In accordance with longstanding legislative intent as expressed through budget riders, TRS is not increasing the premium rates for TRS-Care, the retiree health insurance plan. As currently structured, TRS-Care is projected to have just enough funds to cover the remainder of the biennium (through August 2017), but legislators have asked that TRS consider some plan changes to reduce costs and increase the projected balance to provide a more comfortable cash flow margin. During the presentation to the Board, staff noted that the plan design had not been revised in 12 years.

The TRS Board considered alternatives that included not taking any action, but ultimately settled on the set of plan changes outlined below.

TRS-Care 1

Retiree or Surviving Spouses enrolled in Medicare Part A and eligible for Part B Retiree or Surviving Spouses NOT enrolled in Medicare Part A and eligible for Part B Retiree or Surviving Spouses with no Medicare
Deductible Individual: $2,350
Family: $4,700
Individual: $3,900
Family: $7,800
Individual: $5,250
Family: $10,500
Network Coinsurance 80% / 20% 80% / 20% 80% / 20%
Out of Network
Coinsurance: Medical and Part B expenses
80% / 20% 80% / 20% 60% / 40%
Out of Network
Coinsurance: Hospital and Part A Expenses
80% / 20% 60% / 40% 60% / 40%
Maximum Out of Pocket:
includes deductibles and coinsurance
Individual: $6,250
Family: $12,500

Individual: $7,800
Family: $15,600

Individual: $8,250
Family: $16,500
Prescription expenses Same as Medical Same as Medical Same as Medical

TRS-Care 2

Retiree or Surviving Spouses enrolled in Medicare Part A and eligible for Part B Retiree or Surviving Spouses NOT enrolled in Medicare Part A and eligible for Part B Retiree or Surviving Spouses with no Medicare
Deductible Individual: $1,300
Family: $2,600
Individual: $1,300
Family: $2,600
Individual: $1,300
Family: $2,600
Network Coinsurance 80% / 20% 80% / 20% 80% / 20%
Out of Network
Coinsurance: Medical and Part B expenses
80% / 20% 80% / 20% 60% / 40%
Out of Network
Coinsurance: Hospital and Part A Expenses
80% / 20% 60% / 40% 60% / 40%
Maximum Out of Pocket:
includes deductibles and coinsurance
Individual: $5,800
Family: $11,600

Individual: $5,800
Family: $11,600

Individual: $5,800
Family: $11,600
Office Visit Copay N/A N/A $35
Prescription
Expenses
Retail
Maintenance
Mail
Generic/Preferred/Non-Preferred
$13/$40/$65
$23/$50/$75
$25/$100/$165

Generic/Preferred/Non-Preferred
$13/$40/$65
$23/$50/$75
$25/$100/$165

Generic/Preferred/Non-Preferred
$13/$40/$65
$23/$50/$75
$25/$100/$165

TRS-Care 3

Retiree or Surviving Spouses enrolled in Medicare Part A and eligible for Part B Retiree or Surviving Spouses NOT enrolled in Medicare Part A and eligible for Part B Retiree or Surviving Spouses with no Medicare
Deductible Individual: $400
Family: $800
Individual: $400
Family: $800
Individual: $400
Family: $800
Network Coinsurance 80% / 20% 80% / 20% 80% / 20%
Out of Network
Coinsurance: Medical and Part B expenses
80% / 20% 80% / 20% 60% / 40%
Out of Network
Coinsurance: Hospital and Part A Expenses
80% / 20% 60% / 40% 60% / 40%
Maximum Out of Pocket:
includes deductibles and coinsurance
Individual: $4,900
Family: $9,800

Individual: $4,900
Family: $9,800

Individual: $4,900
Family: $9,800
Office Visit Copay N/A N/A $25
Prescription
Expenses
Retail
Maintenance
Mail
Generic/Preferred/Non-Preferred
$13/$30/$50
$23/$40/$60
$25/$65/$105

Generic/Preferred/Non-Preferred
$13/$30/$50
$23/$40/$60
$25/$65/$105

Generic/Preferred/Non-Preferred
$13/$30/$50
$23/$40/$60
$25/$65/$105

Medical deductibles and maximum out-of-pocket limits will increase, as will pharmacy co-pays. There will be a new co-pay structure for maintenance drugs (higher costs for filling prescriptions at a retail pharmacy) to encourage participants to use the mail-order program. Medicare Part D will become the only prescription drug coverage available (about 80% of TRS-Care enrollees are already participating in Part D).