The following was included in TCTA's 2017-18 Survival Guide, the ultimate reference tool for Texas educators, and is current as of September 2017 but is subject to change.

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

Active Employee Health Insurance (TRS-ActiveCare)

The state plan for active Texas public school employees, TRS-ActiveCare, has three levels of coverage. Download a detailed chart.

ActiveCare is administered by Aetna, with pharmacy benefits managed by Caremark.

2017-18 Rates for TRS-ActiveCare Plans*

  ActiveCare 1-HD ActiveCare Select ActiveCare 2
Coverage Category Rate Rate Rate
Employee only $351 $512 $714
Employee and spouse $991 $1,264 $1,694
Employee and child(ren) $671 $834 $1,062
Employee and family $1,316 $1,589 $2,004

* Rates and benefits under locally provided plans or state-approved HMOs will vary.

Note: The premium costs listed 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.

Funding

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, 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. 

Districts choosing not to participate must still provide access to health insurance. 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.

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 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.

Portability of insurance/continuing coverage

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 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 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 ActiveCare Aetna plan, and details are available on the TRS website in the Active Members > TRS-ActiveCare section.

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 Allegian (formerly 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 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 on the TRS website. TRS-Care plans and premiums changed significantly as a result of legislation passed in the 2017 legislative session (and subsequent special session).

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.

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. The lowest level of coverage will no longer be free, as it was under the previous law; however, a disability retiree who retired on or before Jan. 1, 2017, who is not Medicare-eligible will not have to pay a monthly premium for the high-deductible individual coverage (that exemption expires at the end of 2021). See the TRS website for more details, plan benefits and premium rates.

See also: TRS & Social Security