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Teachers Retirement System

 Not eligible for Medicare?

The Pulse, June 2017 (Updated August 2017)

What you need to know about your 2018 TRS-Care health benefits

Beginning Jan. 1, 2018, the health plan options listed in your 2017 materials will no longer be available.

As a result of recent legislation passed by the 85th Texas Legislature, all TRS-Care retirees and covered spouses and dependents who are not eligible for Medicare will be transitioned to a new health plan.

Once you meet your annual deductible, the 2018 health plan will pay 80 percent of your eligible in-network medical and prescription expenses. Preventive services, such as your annual physical, cancer screenings, immunizations and flu shots, will still be available at no cost to you.

How the 2018 health plan works

How the 2018 health plan works
Plan detailsIn-networkOut-of-network
Deductible for medical and prescription expenses$1,500 individual
$3,000 family
$3,000 individual
$6,000 family
Maximum out-of-pocket for medical and prescription expenses $5,650 individual
$11,300 family
$11,300 individual
$22,600 family
Coinsurance for medical and prescription expensesYou pay 20% after meeting your deductibleYou pay 40% after meeting your deductible
Teladoc ​– Board-certified doctors diagnose, treat and write prescriptions via phone or video, available 24/7$40 consultation
Coverage for certain generic drugsNo cost for certain maintenance medications taken to prevent or treat chronic conditions. The list is available on the CVS Caremark website.

 

Monthly premiums for non-Medicare retirees in 2018
Retiree/Surviving Spouse Only: $200*
Retiree + Spouse: $689
Retiree/Surviving Spouse + Child(ren): $408**
Retiree + Family: $999

*TRS-Care will no longer offer a $0 premium health plan option for retiree-only coverage. Retirees will pay $200 for retiree-only coverage beginning Jan. 1, 2018.

**Retirees without Medicare who cover disabled children will have their monthly premiums reduced by $200. Their monthly premium for the Non-Medicare Retiree + Children tier will be $208. For the Non-Medicare Retiree + Family tier, their monthly premium will be $799.

In addition, the plan year is changing to a calendar year, with the new plan beginning on Jan. 1, 2018 (instead of Sept. 1, 2017), providing you an additional four months to prepare for the change. This also means that your deductibles and maximum out-of-pocket amounts will not start over until Jan. 1, 2018.

The vendor for our prescription drug plan is also changing. Beginning Sept. 1, 2017, CVS Caremark will become the new administrator for pharmacy benefits. Stay tuned for more information on this transition in the coming months.

Important Update

The Texas Legislature convened on July 18, 2017 for a special legislative session and passed legislation providing additional funding to TRS-Care. On Friday, Sept. 1, 2017, TRS’ Board of Trustees passed a motion to apply additional funding from the special legislative session to reduce deductibles from $3,000 to $1,500 for TRS-Care non-Medicare participants and decrease premiums for TRS-Care Medicare-eligible participants. In addition, premiums for retirees with disabled children were reduced by $200. The plan information on our website has been updated to reflect these changes. Plan participants will receive additional information including an invitation to an in-person information session in their area and new plan guides by mid-November with details about the 2018 plans.

 

Why the change?

TRS-Care is a self-funded health benefits program, which means the cost of every member’s health care is paid by premiums, and funds from schools, the state and active employees. Due to rising health care costs, TRS-Care was in danger of becoming too expensive to continue. These changes to the program — as well increases to premiums and additional funding from the Texas Legislature — help ensure its sustainability for you, as well as for future retirees.

What’s not changing?

Doctors play significant roles in your lives and we have worked to insure you still have the same broad choice of quality doctors, useful tools and resources that can help you get a clear picture of your new health care costs.

Planning to retire due to a disability?

If you are planning to retire due to a disability, you will pay the premium listed on this page.

Already retired through a disability?

If you retired prior to Jan. 1, 2017, receive TRS disability benefits, and are not eligible for Medicare, you won't pay a premium in the 2018 plan year (Jan. 1 - Dec. 31, 2018).

 

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