Medical- TRS ActiveCare

2019-20 TRS ActiveCare PPO Plan Highlights

2019-20 TRS ActiveCare PPO Plan Highlights (Spanish)

2019-20 TRS ActiveCare – What’s New & What’s Changing Comparison

 

2018-19 TRS ActiveCare PPO Plan Highlights

2018-19 Medical Plan Highlights (Spanish)

2018-19 TRS ActiveCare PPO – What’s New & What’s Changing Comparison

Coordination of Benefits
TRS-ActiveCare includes a Coordination of Benefits (COB) provision that determines how benefits will be paid when you or your dependent is covered by more than one group health plan. When you have other group medical coverage (through your spouse’s employer, for example), your TRS-ActiveCare benefits may be combined with others to pay covered charges. The COB provision eliminates duplicate payments for the same medical expenses. Coordination of Benefits does not apply to individual policies.

Under the COB provision, the plan that pays first is called the primary plan. The secondary plan typically makes up the difference between the primary plan’s benefit and the covered charge. When one plan does not have a COB provision, that plan is always considered primary and always pays first. COB payments do not always total 100% of charges.

How to Determine Which Plan is Primary
These rules are applied in the order in which they appear until one resolves the issue.

• If a person is covered as an employee under one plan and as a dependent under another plan, the plan that covers the person as an employee is primary over the plan that covers the person as a dependent.
• If a child is covered under both parents’ plans, the plan of the parent whose birth date is earlier in the calendar year is primary. If both parents have the same birthday, the plan which has covered one parent longer is primary. If the other plan does not have this provision regarding birthdays, then the rules in that plan determine the order of benefits.
• The parent with financial responsibility for the child’s health care expenses under a court decree is primary. The other parent’s plan would be secondary.  In the case of joint custody with no specific requirements to provide health care expenses, the birthday rule as described above would apply. Dependent children of divorced or separated parents receive benefits payments in this order from the plan of the: (1) Parent with custody; (2) Stepparent with custody; (3) Parent without custody.
• The plan that covers a person as an active employee is primary over the plan that covers that person as a laid-off or retired employee.
• The plan covering the patient as an employee rather than a dependent is primary.

Important Information for ActiveCare Select Plan Members

The TRS-ActiveCare Select Whole Health plans are expanding into your area effective September 1, 2018.

What does this change mean for a plan participant?

The participant’s current plan network, the TRS-ActiveCare Select nationwide network, will no longer be available. If the participant does not take action prior to Aug. 10, 2018, he/she will be automatically placed in the TRS-ActiveCare Select Whole Health local network plan for 2018-19. If the participant does not want this plan for 2018-19, he/she must make an active enrollment decision by July 31, 2018, to either elect the TRS-ActiveCare 1-HD plan or opt out of coverage entirely.

It’s important for a participant to know that the TRS-ActiveCare Select Whole Health local network plan only covers care from in-network providers. If it’s a true medical emergency, the plan will cover care from an out-of-network provider. If a participant has dependents that do not live with him/her and must receive care from providers outside of the TRS-ActiveCare Select Whole Health local network, he/she may want to consider enrolling in the TRS-ActiveCare 1-HD plan. The TRS-ActiveCare 1-HD plan has a nationwide network and covers out-of-network care.

Will participants be notified of this change?

Aetna will be sending a mailer to participants affected by this in early July informing them of this change. Please use the links below to see the mailer.

The TRS-ActiveCare Select Whole Health expansion areas include:

  • TRS-ActiveCare Select Whole Health Seton Alliance plan is expanding to include Bastrop, Bell, Burnett and Caldwell counties. Seton Health Alliance
  • TRS-ActiveCare Select Whole Health Baylor Scott & White Quality Alliance plan is expanding to include Brazos, McLennan, Milam, Washington, Bell, Hays, Travis and Williamson counties. Baylor Scott & White Quality Alliance
  • TRS-ActiveCare Select Whole Health Memorial Hermann plan is expanding to include some specific zip code areas in Galveston and Brazoria counties. Memorial Herman Accountable Care Network

Please note: If a participant has not visited providers in either plan network, he/she will be covered under the plan closest to his/her home address.

The TRS-ActiveCare Select Whole Health plans are a different way of receiving care. Participants have access to a local network of primary care doctors, specialists, nurses and hospitals dedicated to keeping participants healthy and providing the right care when they need it.  Their care is led by the primary care doctor. Health care is coordinated within the Whole Health team to provide a better experience.

Eligibility:

All full-time employees who work at least twenty (20) hours per week are eligible for medical coverage. The employee has the choice of:

(1) his or her actively-at-work date, or

(2) the first of the month following the employee’s actively-at-work date Premium is billed for the full month in which coverage begins.

New hires must choose the effective date of coverage within 31 days after the actively-at work date.  The online enrollment system will enroll you in Option #2.  If you are interested in coverage effective your actively-at-work date, you must email InsuranceBenefits@hayscisd.net within 31 days from your date of hire.

Dependent Eligibility

Your eligible dependents include : • Your spouse; • A child under the age of 26 who is: a natural child; an adopted child or child lawfully placed for adoption; a stepchild; a foster child; a child under your legal guardianship.

Common Law Spouse is not considered eligible for coverage unless there is a Declaration of Informal Marriage field with an authorized government agency. To add a Common Law Spouse, please have proof of Declaration of Informal Marriage from the government agency that it was filed with and contact HR Benefits at InsuranceBenefits@hayscisd.net.

Grandchild under age 26 whose primary residence is the household of the employee and who is a dependent of the employee for federal income tax purposes for the reporting year in which coverage of the grandchild is in effect. To add a Grandchild, please have proof of your current Income Tax return that was filed with the IRS and contact HR Benefits at InsuranceBenefits@hayscisd.net .

Any Other Dependent under the age of 26 in a regular parent-child relationship with the employee, MUST MEET ALL (4) four of the following requirements:

  1. The child’s primary residence is the household of the employee;
  2. The employee provides at least 50% of the child’s support;
  3. Neither of the child’s natural parents resides in that household; and
  4. The employee has the legal right to make decisions regarding the child’s medical care.*

*This requirement only applies to children under the age of 18.

A dependent does not include a brother or a sister of an employee, unless the brother or sister is an individual under age 26 who is either: (1) under the legal guardianship of an employee, or (2) in a regular parent-child relationship with an employee, as defined in the “any other dependent” category above. Parents and grandparents of the covered employee do not meet the definition of an eligible dependent.

Note: It is against the law to elect coverage for an ineligible person. Violations may result in prosecution and/or expulsion from the TRS-ActiveCare program for up to five years.

Benefit Forms

Aetna Medical Claim Form

Member Authorization to Release Personal Health Information

Continuation of Coverage for Handicap Child

Enrollment Opportunities for Same Sex Spouses

Enrollment Form

Request for Continuation of Coverage for Handicapped Child Form

Attending Physician Statement Form

Search Prescription Cost

Wellness

Maternity

 

Teladoc Logo

Talk to a doctor anytime
1-855-835-2362

As a TRS-ActiveCare plan participant you and your eligible dependents have 24/7/365 access to U.S. board-certified doctors and pediatricians by phone.

Teladoc can treat conditions like:

  • Cold and flu symptoms
  • Allergies
  • Bronchitis
  • Ear infections
  • Respiratory infections
  • Sinus problems
  • Skin problems
  • …and More

The consultation is covered at 100% for ActiveCare Select plan and ActiveCare 2 plan. Under the ActiveCare 1-HD plan your cost is a $40 consultation fee that counts towards your deductible and out-of-pocket maximum. To Learn more check out this video!

Get Started

  • Visit Teladoc online at www.teladoc.com/trsactivecare and click on “Set Up Account.”
  • Download the mobile app at www.teladoc.com/mobile.
  • Text “Get Started” to 469-804-9918 for instructions on setting up your account.
  • Call 1-855-Teladoc (835-2362) to set up your account by phone.

 

Beginning Right Maternity Program

Join the Beginning Right maternity program

Check out the amazing “Waiting for Baby” video here.

Whether you are thinking about starting a family or you are pregnant now, the Beginning Right Maternity program will provide essential information and even one-on-one support to get off on the right foot.

And it’s all free and confidential.

First, you’ll take the Beginning Right pregnancy risk survey to find potential risk factors that could affect your pregnancy. If your results show that you have an elevated risk level, our nurses will work directly with you to discuss helpful next steps.

Join as soon as you know you’re pregnant and get these extra perks:

  • Knowledge, straight to your mailbox.
    Get educated on prenatal care, labor and delivery, as well as immunization schedules.
  • Free copy of Mayo Clinic’s Guide to a Healthy Pregnancy when you sign up and complete the pregnancy risk survey by your 16th week.
    This book features important milestones, health information and tips to help you better manage your pregnancy and care for your newborn.
  • Information for dads and partners.
    Help them get ready for baby, too!
  • Access to the nicotine-free, Smoke-Free Moms-to-Be® program.
    Get materials and support from one of our nurses to help you quit using tobacco for good.

To participate or learn more about the program, call toll-free 1-800-CRADLE1 (1-800-272-3531), or log in to Aetna Navigator and look under “Health Programs.”

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