated list of prescriptions for the user.

Your potential savings are clearly presented

Members may print a kit to discuss with their doctor

Generic alternatives are provided

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Generic Dispensing is important…

Savings Savings For every 1% of increase generic usage, TRS could save millions of dollars

Cost Difference Cost Difference Average cost of generic prescription is just over $15 as compared to $151 for a brand

Approximately 6,000 web hits per monthMy Rx ChoicesMy Rx Choices®

Generic WaiverGeneric WaiverProgramProgram First phase January-March 2010

Next waiver period will be June – August 2010

* Annual savings based upon initial waiver period performance and an 80% refill rate.

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Information Resources TRS Web site – www.trs.state.tx.us/trs-activecare

– Pharmacy Benefit Highlights– List of maintenance medications– FAQs– Download forms

Medco Member Web site – www.medco.com– Prior authorization list– Formulary information– Locate a participating pharmacy– Health and wellness information– My Rx Choices® / Price a Medication– Online ordering– Order Medco By Mail refills– Download forms– Medco widget

Customer Service 1-866-355-5999 Benefits Booklet

HMO Plan Options2010-2011 Plan Year

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TRS-ActiveCare Participating HMOs

FirstCare Health Plans

HMO Plan Option

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We have been part of the TRS-ActiveCare program since 2003 and currently cover more than 11,000 school employees and their dependents.

We are a hospital-based health plan, founded in 1985 and are owned by Covenant Health System in Lubbock, Texas and Hendrick Medical Center in Abilene, Texas.

We focus exclusively on the Texas market and have offices in Abilene, Amarillo, Lubbock, and Waco.

Our local presence in each of our regions enables us to provide the level of service you and your family deserve.

Company Overview

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Service Area – 93 counties across Texas

TRSService Area

To be eligible to enroll in FirstCare, you must live, reside or work in one of the shaded counties.

4343

No referrals to network specialists

No routine claim forms

Worldwide emergency care

No preexisting limitations

College-age dependents living outside our service area have full coverage (address must be on file)

Secure online access to your membership and claim information at www.firstcare.com

Benefit Highlights

NOTE: Care must be accessed through one of our affiliate provider networks

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New for 2010-2011

The national average increase for health insurance premiums is 7 to 11 percent per year

FirstCare has lowered premiums for two years in a row to help you combat the rising cost of health care

Coverage Category 2010-2011

Employee Only $351.36

Employee and Spouse $870.48

Employee and Child(ren) $558.82

Family $874.02

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Preventive care is now covered at 100%. No office visit copayments and the deductible is waived* Well woman exam Screening mammograms including X-ray, digital, and

ultrasound Routine physicals Immunizations Routine sight, speech, and hearing screenings Routine lab and X-ray

Primary Care Physician office visit copayment is $25

Specialist office visit copayment is $40

*Exception: Colorectal Cancer Procedure has a $50 copayment

New for 2010-2011

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2009-2010 2010-2011

Deductible $100 per individual no family maximum

Deductible$250 per individual

$500 per familyA family of four can save $100!

Out-of-Pocket Maximum$3500 per individualno family maximum

Out-of-Pocket Maximum $3000 per individual

$6000 per familyA family of four can save $8,000!

Lifetime MaximumUnlimited

Lifetime Maximum$2 million

The plan included various levels of copayments for each service in addition to

the annual deductible.

Benefits are simplified to now include a flat copayment after deductible.

Ex. 20% copayment for outpatient ER visits 10% copayment for inpatient services

New for 2010-2011

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Abilene Region Provider Network

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FirstCare has a comprehensive network of local physicians, hospitals, and

pharmacies that offer a full range of medical services.

A complete list of network providers is available at www.firstcare.com.

Our Abilene office is located at:

2 Village Drive, Suite 510Abilene, TX 79606

(325) 670-3525

Come visit us and meet the staff.

Abilene Hospital:Hendrick Medical Center

Other Regional Hospitals:Anson General HospitalBallinger Memorial Hospital Coleman County Medical CenterComanche County Medical CenterEastland Memorial HospitalFisher County HospitalHamlin Memorial HospitalHaskell Memorial HospitalHeart of Texas Memorial HospitalHendrick Medical CenterKnox County HospitalMitchell County HospitalNorth Runnels HospitalRolling Plains Memorial HospitalStamford Memorial HospitalStephens Memorial HospitalStonewall Memorial HospitalThrockmorton County Memorial Hospital

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Amarillo Region Provider Network

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Our Amarillo office is located at:

600 S Tyler St Box# 12019

Amarillo, TX 79101(806) 356-5265


Amarillo Hospitals:Northwest Texas Healthcare SystemNorthwest Texas Surgery CenterPlum Creek Specialty Hospital

Other Regional Hospitals:Childress Regional Medical CenterCollingsworth General HospitalCoon Memorial HospitalGolden Plains Community HospitalHansford County HospitalHardeman County Memorial HospitalHemphill County HospitalHereford Regional Medical CenterMoore County Hospital District Ochiltree Hospital DistrictPampa Regional Medical CenterParkview HospitalParmer County Community HospitalShamrock General HospitalSwisher Memorial Hospital

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Lubbock Region Provider Network

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Our Lubbock office is located at:

1901 W. Loop 289 Suite# 9

Lubbock, TX 79407(806) 784-4300


Lubbock Hospitals:Covenant Health SystemUniversity Medical Center

Other Regional Hospitals:Brownfield Regional Medical CenterCochran Memorial HospitalCogdell Memorial HospitalCovenant Health SystemCrane Memorial HospitalCrosbyton Clinic HospitalHealthSouth Rehabilitation HospitalIraan General Hospital DistrictLamb Healthcare Center McCamey Hospital Medical Arts HospitalMedical Center HospitalMidland Memorial HospitalMuleshoe Area Medical CenterPecos County MemorialPermian Regional Medical CenterPlains Memorial HospitalRankin County HospitalReeves County HospitalSeminole Memorial HospitalWard Memorial HospitalWinkler County Memorial HospitalW J Mangold Memorial HospitalYoakum County Hospital

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Waco/ Bryan-College Station Region Provider Network

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Our Waco office is located at:

1105 Wooded Acres Dr. Suite # 404

Waco, TX 76710(254) 761-5800


Waco Hospitals:Hillcrest Baptist Medical CenterProvidence Health Center

Bryan/College Station Hospitals:College Station Medical CenterSt. Joseph Regional Health Center

Other Regional Hospitals: Burleson St. Joseph Health CenterCentral Texas HospitalCoryell County Memorial HospitalEast Texas Medical Center – Crockett & FairfieldFalls Community HospitalGoodall-Witcher Hospital Grimes St. Joseph Health CenterHamilton General HospitalHill Regional HospitalHuntsville Memorial Hospital King’s Daughters HospitalLake Whitney Medical CenterLimestone Medical CenterLittle River Medical CenterLlano Memorial HospitalMadison St. Joseph Health CenterMetroplex Adventist HospitalParkview Regional HospitalRollins Brook Community HospitalSeton Highland LakesTexas Health Harris Methodist Hospital StephenvilleTrinity Medical Center

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Why Choose FirstCare?

We have experience with TRS-ActiveCare benefits. In fact, we cover more than 11,000 school employees and their dependents.

We are a hospital based health plan that supports our local communities.

Medical decisions are made locally by physicians who understand how health care is delivered in your area.

A dedicated FirstCare representative is available in your area to answer questions.

FirstCare values Texas teachers, administrators, and school employees. We are proud to serve you.

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You may submit your questions or comments via e-mail to [email protected]

You can also write or call customer service at: FirstCare Health Plans

1901 West Loop 289Suite #9

Lubbock, TX 79407800-884-4901

http://www.trs.state.tx.us/trs-activecare

Contact Us

Scott & White Health Plan

HMO Plan Option

5454

Service Area

Hospital Locations

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Hospital Providers

Central Texas Hospitals

Parkview Regional Hospital-New! Limestone County Medical Center Burleson St. Joseph Health Center Coryell Memorial Glen Rose Medical Center Goodall-Witcher Healthcare Grimes St. Joseph Health Center Hamilton General Hospital Hillcrest Medical Health Center Johns Community Hospital King’s Daughter’s Hospital

Lakeside Hospital Llano Memorial Hospital Madison, St. Joseph Health Center Metroplex Hospital Providence Health Center Richards Memorial Hospital Rollins Brook Community Hospital Scott & White Healthcare-Round Rock Scott & White Hospital St. Joseph Regional Health Center The Hospital at Westlake Medical Center Trinity Medical Center

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Hospital Providers

West Texas Hospitals

New! Ballinger Memorial Hospital

Ballinger, TX Shannon Medical Center

San Angelo, TX Reagan Memorial Hospital

Big Lake, TX Coleman County Medical Ctr.

Coleman, TX

Schleicher County Medical Ctr.

El Dorado, TX Kimble Hospital

Junction, TX Lillian M. Hudspeth Memorial

Hospital

Sonora, TX Concho County Hospital

Eden, TX

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What’s New for 2010-2011

Our plan still has a $0 medical deductible

We reduced the annual out-of-pocket maximum from $3,000 down to $2,000 for an individual

– Copays and medical expenses count toward your out-of-pocket max

The family out-of-pocket maximum remains unchanged at $6,000

Your annual prescription drug benefit is now unlimited!

– We removed the annual cap, which was previously set at $4,000 per person

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What’s New for 2010-2011 (cont’d)

We reduced the primary care office visit copay to $20 per visit — last year it was $25

The specialty office visit copay is now $35 per visit

For allergy serum you pay 20%

Outpatient surgery, $100 copay plus 20%

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5959

$0 Medical Deductible, $20 PCP Office Visit

See Enrollment Guide for full list of benefits.

Benefit Copay

Medical Deductible $0

Primary Care Physician $20

Specialist Office Visit $35

Preventive Care $0

Outpatient Surgery Facility $100 copay plus 20%

Inpatient Hospital $100 copay per day ($500 max) plus 20%

Emergency Room$100 copay per visit plus 20%

($100 copay waived if admitted within 24 hours)

Urgent Care $40 copay per visit plus 20%

Out-of-Pocket Maximum $2,000 individual/$6,000 family

6060

Unlimited Rx Benefit

Prescription Drugs

Retail (up to 34-day supply

Mail Order (up to 90-day supply)

Rx Maximum Unlimited

Rx Deductible Applies to brand and non-preferred

$50 $50

Generic $5 $10

Preferred Brand* 30% after deductible 30% after deductible

Non-Preferred Brand 50% after deductible 50% after deductible

Non-Formularygreater of $50 or 50%

after deductibleN/A

*If a brand-name prescription is dispensed when a generic is available, a copay of 50% applies after deductible

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Scott & White Health Plan Accolades

Scott & White Health Plan has been named one of the Highest Ranked Health Plans in Texas by U.S. News & World Report 1 for the fifth year in a row.2

Scott & White Health Plan has also earned an “Excellent Accreditation” from the National Committee for Quality Assurance (NCQA) for both Commercial and Medicare products (2000-2009)

This is our 10th consecutive year with “Excellent Accreditation.”

The NCQA is a private, not-for-profit organization that evaluates how well a health plan operates along with the results it delivers to members in terms of care, service and efficiency.

1U.S. News/NCQA America’s Best Health Plans 2009-10. “America’s Best Health Plans” is a

trademark of U.S. News & World Report.2Previous rankings posted on www.usnews.com.

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Find a Provider Online – www.swhp.org

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Login to MyPlan

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Online Lifestyle Management Programs

Balance– Weight Management

Overcoming Binge Eating– Compulsive Eating

Breathe– Smoking Cessation

Care for Your Health– Chronic Condition Guidance

Relax – Stress Management

Overcoming Depression– Depression Guidance

Care for your Back– Back Care

Overcoming Insomnia– Sleep Problems

Move– Physical Activity

Nourish– Healthy Eating

Succeed– Health Risk Assessment

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Personalized Service

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24-hour Nurse Advice Line 1-800-975-6612 Available to all SWHP members

VitalChat Instant Message with a nurse

online and have your questions answered

Customer Service Advocate 1-800-321-7947

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Simple

Helpful

Honest

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We are Texas Friendly

Valley Baptist Health Plans

HMO Plan Option

68

Service Area Rio Grande Valley Counties

– Cameron– Hidalgo– Starr (partial)– Willacy

Provider Network– More than 870 providers– 12 hospitals Valley-wide


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Low deductibles No claim forms No preexisting condition limitations Controllable costs

70


Free diabetic supplies available Worldwide emergency care Locally owned and operated in the Rio Grande

Valley by Valley Baptist Health System

99% member satisfaction (employer group survey)

97% of our providers would recommend our plan to their patients (provider survey)

71


PCP will refer you to a specialist No referral needed for a designated OB/GYN Case management services for diabetes mellitus

72


What’s New for 2010-2011

Approximately 9.0% premium decrease

$2 million lifetime maximum

New copays for outpatient services, ER, ambulance and urgent care

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Benefit Copay

PCP office visit $25

Specialist office visit $35

Preventive care $25 PCP/$35 Specialist

Outpatient surgery facility 20% after deductible

Inpatient hospital 20% after deductible

Emergency room 20% after deductible (waived if admitted)

Urgent care $75 copay (deductible waived)

Out-of-pocket maximum $3,000 maximum (individual)$6,000 maximum (family)

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Prescription Drugs

Retail (up to 30-day supply)

Mail Order (up to 90-day supply)

Generic $10 $30

Preferred Brand $30 $90

Non-Preferred Brand $60 $180

Maximum plan year prescription benefit is $10,000 per individual

How to Enroll

2010-2011 Plan Year

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Who is Eligible to Enroll?

To be eligible for TRS-ActiveCare coverage, you must: Be employed by a participating district/entity and

– Be an active, contributing TRS member or– Be employed 10 or more regularly scheduled hours

each week

Health care coverage for public school employees and their families

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Employees NOT Eligible to Enroll

State of Texas employees or retirees Higher education employees or retirees TRS retirees, receiving or who declined coverage

under TRS-Care

These individuals are not eligible to enroll for TRS-ActiveCare coverage as employees, but they can be covered as a dependent of an eligible employee.

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Eligible Dependents

Spouse (including a common law spouse)

Unmarried children under age 25– Natural child– Adopted child– Stepchild– Foster child

Other eligible dependents listed inEnrollment Guide– Grandchildren (unmarried)

– Disabled children (unmarried, of any age)

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Special Eligibility Situations

If employee and spouse both work for a participating district/entity:

– A spouse may be covered as an employee or as a dependent of an employee

– Only one parent can cover dependent children

A child (under age 25) employed by a district/entity and a contributing TRS member cannot be covered as a dependent

The child must be covered as an employee If the child is not a contributing TRS member, the child

may be covered as a dependent

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Enrollment

Enrollment Periods for 2010-2011 Plan Year:– April 19 - May 21 (Spring Enrollment)– August 1 - August 31 (Summer Enrollment)

Preexisting condition exclusion applies to those that previously declined coverage; may be reduced by prior creditable coverage

Passive enrollment; no need to enroll unless you want to:– Change TRS-ActiveCare plan option– Add or drop dependents– Cancel and/or decline coverage– Enroll for TRS-ActiveCare coverage with a different

participating district/entity – Change name or address or correct date of birth or Social Security number

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Preexisting Condition Waiting Period and Creditable Coverage

Pre-x does not apply to employees that initially enroll when the district/entity begins participating in TRS-ActiveCare or to new hires who enroll within 31 days after their actively-at-work date

A 12-month pre-x condition waiting period may apply due to:– A special enrollment event

– A future plan enrollment period (to be determined by TRS for each plan enrollment period)

– A transfer to another participating district/entity (or rehire) if the employee or any covered dependent has any remaining preexisting waiting period or a gap in coverage of 63 or more consecutive days

Pre-x waiting period may be reduced by creditable coverage

Exception: If a participant has been covered by TRS-ActiveCare at any time since 2002, pre-x may apply if employee is hired by another participating district/entity (or rehired by same district/entity)

2010-2011 Plan Year

Cost for Health Coverage

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Monthly Costfor Coverage

See page 27 of Enrollment Guide

$225 in district/entityand state funds to help pay for coverage

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Cost of Coverage (Cont’d)

Employee and family coverage for ActiveCare 1-HD is more expensive than ActiveCare 1 because the deductible and out-of-pocket maximum amounts for family are less and the plan may begin paying 100% benefits sooner

PPO Plans ActiveCare 1-HD ActiveCare 1

Coverage Category Total Cost Total Cost

Employee Only $262 $297

Employee and Spouse $642 $677

Employee and Child(ren) $409 $474

Employee and Family $840 $746

Family Deductible $2,400 $3,000

Family Out-of-Pocket Maximum

$7,400 $9,000

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Application to Split Premium

Married couples working for different participating entities may “pool” funds

Optional

Requires an Application to Split Premium form to be completed by both employees and employers

Form available online

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Can Changes in Coverage Be Made After Your Application Has Been Submitted?

Changes can be made up to the end of your enrollment period

Plan choices will remain in effect through August 31, 2011 unless there’s a special enrollment event such as:

– Marriage or divorce– Birth, adoption or placement for adoption of a child– A child marries or reaches age 25– A court order to provide health coverage for an eligible child – Loss of coverage

Changes must be made within 31 days after the event date (special rules apply to newborns)

New application must be submitted for any change

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Newborns

Covered first 31 days if employee has coverage

Must add newborn within 60 days after the date of birth or up to one year after the date of birth if:

– Employee has “employee and family” or “employee and child(ren)” coverage at the time of birth and at the time of enrollment

Not necessary to wait for newborn’s Social Security number

– Submit application without SSN to enroll– Re-submit another form after SSN is issued

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Your TRS-ActiveCare ID card will be mailed to your home

Enroll by May 19 to receive ID card by September 1 ActiveCare 1-HD, 1, 2 and 3

– All enrollees, including existing plan participants, will receive new ID cards

– New! Separate cards for medical and prescription drugs• Blue Cross and Blue Shield of Texas

• Medco

HMO plans – All HMO participants will receive new cards (except for

Valley Baptist Health Plans)– Each individual covered under the plan will receive a card

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Enrollment Support

Dedicated Customer Service ActiveCare 1-HD,1, 2 or 3 866-355-5999

(Blue Cross and Blue Shield of Texas and Medco)

FirstCare Health Plans 800-884-4901 Scott and White Health Plan 800-321-7947 Valley Baptist Health Plans 800-829-6440

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Enrollment Support

Available Online

Enrollment guide (English and Spanish)

Downloadable forms(enrollment application, split premium, claim form, etc.)

Provider locator Frequently asked

questions

www.trs.state.tx.us/trs-activecare

Questions

Thank you for attending

Documents

2010-2011 Plan Year Effective September 1, 2010. 2 Agenda TRS-ActiveCare Program Highlights –Enrollment Summary –Facts and Figures 2010-2011 Health