TRS-ActiveCare is your money, and we’re making it go further

The Pulse, June 2018

TRS-ActiveCare provides health coverage for more than 440,000 people, and it funds that coverage through a self-funded health plan model. We’ve recently received some questions regarding how this health insurance plan is structured. Many are surprised to find that TRS health care works differently than health insurance available for purchase on the individual market.

The premiums paid by public school employees are combined with district funds (a minimum of $150 per employee per month) and state funds ($75 per employee per month) into a pool that makes up TRS-ActiveCare. The money in this fund is what pays for health care claims.

Each week, Aetna and CVS Caremark―who are paid to administer the plan but do not otherwise receive TRS money―send TRS the medical and prescription drug claims for our members’ care. TRS then pays the claims from the TRS-ActiveCare Fund.

Let’s contrast that with a private, or commercial insurance product. Individuals and companies pay a commercial insurance company to administer health care claims and assume risk. In the private market, health insurance companies are responsible for profit and loss. In a self-funded health plan like TRS-ActiveCare, the plan administrator (Aetna) gets a fixed administrative fee but carries none of the risk.

Educators, public school employees and districts are our critical partners in running TRS-ActiveCare. Together, we are stewards of the TRS-ActiveCare plan. It’s your money, and we must protect it. This duty requires special diligence as we all face the challenge of rising prices in the U.S. health care sector.

These are just a few ways we take action to preserve the TRS-ActiveCare plan:

Encourage use of in-network providers and generic prescription drugs, when possible
Help members find lower-cost health settings like the doctor’s office or urgent care instead of the emergency room
Offer flexible and convenient options like Teladoc and the Informed Health Line
Make health care information easily accessible through The Pulse newsletter
Offer high-quality, value-packed health care models like Accountable Care Organizations

You help us control costs and strengthen the TRS-ActiveCare Fund by being an active participant in your health care decisions and choosing options like those listed above.

Your medical spending is just like any other spending. Always consider the services you really need and take into account what they will cost versus alternative measures. For instance, in a life-threatening emergency, please go to the ER. But if you have a condition like pink-eye, visit your doctor or urgent care instead. In this way, both you and TRS-ActiveCare save money.

You can also take advantage of free preventive programs and wellness visits, which may help you avoid costly medical conditions in the future.

If you’re receiving treatment for a chronic condition, you can save money by regularly meeting with your physician or care staff and taking medications as directed. Compliance has been shown to lower episodes of acute care and provide a better quality of life.

Together, we can make sure that the TRS-ActiveCare Fund is preserved for the future.

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