TRS-ActiveCare Rates and Benefits for FY 2015 Part 2

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

June 6, 2014
TRS-ActiveCare 3
Recommendations
2
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

TRS-ActiveCare 1HD Benefit
Recommendations
3
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
TRS-ActiveCare 2 Benefit
Recommendations
4
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
TRS-ActiveCare Select
5
New statewide self-funded Exclusive Provider
Organization (EPO) plan
Similar to an HMO
No out-of-network benefits (except for
emergencies)

TRS-ActiveCare Select
6
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

TRS-ActiveCare Select
7
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
TRS-ActiveCare Select
8
Same drug benefit as ActiveCare 2 except:
50% coinsurance for non-preferred brand drugs
20% coinsurance for specialty medications


TRS-ActiveCare Rates
9
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




TRS-ActiveCare Rates
10
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





TRS-ActiveCare 1HD
Proposed Rates
11
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%
TRS-ActiveCare Select
Proposed Rates
12
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
TRS-ActiveCare 2
Proposed Rates
13
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%