Health Care Coverage for You and Your Family!

1
Health Care Coverage for You and Your Family!

• Welcome

2
Agenda

• Who is eligible to enroll
• Plan options and whats new
• Cost of health coverage
• How to enroll
• Enrollment support
• Questions

3
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
4
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.
5
Eligible Dependents

• Spouse (including a common law spouse)
• Unmarried children under age 25
• Natural child
• Adopted child
• Stepchild
• Foster child
• Other eligible dependents listed in
  Enrollment Guide
• Grandchildren (unmarried)
• Disabled children
  (unmarried, of any age)

6
Newborns

• Covered the first 31 days if employee has
  coverage
• To continue coverage, employee must add newborn
  within 60 days after the date of birth
• However, an employee has up to one year after the
  newborns 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

7
PPO Plan Options

• ActiveCare 1, 2 and 3

8
Whats New for 2008-2009?

• ActiveCare 1, 2 and 3
• No premium increase
• No benefit changes
• Emphasis on health and wellness
• New plan features available April 1, 2008
• Blue Care Connection
• 24/7 Nurseline
• Personal Health Manager (PHM) online health and
  wellness resource
• Live Chat secure, online real-time access for
  customer service inquiries

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PPO Network for ActiveCare 1, 2 and 3
Need to locate a Network Provider?
www.trs.state.tx.us/trs-activecare www.bcbstx.com/
trs
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Plan Overview
Illustrates benefits when network providers are
used. Non-network benefits are also available
see Enrollment Guide for more information.
11
Plan Overview
Illustrates benefits when network providers are
used. Non-network benefits are also available
see Enrollment Guide for more information.
12
Blue CareConnection

• Health and Wellness Programs

TRS-ActiveCare is administered by Blue Cross and
Blue Shield of Texas, a Division of Health Care
Service Corporation, a Mutual Legal Reserve
Company, an Independent Licensee of the Blue
Cross and Blue Shield Association. Blue Cross
and Blue Shield of Texas provides claims payment
services only and does not assume any financial
risk or obligation with respect to claims.
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24/7 Nurseline
New!
Advice anytime. Round-the-clock health and the
wellness advice from licensed professionals

• Advice isnt 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 nights
  rest

1-800-581-0368
24/7
Available in English and Spanish
14
Personal Health Manager
New!

• Your online wellness experience begins here
  www.bcbstx.com/trs
• Take a Health Risk Assessment
• Improve your health with the Eat Right
  nutrition planner
• Create a fitness plan to suit your personal
  health goals and needs with Get Fit

Click on the Personal Health Manager iconon Blue
Access for Members
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Ask-A Online Advisor
Expert advice at your fingertips.Our Ask-A
feature is here to help.
Ask the experts. Expert advice from licensed
professionalsvia the Personal Health Manager
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 SECURE Receive a response within
one business day
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Blue PointsSM Incentives
ActiveCare 1, 2 and 3 plan participants and their
covered dependents accumulate Blue PointsSM in
the Personal Health Manager.
Stay motivated. Earn Blue PointsSM 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 PointsSM for a variety of
  items!

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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

Weight Management Program Support for a Healthier
You
Tobacco Cessation Program Support for members who
want to quit

• Personalized Lifestyle Management Support
• Counseling and coaching with licensed Wellness
  Coaches
• Motivational toolkit
• 24/7 Nurseline
• Referrals when appropriate

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Expecting? Special Beginnings Program
1-800-462-3275
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Live ChatSecure Online Customer Service
New!

• Send inquiries to customer service via e-mail
• Immediate access to BCBSTX customer advocates
• Available Monday Friday, 7 a.m. to 10 p.m. (CT)

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What if I Have Questions?

• Personalized Service
• Call the TRS-ActiveCare customer service team
  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!

Customer Service 1-866-355-5999
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Blue Access for MembersOnline Member Management
Tool

• Online member management tool.
• Check claim status, view and download EOBs
  (Explanations of Benefits)
• Order additional ID cards, and print temporary ID
• Send secure e-mail messages to BCBS Customer
  Advocates
• Monthly health articles
• Links to health information and wellness tools
  and resources

22
Prescription Drugs

• ActiveCare 1, 2 and 3

23
Your Medco Prescription Drug Plan

• Your TRS-ActiveCare health plan has two
  prescription drug components
• Blue Cross and Blue Shield of Texas manages your
  medical plan expenses, including prescription
  drug expenses under ActiveCare 1
• Medco manages your prescription drug plan
  expenses for ActiveCare 2 and 3

24
Your Medco Prescription Drug Plan

• Medco has its own mail-order pharmacy Medco By
  Mail which delivers medications to your home at
  a lower cost
• Medcos 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
25
Specific Rx Benefit Information

• If you are taking a long-term medication, filling
  your prescriptions through Medcos mail-order
  pharmacy provides several benefits
• You receive a 90-day supply of your medication at
  a lower copay
• You have access to Specialist Pharmacists who
  receive additional training in conditions such as
  asthma, diabetes, heart disease and more
• While retail pharmacists know the medications you
  fill at one pharmacy, Medcos Specialist
  Pharmacists have a complete view of all of your
  medications so they know if there are potential
  safety issues and will contact you and your
  doctor to discuss these issues
• 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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Prescription Drug Benefits
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.
27
Prescription Drug Benefits

• Once the deductible is satisfied, the member pays
  the applicable copay
• Member-paid cost differences between a brand-name
  drug and a generic equivalent do not apply to the
  deductible
• Member cost share will not exceed the cost of the
  medication

28
Prescription Drug Benefits

• Once the deductible is satisfied, the member pays
  the applicable copay
• Member-paid cost differences between a brand-name
  drug and a generic equivalent do not apply to the
  deductible
• Member cost share will not exceed the cost of the
  medication.

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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
• Download forms
• Customer Service Number 1-866-355-5999
• Benefits Booklet

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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 medications
  that you or covered family members take on an
  ongoing basis.
• Best-value alternatives based upon greatest cost
  savings to you presented in order from highest
  value to member
• Brand-to-generic and retail-to-mail compare
  options available
• Easy-to-understand explanations of complicated
  concepts
• The average amount saved by My Rx Choices users
  is 294!
• Your doctor knows which medications are right for
  you but you may not know how much they cost. My
  Rx Choices provides you with available lower-cost
  options so that you and your doctor can make the
  most informed decisions based on health and cost.
• Simply visit www.medco.com/save. Youll to take
  a moment to register before using this service.
  You can also call 1-866-355-5999.

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My Rx Choices Available through Customer
Service or on www.medco.com

• The My Rx Choices home page allows the user to
• Select a patient (pre-populated with all covered
  household members)
• Select a drug to compare from a pre-populated
  list of prescriptions for the user.
• Your potential savings are clearly presented.

32
My Rx Choices
Medco can facilitate on generic equivalents
received through mail order
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My Rx Choices
Members may print a kit to discusslower-cost
alternatives with their doctor
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More about Your Rx Benefits

• Refill your medication at www.medco.com when you
  use Medco By Mail
• Sign-up for Refill Reminders at www.medco.com
• Speak to a specialist pharmacist about the
  medications you are taking for a specific
  condition
• Send e-mails to Customer Service and to Medco
  pharmacists through the Medco member Web site

35
Medco Tour of Champions

• An endorsement campaign featuring six Olympic
  gold medalists each with a chronic or complex
  condition
• Promotes Specialist Pharmacists as providing a
  higher level of care for people with chronic
  and complex conditions like asthma and diabetes
• Campaign runs through 12/08

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HMO Plan Options

• 2008-2009 Plan Year

37
FirstCare

• HMO Plan Option

38
FirstCare Health PlansService Area
92 counties across Texas
39
FirstCare Health Plans

• No claim forms
• No preexisting limitations
• Emphasis on preventive health care
• No referrals required
• Extensive provider network
• Local hospitals and doctors
• Nationwide network through Texas True Choice and
  PHCS (outside Texas)
• Worldwide emergency care

40
FirstCare Health PlansMember Satisfaction

• Timely Customer Service
• Minimum automation calls answered in Lubbock,
  Texas
• Limited wait time to talk to a live
  representative
• High member satisfaction for claims processing
  (90)
• Web site accessibility for information 24 hours a
  day
• Regional offices in Abilene, Amarillo, Lubbock
  and Waco to serve local communities

41
FirstCare Health PlansWhats New for 2008-2009

• 400 deductible not applicable on most office
  visit services see Plan Summary
• Out-of-pocket maximum reduced to 3,500 per
  person
• 100 copay on radio-nuclide stress test
• 100 copay on non-pregnancy ultrasound tests
• 40 copay on bone mass measurement test
• Limited dental-related services have a maximum
  allowance of 10,000
• External prosthetics devices have a lifetime
  maximum allowance of 10,000
• 10 copay on preferred diabetic testing supplies
• No copay on preferred glucose monitors
• Premium increase of approximately 9.9

42
FirstCare Health PlansWhats New for 2008-2009

• 24/7 NurseLine available
• Access a Registered Nurse with your medical
  questions
• Staying Healthy Questions
• Minor Injuries
• Routine Illnesses
• Medication Questions
• Understanding Your Treatment Options
• Access Their Web site (www.healthforums.com)
• Health Assessments
• Health Topics

1-800-981-7912
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FirstCare Health Plans
44
FirstCare Health Plans
10,000 maximum prescription benefit per person
per plan year
Excludes insulin and allergy serum Not subject
to 10,000 benefit maximum
45
FirstCare Health PlansMember Portal

• Link from the TRS-ActiveCare Web site for easy
  access to
• Change PCP
• Request ID Cards
• Print temporary ID Cards
• Change address
• Check status of claims
• Check status of authorizations

46
Legacy Health Solutions

• HMO Plan Option

47
Legacy Health SolutionsService Area
18 counties West Texas
48
Legacy Health Solutions

• HMO Network Expansion
• 389 Physicians in Legacy HMO Network
• Added physicians of West Texas Medical Associates
  to our HMO
• Members like HMO features
• Predictable medical expense
• No deductibles
• No coinsurance
• Coverage for preexisting conditions
• No referrals needed for specialists
• In CAHPS Customer Satisfaction Survey, members
  ranked Legacy HMO in 93
• Local management means timely feedback for
  participant questions, concerns, medical
  appointments

49
Legacy Health Solutions

• Emergencies covered anywhere
• 24 Hour Nurse Hotline
• Health Advisory Tools customized to each member
• Online Personal Health Record
• Out-of-area care for dependents
• LHS network has 349 physicians representing over
  43 specialties throughout West Texas
• Disease and case management for chronic
  conditions

50
Legacy Health SolutionsWhats New for 2008-2009

• 300 copay per day for inpatient hospital(1,500
  maximum per admission)
• 300 copay for outpatient hospital
• 3,000/9,000 out-of-pocket maximum per
  individual/family
• 150 copay for emergency room care within 48
  hours (copay waived if admitted)
• 35 copay for preferred brand-name drug(retail
  up to 30-day supply)
• 70 copay for preferred brand-name drug(mail up
  to 90-day supply)
• Premium increase of approximately 5

51
Legacy Health Solutions Claim Messaging
52
Legacy Health SolutionsPharmacy Savings Messaging
3,835.46
1,235.55/yr
Potential Savings
How to Save Talk to your doctor about switching
from Nexium to Prilosec OTC or another comparable
drug.
Print Report
53
Legacy Health Solutions Web Tools

• Best in class tools to help members understand
  and manage their health and health care finances

54
Legacy Health Solutions
55
Legacy Health Solutions
Injectable Prescription Drugs - 25 of charges
56
Mercy Health Plans

• HMO Plan Option

57
Mercy Health PlansService Area

• 4 Texas counties
• Webb
• Jim Hogg
• Zapata
• Duval

58
Mercy Health Plans

• No claim forms
• No lifetime maximum
• No preexisting condition limitations

59
Mercy Health Plans

• Low out-of-pocket expense
• Emergencies covered anywhere
• Case management
• Diabetes mellitus
• Hypertension
• Asthma
• Other chronic diseases
• CuraScript Injectable Program

60
Mercy Health Plans

• Mercy Health Plans ranked 1 on Consumer
  Assessment Health Plans Survey (CAHPS) on the
  following
• How people rated their plan
• How people rated their health care
• How people rated their doctor
• How people rated their specialist
• How people rated the efficiency and helpfulness
  of customer service

Office of Public Insurance Council
61
Mercy Health PlansReferrals

• To visit a specialist, a PCP referral is
  required however, referrals are not required for
  the following
• Women may self refer to a designated OB/GYN
• Ophthalmologist/optometrist (annual eye exam)
• Orthopedic surgeon
• Dermatologist
• No benefits available for non-emergency care
  outside the network or for a specialist visit
  without a referral from a PCP

62
Mercy Health PlansWhats New for 2008-2009

• Office visit copay changes from 10 to 20
• 10 coinsurance for inpatient, outpatient and
  diagnostic services
• Prescription drug copays change from
• Retail
• 5 to 10 generic
• 20 to 25 preferred brand (formulary)
• 35 to 45 non-preferred brand (non-formulary)
• Mail Order
• Copays 2x retail copays
• Approximately 10 premium increase

63
Mercy Health Plans
64
Mercy Health Plans
Infertility drugs are covered at 50 2,000
maximum prescription drug benefit per person per
plan year
65
Scott White Health Plan

• HMO Plan Option

66
Scott and White Health PlanService Area
32 counties across Texas
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Scott and White Health Plan

• Named one of the Highest Ranked Health Plans in
  Texas by U.S. News World Report (2007) for the
  third year in a row
• No claim forms, no deductibles
• Coverage for preexisting conditions
• Worldwide emergency care
• Direct access to OB/GYN and ophthalmology
• Regional customer service centers in
  Georgetown,Temple, Bryan/College Station and
  Waco
• 24-hour Nurse Advice Line 1-800-975-6612

68
Scott and WhiteNew Cancer Treatment Center
Temple Campus
First phase of work is underway Estimated
completion date is 1QTR 2009
69
Scott and White Health PlanExpanding Network of
Providers

• Hospital Additions
• Hillcrest Baptist Medical Center/Waco
• Grimes St. Joseph Hospital/Navasota
• Physician Group Additions
• SW Wells Branch Clinic March 2008
• Kings Daughters Clinic March 2008
• SW Salado Clinic September 2008
• Expansions/additions proposed in 2008 for
  Williamson, Travis and Bastrop counties
• Pharmacy Additions
• SWHP Canyon Creek Pharmacy Temple April 2008
• SWHP Salado Pharmacy September 2008

70
Scott and White Health PlanWhats New for
2008-2009

• Prescription benefit maximum
• Increasing from 2,000 to 3,000 per person
• Diabetic test strips
• Preferred brand 5
• Non-preferred brand 25
• Home infusion therapy benefit
• 100 per day
• 500 maximum copayment per course of treatment
• Premium increase of approximately 9

71
Scott and White Health Plan
72
Scott and White Health Plan
3,000 maximum benefit per person per plan
year If a brand-name prescription is dispensed
when a generic is available, enrollee pays 50 of
brand-name cost
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Scott and White Health PlanOnline Wellness Tools

• Succeed Health risk appraisal
• Breathe Smoking cessation
• Balance Weight management
• Relax Stress management
• Nourish Nutrition
• CareTM for Your Back Back pain management
• CareTM for Your Health Healthy living program
• OvercomingTM Depression Depression management

www.trs.state.tx.us/trs-activecare
74
Valley Baptist Health Plans

• HMO Plan Option

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Valley Baptist Health PlansService Area

• Rio Grande Valley
• Counties
• Cameron
• Hidalgo
• Starr (partial)
• Willacy
• Provider Network
• More than 780 providers
• 11 hospitals Valley-wide

76
Valley Baptist Health Plans

• No deductibles or coinsurance
• No claim forms
• No lifetime maximum
• No preexisting condition limitations
• Predictable costs

77
Valley Baptist Health Plans

• Free diabetic supplies available
• Worldwide emergency care
• Locally owned and operated in the Rio Grande
  Valley by Valley Baptist Health System

78
Valley Baptist Health Plans

• 99 member satisfaction (employer group survey)
• 97 of our providers would recommend our plan to
  their patients (provider survey)

79
Valley Baptist Health Plans

• PCP will refer you to a specialist
• No referral needed for a designated OB/GYN
• Case management services for diabetes mellitus

80
Valley Baptist Health PlansWhats New for
2008-2009

• No plan changes
• Approximately 8.5 premium increase

81
Valley Baptist Health Plans
82
Valley Baptist Health Plans
83
Cost for Health Coverage

• 2008-2009 Plan Year

84
Coverage Categories

• Employee Only
• Employee and Spouse
• Employee and Child(ren)
• Employee and Family

85
Monthly Costof Coverage
Page 35 of the Enrollment Guide
86
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 both employers

87
How to Enroll

• 2008-2009 Plan Year

88
How to Enroll

• 2 Complete an Enrollment Application and Change
  Form
• Available in the Enrollment Guide
• Also available online

3 Sign, date and submit form to your Benefits
Administrator
1 Choose your health plan
89
How to Enroll

• If you do not wish to make changes to your
  current health benefit plan, you do not need to
  submit an enrollment application form
• You will be enrolled in the same plan you
  selected for 2007-2008 at the same level of
  coverage
• To decline coverage You must complete and
  submit a form even if you have declined
  coverage before

90
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, 2009 unless theres 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

91
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

92
Are There Preexisting Condition Exclusions?

• Pre-x does not apply to employees that initially
  enroll when the district/entity begins
  participating in TRS-ActiveCare or to new hires
  who enroll within 31 days after their
  actively-at-work date
• If covered at any time since 2002, pre-x may
  apply if employee is hired by another
  participating district/entity (or rehired by same
  district/entity) unless gap in coverage is less
  than 63 days and the employee has proof of prior
  creditable coverage
• A 12-month pre-x condition waiting period may
  apply due to
• A special enrollment event
• A future plan enrollment period (to be determined
  by TRS for each plan enrollment period)
• A transfer to another participating
  district/entity (or rehire) if the employee or
  any covered dependent has any remaining
  preexisting waiting period or a gap in coverage
  greater than 63 days
• Pre-x waiting period may be reduced by creditable
  coverage

93
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 [phone]

94
Your TRS-ActiveCare ID card will be mailed to
your home

• ActiveCare 1, 2 and 3
• New ID cards will not be issued to current
  participants unless changing plans new enrollees
  will receive new cards
• HMO plans
• All HMO participants will receive new cards
  (except for Scott and White Health Plans)
• Each individual covered under the plan will
  receive a card

95
Enrollment Support

• Dedicated Customer Service
• ActiveCare 1, 2 or 3 1.866.355.5999(Blue Cross
  and Blue Shield of Texas and Medco)
• FirstCare Health Plans 1.800.884.4901
• Legacy Health Solutions 1.877.410.2432
• Mercy Health Plans 1.800.617.3433
• Scott and White Health Plan 1.800.321.7947
• Valley Baptist Health Plans 1.800.829.6440

96
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
97
Questions

• Thank you for attending