This Versus That: Health Care Edition

High Deductible Plan Versus Physician-Directed Plan

​With TRS-ActiveCare, you can choose between one high deductible plan and two physician-directed plans. 

To figure out which health plan is best for you and your family, we've highlighted plan features to show you what you can expect. 

Physician-Directed Plans: TRS-ActiveCare Primary and TRS-ActiveCare Primary+ 

These physician-directed plans have a broad statewide network with no regional boundaries. You choose a Primary Care Provider (PCP) to coordinate your care. Other plan features include: 

• copays for doctor visits and generic drugs before you meet your deductible
• no charge for diagnostic labs at your doctor's office or an independent lab
• $0 preventive care
• $0 option for TRS virtual health visits
• specialist visits require a referral from your PCP 

High Deductible (HD) Plan: TRS-ActiveCare HD 

The high deductible plan has a nationwide network with lower premiums. It works with a health savings account (HSA) and has out-of-network coverage. Other plan features include: 

• no PCP required, but recommended
• no referrals for specialist visits
• $0 preventive care
• you must meet your deductible before the plan starts to pay​

In-Network Facility Versus Out-of-Network Provider

When you get services from an in-network facility, some providers in the facility may still be out-of-network. In these cases, the providers can bill only your plan's in-network cost-sharing amount. This applies to: 

• emergency medicine
• anesthesia
• pathology
• radiology
• laboratory
  
• neonatology
  
• assistant surgeon
• hospitalist
• intensivist services 

So, if you get treated by an out-of-network provider at an in-network facility, your plan protects you from surprise billing or balance billing.  

What is balance billing or surprise billing? 

Balance billing is when out-of-network providers bill you for the difference between what your plan agreed to pay, and the full amount the out-of-network provider charges for a service. 

This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. 

Surprise billing is an unexpected balance bill. This can happen when you can't control who gives you care. 

For example, you have an emergency or schedule a visit at an in-network facility but get unexpected treatment from an out-of-network provider.   

Learn more about balance (surprise) billing.

Diagnostic Care Versus Preventive Care

Knowing the difference between preventive care and diagnostic care can help you get the right care at the right time — and save you money. 

Preventive care includes recommended annual vaccinations, wellness exams, and routine screenings and tests. It focuses on keeping you healthy and preventing illness and disease. 

Your TRS-ActiveCare plan covers preventive care visits at 100%. 

Diagnostic care focuses on diagnosing and treating chronic conditions or other health concerns. 

It includes things like monitoring symptoms and ongoing pain management. Talking with your doctor about symptoms of a new or existing condition can also be diagnostic care. 

Examples of Preventive and Diagnostic Care 

Learn more about covered preventive services.

Go Here, Not There

Knowing where to go for the right kind of care can save you time and money. Remember, if you have a life-threatening emergency, go to the nearest hospital or call 911.​

​​

Non-Emergency Care

​Virtual Health — get 24/7 non-emergency care on the phone from a board-certified doctor for: 

• allergies
• cold, fever
• stomach problems 

Primary Care Provider (PCP) — schedule an appointment with your PCP for: 

• minor injury or illness
• no-cost annual wellness exams
• no-cost routine screening 

Retail walk-in clinic — found in stores and pharmacies, these clinics offer low-cost quality care without an appointment for: 

• cold, flu, fever
• infections
• sore or strep throat 

Urgent carecenter – when you need immediate attention that isn't an emergency, go here for: 

• cuts that need stitches
• minor burns
• sprains

​ 

Life-Threatening Conditions

Emergency Room (ER) – If you think your life is in danger, immediately go to the nearest ER or call 911. ERs are for: 

• chest pain
• heart attack
• heavy bleeding
• stroke
• sudden or severe pain
• trouble breathing
• any condition you feel puts your life at risk