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2010-2011 Plan Year Effective September 1, 2010

2010-2011 Plan Year Effective September 1, 2010. Agenda. TRS-ActiveCare Program Highlights Enrollment Summary Facts and Figures 2010-2011 Health Plan Options ActiveCare 1-HD, 1, 2 and 3 HMOs How to Enroll Who is Eligible to Enroll Cost of Coverage Enrollment Support.

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2010-2011 Plan Year Effective September 1, 2010

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  1. 2010-2011 Plan Year Effective September 1, 2010

  2. Agenda • TRS-ActiveCare Program Highlights • Enrollment Summary • Facts and Figures • 2010-2011 Health Plan Options • ActiveCare 1-HD, 1, 2 and 3 • HMOs • How to Enroll • Who is Eligible to Enroll • Cost of Coverage • Enrollment Support

  3. What is TRS-ActiveCare? • Established and signed into law in 2001 (Chapter 1579, Texas Insurance Code) • Blue Cross and Blue Shield of Texas selected to administer the program in January 2002 and 2008 • Medco selected as PBM in January 2002 and 2008 • Program effective date was September 1, 2002 • HMO options added in 2003 • A statewide health care benefits program for employees of school districts, charter schools, regional educational service centers and other educational districts • Law authorizes funding levels to help employees pay for coverage

  4. Enrollment Summary(Employees by Plan, Jan. 2010) FirstCare Health Plans 2.5% Scott & White Health Plan 1.9% Valley Baptist Health Plans 0.1% 237,107 Contracts (Employees) • 398,099 Members

  5. PPO Medical Plans ActiveCare 1-HD, 1, 2 & 3 Plans

  6. Network There is no need to: Select a Primary Care Physician Obtain referrals for specialist care Receive the highest level of benefits: Pay less for care No balance billing No claim forms Provider files claim for you PPO Network for ActiveCare 1-HD, 1, 2 and 3 Always verify provider network status Non-Network: • You pay more of the cost of out-of-network benefits • Higher deductibles, coinsurance • You may need to file your own claim • You could be balance billed for amounts over allowed amount New for 2010-2011: The allowable amount for non-contracting providers will be limited to 50% of billed charges

  7. PPO Plan Overview (Network Level of Benefits) New Deductiblesfor 2010-2011 (per IRS rules) ActiveCare 1-HD and ActiveCare 1

  8. PPO Plan Overview(Network Level of Benefits) New Copaysfor 2010-2011ActiveCare 2

  9. ActiveCare 1-HD vs. ActiveCare 1 New for 2010-2011: Deductible and out-of-pocket maximum amounts increased per IRS guidelines New for 2010-2011: Deductible and out-of-pocket maximum amounts increased per IRS guidelines

  10. 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

  11. Blue Distinction Centers for Bariatric Surgery • List of Blue Distinction Centers for Bariatric Surgery is subject to change • Refer to the Doctors and Hospitals section of the Web site, www.bcbstx.com/trs or call Customer Service for most current list Important: Bariatric surgery procedures for weight loss, such as lap band and gastric bypass, must be performed at one of the Blue Distinction Centers for Bariatric Surgery or the procedure will not be covered by TRS-ActiveCare

  12. Blue Care Connection® • Whether you decide toskip fast food, quit smoking, or walk more, every day decisions can have a positive impact on your health; Blue Care Connectionoffers guidance at every level of health Total Care Approach to Health and Wellness Well Members Low- Risk Moderate- Risk High-Risk Complex / Catastrophic < < < Wellness > > >

  13. Condition Management If you have a chronic condition, we offer support. • Supportfrom Blue Care Advisors—clinical professionals who can help you manage chronic health conditions such as: asthma, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disorder and other health conditions • Understanding and following your physician’s orders • Review medications, side effects, compliance, refills and current services • Establish goals with you and caregivers, scheduling follow-ups as appropriate 1-800-462-3275

  14. Tobacco Cessation and Weight Management • Self-Paced Approach • Online program and resources available in the Personal Health Manager • Secure e-mail outreach to keep members on track • Lifestyle Management Support • Counseling and coaching with licensed Wellness Coaches • 24/7 Nurseline • Referrals when appropriate 1-800-462-3275

  15. 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 at no additional cost • Once enrolled in the program, plan participants receive: • Pregnancy risk assessment and ongoing communication/monitoring • Educational material covering pregnancy and infant care topics • Frequent, personal contact with program staff from early pregnancy through six weeks after delivery • Assistance in managing high-risk conditions such as gestational diabetes and preeclampsia • Program components are available in English and Spanish 1-888-421-7781

  16. 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 Advice anytime. Round-the-clock health and the wellness advice from licensed professionals 24/7 1-800-581-0368 Available in EnglishandSpanish

  17. 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

  18. Personal Health Manager – Home Page Read secure messages Take a Health Risk Assessment Review member alerts Access MemberCare Profile Ask a Question to a certified Nurse, Trainer, Dietitian or Life Coach Use the Interactive Symptom Checker Read the latest health news, search for specific health topics or explore the prescription drug index Explore topics in the Health Information and Care Center

  19. “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 Nurse: Interact online with a Blue Care Advisor on non-emergency, health-related questions using the secure “Ask A Nurse” feature. Ask A Trainer, Dietitian orLife Coach: Send questions about fitness, nutrition, or managing stress. Confidential and Secure – Receive an e-mail response within one business day

  20. Health Risk Assessment – Easy To Use 1 2 3 • Choose your assessment topic: • Health & well-being* • Sleep • Stress management • Nutrition • Fitness & physical activity • Back & joint health • *We recommend completingthe Health & Well-beingassessment first. Complete the assessment in as little as10 to 15 minutes • Receive Personalized report and next steps: • Report provides member with summary of health risks and areas where they could improve • Recommended ‘next steps’ and suggestions to make positive changes to your lifestyle.

  21. 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 (results are not shared with employers) Earn Blue PointsSM

  22. Blue PointsSMIncentives TRS-ActiveCare PPO plan participants and their covered dependents accumulate Blue Points in the Personal Health Manager Stay motivated. Earn 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!

  23. www.bcbstx.com/trs Available online Enrollment Video Application Form Enrollment GuideBenefits Booklet 24/7 Nurseline, Lifestyle and Condition ManagementandSpecial Beginnings phone numbers

  24. Blue Access® for Members • Online member management tool • Check claim status, view claim summaries and print 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 Send secure e-mail messages to BCBS Customer Advocates available Monday thru Friday, 7 a.m. to 10 p.m. (CT)

  25. What if I Have Questions? Personalized Service • 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! Customer Service1-866-355-5999

  26. Prescription Drugs ActiveCare 1-HD,1, 2 & 3

  27. Your Medco Prescription Drug Plan • Medco administers your prescription drug plans on behalf of TRS • ActiveCare 1-HD, 1, 2, and 3 plans • 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

  28. Prescription Drug Benefits - Network Level * 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.

  29. Specific Rx Benefit Information • Retail pharmacies are ideal for acute (short-term) and new medication you may be trying for the first time In compliance with SB 0704, 81 (R) Texas Legislature, TRS will make available through Medco a retail maintenance network effective September 1, 2010.  Retail pharmacies who choose to participate in this network will be able to dispense up to a 90-day supply of medication.  Please contact Medco customer service for more information on pharmacies that may choose to participate in the retail maintenance network. Medco is in the process of soliciting this network. We will not know which pharmacies will choose to participate until later this summer.

  30. Specific Rx Benefit Information • If you are taking a long-term medication, filling your prescriptions through Medco’s mail-order pharmacy provides several benefits: • You can receive up to 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

  31. Getting the right drug, to the right person, at the right time Specialization and member engagement are critical components to controlling health care costs and driving quality clinical outcomes: • Specialist pharmacist • Personalized medicine offering • Research-driven protocols • My Rx Choices® • Other available resources

  32. 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 • In 2009, TRS began providing this service toTRS-ActiveCare patients if both the doctor and patient wish to take the test • How patients metabolize drugs can have significant impacts on both medication choice and dosage • Testing consists of a cheek swab…what do you have to lose?

  33. High-level Process Flow • Prescription comes in for a pharmacy claim for a product with an associated test through the prescription. Fill the prescription, then… Identification Communication • Contact physician for approval to test patient • Contact patient to discuss program and test kit mailing • 800 number provided for questions 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 Follow-up • Monitor lab outcomes and follow-up as needed

  34. 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 need 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

  35. 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 within a household (pre-populated with all under age 18 dependents and spouse information will be shown if authorization has been given) • Select a drug to compare from a pre-populated list of prescriptions for the user. • Your potential savings are clearly presented • Members may print a kit to discuss with their doctor • Generic alternatives are provided

  36. Generic Dispensing is important… Generic Waiver Program First phase January-March 2010 My Rx Choices® Approximately 6,000 web hits per month Cost Difference Average cost of generic prescription is just over $15 as compared to $151 for a brand Savings For every 1% of increase generic usage, TRS could save millions of dollars Next waiver period will be June – August 2010 * Annual savings based upon initial waiver period performance and an 80% refill rate.

  37. 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 • Medco widget • Customer Service 1-866-355-5999 • Benefits Booklet

  38. HMO Plan Options 2010-2011 Plan Year

  39. TRS-ActiveCare Participating HMOs

  40. FirstCare Health Plans HMO Plan Option

  41. Company Overview We have been part of the TRS-ActiveCare program since 2003 and currently cover more than 11,000 school employees and their dependents. We are a hospital-based health plan, founded in 1985 and are owned by Covenant Health System in Lubbock, Texas and Hendrick Medical Center in Abilene, Texas. We focus exclusively on the Texas market and have offices in Abilene, Amarillo, Lubbock, and Waco. Our local presence in each of our regions enables us to provide the level of service you and your family deserve. 41

  42. Service Area – 93 counties across Texas TRS Service Area To be eligible to enroll in FirstCare, you must live, reside or work in one of the shaded counties.

  43. Benefit Highlights • NOTE: Care must be accessed through one of our affiliate provider networks 43 No referrals to network specialists No routine claim forms Worldwide emergency care No preexisting limitations College-age dependents living outside our service area have full coverage (address must be on file) Secure online access to your membership and claim information at www.firstcare.com

  44. New for 2010-2011 44 The national average increase for health insurance premiums is 7 to 11 percent per year FirstCare has lowered premiums for two years in a row to help you combat the rising cost of health care

  45. New for 2010-2011 • Preventive care is now covered at 100%. No office visit copayments and the deductible is waived* • Well woman exam • Screening mammograms including X-ray, digital, and ultrasound • Routine physicals • Immunizations • Routine sight, speech, and hearing screenings • Routine lab and X-ray • Primary Care Physician office visit copayment is $25 • Specialist office visit copayment is $40 *Exception: Colorectal Cancer Procedure has a $50 copayment

  46. New for 2010-2011 46

  47. Abilene Region Provider Network FirstCare has a comprehensive network of local physicians, hospitals, and pharmacies that offer a full range of medical services. A complete list of network providers is available at www.firstcare.com. Our Abilene office is located at: 2 Village Drive, Suite 510Abilene, TX 79606(325) 670-3525 Come visit us and meet the staff. Abilene Hospital: Hendrick Medical Center Other Regional Hospitals: Anson General Hospital Ballinger Memorial Hospital Coleman County Medical Center Comanche County Medical Center Eastland Memorial Hospital Fisher County Hospital Hamlin Memorial Hospital Haskell Memorial Hospital Heart of Texas Memorial Hospital Hendrick Medical Center Knox County Hospital Mitchell County Hospital North Runnels Hospital Rolling Plains Memorial Hospital Stamford Memorial Hospital Stephens Memorial Hospital Stonewall Memorial Hospital Throckmorton County Memorial Hospital 47

  48. Amarillo Region Provider Network Amarillo Hospitals: Northwest Texas Healthcare System Northwest Texas Surgery Center Plum Creek Specialty Hospital Other Regional Hospitals: Childress Regional Medical Center Collingsworth General Hospital Coon Memorial Hospital Golden Plains Community Hospital Hansford County Hospital Hardeman County Memorial Hospital Hemphill County Hospital Hereford Regional Medical Center Moore County Hospital District Ochiltree Hospital District Pampa Regional Medical Center Parkview Hospital Parmer County Community Hospital Shamrock General Hospital Swisher Memorial Hospital FirstCare has a comprehensive network of local physicians, hospitals, and pharmacies that offer a full range of medical services. A complete list of network providers is available at www.firstcare.com. Our Amarillo office is located at: 600 S Tyler St Box# 12019Amarillo, TX 79101(806) 356-5265 Come visit us and meet the staff. 48

  49. Lubbock Region Provider Network Lubbock Hospitals: Covenant Health System University Medical Center Other Regional Hospitals: Brownfield Regional Medical Center Cochran Memorial Hospital Cogdell Memorial Hospital Covenant Health System Crane Memorial Hospital Crosbyton Clinic Hospital HealthSouth Rehabilitation Hospital Iraan General Hospital District Lamb Healthcare Center McCamey Hospital Medical Arts Hospital Medical Center Hospital Midland Memorial Hospital Muleshoe Area Medical Center Pecos County Memorial Permian Regional Medical Center Plains Memorial Hospital Rankin County Hospital Reeves County Hospital Seminole Memorial Hospital Ward Memorial Hospital Winkler County Memorial Hospital W J Mangold Memorial Hospital Yoakum County Hospital FirstCare has a comprehensive network of local physicians, hospitals, and pharmacies that offer a full range of medical services. A complete list of network providers is available at www.firstcare.com. Our Lubbock office is located at: 1901 W. Loop 289 Suite# 9Lubbock, TX 79407(806) 784-4300 Come visit us and meet the staff. 49

  50. Waco/ Bryan-College Station Region Provider Network FirstCare has a comprehensive network of local physicians, hospitals, and pharmacies that offer a full range of medical services. A complete list of network providers is available at www.firstcare.com. Our Waco office is located at: 1105 Wooded Acres Dr. Suite # 404Waco, TX 76710(254) 761-5800 Come visit us and meet the staff. Waco Hospitals: Hillcrest Baptist Medical Center Providence Health Center Bryan/College Station Hospitals: College Station Medical Center St. Joseph Regional Health Center Other Regional Hospitals: Burleson St. Joseph Health Center Central Texas Hospital Coryell County Memorial Hospital East Texas Medical Center – Crockett & Fairfield Falls Community Hospital Goodall-Witcher Hospital Grimes St. Joseph Health Center Hamilton General Hospital Hill Regional Hospital Huntsville Memorial Hospital King’s Daughters Hospital Lake Whitney Medical Center Limestone Medical Center Little River Medical Center Llano Memorial Hospital Madison St. Joseph Health Center Metroplex Adventist Hospital Parkview Regional Hospital Rollins Brook Community Hospital Seton Highland Lakes Texas Health Harris Methodist Hospital Stephenville Trinity Medical Center 50

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