The TRS Board of Trustees approved significant changes to plan designs and benefits for TRS-ActiveCare participants, and approved new rates and one provider change for the three HMOs that serve certain regions of the state. (For more about other topics discussed during the April meeting, click here.)

ActiveCare Changes

After meeting with participating school districts and stakeholders in February, the TRS staff began working on major changes to ActiveCare in an effort to address the myriad concerns about the plan, ranging from high costs to low benefits. It is important to note that the main problem is the lack of adequate funding from the state, which has tied TRS’s hands in developing more affordable options. But several changes were approved today to provide a small measure of relief.

Overall, the goals were to lower premiums for child/family coverage where possible, allow broader access to providers, lower deductibles for individuals in family coverage, and provide a new, lower cost option.

Plan changes

ActiveCare will now include four options:

  • HD-1 — the existing high deductible option. The deductible will rise slightly from $2,750 to $2,800, and the in-network out-of-pocket maximum will increase from $6,750 to $6,900. Other benefits remain largely the same.
  • Primary and Primary Plus — new plans considered to be replacements for ActiveCare Select, which had provided benefits only for the use of specified network providers inside the member’s own region. Primary and Primary Plus will still restrict benefits to those using network providers but will allow participants to access any of the providers statewide (not only in the county in which the member resides).
    Benefits for Primary Plus are similar to the Select plan, except that the in-network out-of-pocket maximum will decrease from $7,000 to $6,900, the co-pay for therapy is reduced from $70 to $30, many copays are eliminated, and the individual deductible is reduced.
    Primary offers lower premiums coupled with lower benefits, including a $2,500 individual deductible, 30% coinsurance (i.e., insurance covers 70% of charges after the deductible is met, instead of 80% as in the other plans), and an out-of-pocket maximum of $8,150.
  • ActiveCare-2 (no change in benefits from the current ActiveCare-2). This option remains closed to new enrollees and is only available to those who are already enrolled in ActiveCare-2.

A significant change for HD, and a benefit for Primary and Primary Plus, is that for dependent coverage, any individual in the plan can reach the deductible and that person’s benefits will kick in. It is not required that all family members meet the deductible before an individual’s benefits begin.

Premium rates

For the high deductible (HD) plan, premiums will rise slightly for employee only and employee/spouse coverage, but will decrease slightly for employee/child and family coverage.

ActiveCare-2 rates will increase nearly 10% at each level.

Rates for Primary Plus are similar to, but less than, those for the now-eliminated ActiveCare Select.

Rates for Primary are the lowest available among the four options.

The charts below provide information on the benefits and premium rates for the four plans. (If you have trouble reading the charts, click here.)

TRS released this FAQ on the ActiveCare changes.

HMO changes

The three HMOs currently operating will continue for 2020-21, with mostly minor changes. The most significant difference is that the HMO currently operating in the Panhandle and most West Texas counties is switching to Blue Cross Blue Shield, with some accompanying changes in co-pays and co-insurance.

Benefits for Baylor Scott & White and South Texas BCBSTX will remain the same.

Rate changes for the three HMOs were a mixed bag. The South Texas BCBSTX plan will see very small premium increases ($5-10); Baylor Scott and White will provide an $8 decrease in employee-only premiums but increases at other levels; and West Texas BCBS premiums are decreasing across the board, ranging from -$27 for employee-only coverage to -$129 for employee/spouse.

(If you have trouble reading the chart, click here.)

More information is available on ActiveCare at TRS's website.