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New Headquarters

Please note TRS Headquarters in Austin moved to a new address at 4655 Mueller Blvd., Austin, TX 78723 (get directions).  

Questions for Brokers

If you’re looking into health plans outside of TRS-ActiveCare, you’ll want to understand the full picture of what other plans can provide. 

We want you to make the decision that makes the most sense for your district, so we suggest asking brokers these questions about the coverage they offer. 
 

woman talks to pharmacist while looking at phone

Prescription Coverage

  • What drugs are covered and excluded by the prescription pharmacy benefits plan?
     
    • Are specialty drugs included?
    • What coverage is provided for GLP-1s?
       
  • How is your formulary (list of drugs by tier) structured (open, closed formulary) and how does that affect my participants’ costs?
     
  • How do pharmacy rebates, including guarantees, (both through medical and the pharmacy benefits manager) affect my plan?
     
couple shakes hands with doctor in medical lobby

Network Access

  • What network options are included in the plan? Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO)?
     
  • Does the plan you’re being offered have reference-based pricing, or an existing provider network for hospital services?
     
  • How are out-of-network claims handled? (wrap networks with shared savings, percentage of Medicare)
     
  • Are the facilities, primary care providers and specialists my employees use in network?

  • What hospital systems are currently negotiating or at risk with the carrier you are recommending? If a hospital system drops out of the carrier network do you have the ability to set up a direct contract for us with that provider so that we do not lose an important group of providers?

     

woman talks on phone in front of Austin skyline

Claims and Customer Service

  • What type of support would I receive for customer service and to replace my TRS district ambassador?
     
  • What type of customer service performance guarantees will I get?
     
  • Do I have an escalated claim contact with the Medical and PBM carrier assigned only to our account? If not, how will I manage escalated member claim issues?
     
  • Is the customer service line for employees available 24/7?
     
blocks that illustrate health insurance premiums

Premiums and Risk

  • What happens if we have a big increase in large claims during our first year with your program?
     
  • What type of claim target and multi-year premium guarantees could we get from the carriers bidding on our business?
     
  • Will my procurement department have to go out to bid every year for medical-RX to stay competitive with the market? If not, how often will we need to bid our program?
     
  • Are we large enough to have a carrier view our claims as 100% credible? If not, will they just blend us in with all of their business in our area? What risks are there for us in getting blended with other groups that are not school districts?
     
  • Does my district need stop-loss insurance with this plan? How can we secure a firm stop-loss rate for the next plan year? (ASO only)
     
  • Would my district be subject to “lasers” due to high-cost claims?