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FAQs: TRS-ActiveCare

General Questions | Eligibility and Enrollment Questions (TRS Health) | Medical Questions: UnitedHealthcare (UHC) | Prescription Drug Questions: Express Scripts (ESI)

General Questions

What’s the difference between TRS-Care Standard and TRS-Care Medicare?

What are my TRS-Care premiums?

Who should I contact if I have questions?

Eligibility and Enrollment Questions (TRS Health)

Which plan am I eligible for?

How do I apply for Medicare?

What do I do after I enroll in Medicare?

Do I need to buy Medicare Part A?

Do I need to buy Medicare Part B?

What is the Medicare Income-Related Medicare Adjustment Amount (IRMAA)?

How do I send my premium payments?

Why does the TRS-Care Medicare plan have a premium? Some other Medicare Advantage plans don’t.

What is the difference between annual deductible and annual maximum out-of-pocket?

What does and doesn’t count toward my deductible?

What is coinsurance?

If I leave TRS-Care, can I come back?

How do I add a dependent to my existing TRS-Care coverage?

How do I remove a dependent from my TRS-Care coverage?

How do I completely terminate my TRS-Care coverage?

If I terminate TRS-Care coverage, when will my annuity change?

Do I need to do anything to stay enrolled in TRS-Care Medicare?

For Employers Only

If an employer wants to participate in TRS-ActiveCare, can they opt out later?

How and when do employers send TRS-ActiveCare premiums to TRS?

Can an employee or dependent drop coverage during the plan year?

What kind of audit does TRS require for charter schools that participate in TRS-ActiveCare? Is it the same audit that charter schools do for TEA each year?

Who administers COBRA for TRS-ActiveCare?

Because TRS-ActiveCare does not provide optional coverage such as life, dental or vision, who administers existing COBRA enrollees in these plans for entities participating in TRS-ActiveCare?

Medical Questions: UnitedHealthcare (UHC)

What kind of health care plan is TRS-Care Medicare Advantage?

Will I benefit from using an in-network provider instead of an out-of-network provider?

How do I know if my doctor will take UnitedHealthcare?

Does TRS-Care Medicare Advantage cover ambulance services?

Where is the closest 24-hour urgent care, emergency room or hospital covered by UnitedHealthcare?

Do I need a referral to see a specialist? What is the copay?

Is prior authorization required if I go out of network?

Is there a limit to what UnitedHealthcare will pay for my benefits?

Can a provider balance bill me?

Is TRS-Care Medicare Advantage a supplement to existing insurance?

If I travel outside of the U.S., can I use my insurance in that country?

Will UnitedHealthcare coordinate benefits with TRICARE?

How much does a primary care or specialist visit cost?

How much does a virtual care visit cost?

Are routine vision services covered?

Are dental services covered?

How much do I pay if I’m admitted to a hospital?

Is outpatient surgery covered?

Is cataract surgery covered?

Are chiropractor visits covered?

Is acupuncture covered?

Is COVID-19 covered?

Where can I get more information about what the plan covers?

Will I get a new TRS-care medical ID card each year?

What preventive care does the plan cover?

What is the difference between preventive care and diagnostic care?

What is the difference between an Annual Physical and an Annual Wellness Visit?

Do I have to wait 365 days (one year) until my next Annual Wellness Visit?

Are colonoscopies preventive?

Does the plan cover continuous glucose monitors?

Does the plan cover hearing aids?

What is the Renew program?

Will I get $40 every quarter to spend on over-the-counter products?

What health coaching programs are available to me?

Does this plan include SilverSneakers®?

What is a UnitedHealthcare® HouseCalls visit? How do I schedule one?

Does the plan cover a medical alert device?

What is the transportation benefit?

Does the plan cover a caregiver program?

Does the plan offer a fall prevention program?

What help can I get after I am discharged from the hospital?

What coverage is available worldwide?

Prescription Drug Questions: Express Scripts (ESI)

Who is the pharmacy benefit manager (PBM) for TRS-Care Medicare Rx?

What benefits do I have under the TRS-Care Medicare Rx prescription drug plan?

Is my local pharmacy in the network?

Do I need to sign up for a separate Medicare Part D plan?

May I opt out of TRS-Care Medicare Rx?

Does TRS-Care Medicare Rx have the “donut hole” or coverage gap that results in higher out-of-pocket costs during the plan year?

Which medical plans can I have if I enroll in the TRS-Care Medicare Rx prescription drug plan?

I lost my Rx ID card. How can I order a new one?

Where can I access the drug formulary and find out my medication cost?

Do I have to meet the $400 Medicare Advantage deductible before paying drug copays?

How can I check the status of my prescription?

Do I need new prescriptions and a new prior authorization (PA) for the new plan year?

Do I need to re-apply for prior authorizations if I transfer from TRS-Care Standard to TRS-Care Medicare and will my prescriptions transfer to my new plan?

Do I need a prior authorization to get pain medication?

Can I get my Explanation of Benefits (EOB) online?

What is a Retail-Maintenance Pharmacy? How can I find one?

Can I use a CVS Pharmacy to fill my medications?

When will I get the drug formulary for the new plan year?

What do I need to do to get my diabetic test strips at the pharmacy? Do I need a prescription?

Are flu shots covered?

Are there medications Express Scripts does not cover?

What are generic, preferred, and non-preferred drugs?

TRS Health reviewed this page on Feb. 28, 2024.