Medical

TRS-ActiveCare Primary

      EMPLOYEE RATE
Coverage TRS
Total Premium		 HCDE
Contribution		 Monthly Semi-Monthly
Employee Only $471 $471 $0 $0
Employee + Spouse $1,272 $484 $788 $394
Employee + Child(ren) $801 $484 $317 $158.50
Employee + Family $1,602 $484 $1,118 $559


* This plan is an In-network-plan only, and you are required to enter a 10 digit PCP number into the enrollment system when you elect the plan. Visit www.bcbstx.com/trsactivecare to find a PCP prior to enrolling.

  • Plan Highlights
    • Copays for doctor visits and generic prescriptions before you meet deductible 
    • Statewide Network 
    • Participants must select a primary care provider who will make referrals to specialists
    • No out-of-network coverage 
    • Employee will receive two (2) ID cards (BCBS & Express Scripts) 
  • Find a Provider Search physicians, hospitals,
    and more that are covered under
    TRS-ActiveCare Primary

TRS-ActiveCare HD

      EMPLOYEE RATE
Coverage TRS
Total Premium		 HCDE
Contribution		 Monthly Semi-Monthly
Employee Only $484 $484 $0 $0
Employee + Spouse $1,307 $484 $823 $411.50
Employee + Child(ren) $823 $484 $339 $169.50
Employee + Family $1,646 $484 $1,162 $581.00
  • Plan Highlights
    • Must meet deductible before plan pays for non-preventive care
    • In-network and out-of-network benefits – separate out-of-network deductible/out-of-pocket maximum
    • Nationwide network Deductible applies to medical and pharmacy
    • No requirement for PCP or referrals
    • Compatible with health savings account (HSA)
    • Employee will receive two (2) ID cards (BCBS & Express Scripts)
  • Find a Provider Search physicians, hospitals, and more that are covered under TRS-ActiveCare HD

ActiveCare Primary +

      EMPLOYEE RATE
Coverage TRS
Total Premium		 HCDE
Contribution		 Monthly Semi-Monthly
Employee Only $553 $484 $69 $34.50
Employee + Spouse $1,438 $484 $954 $477
Employee + Child(ren) $941 $484 $457 $228.50
Employee + Family $1,825 $484 $1,341 $670.50


* This plan is an In-network-plan only, and you are required to enter a 10 digit PCP number into the enrollment system when you elect the plan. Visit www.bcbstx.com/trsactivecare to find a PCP prior to enrolling.

  • Plan Highlights
    • Copays for many services and drugs 
    • Statewide Network 
    • Participants must select a primary care provider who will make referrals to specialists 
    • No out-of-network coverage 
    • Employee will receive 2 ID cards (BCBS & Express Scripts) 
  • Find a Provider Search physicians, hospitals, and more
    that are covered under TRS-ActiveCare Primary+
  • Medical Blue Cross Blue Shield of Texas

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Compare Plans

      Plan Features

      Plan Features ActiveCare
      Primary      		 ActiveCare
      Primary+      		 ActiveCare HD
      (In-Network)      		 ActiveCare HD
      (Out-of-
      Network)
      Type of Coverage In-Network Coverage Only In-Network Coverage Only In-Network Out-of-Network
      Individual/Family Deductible $2,500/$5,000 $1,200/$2,400 $3,200/$6,400 $6,400/$12,800
      Coinsurance You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible
      Individual/Family Maximum Out-of-Pocket $8,050/$16,100 $6,900/$13,800 $8,050/$16,100 $20,250/$40,500
      Network Statewide Network Statewide Network Nationwide Network Nationwide Network
      PCP Required Yes Yes No No

      Doctor Visits

        ActiveCare
      Primary      		 ActiveCare
      Primary+      		 ActiveCare HD
      (In-Network)      		 ActiveCare HD
      (Out-of-
      Network)
      Primary Care $30 copay $15 copay You pay 30% after deductible You pay 50% after deductible
      Specialist $70 copay $70 copay You pay 30% after deductible You pay 50% after deductible

      Immediate Care

        ActiveCare
      Primary      		 ActiveCare
      Primary+      		 ActiveCare HD
      (In-Network)      		 ActiveCare HD
      (Out-of-
      Network)
      Urgent Care $50 copay $50 copay You pay 30% after deductible You pay 50% after deductible
      Emergency Care You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 30% after deductible
      TRS Virtual Health-RediMDTM $0 per medical consultation $0 per medical consultation $30 per medical consultation $30 per medical consultation
      TRS Virtual Health-Teladoc® $12 per medical consultation $12 per medical consultation $42 per medical consultation $42 per medical consultation

      Prescription Drugs

        ActiveCare
      Primary      		 ActiveCare
      Primary+      		 ActiveCare HD
      (In-Network)      		 ActiveCare HD
      (Out-of-
      Network)
      Drug Deductible Integrated with medical $200 deductible per participant (brand drugs only) Integrated with medical Integrated with medical
      Generics (31-Day Supply/90-Day Supply) $15/$45 copay; $FIELD1 copay for certain generics $15/$45 copay You pay 20% after deductible; $FIELD3 coinsurance for certain generics You pay 20% after deductible; $FIELD4 coinsurance for certain generics
      Preferred (Max does not apply if brand is selected and generic is available) You pay 30% after deductible You pay 25% after deductible ($100 max)/ You pay 25% after deductible ($265 max) You pay 25% after deductible You pay 25% after deductible
      Non-preferred You pay 50% after deductible You pay 50% after deductible You pay 50% after deductible You pay 50% after deductible
      Specialty (31-Day Max) $0 if SaveOnSP eligible; You pay 30% after deductible $0 if SaveOnSP eligible; You pay 30% after deductible You pay 20% after deductible You pay 20% after deductible
      Insulin Out-of-Pocket Costs $25 copay for 31-day supply; $75 for 61-90 day supply $25 copay for 31-day supply; $75 for 61-90 day supply You pay 25% after deductible You pay 25% after deductible

      Common Medical Services

      Plan Features ActiveCare
      Primary      		 ActiveCare
      Primary+      		 ActiveCare HD
      (In-Network)      		 ActiveCare HD
      (Out-of-
      Network)
      Network Availability In-Network Only In-Network Only In-Network Out-of-Network
      Diagnostic Labs** (Office/ Independent Lab) Office/Independent Lab: You pay $0 Office/Independent Lab: You pay $0 You pay 30% after deductible You pay 50% after deductible
      Diagnostic Labs** (Outpatient) Outpatient: You pay 30% after deductible Outpatient: You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible
      High-Tech Radiology You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible
      Outpatient Costs You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible
      Inpatient Hospital Costs You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible ($500 facility per day maximum)
      Freestanding Emergency Room You pay $500 copay + 30% after deductible You pay $500 copay + 20% after deductible You pay $500 copay + 30% after deductible You pay $500 copay + 50% after deductible
      Bariatric Surgery (Facility) Facility: You pay 30% after deductible Facility: You pay 20% after deductible Not Covered Not Covered
      Bariatric Surgery (Professional Services) Professional Services: You pay $5,000 copay + 30% after deductible Professional Services: You pay $5,000 copay + 20% after deductible Not Covered Not Covered
      Bariatric Surgery (Coverage) Only covered if rendered at a BDC+ facility Only covered if rendered at a BDC+ facility Not Covered Not Covered
      Annual Vision Exam (one per plan year; performed by an ophthalmologist or optometrist) You pay $70 copay You pay $70 copay You pay 30% after deductible You pay 50% after deductible
      Annual Hearing Exam (one per plan year) $30 PCP copay $70 specialist copay $15 PCP copay $70 specialist copay You pay 30% after deductible You pay 50% after deductible
      **Pre-certification for genetic and specialty testing may apply. Contact a PHG at 1-866-355-5999 with questions.