What is regional pricing?
Just like gas or groceries, the price of health care can be different from place to place. Regional pricing localizes premium rates to where you work.
Starting on Sept. 1, 2022, TRS-ActiveCare premiums will vary by your Education Service Center (ESC) region. There are 20 regions in Texas.
The only difference in your plan is how it’s priced. TRS-ActiveCare participants still have:
- the same plan options,
- benefits that personalize their care, and
- statewide and nationwide networks.
Why did TRS-ActiveCare switch to regional pricing?
Health care is personal, not one-size-fits-all. It changes as we age, shift lifestyles, and grow our families. It can even change depending on where we work.
This is why TRS-ActiveCare is moving to regional pricing – so your premium rates and benefits reflect the cost of health care in the area.
Regional pricing also helps us provide your district with more competitive rates while still accessing the stability of TRS-ActiveCare. You still have the same plan options and broad networks.
How will regional pricing affect me?
The only change is how the plans are priced.
You can still access 90% of Texas hospitals and the network with the most doctors in Texas. And you don’t need to limit where you seek care. If you work in Region 1 but want to see a doctor in Region 2, you can!
While pricing is more localized, you still benefit from TRS-ActiveCare's strength, stability and networks. Other health plans may have greater risk because of their smaller pool of participants.
For example, in a smaller health care plan, a coworker having a high-cost claim like a heart attack or premature birth can result in premium spikes for everyone. With TRS-ActiveCare, the cost is spread across our Texas-sized risk pool, protecting you from unreasonable increases.
How did TRS calculate the regional rates?
We started with the average statewide rate of health care. Then, we adjusted each region's rate based on the cost of care in your ESC.
Lower-cost regions have lower rates than the statewide average. Rates in higher-cost areas have higher rates than the statewide average.
Regional prices vary based on the:
- number of doctors and hospitals in the area
- ability to access care
- demographics of enrolled participants in each region, including ages, gender and health issues
- historical health care costs in your region
- ratio of individual policy holders to policy holders with dependents in your region
For example, if your region has a high rate of chemotherapy treatments, this could make the costs higher than a region where that service isn’t common.
How many regions are there? How will I know what region I’m in?
Regions were set by the 20 Education Service Centers (ESCs) in Texas. Your rate is based on the ESC of your employer. If you don’t know which ESC that is, review the TRS-ActiveCare participating districts by Education Service Center list (pdf).
What if I change regions during the school year?
It depends on whether or not your new employer participates in TRS-ActiveCare.
If your new employer participates in TRS-ActiveCare but is in another ESC region, your premium amounts change to reflect the new region. This would happen on the first of the month after your termination with the old employer.
If you decide to switch jobs and move to an employer that doesn't use TRS-ActiveCare, you would enroll in a health plan offered by that employer.
I work in a different region than where I live. Which region's price will I pay?
Regardless of where you live, you'll pay the premiums for the region where you're employed. However, this will not limit where you seek care. You can see in-network doctors and use facilities in any region.
Will TRS regionally price plans every year moving forward?
Yes. TRS will regionally rate plans in the 2022-23 plan year and moving forward.
Can I still see doctors and use facilities outside my region?
Yes. You can see doctors and visit facilities outside your region as long as they're in-network for TRS-ActiveCare.
Regional pricing doesn’t impact your network. You still have access to the plan with the most Texas doctors and 90% of Texas hospitals.
Remember that if you’re enrolled in TRS-ActiveCare Primary or TRS-ActiveCare Primary+, you can only see your Primary Care Provider (PCP) or specialists referred by your PCP.
Will premiums be higher or lower in my region?
Premiums vary by region, depending on the ESC of your employer.
If you're in a lower-cost region, your premium will be lower than average. If you're in a higher-cost region, your premium will be higher than average. The cost of care in each area will determine premiums (see How did TRS calculate the regional rates? question above).
Why did premiums go up in my region and down in the region next to mine?
If your premium went up, your district’s region could have a higher cost than the statewide average. This could be due to population factors such as age, gender and health issues/treatments.
For example, if your region has a high rate of chemotherapy treatments, this could make the overall premium costs higher than a region where that service isn’t common.
It could also be that your region has fewer doctors and hospitals, or participants may cover more dependents.
Will TRS offer the same health plans and benefits in every region?
Yes. All regions have access to the same TRS-ActiveCare plans and benefits. Only the premiums are different between regions.
More information about the 2022-23 TRS-ActiveCare plans will be available in April 2022.
Are there any changes to my plan or benefits besides pricing?
No. TRS-ActiveCare plans and benefits are not changing for the 2022-23 plan year. Your benefits can continue to customize health care to your needs and help remove confusing barriers.
You still have access to things like:
- 24/7 customer service through Personal Health Guides
- Health advocates who can work directly with your doctors
- One-on-one coaching to help you reach wellness goals
- Copay plans so you pay a set amount for your medical visits
- Zero-to-low-cost telemedicine for care anytime, anywhere
- And more!