TRS Health Plans Changing—Focus on ActiveCare

On June 2 the Teacher Retirement System of Texas board of trustees considered premium rates and benefits for its health-care programs for retired and active public school employees. As anticipated with passage of HB 3976—now awaiting action by the governor—not only have premiums and benefits changed in TRS-Care but the basic structure of health care for retirees will be very different in upcoming years. No such structural changes were made for TRS-ActiveCare, but active school employees will face higher premiums and some reduced benefits.

TRS-ActiveCare — Active school district employees’ health care

The Legislature made no changes during the regular session to the state’s contribution for active employee health care ($75 per month) or to the minimum required school district contribution ($150 a month). Hence, as has been the case for some 15 years, any premium increase falls entirely on employees unless their individual employing district steps up with a higher contribution. For that reason, the TRS board chose to reduce benefits in the upcoming plan year, limiting to 8.1 percent what otherwise would have been an overall average premium increase of 9.9 percent. In general, both the amount and percentage of premium increases for next year are larger for richer benefit plans and for covering spouses.

Here are the current ActiveCare premiums and corresponding rates for the new plan year starting September 1, 2018.

Coverage FY 17 Premium FY 18 Premium Dollar Increase Percent Increase
TRS-ActiveCare 1HD Employee Only $341 $351 $10 3%
Employee & Spouse $914 $991 $77 8%
Employee & Children $615 $671 $56 9%
Employee & Family $1,231 $1,316 $85 7%
TRS-ActiveCare Select Employee Only $484 $514 $30 6%
Employee & Spouse $1,147 $1,264 $117 10%
Employee & Children $779 $834 $55 7%
Employee & Family $1,361 $1,589 $228 17%
TRS-ActiveCare 2 Employee Only $645 $714 $69 11%
Employee & Spouse $1,552 $1,694 $142 9%
Employee & Children 1,042 $1,062 $20 2%
Employee & Family $1,597 $2,004 $407 25%

 

Benefit reductions for ActiveCare come in the form of:

  • Higher in-network out-of-pocket maximums;
  • New deductibles and out-of-pocket maximums for out-of-network providers; and
  • Higher emergency room copays.

Prescription drug benefits remain the same for the upcoming plan year.

This chart shows current and reduced 2018 benefits for ActiveCare 1HD:

FY2017 FY2018
AC 1HD AC 1HD
In-Network
Deductible
Individual $2,500 $2,500
Family $5,000 $5,000
In-Network
Maximum
Out-of-Pocket
Limit
Individual $6,550 $6,550
Family $13,100 $13,100
Out-of-Network
Deductible
Individual Included in
in-network
deductible
$5,000
Family $10,000
Out-of-Network
Maximum
Out-of-Pocket
Limit
Individual Included in
in-network
deductible
$13,100
Family $26,200
Other ER Copay 20% after deductible 20% after deductible

 

This chart shows current and reduced 2018 benefits for ActiveCare Select:

FY2017 FY2018
AC Select AC Select
In-Network
Deductible
Individual $1,200 $1,200
Family $3,600 $3,600
In-Network
Maximum
Out-of-Pocket
Limit
Individual $6,850 $7,150
Family $13,700 $14,300
Out-of-Network
Deductible
Individual N/A N/A
Family
Out-of-Network
Maximum
Out-of-Pocket
Limit
Individual N/A N/A
Family
Other ER Copay $150 copay
+ 20% after deductible
$200 copay
+ 20% after deductible

 

This chart shows current and reduced 2018 benefits for ActiveCare 2:

FY2017 FY2018
AC 2 AC 2
In-Network
Deductible
Individual $1,000 $1,000
Family $3,000 $3,000
In-Network
Maximum
Out-of-Pocket
Limit
Individual $6,850 $7,150
Family $13,700 $14,300
Out-of-Network
Deductible
Individual Included in
in-network
deductible
$2,000
Family $6,000
Out-of-Network
Maximum
Out-of-Pocket
Limit
Individual Included in
in-network
deductible
$14,300
Family $28,600
Other ER Copay $150 copay
+ 20% after deductible
$200 copay
+ 20% after deductible