Plannin​g Ahead: What's happening with my health insurance this year?

The Classroom Teacher, summer 2014

If your school district does NOT participate in Texas' TRS-ActiveCare plan, your administrators should notify you of any changes in your coverage, options and premiums. The state will continue to provide $75 per month per employee for health insurance costs. Your district’s contribution (which must be at least $150 per month) may stay the same or increase, depending on local budget decisions.

The HMO options for 2014-15 have remained the same. If you are enrolled in a FirstCare, Scott & White, or Valley Baptist HMO, check the TRS website for changes in your benefits and premiums.

If you participate in TRS-ActiveCare, you will see major changes for the 2014-15 school year, including:

Premium increases

Rates for TRS-ActiveCare will increase by up to 8 percent, depending on the level and type of coverage chosen. Premiums for ActiveCare 1-HD employee and employee-child coverage will remain at 2013-14 levels, as will the rates for family coverage for ActiveCare 2. See also TRS-ActiveCare premiums to increase for most employees in 2014-15.

Change in plan administrator

Aetna will administer ActiveCare, taking the job over from Blue Cross/Blue Shield. Aetna has a wide network of providers, but some members may find that their doctors are no longer in-network.

If you find that your physicians are not in the Aetna network, you may still be eligible to use a non-network provider if you qualify for a “Transition of Care” benefit. This is available to members engaged in an ongoing course of treatment that meets certain guidelines (examples provided by TRS include a woman who is pregnant when the coverage changes on Sept. 1, or a patient undergoing cancer treatment who is scheduled to finish chemotherapy in October). If you believe you may qualify for the Transition of Care benefit, you must submit a Transition of Care form and receive approval from Aetna.

Change in pharmacy manager

Caremark will take over the management of pharmacy benefits from Express Scripts. Caremark is the largest pharmacy provider in the country, and its extensive network includes CVS and other chain and independent pharmacies.

Elimination of ActiveCare 3

The highest level of coverage, ActiveCare 3, has been eliminated due to unsustainable increases in premiums (the cost of family coverage had risen to nearly $2,000 per month last year). Those enrolled in ActiveCare 3 will be transferred to ActiveCare 2 for the upcoming year unless they choose another level of coverage during open enrollment. See a chart that compares the available plans.

Implementation of ActiveCare Select

The TRS Board of Trustees approved a new level of coverage called ActiveCare Select. Select has premiums and benefits that generally fall between those of ActiveCare 1-HD and ActiveCare 2. A major difference, however, has to do with the provider network. The plan will not cover services provided by a non-network provider, and the networks are more narrowly prescribed than the general Aetna network. The ActiveCare enrollment guide provides additional important details about this plan.

New benefits

Two new benefits will be implemented this year: the Teladoc service and Quest lab coverage.

Teladoc provides 24-hour telephone access to a national network of doctors who can diagnose illnesses and prescribe medication for common issues. This service is available free for those enrolled in ActiveCare 2 or Select; it is also available for a fee of $40 per consultation for ActiveCare 1 participants.

Quest Diagnostic lab services will also be covered at 100 percent for ActiveCare 2 and Select enrollees.

Enrollment period

The open enrollment period for ActiveCare runs July 21 through Aug. 31, 2014.

More information

ActiveCare enrollment guide (includes new premium rates, as well as rates and coverage information for the ActiveCare HMOs)

Aetna ActiveCare

Caremark ActiveCare