1. Health Care Coverage for You and Your Family! 2009-2010 Plan Year Welcome

2. 2 Agenda  TRS-ActiveCare Program Highlights –Enrollment Summary –Facts and Figures  What’s New for 2009-2010 –ActiveCare 1, 2 and 3, plus new 1-HD option –HMOs  How to Enroll –Who is Eligible to Enroll –Cost of Coverage –Enrollment Support

3. 3 Enrollment Summary Percentage of Employees by Plan February 2009 216,896 Employees 361,918 Members

4. 4 Facts and Figures 2006-20072007-2008 Percent Increase Billed Charges $2.1 billion$2.5 billion19% Medical Claims Transactions 2.9 million3.2 million10% Pharmacy Claims Transactions 2.7 million3.0 million11% Paid Claims— Medical $656 million$783 million19% Paid Claims— Prescription Drugs $151 million$176 million17%

5. 5 What’s New for 2009-2010? ActiveCare 1, 2 and 3  4.5 percent premium increase  Continued emphasis on health and wellness  One benefit change: Bariatric surgery New Option! ActiveCare 1-HD  Basically same as ActiveCare 1, but –Higher deductible (meets IRS definition of a high deductible health plan—all coverage categories) –Slightly lower premium cost (for most coverage categories)

6. 6 PPO Network for ActiveCare 1-HD, 1, 2 and 3 Largest PPO network in the state  Includes over 50,000 physicians and over 400 hospitals in Texas  Available in all 254 Texas counties  Advantages to using network providers  Receive highest level of benefits  No claims to file  No balance billing www.trs.state.tx.us/trs-activecare www.bcbstx.com/trs Need to locate a Provider?

7. Plan Overview – Network Level of Benefits Plan Features ActiveCare 1-HDActiveCare 1ActiveCare 2ActiveCare 3 Deductible (individual/family) $2,300/$2,300$1,150/$3,000$500/$1,500None Out-of-Pocket Maximum (does not include deductibles) $3,000/$5,000$2,000/$6,000 $1,000 per individual Coinsurance (Plan pays/participant pays) 80% / 20% Illustrates benefits when network providers are used. Non-network benefits are also available; see Enrollment Guide for more information.

8. 8 Plan Overview – Network Level of Benefits Services ActiveCare 1-HD ActiveCare 1ActiveCare 2ActiveCare 3 Office Visit Copay 20% after deductible$25 for primary $35 for specialist $20 for primary $30 for specialist Preventive Care  Routine physicals*  Well-woman exams*  Routine mammograms*  Eye exams*  Well-baby exams  Immunizations  Hearing exams  PSA screenings  Colorectal screenings  Osteoporosis screenings * Services limited to one per person per plan year $0 copay up to $500 per person, per plan year Remaining charges subject to deductible and coinsurance $25 for primary $35 for specialist Includes all preventive care services billed with an office visit by a network doctor Coinsurance applies when no office visit is billed or when services are performed outside the office (deductible waived) $20 for primary $30 for specialist Includes all preventive care services billed with an office visit by a network doctor Coinsurance applies when no office visit is billed or when services are performed outside the office (no deductible) Non-network benefits are also available; see Enrollment Guide for more information.

9. 9 Plan Overview – ActiveCare 1-HD vs. ActiveCare 1 Plan Features ActiveCare 1-HDActiveCare 1 Meets IRS definition of High Deductible Health Plan and offers opportunity to contribute pretax dollars into a Health Savings Account (HSA) Yes, for all coverage categories (employee only, employee and spouse, employee and child(ren) and employee and family) Yes, for employee-only coverage No, for other coverage categories Deductible $2,300 for employee only $2,300 for family $1,150 per individual $3,000 per family Maximum Coinsurance $3,000 for employee only $5,000 for family $2,000 per individual $6,000 per family Out-of-Pocket Maximum (includes deductibles) $5,300 for employee only $7,300 for family $3,150 per individual $9,000 per family Monthly Premium Cost Less expensive than ActiveCare 1 in all coverage categories except employee and family More expensive than ActiveCare 1-HD in all coverage categories except employee and family Note: The amounts shown for “family” refer to the coverage categories for employee and spouse, employee and child(ren) and employee and family.

10. 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. 11 What You Need to Know  Participating districts/entities in TRS-ActiveCare are not expected or required to offer HSAs –You may seek an HSA administrator on your own –No integration with Blue Cross or Medco systems –No tax or legal advice available from TRS or TRS-ActiveCare customer service; HSA inquiries should be directed to your tax or legal counsel and/or your HSA administrator  ActiveCare 1-HD is not for everyone –You need to look beyond the premium cost –Premium savings may not be enough to justify the additional deductible and out-of-pocket expenses

12. 12 Benefit Change – Bariatric (Weight Loss) Surgery Important: Effective September 1, 2009, coverage for bariatric surgery will be available only when performed at one of the Blue Distinction Centers for Bariatric Surgery List is subject to change: Check online or call Customer Service for most current list

13. Health and Wellness Programs ActiveCare 1-HD, 1, 2 & 3 Plans

14. 14 Personalized Support. Motivational and lifestyle coaching by clinical professionals Wellness Coaches Lifestyle and condition management can be challenging Our Wellness Coaches are here to help Personalized telephonic support Motivational and behavioral coaching Personalized and coordinated goal-setting with action plans Communications via US mail Monitoring compliance and tracking outcomes 1-800-462-3275

15. 15  Voluntary programs designed for those diagnosed with: asthma, diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disorder, metabolic syndrome (high blood pressure, high cholesterol and obesity), lower back pain, rare conditions or depression  Enrolling in a program can help: –Decrease the intensity and frequency of symptoms –Enhance self-management skills –Minimize missed days at work –Enrich quality of life  Call to enroll or ask questions –Condition management telephone number is also listed on ID cards Condition Management Programs 1-800-462-3275

16. 16 Tobacco Cessation Program Support for members who want to quit 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 Personalized Lifestyle Management Support Counseling and coaching with licensed Wellness Coaches Motivational toolkit 24/7 Nurseline Referrals when appropriate Weight Management Program Support for a Healthier You

17. 17 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 from pregnancy to six weeks after delivery Once enrolled in the program, plan participants receive: Pregnancy risk assessment by an experienced obstetric registered nurse to determine risk level of pregnancy and level of outreach needed A welcome packet full of product samples, coupons and magazines Educational materials on a variety of topics Frequent, personal contact with a nurse case manager who helps coordinate care with the mom’s physician Immunization schedules Program components are available in English and Spanish 1-800-462-3275

18. 18 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 Points SM Rewards  “Ask-A” feature – health and wellness questions via secure e-mail  Online health encyclopedia  Interactive symptom checker

19. 19 Personal Health Manager – Home Page Use the Interactive Symptom Checker Read the latest health news, search for specific health topics or explore the prescription drug index Ask a Question to a certified Nurse, Trainer, Dietitian or Life Coach Access Member Care Profile Take a Health Risk Assessment Read secure messages Review member alerts Explore topics in the Health Information and Care Center

20. 20 Health Risk Assessment (HRA) Be informed about your overall health and well-being A Health Risk Assessment helps assess 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

21. 21 Ask the experts. Expert advice from licensed professionals via the Personal Health Manager “Ask-A” Online Advisor Expert advice at your fingertips. Our “Ask-A” feature is here to help. Ask a Trainer, Dietitian or Life 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

22. 22 Stay motivated. Earn Blue Points in the Personal Health Manager Blue Points SM Incentives TRS-ActiveCare PPO plan participants and their covered dependents accumulate 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. 23 Advice anytime. Round-the-clock health and the wellness advice from licensed professionals 24/7 Nurseline Advice isn’t just needed from 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 Available in English and Spanish 24/7 1-800-581-0368

24. 24 Learn more about the Blue Care Connection health and wellness programs online www.bcbstx.com/trs

25. 25 Online member management tool  Check claim status, view and download 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 Blue Access ® for Members Send secure e-mail messages to BCBS Customer Advocates available Monday thru Friday, 7 a.m. to 10 p.m. (CT)

26. 26 Customer Service 1-866-355-5999 What if I Have Questions?  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! Personalized Service

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

28. 28 Your Medco Prescription Drug Plan  Medco administers your prescription drug plans on behalf of TRS –ActiveCare 1, 2, and 3 and now the new 1-HD plan  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

29. 29 Prescription Drug Benefits - Network Level Features ActiveCare 1-HD ActiveCare 1ActiveCare 2ActiveCare 3 Drug Deductible (per person, per plan year) Subject to $2,300 plan year deductible Subject to $1,150 plan year deductible $50 Retail Short-Term (up to 30-day supply) Generic/Preferred Brand/Non- Preferred Brand 20% coinsurance after deductible $10 $25* $45* $10 $25* $40* Retail Maintenance (after second fill, up to 30-day supply) Generic/Preferred Brand/Non- Preferred Brand $15 $35* $60* $15 $35* $55* Medco by Mail (up to 90-day supply) Generic/Preferred Brand/Non- Preferred Brand $20 $62.50* $112.50* $20 $62.50* $100* * 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.

30. 30 Specific Rx Benefit Information  Retail pharmacies are ideal for acute (short-term) and new medication you may be trying for the first time  If you are taking a long-term medication, filling your prescriptions through Medco’s mail-order pharmacy provides several benefits: –You receive 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. 31 Patient Centric Care Different members have different needs Colds and flu, strep throat, ear infection, headache, sprains Acute Wrinkles, baldness, contraception, vitamins Well Cancer, AIDS, pulmonary hypertension, multiple chronic conditions such as heart failure and diabetes Complex Heart disease, diabetes, arthritis, high blood pressure, high cholesterol, dementia, chronic back pain Chronic

32. 32 Specialist Pharmacists An industry leading platform to better care  Specialist pharmacists have special training and unparalleled experience  A unique model and scale that enables each Medco pharmacy to specialize in a particular disease  Proprietary data capabilities bring specialist services to members Medco’s specialist pharmacists create a patient experience which improves the quality of member care and increases savings for our clients Oncology Immunology Neurology Psychiatry Pulmonary Rare & Specialty Cardio- vascular Gastro- intestinal Diabetes

33. 33 Medco’s Therapeutic Resource Centers provide specialized pharmacy services 817 patients 4.9% Rx cost Oncology Immunology Neurology Psychiatry Pulmonary Rare & Specialty Cardio- vascular Gastro- intestinal Diabetes 1,832 patients 13.5% Rx cost 3,668 patients 6.4% Rx cost 16,109 patients 18.0% Rx cost 39,091 patients 25.3% Rx cost 39,465 patients 15.1% Rx cost 54,353 patients 17.0% Rx cost 5,539 patients 1.2% Rx cost FY’08 TRS data Complex & Chronic patients > 59% of TRS-AC members have chronic & complex needs > 96% of Rx cost is for members with chronic & complex conditions Well 19.2% of members and <1% of FY08 costs Acute 21.9% of members and 3.1% of FY08 costs Chronic 49.8% of members and 55.1% of FY08 costs Complex 9.1% of members and 41.3% of FY08 costs

34. 34 Focus on right drug at right time for the right person The future of medicine lies in specialization:  Specialist Pharmacist  Personalized Medicine offering  My Rx Choices ®  Other Available Resources

35. 35 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  New this year, TRS is providing this service to TRS-ActiveCare patients if both the doctor and patient wish to take the test  Out with the old….drugs aimed at processes or diseases  In with the new….. drugs designed for specific interventions based on your genetics

36. 36 Your Genes: Which dose is right for you? Old: Trial and error 100mg New: Pharmacogenomics-driven 500mg100mg10mg Daily dose has been “personalized” Source: http://www.fda.gov/cder/genomics/presentations.htm; August 26, 2005

37. 37 High-level Process Flow Identification  Identify pharmacy claim indicating warfarin or tamoxifen were dispensed 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 Communication  Contact physician for approval to test patient  Contact patient to discuss program and test kit mailing  800 number provided for questions Follow-up  Monitor lab outcomes and follow-up as needed

38. 38 Personalized Medicine Patients in Need  The ability to determine how patients metabolize drugs can have significant impacts on financial and clinical outcomes  Avoiding breast cancer re-occurrence, severe bleeding events, and strokes is possible with a cheek swab test New Warfarin Users 620 Tamoxifen Users 373 Action The avg. cost/patient tested is $1,000-$1,500 less than those NOT tested Testing could result in significant quality of life improvement 49 patients estimated to receiving no benefit from Tamoxifen Prevents $96,000/re-occurrence 372 patients estimated to need dosing adjustment Prevents $13,800/severe bleed $39,500/stroke STOP Action

39. 39 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 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

40. 40 My Rx Choices  Medco can facilitate on generic equivalents received through mail order

41. 41 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  Customer Service Number 1-866-355-5999  Benefits Booklet

42. HMO Plan Options 2009-2010 Plan Year

43. 43 TRS-ActiveCare Participating HMOs

44. How to Enroll 2009-2010 Plan Year

45. 45 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

46. 46 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.

47. 47 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)

48. 48 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 25) 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

49. 49 Enrollment  Enrollment Periods for 2009-2010 Plan Year: –April 13 - May 15 (Spring Enrollment) –August 1 - August 31 (Summer Enrollment)  Preexisting condition exclusion applies to those that previously declined coverage; may be reduced by prior creditable coverage  Passive enrollment; no need to enroll unless you want to: –Change TRS-ActiveCare plan option –Add or drop dependents –Cancel and/or decline coverage –Enroll for TRS-ActiveCare coverage with a different participating district/entity –Change name or address or correct date of birth or Social Security number The HMO option from Legacy Health Solutions will not be available for 2009-2010 plan year. All existing Legacy enrollees must select a new TRS-ActiveCare plan option.

50. 2009-2010 Plan Year Cost for Health Coverage

51. 51 Monthly Cost for Coverage Page 33 of the Enrollment Guide

52. 52 Cost of Coverage Employee and family coverage for ActiveCare 1-HD is more expensive than ActiveCare 1 because the deductible and out-of-pocket maximum amounts for family are less and the plan may begin paying benefits sooner PPO Plans ActiveCare 1-HDActiveCare 1 Coverage CategoryTotal Cost Employee Only$245$278 Employee and Spouse$600$633 Employee and Child(ren)$382$443 Employee and Family$785$697 Family Deductible$2,300$3,000 Family Out-of-Pocket Maximum $7,300$9,000

53. 53 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 employers  Form available online

54. 54 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, 2010 unless there’s 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

55. 55 Newborns  Covered first 31 days if employee has coverage  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  Not necessary to wait for newborn’s Social Security number –Submit application without SSN to enroll –Re-submit another form after SSN is issued

56. 56 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

57. 57 Important Notice Supplemental 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 (800) 252-3439

58. 58 Your TRS-ActiveCare ID card will be mailed to your home  Enroll by May 15 to receive ID card by September 1  ActiveCare 1-HD, 1, 2 and 3 –New ID cards will not be issued to current participants unless changing plans –New enrollees will receive new cards

59. 59 Enrollment Support Dedicated Customer Service  ActiveCare 1-HD,1, 2 or 31.866.355.5999 (Blue Cross and Blue Shield of Texas and Medco)  FirstCare Health Plans 1.800.884.4901  Mercy Health Plans1.800.617.3433  Scott and White Health Plan1.800.321.7947  Valley Baptist Health Plans1.800.829.6440

60. 60 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

61. Questions Thank you for attending