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