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Health Care Coverage for You and Your Family! PowerPoint Presentation
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Health Care Coverage for You and Your Family!

Health Care Coverage for You and Your Family!

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Health Care Coverage for You and Your Family!

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  1. Health Care Coverage for You and Your Family! Welcome

  2. Agenda • Who is eligible to enroll • Plan options and what’s new • Cost of health coverage • How to enroll • Enrollment support • Questions

  3. Who is Eligible to Enroll? To be eligible for TRS-ActiveCare coverage, you must: • Be employed by a participating district/entity and • Be an active, contributing TRS member or • Be employed 10 or more regularly scheduled hours each week Health care coverage for public school employees and their families

  4. Employees NOT Eligible to Enroll • State of Texas employees or retirees • Higher education employees or retirees • TRS retirees, receiving or who declined coverage under TRS-Care These individuals are not eligible to enroll for TRS-ActiveCare coverage as employees, but they can be covered as a dependent of an eligible employee.

  5. Eligible Dependents • Spouse (including a common law spouse) • Unmarried children under age 25 • Natural child • Adopted child • Stepchild • Foster child • Other eligible dependents listed in Enrollment Guide • Grandchildren (unmarried) • Disabled children (unmarried, of any age)

  6. Newborns • Covered the first 31 days if employee has coverage • To continue coverage, employee must add newborn within 60 days after the date of birth • However, an employee has up to one year after the newborn’s date of birth if: • Employee has “employee and family” or “employee and child(ren)” coverage at the time of birth and at the time of enrollment

  7. PPO Plan Options ActiveCare 1, 2 and 3

  8. What’s New for 2008-2009? ActiveCare 1, 2 and 3 • No premium increase • No benefit changes • Emphasis on health and wellness New plan features available April 1, 2008 • Blue Care Connection • 24/7 Nurseline • Personal Health Manager (PHM) online health and wellness resource • Live Chat secure, online real-time access for customer service inquiries

  9. PPO Network for ActiveCare 1, 2 and 3 Need to locate a Network Provider?

  10. Plan Overview Illustrates benefits when network providers are used. Non-network benefits are also available; see Enrollment Guide for more information.

  11. Plan Overview Illustrates benefits when network providers are used. Non-network benefits are also available; see Enrollment Guide for more information.

  12. Blue CareConnection® Health and Wellness Programs TRS-ActiveCare is administered by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Texas provides claims payment services only and does not assume any financial risk or obligation with respect to claims.

  13. 24/7 Nurseline New! Advice anytime. Round-the-clock health and the wellness advice from licensed professionals • Advice isn’t just neededfrom 9 to 5.24/7 Nurseline is here to help. • Nurses provide health advice and information about high fevers, earaches, cuts and bruises and more • Audio health library on topics such as kicking the smoking habit and ways to get a good night’s rest 1-800-581-0368 24/7 Available in EnglishandSpanish

  14. Personal Health Manager New! • Your online wellness experience begins here: • Take a Health Risk Assessment • Improve your health with the “Eat Right” nutrition planner • Create a fitness plan to suit your personal health goals and needs with “Get Fit” Click on the Personal Health Manager iconon Blue Access® for Members

  15. “Ask-A” Online Advisor Expert advice at your fingertips.Our “Ask-A” feature is here to help. Ask the experts. Expert advice from licensed professionalsvia the Personal Health Manager Ask a Nurse: Interact online with a Blue Care Advisor on non-emergency, health-related questions using the secure “Ask a Nurse” feature. Ask a Trainer, Dietitian orLife Coach: Send questions about fitness, nutrition, or managing stress. CONFIDENTIAL AND SECURE Receive a response within one business day

  16. Blue PointsSM Incentives ActiveCare 1, 2 and 3 plan participants and their covered dependents accumulate Blue PointsSM in the Personal Health Manager. Stay motivated. Earn Blue PointsSM in the Personal Health Manager • Complete designated health and wellness activities • Report completed activities in the Personal Health Manager • Track your available balance • Redeem earned Blue PointsSM for a variety of items!

  17. Weight Management and Tobacco Cessation • Self-Paced Approach • Online tools and resources via the Personal Health Manager • Secure e-mail outreach to keep members on track Tobacco Cessation Program Support for members who want to quit Weight Management Program Support for a Healthier You • Personalized Lifestyle Management Support • Counseling and coaching with licensed Wellness Coaches • Motivational toolkit • 24/7 Nurseline • Referrals when appropriate

  18. Expecting? Special Beginnings®Program 1-800-462-3275

  19. Live ChatSecure Online Customer Service New! • Send inquiries to customer service via e-mail • Immediate access to BCBSTX customer advocates • Available Monday – Friday, 7 a.m. to 10 p.m. (CT)

  20. What if I Have Questions? • Personalized Service • Call the TRS-ActiveCare customer service team for: • Claim questions/status • Network provider information • Membership and eligibility • Medical coverage questions • Inquiries (telephone and e-mail) • ID card requests • Transition of care information • Help with online tools! Customer Service 1-866-355-5999

  21. Blue Access®for MembersOnline Member Management Tool • Online member management tool. • Check claim status, view and download EOBs (Explanations of Benefits) • Order additional ID cards, and print temporary ID • Send secure e-mail messages to BCBS Customer Advocates • Monthly health articles • Links to health information and wellness tools and resources

  22. Prescription Drugs ActiveCare 1, 2 and 3

  23. Your TRS-ActiveCare health plan has two prescription drug components Blue Cross and Blue Shield of Texas manages your medical plan expenses, including prescription drug expenses under ActiveCare 1 Medco manages your prescription drug plan expenses for ActiveCare 2 and 3 Your Medco Prescription Drug Plan

  24. Your Medco Prescription Drug Plan • Medco has its own mail-order pharmacy – Medco By Mail – which delivers medications to your home at a lower cost • Medco’s mail-order pharmacies fill about 2 million prescriptions per week through a highly automated process that is 99.9997% accurate and is 23 times more accurate than a retail pharmacy* * “Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice”; Nov. 2007, Pharmacology, a peer-reviewed journal of the American College of Clinical Pharmacy

  25. Specific Rx Benefit Information • If you are taking a long-term medication, filling your prescriptions through Medco’s mail-order pharmacy provides several benefits: • You receive a 90-day supply of your medication at a lower copay • You have access to Specialist Pharmacists who receive additional training in conditions such as asthma, diabetes, heart disease and more • While retail pharmacists know the medications you fill at one pharmacy, Medco’s Specialist Pharmacists have a complete view of all of your medications so they know if there are potential safety issues and will contact you and your doctor to discuss these issues • You have access to specialist pharmacists whether you fill your prescription at a retail pharmacy or at Medco By Mail • Your medication questions can be answered by calling 1-866-355-5999

  26. Prescription Drug Benefits * If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Non-network benefits are also available; see Enrollment Guide for more information.

  27. Prescription Drug Benefits • Once the deductible is satisfied, the member pays the applicable copay • Member-paid cost differences between a brand-name drug and a generic equivalent do not apply to the deductible • Member cost share will not exceed the cost of the medication

  28. Prescription Drug Benefits • Once the deductible is satisfied, the member pays the applicable copay • Member-paid cost differences between a brand-name drug and a generic equivalent do not apply to the deductible • Member cost share will not exceed the cost of the medication.

  29. Information Resources • TRS Web site – • Pharmacy Benefit Highlights • List of maintenance medications • FAQs • Download forms • Medco Member Web site – • Prior Authorization List • Formulary Information • Locate a Participating Pharmacy • Health and Wellness Information • My Rx Choices® / Price a Medication • Online Ordering • Download forms • Customer Service Number 1-866-355-5999 • Benefits Booklet

  30. My Rx Choices®Your online savings tool Lower your cost for prescriptions with My Rx Choices • Features include: • Personal assessment of cost-saving opportunities based on your prescription plan and medications that you or covered family members take on an ongoing basis. • Best-value alternatives based upon greatest cost savings to you presented in order from highest value to member • Brand-to-generic and retail-to-mail compare options available • Easy-to-understand explanations of complicated concepts • The average amount saved by My Rx Choices users is $294! • Your doctor knows which medications are right for you but you may not know how much they cost. My Rx Choices provides you with available lower-cost options so that you and your doctor can make the most informed decisions based on health and cost. • Simply visit You’ll to take a moment to register before using this service. You can also call 1-866-355-5999.

  31. My Rx ChoicesAvailable through Customer Service or on • The My Rx Choices home page allows the user to: • Select a patient (pre-populated with all covered household members) • Select a drug to compare from a pre-populated list of prescriptions for the user. • Your potential savings are clearly presented.

  32. My Rx Choices Medco can facilitate on generic equivalents received through mail order

  33. My Rx Choices Members may print a kit to discusslower-cost alternatives with their doctor

  34. More about Your Rx Benefits • Refill your medication at www.medco.comwhen you use Medco By Mail • Sign-up for “Refill Reminders” at • Speak to a specialist pharmacist about the medications you are taking for a specific condition • Send e-mails to Customer Service and to Medco pharmacists through the Medco member Web site

  35. Medco Tour of Champions • An endorsement campaign featuring six Olympic gold medalists – each with a chronic or complex condition • Promotes Specialist Pharmacists as providing a higher level of care for people with chronic and complex conditions like asthma and diabetes • Campaign runs through 12/08

  36. HMO Plan Options 2008-2009 Plan Year

  37. FirstCare HMO Plan Option

  38. FirstCare Health PlansService Area 92 counties across Texas

  39. FirstCare Health Plans • No claim forms • No preexisting limitations • Emphasis on preventive health care • No referrals required • Extensive provider network • Local hospitals and doctors • Nationwide network through Texas True Choice and PHCS (outside Texas) • Worldwide emergency care

  40. FirstCare Health PlansMember Satisfaction • Timely Customer Service • Minimum automation; calls answered in Lubbock, Texas • Limited wait time to talk to a live representative • High member satisfaction for claims processing (90%) • Web site accessibility for information 24 hours a day • Regional offices in Abilene, Amarillo, Lubbock and Waco to serve local communities

  41. FirstCare Health PlansWhat’s New for 2008-2009 • $400 deductible – not applicable on most office visit services; see Plan Summary • Out-of-pocket maximum reduced to $3,500 per person • $100 copay on radio-nuclide stress test • $100 copay on non-pregnancy ultrasound tests • $40 copay on bone mass measurement test • Limited dental-related services have a maximum allowance of $10,000 • External prosthetics devices have a lifetime maximum allowance of $10,000 • 10% copay on preferred diabetic testing supplies • No copay on preferred glucose monitors • Premium increase of approximately 9.9%

  42. FirstCare Health PlansWhat’s New for 2008-2009 • 24/7 NurseLine available • Access a Registered Nurse with your medical questions • Staying Healthy Questions • Minor Injuries • Routine Illnesses • Medication Questions • Understanding Your Treatment Options • Access Their Web site ( • Health Assessments • Health Topics 1-800-981-7912

  43. FirstCare Health Plans

  44. FirstCare Health Plans $10,000 maximum prescription benefit per person per plan year *Excludes insulin and allergy serum †Not subject to $10,000 benefit maximum

  45. FirstCare Health PlansMember Portal • Link from the TRS-ActiveCare Web site for easy access to: • Change PCP • Request ID Cards • Print temporary ID Cards • Change address • Check status of claims • Check status of authorizations

  46. Legacy Health Solutions HMO Plan Option

  47. Legacy Health SolutionsService Area 18 counties West Texas

  48. Legacy Health Solutions • HMO Network Expansion • 389 Physicians in Legacy HMO Network • Added physicians of West Texas Medical Associates to our HMO • Members like HMO features • Predictable medical expense • No deductibles • No coinsurance • Coverage for preexisting conditions • No referrals needed for specialists • In CAHPS Customer Satisfaction Survey, members ranked Legacy HMO in 93% • Local management means timely feedback for participant questions, concerns, medical appointments

  49. Legacy Health Solutions • Emergencies covered anywhere • 24 Hour Nurse Hotline • Health Advisory Tools customized to each member • Online Personal Health Record • Out-of-area care for dependents • LHS network has 349 physicians representing over 43 specialties throughout West Texas • Disease and case management for chronic conditions

  50. Legacy Health SolutionsWhat’s New for 2008-2009 • $300 copay per day for inpatient hospital($1,500 maximum per admission) • $300 copay for outpatient hospital • $3,000/$9,000 out-of-pocket maximum per individual/family • $150 copay for emergency room care within 48 hours (copay waived if admitted) • $35 copay for preferred brand-name drug(retail; up to 30-day supply) • $70 copay for preferred brand-name drug(mail; up to 90-day supply) • Premium increase of approximately 5%