Health Care Coverage for Youand Your Family!2009-2010 Plan Year Welcome

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Agenda

TRS-ActiveCare Program Highlights– Enrollment Summary– Facts and Figures

What’s New for 2009-2010– ActiveCare 1, 2 and 3, plus new 1-HD option– HMOs

How to Enroll– Who is Eligible to Enroll– Cost of Coverage– Enrollment Support

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Enrollment SummaryPercentage of Employees by Plan • February 2009

HMO Plans10,488

5%

ActiveCare 315,062

7%

ActiveCare 2151,505

70%

ActiveCare 139,84118%

216,896 Employees • 361,918 Members

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Facts and Figures

2006-2007 2007-2008Percent Increase

Billed Charges $2.1 billion $2.5 billion 19%

Medical Claims Transactions

2.9 million 3.2 million 10%

Pharmacy Claims Transactions

2.7 million 3.0 million 11%

Paid Claims—Medical

$656 million $783 million 19%

Paid Claims—Prescription Drugs

$151 million $176 million 17%

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What’s New for 2009-2010?

ActiveCare 1, 2 and 3 4.5 percent premium increase Continued emphasis on health and

wellness One benefit change: Bariatric surgery

New Option! ActiveCare 1-HD Basically same as ActiveCare 1, but

– Higher deductible (meets IRS definition of a high deductible health plan—all coverage categories)

– Slightly lower premium cost (for most coverage categories)

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PPO Network for ActiveCare 1-HD, 1, 2 and 3

Largest PPO network in the state

Includes over 50,000 physicians and over 400 hospitals in Texas

Available in all 254 Texas counties

Advantages to using network providers Receive highest level of benefits

No claims to file

No balance billing

www.trs.state.tx.us/trs-activecare

www.bcbstx.com/trs

Need to locate a Provider?

Plan Overview – Network Level of Benefits

Plan Features ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Deductible (individual/family)

$2,300/$2,300 $1,150/$3,000 $500/$1,500 None

Out-of-Pocket Maximum

(does not include deductibles)

$3,000/$5,000 $2,000/$6,000 $2,000/$6,000 $1,000 per individual

Coinsurance

(Plan pays/participant pays)

80% / 20% 80% / 20% 80% / 20% 80% / 20%

Illustrates benefits when network providers are used. Non-network benefits are also available; see Enrollment Guide for more information.

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Plan Overview – Network Level of Benefits

Services ActiveCare 1-HD

ActiveCare 1 ActiveCare 2 ActiveCare 3

Office Visit Copay 20% after deductible $25 for primary

$35 for specialist

$20 for primary

$30 for specialist

Preventive Care Routine physicals* Well-woman exams* Routine mammograms* Eye exams* Well-baby exams Immunizations Hearing exams PSA screenings Colorectal screenings Osteoporosis

screenings

* Services limited to one per person per plan year

$0 copay up to $500 per person, per plan year

Remaining charges subject to deductible and coinsurance

$25 for primary

$35 for specialist

Includes all preventive care

services billed with an office visit by a network doctor

Coinsurance applies when no

office visit is billed or when services

are performed outside the office

(deductible waived)

$20 for primary

$30 for specialist

Includes all preventive care

services billed with an office visit by a network doctor

Coinsurance applies when no office visit

is billed or when services are

performed outsidethe office

(no deductible)

Non-network benefits are also available; see Enrollment Guide for more information.

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Plan Overview – ActiveCare 1-HD vs. ActiveCare 1

Plan Features ActiveCare 1-HD ActiveCare 1

Meets IRS definition of High Deductible Health Plan

and offers opportunity to contribute pretax dollars into a Health Savings Account

(HSA)

Yes, for all coverage categories

(employee only, employee and spouse, employee and child(ren)

and employee and family)

Yes, for employee-only coverage

No, for other coverage categories

Deductible$2,300 for employee only

$2,300 for family

$1,150 per individual

$3,000 per family

Maximum Coinsurance $3,000 for employee only

$5,000 for family

$2,000 per individual

$6,000 per family

Out-of-Pocket Maximum

(includes deductibles)

$5,300 for employee only

$7,300 for family

$3,150 per individual

$9,000 per family

Monthly Premium Cost Less expensive than ActiveCare 1in all coverage categories

except employee and family

More expensive than ActiveCare 1-HD in all coverage categories

except employee and family

Note: The amounts shown for “family” refer to the coverage categories for employee and spouse, employee and child(ren) and employee and family.

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Health Savings Account (HSA)

What is an HSA?– Special account owned by an individual and used to pay out-of-pocket

expenses (such as deductibles) or to grow as savings– May be funded by the employee, the employer or both– Portable, meaning the HSA funds always belong to the individual

Who is eligible? Per IRS rules, any adult can contribute to an HSA if he/she:

– Has coverage under an HSA-qualified high deductible health plan– Has no other first-dollar medical coverage– Is not enrolled in Medicare– Cannot be claimed as a dependent on someone else’s tax return

Does TRS offer an HSA?– No! But ActiveCare 1-HD qualifies as an HDHP for all coverage

categories and ActiveCare 1 qualifies for employee-only coverage

– Employees are not required to have an HSA to enroll in these plans

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What You Need to Know

Participating districts/entities in TRS-ActiveCare are not expected or required to offer HSAs

– You may seek an HSA administrator on your own– No integration with Blue Cross or Medco systems– No tax or legal advice available from TRS or TRS-ActiveCare

customer service; HSA inquiries should be directed to your tax or legal counsel and/or your HSA administrator

ActiveCare 1-HD is not for everyone– You need to look beyond the premium cost– Premium savings may not be enough to justify the additional

deductible and out-of-pocket expenses

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Benefit Change – Bariatric (Weight Loss) Surgery

Important:

Effective September 1, 2009, coverage for bariatric surgery will be available only when performed at one of the Blue Distinction Centers for Bariatric Surgery

List is subject to change: Check online or call Customer Service for most current list

Health and Wellness Programs

ActiveCare 1-HD, 1, 2 & 3 Plans

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Personalized Support.Motivational and lifestyle coaching by clinical professionals

Wellness Coaches

Lifestyle and condition management can be challengingOur Wellness Coaches are here to help

• Personalized telephonic support

• Motivational and behavioral coaching

• Personalized and coordinated goal-setting with action plans

• Communications via US mail

• Monitoring compliance and tracking outcomes

1-800-462-32751-800-462-3275

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Voluntary programs designed for those diagnosed with: asthma, diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disorder, metabolic syndrome (high blood pressure, high cholesterol and obesity), lower back pain, rare conditions or depression

Enrolling in a program can help:– Decrease the intensity and frequency of symptoms– Enhance self-management skills– Minimize missed days at work– Enrich quality of life

Call to enroll or ask questions– Condition management telephone

number is also listed on ID cards

Condition Management Programs

1-800-462-32751-800-462-3275

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Tobacco Cessation ProgramSupport for members who want to quit

Weight Management and Tobacco Cessation

Self-Paced Approach• Online tools and resources via the Personal Health Manager

• Secure e-mail outreach to keep members on track

Personalized Lifestyle Management Support

• Counseling and coaching with licensed Wellness Coaches

• Motivational toolkit• 24/7 Nurseline• Referrals when appropriate

Weight Management Program

Support for a Healthier You

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Special Beginnings®

Special Beginnings helps expectant mothers and their babies get off to a healthy start by providing prenatal and postnatal health education, and guidance from pregnancy to six weeks after delivery

Once enrolled in the program, plan participants receive:

• Pregnancy risk assessment by an experienced obstetric registered nurse to determine risk level of pregnancy and level of outreach needed

• A welcome packet full of product samples, coupons and magazines

• Educational materials on a variety of topics

• Frequent, personal contact with a nurse case manager who helps coordinate care with the mom’s physician

• Immunization schedules

Program components are available in English and Spanish

1-800-462-32751-800-462-3275

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Personal Health Manager (PHM)

Your online wellness experience begins with the Personal Health Manager

Features include: Lifestyle Management tools:

Weight Management Tobacco Cessation Fitness and Nutrition Plans Stress Reduction

Health Risk Assessment

“For Your Health” features Blue PointsSM Rewards “Ask-A” feature – health and

wellness questions via secure e-mail

Online health encyclopedia Interactive symptom checker

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Personal Health Manager – Home Page

Use the Interactive Symptom Checker

Read the latest health news, search for specific health topics or explore the prescription drug index

Ask a Question to a certified Nurse, Trainer, Dietitian or Life Coach

Access MemberCare Profile

Take a Health Risk Assessment

Read secure messages

Review member alerts

Explore topics in the Health Information and Care Center

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Health Risk Assessment (HRA)

Be informed about your overall health and well-being

A Health Risk Assessment helpsassess your health risks, interests and readiness to change Examines your overall health

and well-being

Provides a detailed report with overall health and well-being score and sub-scores for: Medical health, job satisfaction,

life load, risk and lifestyle, mood, nutrition, sleep, stress, pain and body weight

Recommends areas for improvement

Confidential and secure

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Ask the experts.Expert advice from licensed professionalsvia the Personal Health Manager

“Ask-A” Online Advisor

Expert advice at your fingertips.Our “Ask-A” feature is here to help.

Ask a Trainer, Dietitian orLife Coach: Send questions about fitness, nutrition, or managing stress.

Ask a Nurse:Interact online with a Blue Care Advisor on non-emergency, health-related questions using the secure “Ask a Nurse” feature.

CONFIDENTIAL AND SECUREReceive a response within one business day

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Stay motivated.Earn Blue Points in the Personal Health Manager

Blue PointsSM Incentives

TRS-ActiveCare PPO plan participants and their covered dependents accumulate Blue Points in the Personal Health Manager

Complete designated health and wellness activities

Report completed activities in the Personal Health Manager

Track your available balance

Redeem earned Blue Points for a variety of items!

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Advice anytime.Round-the-clock health and the wellness advice from licensed professionals

24/7 Nurseline

Advice isn’t just neededfrom 9 to 5.24/7 Nurseline is here to help. Nurses provide health advice and

information about high fevers, earaches, cuts and bruises and more

Audio health library on topics such as kicking the smoking habit and ways to get a good night’s rest

Available in English and Spanish

24/7 1-800-581-03681-800-581-0368

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Learn more about the Blue Care Connection health and wellness programs online

www.bcbstx.com/trs

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Online member management tool Check claim status, view

and download EOBs (Explanations of Benefits)

Order additional ID cards, and print temporary ID

Monthly health articles Links to health information

and wellness tools and resources, including the Personal Health Manager

Blue Access® for Members

Send secure e-mail messages to BCBS Customer Advocates available Monday thru Friday, 7 a.m. to 10 p.m. (CT)

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Customer Service

1-866-355-5999

What if I Have Questions?

Call TRS-ActiveCare customer service for:– Claim questions/status– Network provider information– Membership and eligibility – Medical coverage questions– Inquiries (telephone and e-mail)– ID card requests– Transition of care information– Help with online tools!

Personalized Service

Prescription Drugs

ActiveCare 1-HD,1, 2 & 3

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Your Medco Prescription Drug Plan

Medco administers your prescription drug plans on behalf of TRS– ActiveCare 1, 2, and 3 and now the

new 1-HD plan Benefit includes both a retail and mail

component Medco has its own mail-order

pharmacy – Medco By Mail – where specialist pharmacist focus on compliance and lower cost options for the patient, and the automated filling system ensures the prescription is filled accurately.*

• Medco’s mail-order pharmacies fill about 2 million prescriptions per week through a highly automated process that is 99.9997% accurate and is 23 times more accurate than a retail pharmacy

“Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice”; Nov. 2007, Pharmacology, a peer-reviewed journal of the American College of Clinical Pharmacy

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Prescription Drug Benefits - Network Level

Features ActiveCare 1-HD

ActiveCare 1 ActiveCare 2 ActiveCare 3

Drug Deductible(per person, per plan year)

Subject to $2,300 plan

year deductible

Subject to $1,150 plan

year deductible$50 $50

Retail Short-Term(up to 30-day supply)

Generic/Preferred Brand/Non-Preferred Brand

20% coinsurance

after deductible

$10

$25*

$45*

$10

$25*

$40*

Retail Maintenance(after second fill, up to 30-day supply)

Generic/Preferred Brand/Non-Preferred Brand

$15

$35*

$60*

$15

$35*

$55*

Medco by Mail(up to 90-day supply)

Generic/Preferred Brand/Non-Preferred Brand

$20

$62.50*

$112.50*

$20

$62.50*

$100*

* If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Non-network benefits are also available; see Enrollment Guide for more information.

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Specific Rx Benefit Information

Retail pharmacies are ideal for acute (short-term) and new medication you may be trying for the first time

If you are taking a long-term medication, filling your prescriptions through Medco’s mail-order pharmacy provides several benefits:– You receive a 90-day supply of your medication at a lower copay– Prescriptions are delivered directly to you and you can order refills online

and check the status of your orders– You have access to specialist pharmacists

• Specifically trained in specific conditions• Review all of your incoming prescriptions for potential safety issues and will

contact you and your doctor to discuss any issue– Medco only buys medication from the most reputable suppliers

You have access to specialist pharmacists whether you fill your prescription at a retail pharmacy or at Medco By Mail

• Your medication questions can be answered by calling 1-866-355-5999

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Patient Centric Care Different members have different needs

Colds and flu,strep throat, ear infection,

headache,sprains

Acute

Wrinkles,baldness,

contraception, vitamins

Well

Cancer, AIDS, pulmonary

hypertension, multiple chronic

conditions such as heart failure and

diabetes

Complex

Heart disease,diabetes, arthritis,

high blood pressure,high cholesterol,

dementia, chronic back pain

Chronic

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Specialist Pharmacists An industry leading platform to better care

Specialist pharmacists have special training and unparalleled experience

A unique model and scale that enables each Medco pharmacy to specialize in a particular disease

Proprietary data capabilities bring specialist services to members

Medco’s specialist pharmacists create a patient experience which improvesthe quality of member care and increases savings for our clients

OncologyImmunology

NeurologyPsychiatryPulmonaryRare &

SpecialtyCardio-

vascularGastro-

intestinalDiabetes

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Medco’s Therapeutic Resource Centers provide specialized pharmacy services

817 patients4.9% Rx cost

OncologyImmunology

NeurologyPsychiatry

Pulmonary

Rare & Specialty

Cardio-vascular

Gastro-intestinal

Diabetes

1,832 patients13.5% Rx cost

3,668 patients6.4% Rx cost

16,109 patients18.0% Rx cost

39,091 patients25.3% Rx cost

39,465 patients15.1% Rx cost

54,353 patients17.0% Rx cost

5,539 patients1.2% Rx cost

FY’08 TRS dataComplex & Chronic patients

• > 59% of TRS-AC members have chronic & complex needs

• > 96% of Rx cost is for members with chronic & complex conditions

Well19.2% of members and

<1% of FY08 costs

Acute21.9% of members and

3.1% of FY08 costs

Chronic49.8% of members and 55.1% of FY08 costs

Complex9.1% of members and 41.3% of FY08 costs

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Focus on right drug at right time for the right person

The future of medicine lies in specialization:

Specialist Pharmacist

Personalized Medicine offering

My Rx Choices®

Other Available Resources

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Personalized Medicine

What is it?– A science that examines the inherited variations in genes that

dictate drug response (whether a drug will be effective or safe)

– Personalizing drug therapy based on each patient's genetic variability

New this year, TRS is providing this service toTRS-ActiveCare patients if both the doctor and patient wish to take the test

Out with the old….drugs aimed at processes or diseases

In with the new….. drugs designed for specific interventions based on your genetics

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Your Genes: Which dose is right for you?

Old: Trial and error

100mg

New: Pharmacogenomics-driven

500mg 100mg 10mg

Daily dose has been “personalized”

Source: http://www.fda.gov/cder/genomics/presentations.htm; August 26, 2005

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High-level Process Flow

Identification Identify pharmacy claim indicating warfarin or

tamoxifen were dispensed

Intervention

Cheek swab completed by patient and mailed to lab Lab processes test, sends results and interpretation to

physician and Medco TRC pharmacist Therapy change made if applicable

Communication Contact physician for approval to test patient Contact patient to discuss program and test kit mailing 800 number provided for questions

Follow-up Monitor lab outcomes and

follow-up as needed

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Personalized MedicinePatients in Need

The ability to determine how patients metabolize drugs can have significant impacts on financial and clinical outcomes

Avoiding breast cancer re-occurrence, severe bleeding events, and strokes is possible with a cheek swab test

New Warfarin

Users 620

Tamoxifen Users

373Action

The avg. cost/patient tested is $1,000-$1,500 less than those NOT testedTesting could result in significant quality of life improvement

49 patients estimated to receiving no benefit from Tamoxifen

Prevents $96,000/re-occurrence

372 patients estimated to need dosing adjustment

Prevents $13,800/severe bleed $39,500/stroke

STOP

STOP

Action

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My Rx Choices® Your online savings tool

Lower your cost for prescriptions with My Rx Choices– Features include:

• Personal assessment of cost-saving opportunities based on your prescription plan and the medications you use

• Print a kit to help your doctor better understand the economic impact of different medication alternatives

• Alternative medications are based upon greatest cost savings to you presented in order, starting with the highest value

• Brand-to-generic and retail-to-mail comparisons are shown

• The average amount saved by My Rx Choices users is $294!

Simply visit www.medco.com/save. You’ll to take a moment to register before using this service. You can also call 1-866-355-5999

You have to shop your benefit. Prices can vary at different retail pharmacies

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My Rx Choices

Medco can facilitate on generic equivalents received through mail order

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Information Resources

TRS Web site – www.trs.state.tx.us/trs-activecare– Pharmacy Benefit Highlights– List of maintenance medications– FAQs– Download forms

Medco Member Web site – www.medco.com– Prior Authorization List– Formulary Information– Locate a Participating Pharmacy– Health and Wellness Information– My Rx Choices® / Price a Medication– Online Ordering– Order Medco By Mail Refills– Download forms

Customer Service Number 1-866-355-5999 Benefits Booklet

HMO Plan Options

2009-2010 Plan Year

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TRS-ActiveCare Participating HMOs

How to Enroll

2009-2010 Plan Year

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Who is Eligible to Enroll?

To be eligible for TRS-ActiveCare coverage, you must: Be employed by a participating district/entity and

– Be an active, contributing TRS member or– Be employed 10 or more regularly scheduled hours

each week

Health care coverage for public school employees and their families

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Employees NOT Eligible to Enroll

State of Texas employees or retirees Higher education employees or retirees TRS retirees, receiving or who declined coverage

under TRS-Care

These individuals are not eligible to enroll for TRS-ActiveCare coverage as employees, but they can be covered as a dependent of an eligible employee.

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Eligible Dependents

Spouse (including a common law spouse)

Unmarried children under age 25– Natural child– Adopted child– Stepchild– Foster child

Other eligible dependents listed inEnrollment Guide

– Grandchildren (unmarried)

– Disabled children (unmarried, of any age)

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Special Eligibility Situations

If employee and spouse both work for a participating district/entity:

– A spouse may be covered as an employee or as a dependent of an employee

– Only one parent can cover dependent children A child (under age 25) employed by a district/entity and a

contributing TRS member cannot be covered as a dependent

The child must be covered as an employee If the child is not a contributing TRS member, the child

may be covered as a dependent

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Enrollment

Enrollment Periods for 2009-2010 Plan Year:– April 13 - May 15 (Spring Enrollment)– August 1 - August 31 (Summer Enrollment)

Preexisting condition exclusion applies to those that previously declined coverage; may be reduced by prior creditable coverage

Passive enrollment; no need to enroll unless you want to:– Change TRS-ActiveCare plan option– Add or drop dependents– Cancel and/or decline coverage– Enroll for TRS-ActiveCare coverage with a different

participating district/entity – Change name or address or correct date of birth or Social Security number

The HMO option from Legacy Health Solutions will not be available for 2009-2010 plan year. All existing Legacy enrollees must select a new TRS-ActiveCare plan option.

2009-2010 Plan Year

Cost for Health Coverage

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Monthly Costfor Coverage

Page 33 of the Enrollment Guide

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Cost of Coverage

Employee and family coverage for ActiveCare 1-HD is more expensive than ActiveCare 1 because the deductible and out-of-pocket maximum amounts for family are less and the plan may begin paying benefits sooner

PPO Plans ActiveCare 1-HD ActiveCare 1

Coverage Category Total Cost Total Cost

Employee Only $245 $278

Employee and Spouse $600 $633

Employee and Child(ren) $382 $443

Employee and Family $785 $697

Family Deductible $2,300 $3,000

Family Out-of-Pocket Maximum

$7,300 $9,000

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Application to Split Premium

Married couples working for different participating entities may “pool” funds

Optional Requires an

Application to Split Premium form to be completed by both employees and employers

Form available online

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Can Changes in Coverage Be Made After Your Application Has Been Submitted?

Changes can be made up to the end of your enrollment period

Plan choices will remain in effect through August 31, 2010 unless there’s a special enrollment event such as:

– Marriage or divorce– Birth, adoption or placement for adoption of a child– A child marries or reaches age 25– A court order to provide health coverage for an eligible child – Loss of coverage

Changes must be made within 31 days after the event date (special rules apply to newborns)

New application must be submitted for any change

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Newborns

Covered first 31 days if employee has coverage

Must add newborn within 60 days after the date of birth or up to one year after the date of birth if:

– Employee has “employee and family” or “employee and child(ren)” coverage at the time of birth and at the time of enrollment

Not necessary to wait for newborn’s Social Security number

– Submit application without SSN to enroll– Re-submit another form after SSN is issued

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Cafeteria Plan Vendor(s)

Making a change through the Section 125 vendor does not automatically generate a change to coverage under TRS-ActiveCare

All changes to TRS-ActiveCare must be signed, dated and submitted on an Enrollment Application and Change Form

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Important NoticeSupplemental Coverage

TRS does not offer or endorse any supplemental coverage for any of the health coverage plans available under TRS-ActiveCare

To obtain information about any coverage that claims to be a companion or supplement to any TRS-ActiveCare plan, employees should contact:

– The organization making such offering and/or – The Texas Department of Insurance (TDI)

http://www.tdi.state.tx.us or the TDI Consumer Helpline (800) 252-3439

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Your TRS-ActiveCare ID card will be mailed to your home

Enroll by May 15 to receive ID card by September 1 ActiveCare 1-HD, 1, 2 and 3

– New ID cards will not be issued to current participants unless changing plans

– New enrollees will receive new cards

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Enrollment Support

Dedicated Customer Service ActiveCare 1-HD,1, 2 or 3 1.866.355.5999

(Blue Cross and Blue Shield of Texas and Medco)

FirstCare Health Plans 1.800.884.4901 Mercy Health Plans 1.800.617.3433 Scott and White Health Plan 1.800.321.7947 Valley Baptist Health Plans 1.800.829.6440

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Enrollment Support

Available Online Enrollment guide

(English and Spanish) Downloadable forms

(enrollment application, split premium, claim form, etc.)

Provider locator Frequently asked questions

www.trs.state.tx.us/trs-activecare

Questions

Thank you for attending