1. Health Coverage for You and Your Family

2. Agenda TRS-ActiveCare Program Highlights –Enrollment Summary –Facts and Figures 2013-2014 Health Plan Options –ActiveCare 1-HD, 2 and 3 PPO Plans –HMO Plans How to Enroll –Who is Eligible to Enroll –Cost of Coverage –Enrollment Support 2

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 (now Express Scripts) 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 3 1,120 districts/entities participate in TRS-ActiveCare (90% of eligible entities)

4. Enrollment Summary (Employees by Plan, Feb. 2013) 4 FirstCare Health Plans 2.5% Scott & White Health Plan 2.7% Valley Baptist Health Plans 0.5% 280,250 Employees 476,767 Members (Employees and Dependents)

5. PPO Plan Overview ActiveCare 1-HD, 2 and 3 Plans 2013-2014 Plan Year

6. New Deductible and Out-of-Pocket Maximum for ActiveCare 1-HD 6 ActiveCare 1-HD meets IRS definition of a high deductible health plan for all coverage tiers May contribute pretax dollars into a health savings account (HSA) to help pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis Individuals can establish an HSA with banks and credit unions 2012-2013 Plan Year2013-2014 Plan Year AC1AC1-HD Deductible (employee only/family) $1,200/$3,000$2,400/$2,400$2,400/$4,800 Out-of-Pocket Maximum (employee only/family; does not include deductibles) $2,000/$6,000$3,000/$5,000$3,850/$4,200

7. New Deductible and Out-of-Pocket Maximum for ActiveCare 2 7 2012-2013 Plan Year2013-2014 Plan Year ActiveCare 2 Deductible (individual/family) $750/$2,250$1,000/$3,000 Out-of-Pocket Maximum (individual/family; does not include deductibles) $2,000/$6,000$4,000/$8,000

8. Family Deductible Illustration Amy covers spouse and three dependents 8 $4,800 $1,000$800 $400 AmySue Chris TedBob Sue ActiveCare 1-HD with $4,800 family deductible The family deductible may be met by one or more people Plan pays benefits once entire $4,800 is met ̶ there is no individual deductible to meet ActiveCare 2 with a $1,000 individual deductible and a $3,000 family deductible Plan pays benefits for an individual as his/her deductible is met Everyone helps to meet the family deductible, but no one person pays more than the individual amount Bob $600 Amy Ted $200 Chris

9. Out-of-Pocket (OOP) Maximum Illustration Amy covers spouse and three dependents 9 $4,200 $4,000$2,000 $600 AmySue Chris TedBob Sue ActiveCare 1-HD with $4,200 family OOP maximum The family out-of-pocket maximum may be met by one or more people Plan pays benefits once entire $4,200 is met ̶ there is no individual amount to meet ActiveCare 2 with a $4,000 individual and $8,000 family OOP maximum Plan pays benefits for an individual as his/her OOP maximum is met Everyone helps to meet the family OOP maximum, but no one person pays more than the individual amount Bob $1,000 Amy Ted $400 Chris

10. PPO Network for ActiveCare 1-HD, 2 and 3 10 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 Always verify provider network status Network Statewide (all 254 counties) No need to : –Select a Primary Care Physician –Obtain referrals for specialist care Receive highest level of benefits: –Pay less for care –No balance billing No claim forms –Provider files claim for you

11. PPO Plan Overview (Network Level of Benefits) 11 ActiveCare 1-HDActiveCare 2ActiveCare 3 Deductible $2,400 employee only $4,800 family $1,000 individual $3,000 family $300 individual $900 family Out-of-Pocket Maximum (does not include copays or deductibles) $3,850 employee only $4,200 family $4,000 individual $8,000 family $1,000 per individual Coinsurance (Plan pays/ participant pays) 80% / 20% Office Visit Copay20% after deductible $30 for primary $50 for specialist $20 for primary $30 for specialist Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians. All other physicians are specialists.

12. PPO Plan Overview (Network Level of Benefits) 12 Preventive Care Clarification ServicesActiveCare 1-HDActiveCare 2ActiveCare 3 Preventive Care Plan pays 100% (deductible waived) Plan pays 100% (no copay required) Routine eye exam (one per plan year) Hearing exam 20% after deductible $30 for primary $50 for specialist $20 for primary $30 for specialist 100% coverage for certain age- and gender-specific preventive care services when network providers are used Must be billed by provider as “preventive care”

13. PPO Plan Overview (Network Level of Benefits) 13 Benefits (continued) ServicesActiveCare 1-HDActiveCare 2ActiveCare 3 High-tech Radiology (CT scan, MRI, nuclear medicine) 20% after deductible $100 copay per service, plus 20% after deductible Inpatient Hospital20% after deductible $150 copay per day, plus 20% after deductible ($750 max copay per admission; $2,250 max/year) $150 copay per day, plus 20% after deductible ($750 max copay per admission; $2,250 max/year) Emergency Room20% after deductible $150 copay, plus 20% after deductible (copay waived if admitted) $150 copay, plus 20% after deductible (copay waived if admitted) Outpatient Surgery20% after deductible $150 copay per visit, plus 20% after deductible

14. 14 New!! Effective Sept. 1, 2013 MRIs CAT or CT Scans Endoscopy procedures Colonoscopy procedures Back or spinal surgery Knee surgery Shoulder surgery Hip or joint replacement surgery Bariatric surgery Benefits Value Advisor Real-time access to current cost and quality transparency Appointment scheduling Clinical decision support tools Understanding benefits and how to best use them Referrals to condition management programs Preauthorization coordination Help get benefits information and find network providers for: One-Call Solution: 1-866-355-5999 Customer Service

15. Prescription Drugs ActiveCare 1-HD, 2 & 3 2013-2014 Plan Year

16. Your Prescription Drug Plan 16 Express Scripts administers your prescription drug plans on behalf of TRS –ActiveCare 1-HD, 2, and 3 plans Benefit includes both a retail and mail component Express Scripts has its own mail-order pharmacy where specialist pharmacists focus on compliance and lower cost options for the patient, and the automated filling system ensures the prescription is filled accurately.* Express Scripts buys medication from the most reputable suppliers *Express Scripts’ 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

17. Prescription Drug Benefits – Network Level 17 * 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. FeaturesActiveCare 1-HDActiveCare 2ActiveCare 3 Drug Deductible (per person, per plan year) Subject to plan year deductible $0 generic; $200 brand $75 Retail Short-Term (up to 31-day supply) Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred Brand) 20% coinsurance after deductible $20 $40* $65* $15 $35* $60* Retail Maintenance (after first fill, up to 31-day supply) Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred Brand) $25 $50* $80* $20 $45* $75* Mail Order and Retail-Plus (up to 90-day supply) Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred Brand) $45 $105* $180* $45 $105* $180* Specialty Medications (retail or mail) 20% coinsurance after deductible $200 per fill

18. New ID Cards for ActiveCare Plans 1, 1-HD and 2 Participants All current ActiveCare 1 participants will receive replacement cards for the new plan option in which they are enrolled. ActiveCare 1-HD and ActiveCare 2, participants will be mailed replacement prescription ID cards reflecting the upcoming changes to benefit design. The effective dates printed on the cards will be the more recent of either the participant’s effective date with the plan or 9/1/10. Participants should expect to receive new cards around mid- to late-August. Participants making changes after the replacements have been mailed will result in a second set of cards being sent. 18

19. Specialized Care is the Key to Quality Outcomes Specialization and participant engagement are critical components to controlling health care costs and driving quality clinical outcomes: Specialist pharmacist Online Tools Closing gaps in care My Rx Choices ® Mobile App Other available resources 19

20. Extremely Satisfied/Very Satisfied with overall counseling experience Specialist Pharmacists are specially trained to counsel patients about their conditions and connect with physicians and healthcare coaches Average patient call lasts 12 minutes Calls are monitored and recorded for training Pharmacists spend their time focused on a single condition Advanced tools let pharmacists see the “whole patient” along with their drug regimen across prescribers and pharmacies 97% of patients Specialist Pharmacists are an integral part of the healthcare continuum 20 “We strive to have our pharmacists deliver the level of patient care that any of us would want for our families.” Glen Stettin, M.D., Express Scripts’ Chief Medical Officer

21. 21 Omission Not Using Controller Medication for Asthma Omission Express Scripts’ online tools and mobile apps help connect patients and their caregivers Online prescription management:  Refills, renewals and order status  Worry-free Fills ®  Transfer to mail  Claims, balances and history  Locate a pharmacy  Preferences Benefit education and management:  Benefit highlights  Forms and cards  Pricing and coverage details  New! Accessibility features Gap In Care Alerts Help participants identify and address potential safety issues with their prescriptions

22. Pharmacy Care Online Alerts 22 Adherence Omission On track

23. Close-up: Sample Alert Message 23 Ability for patients to self-close gaps as appropriate Information about the alert and why it’s important Printable information to take to the doctor Access to email Express Scripts pharmacists Links to additional resources Video clips relevant to each alert

24. 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 Simply visit www.express-scripts.com. 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 24

25. Managing prescription with ease: Transfer to mail online conversion program 25

26. 26 New! Accessibility Features

27. Innovation that can help participants make better decisions for healthier outcomes 27 Save money Enable informed decisions Auto populate with personalized information Update in real-time Improve care Boost compliance and adherence Manage Refills and Renewals Unique functionality not available anywhere in healthcare today

28. Information Resources TRS Website – www.trs.state.tx.us/trs-activecare –Pharmacy Benefit Highlights –List of maintenance medications –FAQs –Download forms Express Scripts Participant Website – www.express-scripts.com –Prior authorization list –Formulary information –Locate a participating pharmacy –Generics Rx Advantage –My Rx Choices® / Price a Medication –Health and wellness information –Mobile App –Check prescription status –Order mail order refills –Download forms –Express Scripts widget Customer Service – 1-866-355-5999 Benefits Booklet 28

29. Valley Baptist Health Plans HMO Plan Option

30. Company Overview We have been part of the TRS-ActiveCare program since 2003 and currently cover more than 1,300 school employees and their dependents. We are a hospital-based health plan, founded in 1998 and are owned by Valley Baptist Health System. We focus exclusively the Valley and cover employees who live or work in Cameron, Hidalgo, Starr and Willacy counties. Valley Baptist Health Plans’ mission is to provided members with comprehensive health care coverage at an affordable price. 30

31. New for 2013-2014 The national average increase for health insurance premiums is 9 to 11 percent per year For the plan year 2013-2014, there is NO rate increase! 31 Coverage Category2013 – 2014 Employee Only$387.06 Employee and Spouse$941.04 Employee and Child(ren) $607.86 Family$960.14

32. Benefit Highlights No routine claim forms 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.valleybaptisthealthplans.com 32 NOTE: Care must be accessed through our affiliate provider network PHCS

33. Medical Benefit Comparison for 2013-2014 33 2012 - 20132013 - 2014 Deductible $500 per individual $1000 per family Deductible $500 per individual $1,000 per family Out-of-Pocket Maximum $3,500 per individual $7,000 per family Out-of-Pocket Maximum $4,000 per individual $8,000 per family Office Visit Primary Care – $25 Specialist – $60 Office Visit Primary Care – $25 Specialist – $60 Inpatient / Outpatient Copayment 20% – after deductible (member share) Inpatient / Outpatient Copayment 20% – after deductible (member share)

34. Rx Benefit Comparison for 2013-2014 34 2012 - 20132013 - 2014 Deductible $50 per individual Deductible $100 per individual Rx Yearly Maximum Unlimited Rx Yearly Maximum Unlimited Copayments Tier 1 – $10 Tier 2 – $30 Tier 3 – $60 Tier 4 – N/A Copayments Tier 1 (Generic) – $10 Tier 2 (Preferred Brand) – $30 Tier 3 (Non-Preferred Brand) – $65 Tier 4 (Specialty) – 20% After Deductible Formulary Open Formulary Closed

35. Valley Baptist Health Plans Service Area Rio Grande Valley Counties –Cameron –Hidalgo –Starr –Willacy Provider Network –More than 900 providers –14 hospitals Valley-wide 35

36. Valley Baptist Provider Network 36 Valley Baptist Health Plans 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.valleybaptisthealthplans.com. Our Harlingen office is located at: 2005 Ed Carey Drive Harlingen, TX 78550 (956) 389-2273 Come visit us and meet the staff. Harlingen Hospitals: Valley Baptist Medical Center Harlingen Medical Center Other Regional Hospitals: Valley Baptist Medical Center- Brownsville Knapp Medical Center McAllen Medical Center McAllen Heart Hospital Doctor’s Hospital Renaissance Edinburg Regional Hospital Edinburg Children’s Hospital Cornerstone Regional Hospital South Texas Rehab Hospital Solara Mission Hospital

37. Why Choose Valley Baptist Health Plans? We have experience with TRS-ActiveCare benefits. In fact, we cover more than 1,300 school employees and their dependents. We are a hospital-based health plan that supports our local communities. Medical decisions are made locally by physicians who understand how health care is delivered in your area. A dedicated Valley Baptist Health Plans representative is available to answer your questions. Unique e-mail address for TRS members and Benefit Administrators. 37

38. Contact Us 38 You may submit your questions or comments via e-mail to cservice@firstcare.com You can also write or call customer service at: Valley Baptist Health Plans 7878 N. 16 th Street Suite 105 Phoenix, AZ 85020-4443 800-829-6440 http://www.trs.state.tx.us/trs-activecare

39. How to Enroll 2013-2014 Plan Year How to Enroll

40. 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 40 Health care coverage for public school employees and their families

41. 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 41 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.

42. Dependent Eligibility 42 Spouse, including common law spouse A child under age 26: a natural child, an adopted child (or a child who is lawfully placed for legal adoption), foster child, or child under legal guardianship of the employee “Any other child” under the age of 26 (unmarried) in a regular parent-child relationship with the employee – Must meet residency and support criteria A grandchild under age 26 Unmarried disabled dependent (age 26+) – Must live with employee A dependent does not include a brother or sister of an employee unless the sibling is an unmarried individual under 26 years of age who is either: (1) under the legal guardianship of the employee, or (2) in a regular parent- child relationship with the employee and meets the “any other child” criteria Parents and grandparents of the covered employee do not meet the definition of an eligible dependent

43. 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 26) 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 43

44. Three Steps to Enroll 44 2 Complete an Enrollment Application and Change Form Available online or from your Benefits Administrator 1 Choose your health plan 3 Sign, date and submit form to your Benefits Administrator

45. Enrollment Enrollment Periods for 2013-2014 Plan Year: –April 22 – May 24 (Spring Enrollment) –August 1 – August 31 (Summer Enrollment) No pre-existing condition exclusion applies except for those who previously declined coverage (may be reduced by prior creditable coverage) Passive enrollment – If no plan or coverage changes, then no form required Premium adjusted to reflect any rate change, effective September 1 45 Exception: If an employee is enrolled in ActiveCare 1, he or she will be automatically enrolled in ActiveCare 1-HD effective September 1, 2013, unless he or she submits an Enrollment Application and Change Form to select a different TRS-ActiveCare plan option or terminate coverage

46. Enrollment Application and Change Form 46 Who needs to submit a form? New hires –Enrolling or declining TRS-ActiveCare coverage –Enrolling for TRS-ActiveCare coverage with a different participating district/entity Employees already enrolled, but making changes such as: –Selecting a different TRS-ActiveCare plan option –Adding or dropping dependents –Choosing to cancel and/or decline coverage (cancellations and declinations must be completed on two separate forms) –Changing name or address or correcting date of birth or Social Security number Current enrollees in ActiveCare 1 will automatically be enrolled in ActiveCare 1-HD, effective September 1, 2013; must submit a form to select a different plan option

47. Enrollment Application and Change Form (Cont’d) Enrolling for the first time: Forms due to the Benefits Administrator before: –The end of the plan enrollment period, or –31 calendar days after the employee’s actively-at-work date, or –31 calendar days after a special enrollment event New hires may choose their effective date of coverage –Actively-at-work date, or –First of the month following their actively-at-work date 47 Full premium for the month will be due if choosing actively-at-work date; premiums are not pro-rated

48. Pre-existing Condition Exclusions 48 Pre-existing condition exclusions will not apply: –To any individual under the age of 19 –To employees that initially enroll when the district/entity begins participating in TRS-ActiveCare –To new hires who enroll within 31 days after their actively-at-work date –To HMO enrollees A 12-month pre-x waiting period may apply to employees or dependents enrolling in the ActiveCare PPO plans due to: –A special enrollment event –A transfer to another participating district/entity (or rehire by the same participating district/entity), if the employee or any covered dependent has any remaining pre-existing waiting period or a gap in coverage of 63 or more consecutive days. Exception: If a participant has been 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)

49. Making Changes/Special Enrollment Events 49 Enrollees may be able to enroll for coverage, change plan options, or change the dependents he or she covers during the plan year within 31 days after a special enrollment event occurs New dependent –Marriage, birth, adoption or placement for adoption –Special rules apply to newborns Loss of other coverage Changing districts/entities is not considered a special enrollment event

50. Newborns Covered first 31 days if employee has coverage –Does not apply to newborn grandchildren 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 Plan changes must be made within 31 days after the newborn’s date of birth Not necessary to wait for newborn’s Social Security number –Submit application without SSN to enroll –Re-submit another form after SSN is issued 50

51. Cost for Health Coverage 2013-2014 Plan Year

52. Cost of Coverage 52 Funding to Help Offset the Cost of TRS-ActiveCare Coverage District/Entity (minimum $150)$165 State of Texas$75 Total Per Month$240 Funding applies to active, contributing TRS members Cost charts illustrate the monthly gross premiums

53. Monthly Cost for Coverage 53 See page 17 of Enrollment Guide $225 in district/entity and state funds to help pay for coverage

54. Application to Split Premium 54 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

55. ID Cards (mailed to your home) PPO plans (ActiveCare 1-HD, 2 and 3) –Separate cards for medical and prescription drugs Blue Cross and Blue Shield of Texas Express Scripts –BCBSTX will reissue ID cards to existing plan participants transitioning from AC1-HD to ActiveCare 1 (medical plan ID cards do not expire) –Prescription drug ID cards will be reissued by Express Scripts for ActiveCare 1-HD and ActiveCare 2 plan participants HMO plans –All HMO participants will receive new cards –Each individual covered under the plan will receive a card 55

56. Online Enrollment Support Available online – www.trs.state.tx.us/trs-activecare and www.bcbstx.com/trs Enrollment guide Summary of Benefits and Coverage (SBC) Downloadable forms (application and change form, application to split premium, claim form, etc.) Provider locator Enrollment presentation 56

57. 57 www.bcbstx.com/trs Enrollment Info Blue Access for Members

58. Blue Access for Members SM 58 Online member management tool Research health conditions View claims history and print Explanation of Benefits (EOB) statements Locate a network doctor or hospital Order additional ID cards, or print a temporary ID Take a confidential health assessment Send secure email messages to BCBSTX Customer Advocates Monday thru Friday 7 a.m. to 10 p.m. (CT) EOBs are available online; you must log in and elect to receive paper copies

59. Blue Access Mobile SM 59 Public Site – No log-in required Health Care 101 Find a Doctor or Hospital Blue Access for Members Log-in Contact Information Provider Finder App For iPhone ® and Android ® phones Blue Access for Members SM Secure Site – Log-in Required ID Card My Coverage – Benefits / Eligibility Visits and Claims Health and Wellness – Diabetes, Obesity, Nutrition, Fitness, Metabolic Syndrome, Maternity Care, Member Care Profile User Profile Register for Blue Access for Members Text Messaging Static – One-Way SMS Messaging Diabetes Management, Claim Status Notification Alerts Dynamic – Two-Way Messaging member initiates text with keyword (ID Card Management)

60. What if I Have Questions? Call TRS-ActiveCare customer service for: –Claim questions/status –Network provider information –Membership and eligibility –Medical and Rx coverage questions –Inquiries (telephone and email) –ID card requests –Transition of care information –Help with online tools! 60 Customer Service 1-866-355-5999 Personalized Service

61. Questions Thank you for attending

62. 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. Prescription drug benefits for ActiveCare 1-HD, 2 and 3 plans are administered by Express Scripts, Inc. HMO plans provided by: SHA, L.L.C. dba FirstCare Health Plans, Scott and White Health Plan, and Valley Baptist Insurance Company dba Valley Baptist Health Plans.