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Learn More About Your Enrollment Options

Trying to figure out which health plan is best for you and your family can be overwhelming.

To help make your decision easier, we've highlighted plan features to show you what each plan covers and what you can expect to pay for medical expenses. 

TRS-ActiveCare Primary and TRS-ActiveCare Primary+ Plans

The TRS-ActiveCare Primary and TRS-ActiveCare Primary+ plans are physician-directed plans with a statewide network.*  

This means you choose a Primary Care Provider (PCP) who will manage and coordinate your health care with other providers. Your PCP will refer you to specialists when needed.

Ask your PCP how they handle specialist referrals. Some may use online messaging portals, some may or may not require a visit before a referral.

*Exceptions are available for covered members who live or attend school outside of Texas.

One of these plans may be right for you if:

  • you or a family member has a chronic health condition like diabetes or heart disease that may require frequent doctor visits
  • you or a family member has a risk factor like high blood pressure that needs careful management
  • you want a doctor to actively manage your family's health care and coordinate your care with other providers
  • you want predictable copays for your medical expenses

Benefits and plan features:

  • broad statewide network with no regional boundaries
  • low copays for doctor visits and generic drugs before you meet your deductible
  • medical and pharmacy expenses both count toward your deductible and maximum out-of-pocket amounts
  • access to Member Rewards, where you can earn credit toward future medical expenses
  • $0 specialty drug coverage through PrudentRx
  • $25 copays for insulin
  • no charge for diagnostic labs at your doctor's office or an independent lab
  • $0 preventive care
  • low copays/$0 option for TRS Virtual Health visits

TRS-ActiveCare HD Plan

The TRS ActiveCare HD plan is a high deductible plan with lower monthly premiums than the other plans. You pay the plan's discounted allowed amount for medical expenses until you meet your deductible. After that, you pay only coinsurance, and the plan pays the rest. 

This plan may be right for you if:

  • you or your family members don't have chronic health issues that require care coordination
  • you don't have many doctors' appointments
  • you want the freedom to choose any provider, even out-of-network
  • you live in Texas, but get care from providers in another state

Benefits and plan features:

  • broad nationwide network, including in-network coverage outside of Texas
  • lower premium
  • higher deductible
  • higher coinsurance rate
  • you must meet your deductible before the plan starts to pay for non-preventive care
  • no PCP required (but recommended)
  • no referrals for specialist visits
  • out-of-network coverage
  • works with a Health Savings Account
  • no-cost preventive care

Understanding Your Family Deductible and Out-Of-Pocket Limits

For all TRS-ActiveCare plans

The deductible is the yearly amount you pay for covered health care services before your plan starts to pay. All health plans pay for certain preventive benefits and medications before you meet your deductible.

Every covered family member has a deductible and maximum out-of-pocket amount. The family all together also has a deductible and maximum out-of-pocket amount.

With all TRS-ActiveCare plans, individuals need to only meet their own deductible before the plan begins to pay coinsurance.

How deductibles work:

  • Claims that count toward a person's deductible also count toward the family's deductible. Once family members meet their individual deductible, they pay coinsurance and copays. These don't count toward the family deductible.   
  • After any combination of family member expenses add up to the family deductible, the entire family pays only coinsurance and copays for medical care and prescriptions for the rest of the year.
  • This means once you and your family meet your limits, you'll start paying only your copays (if any) and coinsurance sooner.

How maximum out-of-pocket limits work:

  • An individual's deductible, copays, and coinsurance count toward individual and family maximum out-of-pocket limits. Once an individual meets their maximum out-of-pocket limit, the plan covers their allowable expenses at 100% for the rest of the year.   
  • After any combination of family members meets the family's maximum out-of-pocket limit, the family's medical care and prescriptions are covered at 100% for the rest of the year.

To see more enrollment information all in one place, including the Annual Enrollment Guide, Annual Enrollment Video, wellness benefits, where to go for care and more, review the Enrollment Toolkit.