Enrollment. Health coverage for you and your family Effective September 1, 2015

Transcription

1 Enrollment Health coverage for you and your family Effective September 1,

2 What is TRS ActiveCare? Established and signed into law in 2001 (Chapter 1579, Texas Insurance Code) A statewide health care benefits program for employees of school districts, charter schools, regional educational service centers and other educational districts Law authorizes funding levels to help employees pay for coverage (Allen ISD District Contribution for is $340/month) 1,127 districts/entities participate in TRS-ActiveCare (90% of eligible entities) 2

3 ActiveCare 1 HD Plan is administered by Aetna ActiveCare 1 HD meets IRS definition of a high deductible health plan for all coverage tiers Least expensive premium of all the TRS ActiveCare plans Plan pays benefits only after deductible is met there is no separate individual deductible* Provider Network Deductible (per plan year) Type of Service Out of Pocket Maximum (per plan year; does include medical deductible/any medical copays/consurance/any prescription drug deductible and applicable copays/coinsurance) ActiveCare 1 HD Aetna Open Access Choice POS II $2,500 employee only $5,000 employee and spouse; employee and child(ren); employee and family $6,450 employee only $12,900 employee and spouse; employee and child(ren); employee and family Nationwide network Plan pays in network as well as out ofnetwork benefits Individual may contribute into a health savings account (HSA) to help pay for current health expenses and save for future qualified medical and retiree health expenses. Contributions to HSA are tax deductible** Prescription drug plan administered by CVS Caremark *when dropping dependent coverage mid year due to qualifying event, only individual deductible amounts will carry over. **TRS ActiveCare and AISD do not offer HSAs. Please check with your preferred bank or credit union for program options. Office Visit Copay 20% after deductible Emergency Room 20% after deductible (true emergency use) Prescription Drugs Subject to plan year deductible Drug deductible (per plan year) Retail Short Term 20% after deductible (up to 31 day supply) Generic copay Brand copay (preferred list) Brand copay (non preferred list) Monthly Premium Cost (before district contribution) Employee only $ Employee and spouse $ Employee and child(ren) $ Employee and family $1,

4 ActiveCare 1 HD Provider Search step by step Go to areaetna.com or use the link for Provider Search located on the BenefitsHUB portal under Medical / TRS ActiveCare. Click on the green Find a Doctor or Facility box. Under the Select a Plan drop down, choose ActiveCare 1 HD; then click on the yellow CONTINUE button. Enter your search criteria; then click on the yellow SEARCH button. 4

5 ActiveCare 2 Plan is administered by Aetna Type of Service ActiveCare 2 Copay for office visits Individual deductible applies to outpatient and in patient services Nationwide network Provider Network Deductible (per plan year) Out of Pocket Maximum (per plan year; does include medical deductible/any medical copays/consurance/any prescription drug deductible and applicable copays/coinsurance) Aetna Open Access Choice POS II $1,000 individual $3,000 family $6,600 individual $13,200 family Plan pays in network as well as out ofnetwork benefits Most expensive premium of all the TRS ActiveCare plans Prescription drug plan administered by CVS Caremark Office Visit Copay $30 copay for primary $50 copay for specialist Emergency Room $150 copay plus 20% after deductible (true emergency use) (copay waived if admitted) Prescription Drugs $0 for generic drugs Drug deductible (per plan year) $200 per person for brand name drugs Retail Short Term (up to 31 day supply) Generic copay $20 Brand copay (preferred list) $40 Brand copay (non preferred list) $65 Monthly Premium Cost (before district contribution) Employee only $ Employee and spouse $1, Employee and child(ren) $ Employee and family $1,

6 ActiveCare 2 Provider Search step by step Go to areaetna.com or use the link for Provider Search located on the BenefitsHUB portal under Medical / TRS ActiveCare. Click on the green Find a Doctor or Facility box. Under the Select a Plan drop down, choose ActiveCare 2; then click on the yellow CONTINUE button. Enter your search criteria; then click on the yellow SEARCH button. 6

7 ActiveCare Select Baylor Scott & White Plan is administered by Aetna Copay for office visits Individual deductible applies to out patient and in patient services Provider Network Deductible (per plan year) Type of Service ActiveCare Select Baylor Scott & White Quality Alliance Baylor Scott & White Quality Alliance (EPO) $1,200 individual $3,600 family You need to select a Primary Care Physician You may see any network physician without a referral Localized network. You and all covered dependents must live in Collin, Dallas, Denton, Ellis, Parker, Rockwall, Tarrant Counties If you are covering dependents who s not/will not be living in the coverage area, this is not the plan for you! No out of network benefits Prescription drug plan administered by CVS Caremark Out of Pocket Maximum (per plan year; does include medical deductible/any medical copays/consurance/any prescription drug deductible and applicable copays/coinsurance) $6,600 individual $13,200 family Office Visit Copay $30 copay for primary $60 copay for specialist Emergency Room $150 copay plus 20% after deductible (true emergency use) (copay waived if admitted) Prescription Drugs $0 for generic drugs Drug deductible (per plan year) $200 per person for brand name drugs Retail Short Term (up to 31 day supply) Generic copay $20 Brand copay (preferred list) $40 Brand copay (non preferred list) 50% coinsurance Monthly Premium Cost (before district contribution) Employee only $ Employee and spouse $1, Employee and child(ren) $ Employee and family $1,

8 ActiveCare Select Baylor Scott & White Provider Search step by step Go to eaetna.com or use the link for Provider Search located on the BenefitsHUB portal under Medical / TRS ActiveCare. Click on the green Find a Doctor or Facility box. Under the Select a Plan drop down, choose Baylor Scott & White Qualify Alliance (DFW Region); then click on the yellow CONTINUE button. Enter your search criteria; then click on the yellow SEARCH button. 8

9 ActiveCare Scott & White Health Plan Plan is administered by Scott & White Health Plan Type of Service Scott & White Health Plan HMO Copay for office visits You are not required to select a Primary Care Physician You may see any network physician without a referral Provider Network Deductible (per plan year) Out of Pocket Maximum (per plan year; does include medical deductible/any medical copays/consurance/any prescription drug deductible and applicable copays/coinsurance) Scott & White HMO $800 individual $2,400 family $5,000 individual $10,000 family Lowest deductible and copay plan that TRS offers In State network (mainly Central Texas). You and all covered dependents must live in the service area No out of network benefits Prescription drug also administered by Scott & White Health Plan Office Visit Copay $20 copay for primary $50 copay for specialist Emergency Room $150 copay plus 20% after deductible (true emergency use) (copay waived if admitted) Prescription Drugs $0 for generic drugs Drug deductible (per plan year) $100 per person for brand name drugs Retail Short Term (up to 31 day supply) Generic copay $3 Brand copay (preferred list) 30% after deductible Brand copay (non preferred list) 50% after deductible Monthly Premium Cost (before district contribution) Employee only $ Employee and spouse $1, Employee and child(ren) $ Employee and family $1,

10 Service area If you are covering dependents who s not/will not be living in the coverage area, this is not the plan for you! 10

11 ActiveCare Scott & White Health Plan Provider Search step by step Go to or use the link for Provider Search located on the BenefitsHUB portal under Medical / Scott & White Health Plan. Click on Provider Information on the top left, then click on Browse Providers Online. Under the Select a Plan drop down, choose TRS ActiveCare Participants Network; input your search criteria, then click on the green SEARCH button. 11

12 TRS ActiveCare Plan Differences Quick Reference Plan Administration Network Used / Plan Type Deductible vs. Copay Out of Network Benefits Prescription Drug Administration Contact Info ActiveCare 1HD ActiveCare 2 ActiveCare Select Baylor Scott & White ActiveCare Scott &White Health Plan Aetna Aetna Aetna Scott & White Health Plan Open Access Choice POS II (Nationwide Coverage) Qualified High Deductible plan Open Access Choice POS II (Nationwide Coverage) Traditional Copay plan Baylor Scott & White Quality Alliance (EPO) (Localized coverage 7 counties) Traditional Copay plan Scott & White HMO (Localized coverage Central TX region) Traditional Copay plan Yes Yes No No CVS Caremark (separate ID card from Aetna medical) aetna.com C/S: CVS Caremark (separate ID card from Aetna medical) aetna.com C/S: CVS Caremark (separate ID card from Aetna medical) aetna.com C/S: Scott & White Health Plan C/S:

13 Split Premium Process Split Premium Form: The Split Premium Form must be completed and signed by both husband and wife who wish to split the cost of employee and spouse or employee and family. Must be employed by different districts/entities participating in TRS ActiveCare The cost for TRS ActiveCare coverage will be split between the two employers The Benefits Administrator at each district must also sign and approve the form Married couples both working for Allen ISD could participate in Pooled Premium, and take advantage of double district contribution. Contact AISD Benefits Dept. for more information. 13

14 Choose wisely Look over your claims history, list your expected and possible costs. Add them to the annualized premiums to determine which plan is most cost effective Employee-only plan AC1HD AC2 AC-Select SWHP annual premium $12.00 $ $ $ sick visits (2x/yr) $ $60.00 $60.00 $40.00 maintenance drugs $ $ $ $36.00 urgent care (1x/yr) $ $50.00 $50.00 $55.00 Total annual cost: $ $ $ $ Compare bottom line *This is only a sample. Please use your own claims history to estimate annual costs. You can also visit TRS Aetna and SWHP websites or call customer service for estimated costs on services. 14

15 Choose wisely Use the Summary of Benefits and Coverage (SBC) for side by side comparison on how each plan may pay for services. ActiveCare 1HD, 2 & Select Plans: Scott & White Health Plan: 15

16 Plan Year Important Messages to Take Away Employees must take action either to enroll or decline coverage. This is mandatory! No action will result in loss of coverage. Choose a plan carefully: Choosing the Baylor Scott & White Select Plan or the Scott & White Health Plan means the entire family must stay in their specific network. After enrollment, any requested changes will be subject to the exception process. Mid year changes can only occur if you experience a qualifying event. Check and make sure your providers are in network. Out of Network doctors CAN and WILL balance bill you. Use a network urgent care center or walk in clinic instead of an ER for nonlife threatening emergencies. Hospital ER s often use contract services. Although the hospital is in network, their contract services may not be in network. You have better control over costs by using an urgent care or walk in clinic. Know your network diagnostic labs. Always request for your provider to send lab works to a network facility. Remember, Quest Diagnostics provides free or discounted services to ActiveCare 1HD, ActiveCare 2 and ActiveCare Select Baylor Scott & White participants. 16