TRS-ActiveCare Rates and Benefits for FY 2015 – Part 2

Betsey Jones and Bill Hickman, Gabriel, Roeder, and Smith

June 6, 2014

2

TRS-ActiveCare 3 Recommendations

FY 14 TRS-ActiveCare 3 closed to new participants

FY 14 rates raised 25% Only 4,425 employees currently enrolled (1.6%) Eliminate ActiveCare 3 and move participants to

ActiveCare 2

3

TRS-ActiveCare 1HD Benefit Recommendations

2013-2014 Plan Design

2014-2015 Plan Design

Individual Deductible $2,400 $2,500

Family Deductible $4,800 $5,000

Individual Out-Of-Pocket Maximum $3,850 $6,350

Family Out-Of-Pocket Maximum $4,200 $9,200

Teledoc Physician Services N/A $40 consultation fee

Out-of-pocket maximums for FY 15 include deductibles, coinsurance, and copayments in compliance with the Affordable Care Act

4

TRS-ActiveCare 2 Benefit Recommendations

2013-2014 Plan Design

2014-2015 Plan Design

Individual Out-Of-Pocket Maximum $4,000 $6,000

Family Out-Of-Pocket Maximum $8,000 $12,000

Specialty Drugs $200 copay per fill $200 copay for up to a 31 day supply: $450 copay for a 32-90 day supply

Teladoc Physician Services N/A 100% covered

Quest Lab Services N/A 100% covered

Out-of-pocket maximums for FY 15 include deductibles, coinsurance, and copayments in compliance with the Affordable Care Act

5

TRS-ActiveCare Select

New statewide self-funded Exclusive Provider Organization (EPO) plan

Similar to an HMO No out-of-network benefits (except for

emergencies)

6

TRS-ActiveCare Select

Accountable Care Organization (ACO) limited network in 4 urban areas:• Memorial Hermann ACO in Houston• Baylor ACO in Dallas• Seton ACO in Austin• Baptist ACO in San Antonio

Statewide EPO network outside of 4 urban areas

7

TRS-ActiveCare Select

Plan Benefit Overview

Individual Deductible $1,200

Family Deductible $3,600

Individual Out-of-Pocket Maximum* $6,350

Family Out-of-Pocket Maximum* $9,200

Bariatric Surgery Not covered

Quest Lab Services 100% covered

Teladoc 100% covered

*Same as TRS-ActiveCare 1-HD

8

TRS-ActiveCare Select

Same drug benefit as ActiveCare 2 except:• 50% coinsurance for non-preferred brand drugs• 20% coinsurance for specialty medications

9

TRS-ActiveCare Rates

Goal is to balance premium increases against the need to build the fund balance to protect the plan

Target is one month of claims, $145 million

10

TRS-ActiveCare Rates

Proposed rates assume that the Board adopts staff recommendation regarding HMO offerings.

Alternative rates will be provided at the Board meeting in the event that the Board does not adopt staff recommendation

11

TRS-ActiveCare 1HD Proposed Rates

TRS ActiveCare 1-HD FY 2014 Rate Proposed

FY 2015 Rate Increase

Employee Only $325.00 $325.00 0%

Employee and Spouse $794.00 $850.00 7%

Employee and Child(ren) $572.00 $572.00 0%

Employee and Family $1,060.00 $1,145.00 8%

12

TRS-ActiveCare Select Proposed Rates

TRS ActiveCare Select FY 2014 Rate Proposed FY

2015 Rate

Employee Only N/A $450.00

Employee and Spouse N/A $1,044.00

Employee and Child(ren) N/A $709.00

Employee and Family N/A $1,238.00

13

TRS-ActiveCare 2 Proposed Rates

TRS ActiveCare 2 FY 2014 Rate Proposed FY

2015 Rate Increase

Employee Only $529.00 $555.00 5%

Employee and Spouse $1,203.00 $1,287.00 7%

Employee and Child(ren) $841.00 $875.00 4%

Employee and Family $1,323.00 $1,323.00 0%