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Help participants choose the right TRS-ActiveCare health plan and get the most out of their health care coverage!
With three great TRS-ActiveCare plans to choose from, it can get overwhelming - but it doesn't have to be! Learn more about the TRS-ActiveCare health plans available to employees.
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EDDIE: Action.
JENNA: Hi. I'm Jenna. And behind the camera is my husband, Eddie. And we explore the ins and outs of health insurance. It's easy to pick the plan with the lowest premium and go with it, right? But there's more to getting the right coverage.
Ask yourself these questions as a starting point. Are you and your family generally healthy and mainly need preventive care? Are you or a family member managing an ongoing health condition that requires frequent doctor visits and specialty drugs? Are you planning to start or add to your family? Are your preferred doctors in network? You can check that in Provider Finder online or on your phone. It's really easy to use.
There are three plans-- TRS ActiveCare Primary, TRS ActiveCare Primary+, and TRS ActiveCare HD. Some people choose TRS ActiveCare Primary when they mainly use their coverage for preventive care or a few doctor's appointments. That's because it has the lowest premium.
People with health conditions like asthma or a heart condition need more care, and might lean toward TRS ActiveCare Primary+. The premiums are higher, but there's more coverage, so overall you may end up spending less. You can see the lower deductibles, coinsurance, and maximum out-of-pocket on Primary+.
The deductible is the highest of the three plans on TRS ActiveCare HD. The Primary plans have a statewide network, the largest in Texas. HD has a nationwide network, so you can see providers outside of Texas.
The HD plan also has out-of-network coverage, but you'll pay less with an in-network provider. With 90% of Texas hospitals in network, you won't have a problem finding in-network care on any TRS ActiveCare plan.
The other main difference is you're required to have a Primary Care Provider, or PCP, on TRS ActiveCare Primary and TRS ActiveCare Primary+, and your PCP gives you a referral when you need a specialist. That's not required on the TRS ActiveCare HD plan.
Now let's dive deeper into the plans. My first guest is Kiana. She's a 3rd grade teacher, newly married, and has two adorable puppies. She has questions about her Primary plan.
So of the three plans, TRS ActiveCare Primary has the lowest premium, so you're paying less per month for your coverage. If you mainly use your coverage for preventive care, which, remember, is no cost on every TRS ActiveCare plan, or if you only use it once in a while for a minor illness or injury, this plan could be a good choice for you.
KIANA: Other than the premium, what are the main differences between this plan and the other two?
JENNA: So TRS ActiveCare Primary has copays for doctor visits before you meet your deductible. So you go to your primary care provider, or PCP, for a sore throat. The cost for the visit is $350, and you still have $2,000 left to meet your deductible. But with this plan, you don't pay $350. You only pay your copay. Set copays make it easier to predict your medical expenses.
With this plan, you do have to choose a PCP who can refer you to specialists when you need one. The Primary plan also has a statewide network, and 90% of all Texas hospitals are in network, so you have choices. Finally, the Primary plan doesn't have out-of-network coverage. So if you do see a provider who's not in network, you will have to pay the total cost of your care.
KIANA: Thank you so much, Jenna.
JENNA: Thank you for being here.
My next guest is Amy, an avid runner. She's training for a marathon, and she has some great questions about her Primary+ plan.
Hey, Amy. Welcome to our channel.
AMY: Thanks so much for having me.
JENNA: So of the three plans, TRS ActiveCare Primary+ has the lowest deductible. It also has the lowest maximum out-of-pocket. So even though it has a higher premium than TRS ActiveCare Primary and TRS ActiveCare HD, it's a better value if your family needs more care, like if anyone in the family has a chronic condition, or your kids play sports, or you have young kids just starting school.
AMY: Where they'll be around all those germs for the first time.
JENNA: Exactly.
AMY: What are the main differences between this plan and the other two?
JENNA: Well, just like the primary plan, TRS ActiveCare Primary+ has copays for doctor visits before you meet your deductible. Let's say you go to your primary care provider, or PCP, for a sore throat. The cost of the visit is $350, but you still have $1,000 left to meet your deductible. With this plan, you don't pay $350. You only pay your copay.
Primary+ also has the lowest costs for things like emergency care, preferred and specialty drugs, X-rays, and lab work. Other than that, this works just like the Primary plan. You'll choose a PCP to manage your care and refer you to specialists in a statewide provider network, the largest in Texas, with no out-of-network coverage. And that statewide network includes 90% of all Texas hospitals.
AMY: Wow. Thanks for letting me know, Jenna.
JENNA: My next guest is Luis. He's a gym teacher and loves playing pickleball. I'll answer his questions about his HD plan.
Hey, Luis. How about we take a closer look at the TRS ActiveCare HD plan?
LUIS: Sounds good.
JENNA: So the TRS ActiveCare HD works differently than the other two plans. It's a high-deductible plan that works with a Health Savings Account, or HSA. It has the highest deductible of all plans and uses coinsurance instead of copays. Preventive care is no cost like the other plans, but unlike the other plans, you have to meet your deductible before the plan pays for nonpreventive care. Yes, that was a mouthful.
So let's use the sore throat example from the Primary and Primary+ videos. Your visit costs $350. You have $2,000 left to meet your deductible, so you pay the whole $350. Once your deductible is met, you'll pay 30% of the cost of your care, and your plan will pay the rest. That's coinsurance. So if you'd already met your deductible, your appointment would cost $105.
But the HD plan also has out-of-network coverage, so your coinsurance for that same appointment with an out-of-network doctor is 50%, not 30%. That means you'd pay $175 instead of $105.
LUIS: That makes sense. What's an HSA?
JENNA: It is a special savings account where you can put money aside, tax-free, to use for health care costs. There's a bit more to it, so we dropped a link below with more details.
LUIS: Are there more differences between HD and the other plans?
JENNA: Yes. The HD plan has a nationwide network. So if you live near the border of, say, Oklahoma and had doctors in both states, you could use them. It's also good for someone who travels for work and needs to get care wherever they are. You don't need to choose a primary care provider, or PCP, with this plan, but it's a good idea to have one anyway. And you don't need a referral from your PCP to see a specialist on the HD plan.
LUIS: Thanks for going over that plan with me.
JENNA: You are so welcome, and thank you for being on the channel. Be sure to check out our other videos and the annual Enrollment Guide for more plan information.
Dive into insurance terminology.
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EDDY: Action.
JENNA: Hi, I'm Jenna.
EDDY: And I'm Eddy.
JENNA: And we explore the ins and outs of health insurance. On today's show, we have Kiana, and we're talking terminology.
KIANA: These terms are so confusing.
JENNA: I hear you, and it can be scary committing to a health plan when you don't understand them. So let's break it down. And we'll start with copay. That is the set amount you pay for a covered service when you get it. So there are examples of copays for seeing your primary care provider, a specialist, getting virtual care, et cetera. And your deductible is the yearly amount you'll pay for covered medical expenses before your insurance starts paying.
So if your plan starts September 1 and on September 2, you break your leg, the total cost to fix your leg is, let's say, $5,000, and your individual deductible is $2,500. You pay that $2,500 and then co-insurance kicks in. Co-insurance is the percentage of costs you pay after you've paid your deductible. If it's 70% and 30%, your plan pays 70% of the remaining $2,500 and you pay 30%. That 70/30 split continues until you have met your maximum out of pocket.
This is the most you pay for medical costs during the plan year. It includes deductibles, co-pays, and co-insurance. Your plan pays 100% of covered services once you've reached that number. Preventive care includes things like annual wellness exams, screenings, and required vaccinations. It's covered at no cost on every TRS ActiveCare plan.
KIANA: Thank you. I have much more clarity now.
JENNA: Excellent, and thank you for being here. If you have any questions, call the number below to connect with a plan specialist.
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See which plan fits your lifestyle.
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SPEAKER: Action.
JENNA: Hey there. I'm Jenna.
EDDIE: And I'm Eddie.
JENNA: And we explore the ins and outs of health insurance. Today we have Kiana, and we'll be helping her compare the benefits of each plan.
KIANA: Hi, Jenna. I need help comparing the benefits of the three TRS ActiveCare plans.
JENNA: So the Plan Highlights is the perfect tool for that. I come back to it all the time. So let's go to the enrollment toolkit and click on Plan Highlights. We're dropping the link down below.
There's a version for each region, so anyone who doesn't know their region can go to the link below. So we click on the dropdown, choose our region, and click Download. Down the left side of page 2, you'll see the wellness benefits. Every plan has preventive care, health coaching, and Ovia pregnancy support at no cost.
For things like virtual health, the costs differ. You can see it's more on the TRS ActiveCare HD plan.
KIANA: This is great.
JENNA: Right? There's a plan summary at the top of page 2. While you're thinking about switching from the HD plan to one of the primary plans, this is a great resource. Under that is a detailed breakdown of costs. I love that you can price a typical doctor's visit, urgent care visit, or prescription.
KIANA: This is so helpful. Thank you.
JENNA: Isn't it a great tool? Hope you found this helpful. See you on the next one.
Estimate what an actual year of expenses looks like.
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EDDY: Action.
JENNA: Hi, I'm Jenna.
EDDY: And I'm Eddy.
JENNA: And we explain the ins and outs of health insurance. On this episode, we have Luis, a gym teacher who loves pickleball, and he brought some great questions about health insurance.
Hey, Luis, are you ready to talk about your real insurance costs?
LUIS: Hey, I'm excited to learn more.
JENNA: Excellent. So today, we're not talking just about your monthly premiums, but figuring out what an actual year of expenses might look like. So we're using this great tool that lays out the costs you know first, and then you estimate the rest. I say estimate because you can't know everything that's going to happen throughout the year.
LUIS: Right, but this will definitely help us make an informed decision.
JENNA: Exactly. So part one, the Plan Costs section with the premiums, deductibles, copays, coinsurance and maximum out of pocket for each plan. Part two is all about you. So you'll input info based on how much care everyone in the family might need. Remember, preventive care is included at no cost on all TRS ActiveCare plans, so don't count that in your estimate. And that includes annual wellness visits, preventive care screenings, and immunizations.
LUIS: How do you figure out how to estimate?
JENNA: Start with last year. How many times did you go to the doctor or urgent care and what did your prescriptions cost?
LUIS: OK.
JENNA: Now, think about this year.
LUIS: There are some changes there.
JENNA: OK, is anyone in the family managing a new health condition?
LUIS: That's changed too.
JENNA: All right. And now think about mental health. TRS ActiveCare has excellent mental health benefits for both in-person and virtual therapy. Factor that in if you think you'll use that benefit. And then in part three you'll calculate your total costs. You might see when you add up the numbers that a different plan makes better sense.
LUIS: Thank you, Jenna. This is very helpful.
JENNA: And thank you for being here today. Be sure to check out our other videos to learn more about your annual enrollment and your TRS ActiveCare plans. I hope you found this video helpful. We'll see you on the next one.
Learn more about your monthly costs.
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EDDY: Action.
JENNA: Hi, I'm Jenna.
EDDY: And I'm Eddie.
JENNA: And we explore the ins and outs of health insurance. We are welcoming back Amy with further questions about her health insurance plan.
Hey, Amy, I hear you have another great question about benefits.
AMY: Yeah, how do I figure out my monthly payment?
JENNA: The first thing you need to know is premiums are different depending on which region you're in. Make sure to check your region for your premium before you do anything else. You can find that at the link below.
AMY: Where do I find my district contribution?
JENNA: Go to your district website. Let's use Dallas ISD as an example. Contributions differ by district, so make sure you're looking at your school district. So we'll click on Departments, and look for Benefits or Human Resources. There it is. Click on Benefits and voila. Now you can call or email to ask what your combined state and district contribution is. Then take that number and subtract it from the plan premium. That is your magic number.
AMY: Thank you. I get it now.
JENNA: Good. That's what we're here for.
For more health care content, be sure to watch our other videos linked below.
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Know what to expect.
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CREW: Action.
JENNA: Hi, I'm Jenna.
EDDIE: And I'm Eddie.
JENNA: And we explored the ins and outs of health insurance. On today's episode, we have Amy, an avid runner.
EDDIE: She's training for a marathon.
JENNA: And she has a lot of great questions about her insurance.
Hi, Amy, welcome to the channel. Do you have any questions for us about your health insurance?
AMY: I'm not sure when I'll get my ID card in the mail.
JENNA: So you should get your ID card a few weeks after you enroll. But it's so easy to get a digital copy of your ID card, there's really no reason to worry about carrying around a physical card anymore. Just download the BCBSTX app or visit Blue Access for members to get a copy anytime you need it. But you can't log in to BAM or use the app without your ID number and group number. If you're an existing participant, you can log in, with your current ID number and get up-to-date information. But anyone new to TRS-ActiveCare won't have that information yet. There's an easy fix. Just call 1-866-355-5999 to talk to a plan specialist.
AMY: Thank you. That's so helpful.
JENNA: You're so welcome. It was a pleasure having you on the channel. Check out our other videos for more useful information about picking a plan and using your insurance. We'll see you on the next one.