The following was included in TCTA's 2020-21 Survival Guide, the ultimate reference tool for Texas educators, and is current as of September 2020 but is subject to change. NOTE: TRS has since adopted new premium rates for the 2021-22 school year; see the new rates here.
The state offers health insurance coverage to both active and retired school employees. Many larger districts offer local health insurance for active employees, rather than the state plan.
The state plan for active school employees has four levels of coverage. Click here for more details on what's covered. For 2020-21, enrollment in the highest level of coverage, ActiveCare 2, is limited to only those who were enrolled in that level in 2019-20. ActiveCare is administered by Blue Cross Blue Shield, with pharmacy benefits managed by CVS Caremark.
All districts and eligible employees, regardless of whether they participate in the state plan, are included in the funding contributed for school employee health insurance (unless the employee has waived coverage). The term “eligible employees” includes part-time employees working at least 10 hours per week. The state provides $75 per month for each participating employee for health insurance coverage, and districts must contribute at least $150 per month per employee.
All school districts are eligible to participate in the statewide plan. Participation for districts with 500 or fewer employees is mandatory; those that are self-funded or participating in a co-op/risk pool were given the opportunity to opt out when the program first began. Districts with more than 500 employees can opt in to the program. Districts choosing not to participate must still provide access to health insurance. The funding arrangement ($75 per month per participating employee from the state and at least $150 per month per employee from the district) will still apply. Individual employees may choose to waive coverage.
A school employee married to another school employee can decide whether to be treated under the district health insurance plan as the primary employee or a dependent. Pursuant to the U.S. Supreme Court’s ruling in Obergefell v. Hodges in June 2015, TRS extends spousal benefits to same-sex spouses.
Legislation initiated by TCTA requires a school district not participating in the state plan to provide for portability of insurance coverage, an essential benefit for employees transferring from one school district to another. This ensures that the employee cannot be refused coverage for a pre-existing condition if the employee has had insurance under another qualifying plan for at least 12 months and applies for coverage under the district plan no more than 63 days after coverage is terminated under the former coverage. (A 2009 TCTA-initiated law prohibits TRS from opting out of federal law that requires coverage of pre-existing conditions, thus maximizing portability between private sector/local district coverage and TRS-ActiveCare. The federal Patient Protection and Affordable Care Act passed in 2010 also restricts the ability of a health care plan sponsor to opt out of the provisions of federal law that ensure portability.)
Other TCTA-initiated legislation requires that districts continue to provide insurance coverage and funding through the summer months for employees who resign after the end of the instructional year.
The TRS-administered plans are providing special COVID-related benefits, including free testing for many eligible enrollees. See the TRS website for details.
TRS has approved three HMOs as an option for employees in participating districts. The benefits offered under these HMOs are significantly different from benefits in the ActiveCare Blue Cross Blue Shield plan, and details are available on the TRS website in the Active Members > TRS-ActiveCare section.
Employees in the Panhandle and parts of West and Central Texas can participate in Blue Essentials West Texas; those in portions of the Rio Grande Valley can opt for Blue Essentials South Texas; Central Texas employees and those in some North Texas counties can choose the Scott & White Health Plan.
Details of the state’s health care coverage for retirees are available at trs.texas.gov. Beginning Jan. 1, 2018, a retiree who is age 65 and eligible for Medicare will be enrolled in a Medicare Advantage Plan with Medicare Part D prescription drug coverage. A retiree under age 65 will be enrolled in a high deductible plan. See the TRS website for complete details.