The new TRS-ActiveCare plan year starts Sept. 1 for the 2024-25 school year . We want to make sure you have a clear understanding of your plan benefits, plan changes and programs available .
Overview of Benefits
There are three TRS-ActiveCare plans available for new enrollees – TRS-ActiveCare Primary, TRS-ActiveCare Primary+ and TRS-ActiveCare HD. These plans differ in what you pay for premiums, coinsurance, deductibles, and maximum out-of-pocket amounts .
| Plan | Coinsurance | Deductibles | Maximum Out of Pocket | Copays |
|---|---|---|---|---|
| TRS-ActiveCare Primary | 30% after deductible | Individual: $2,500 Family: $5,000 | Individual: $8,050 Family: $16,100 | PCP: $30 Specialist: $70 |
| TRS-ActiveCare Primary+ | 20% after deductible | Individual: $1,200 Family: $2,400 | Individual: $6,900 Family: $13,800 | PCP: $15 Specialist: $70 |
| TRS-ActiveCare HD | 30% after deductible | Individual: $3,200 Family: $6,400 | Individual: $8,050 Family: $16,100 | N/A |
TRS-ActiveCare Primary and TRS-ActiveCare Primary+ are physician-directed plans. Meaning, your Primary Care Provider manages your health care and coordinates your care with other providers. An overview of these plans include:
- low copays for doctor visits and generic medications before you meet your deductible
- combined medical and pharmacy deductibles and maximum out-of-pocket amounts
- no charge for diagnostic labs at your doctor's office or at an independent, in-network lab
- preventive care is 100% covered
- a low copay for TRS Virtual Health visits
- PCP required
- specialist visits need a referral from your PCP
- broad statewide network with no regional boundaries
- flexibility to offer out-of-network coverage to dependents who live out of state
- predictable cost-sharing with set copays
- prescription benefits , including coverage for specialty medications
TRS-ActiveCare HD is a high-deductible plan that works with a health savings account (HSA) . An overview of this plan includes:
- higher deductible
- must meet your deductible before the plan starts to pay
- no PCP required
- no referrals needed for specialist visits
- broad nationwide network with coverage outside Texas
- out-of-network coverage
- prescription benefits , including coverage for specialty medications
- works with an HSA
To learn more about your benefits, review the Coverage and Benefits section on our website .
Plan Changes
TRS-ActiveCare HD
- Individual and family maximum out of pocket increased to meet IRS guidelines.
- Individual and family deductibles increased to comply with IRS HSA requirements.
TRS-ActiveCare Primary
- Individual and family maximum out of pocket increased .
These Changes Apply to All Plans:
- Starting Sept. 1, 2024, prior authorization will be referred to as Recommended Clinical Review (RCR). The RCR is an optional review of certain services, procedures and treatments to determine if they are medically necessary.
- The Blue PointsSM rewards online shopping mall will retireat the end of 2024 [CD1]. Physical merchandise will be transitioned to e-gift cards.
- Your deductible resets Sept. 1, 2024. This happens every new plan year.
Like always, TRS-ActiveCare plans include:
- 100% covered preventive care
- broad provider networks
- low copays
- extensive mental health benefits
- specialty drug coverage
- wellness benefits including $0 cost one-on-one health coaching ; Ovia Health TM for prenatal care, pregnancy, parenting, and menopause support; and the Fitness Program .
Programs Included in Your Plan
Whether you want to work on your diet or fitness, focus on saving money or improve your mental health, we have you covered.
Through Blue Access for MembersSM (BAMSM ), you and your family have access to online resources filled with practical and useful information. With BAMSM, you can:
- check the status or history of a claim
- view and print Explanation of Benefits statements
- search for an in-network health care provider, hospital or pharmacy
- request a new or replacement ID card or print a temporary one
- access programs and services
Doctors and Hospitals
- Use Provider Finder® to find a doctor, hospital or other type of medical care. You can search by location, gender or specialty . You can also research providers using patient reviews, certifications and recognition information.
Health and Fitness
- The Fitness Program offers affordable, no-contract memberships at gyms nationwide . Choose what works best for you based on location, budget or personal preference . There's even a virtual-only option ! You'll also save money on wellbeing services like acupuncture, massage and personal training .
- Get one-on-one coaching withcredentialed health experts from Well onTarget® at no added cost! Your coach can help you lose weight, improve your fitness level, manage your diet, improve your blood pressure, and more
Mental Health Care is Health Care
- In-Person – See an in-network therapist, psychiatrist or other mental health professional . Headway is a new program that makes finding mental health providers and scheduling appointments easier.
- Virtually – Use Teladoc to speak with a licensed mental health provider online or over the phone.
- Digitally – Learn to Live is a digital mental health program available at no added cost to you. Its programs can help you with stress, anxiety, depression, substance abuse, and more .
Women’s and Family Health
- Your TRS-ActiveCare plan provides support for your health in every stage of life including pregnancy, parenting and menopause with Ovia Health TM apps. Each app offers daily personalized articles and tips to achieve your goals, unlimited messaging with registered nurses and real-time health data .
- Well onTarget also offers digital self-guided courses to support healthy pregnancies through every stage. Topics include healthy foods, body changes and labor
Save Money
- Get rewards for your hard work through Blue Points SM . Earn points for completing healthy activities like joining the Fitness Program and working out. Spend them in the online shopping mall when you're ready to treat yourself.
- Earn up to $599 per plan year when you use Member Rewards for certain procedures like MRIs, CT scans, colonoscopies, and more.
Have a question? Personal Health Guides (PHG) are your plan experts. They help make it easy to understand your health plan and maximize your benefits . Connect with a PHG by calling 1-866-355-5999 or chatting through the BCBSTX App , available in the Apple App Store or Google Play Store .
You can find all this information and more in the Enrollment Toolkit.