Health insurance

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). Active Care 1-HD is similar to ActiveCare 1 coverage, but has a deductible of $2,400 per individual OR family (to comply with federal guidelines) compared to $1,200 per individual and $3,000 per family for ActiveCare 1. Rates approved by the TRS Board of Trustees for 2011-12 represent a 9.5 percent increase over the 2010-11 rates. However, the actual increase in cost to the member, unless districts choose to increase the local contribution toward premiums, could be much higher than 9.5 percent.

Note that the premium costs below do not take into account the required $75/month contribution from the state and $150/month from the district (some districts contribute more). Actual premium costs for employees will be lower than the amounts reflected in this chart.

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

See the 2011-12 enrollment guide on the TRS website at www.trs.state.tx.us for important changes based on federal healthcare reform.

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 (who are covered under TRS-Care, the retiree health insurance). 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.

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 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 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. Other TCTA-initiated legislation 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 three 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 at www.trs.state.tx.us/TRS-ActiveCare. Employees in the Panhandle and parts of North and Central Texas can participate in FirstCare; those in portions of the Rio Grande Valley can opt for Valley Baptist Health Plan; Central Texas employees and those in several West Texas counties can choose the Scott & White Health Plan. Some employees in Central and West Texas have access to both FirstCare and Scott & White plans.

Retiree health insurance (TRS-Care)

Details of the state’s health care coverage for retirees are available at the TRS website at www.trs.state.tx.us.

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.