Connecticut State Teachers’ Retirement Board Health Plan - PowerPoint PPT Presentation

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Connecticut State Teachers’ Retirement Board Health Plan

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Connecticut State Teachers’ Retirement Board Health Plan

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  1. Connecticut State Teachers’ Retirement BoardHealth Plan Administered by Stirling Benefits, Inc. 2014

  2. TRB Plan • Governed by the Connecticut Teachers’ Retirement Board (TRB) • Covering over 22,000 retired teachers • Administered by Stirling Benefits • Began service to TRB in 1996 • Service company, not an insurance company • Based on the Blue Cross High Option

  3. TRB PlanFunding • Plan funding comes from three sources: • Active teachers pay 1.25% of salary into the health account, • The state is responsible for a third, and • The retiree pays a third

  4. TRB Subsidies Retirees receive either: Local Board subsidy • $110 per retiree or spouse per month • $220 per month if not eligible for Medicare Or TRB coverage subsidy • Two thirds (66%) of the cost of Medical & Rx • Once on the TRB plan, TRB no longer pays local board

  5. TRB -- Who is eligible?

  6. To obtain Medicare… • Need 40 Quarters of Eligible Employment, or… • Married 10 years to someone who has 40 quarters • Part A -- Paid by Medicare • Part B -- Cost Share with Retiree • Pre 1987 hires may not have 40 quarters • TRB members don’t need Part D

  7. TRB -- What’s Covered

  8. TRB Plan Process

  9. TRB Medical • Covers what Medicare allows • Same as Blue Cross High Option • No network, No Copayments, • No Pre-Existing Condition Limitations • No Individual Underwriting • Picks up remainder after Medicare pays • Coverage the same everywhere in the US and Puerto Rico

  10. Lifetime Maximums • Unlimited maximum on Hospitalizations • Unlimited maximum on Basic Medical • Unlimited maximum on Prescriptions • $1 M max on a small portion of remaining claims (totaling about 3% of the total claims) • Applies to: out of country, extra 15% on unassigned Medicare claims, extra 20 days of skilled nursing care • No member has ever come close to hitting the limit.

  11. Assignment of Claims • Medicare claims are either Assigned or Unassigned • Assigned Claims (95% of all claims): • Doctor agrees to accept what Medicare “allows” as full payment • Medicare and TRB plan pays the doctor • Doctor guaranteed to collect 100% of what Medicare allows. • Un-Assigned Claims (5% of all claims) • Doctor may charge 15% more than “allowed” • Medicare and TRB Plan pays Member • Doctor must bill and collect from member

  12. Examples of Claim Assignment

  13. Shingles Vaccine Covered • Effective 1-1-2013 • Plan reimburses 80% of the cost of vaccine • Up to total of $200 per person per lifetime • Send proof of payment to Stirling Benefits • TRB plan reimburses member by check

  14. Out of Country • In-Patient Hospital – 30 days at 100% • Physician’s charges paid at 80% • Non-Emergency Only • 20% for services usually covered by Medicare • Cannot be used for experimental procedures.

  15. Rx Benefits

  16. Retiree Payments for Rx

  17. Dental • $44.00 / Month (2014) • Administered by Aetna Dental • $50 annual deductible • 100% cleanings • 80% basic restorative • 50% Major Restorative • $2,000 annual maximum

  18. Vision & Hearing • $5.00 / Month • Vision • Exams: $75 every 12 months • $100 toward frames and $60 - $200 allowance for lenses every 24 months, or $120 toward contacts every 12 months • Hearing Aids: $750 every three years • Administered by Stirling Benefits

  19. Monthly Cost Per Person

  20. How Members Enroll

  21. For More Information… • Stirling Benefits, Inc. • 20 Armory Lane, Milford, CT 06460 • (203) 876-1660, ext. 0, www.StirlingBenefits.com • Teachers’ Retirement Board • 765 Asylum Avenue, Hartford, CT 06105-2822 • (800) 504-1102, fax: (860) 622-2849, www.ct.gov/trb • CVS /Caremark (800) 318-2572 • Aetna Dental (855) 394-3874 • Medicare (800) 772-1213 www.Medicare.gov