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

2. 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. 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. 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. 6 PPO Network for ActiveCare 1-HD, 1, 2 and 3 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 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 New for 2010-2011: The allowable amount for non-contracting providers will be limited to 50% of billed charges

7. 7 PPO Plan Overview (Network Level of Benefits) Plan Features ActiveCare 1-HDActiveCare 1ActiveCare 2ActiveCare 3 Deductible (individual/family) $2,400/$2,400$1,200/$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% New Deductibles for 2010-2011 (per IRS rules) ActiveCare 1-HD and ActiveCare 1

8. 8 PPO Plan Overview (Network Level of Benefits) Services ActiveCare 1-HDActiveCare 1ActiveCare 2ActiveCare 3 Office Visit Copay20% after deductible$30 for primary $50 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 $30 for primary $50 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) New Copays for 2010-2011 ActiveCare 2

9. 9 ActiveCare 1-HD vs. ActiveCare 1 Plan FeaturesActiveCare 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 $2,400 for employee only $2,400 for family $1,200 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) $5,400 for employee only $7,400 for family $3,200 per individual $9,000 per family Monthly Premium Cost Lower premium than ActiveCare 1 in all coverage categories except employee and family Higher premium than ActiveCare 1-HD in all coverage categories except employee and family New for 2010-2011: Deductible and out-of-pocket maximum amounts increased per IRS guidelines

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 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 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

12. 12 Blue Care Connection ®  Whether you decide to skip fast food, quit smoking, or walk more, every day decisions can have a positive impact on your health; Blue Care Connection offers guidance at every level of health Complex / CatastrophicWell MembersLow- RiskModerate- RiskHigh-Risk > > Total Care Approach to Health and Wellness

13. 13 Condition Management Support from 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 If you have a chronic condition, we offer support. 1-800-462-3275

14. 14 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 Tobacco Cessation and Weight Management 1-800-462-3275

15. 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. 16 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

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

18. 18 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

19. 19 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 an e-mail response within one business day

20. 20 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. Health Risk Assessment – Easy To Use Complete the assessment in as little as 10 to 15 minutes Choose your assessment topic: Health & well-being * Sleep Stress management Nutrition Fitness & physical activity Back & joint health *We recommend completing the Health & Well-being assessment first. 123

21. 21 Health Risk Assessment (HRA) 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 (results are not shared with employers) Be informed about your overall health and well-being Earn Blue Points SM

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. Available online Enrollment Video Application Form Enrollment Guide Benefits Booklet 24/7 Nurseline, Lifestyle and Condition Management and Special Beginnings phone numbers www.bcbstx.com/trs

24. 24 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) Blue Access ® for Members

25. 25 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

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

27. 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. 28 Prescription Drug Benefits - Network Level Features ActiveCare 1-HDActiveCare 1ActiveCare 2ActiveCare 3 Drug Deductible (per person, per plan year) Subject to 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.

29. 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. 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. 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. 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 to TRS-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. 33 High-level Process Flow Identification  Prescription comes in for a pharmacy claim for a product with an associated test through the prescription. Fill the prescription, then… 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

34. 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. 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. 36 Generic Dispensing is important… Savings For every 1% of increase generic usage, TRS could save millions of dollars Cost Difference Average cost of generic prescription is just over $15 as compared to $151 for a brand Approximately 6,000 web hits per month My Rx Choices My Rx Choices ® Generic Waiver Program First phase January-March 2010 Next waiver period will be June – August 2010 * Annual savings based upon initial waiver period performance and an 80% refill rate.

37. 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. 39 TRS-ActiveCare Participating HMOs

40. FirstCare Health Plans HMO Plan Option

41. 41  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. Company Overview

42. 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. 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 Benefit Highlights NOTE: Care must be accessed through one of our affiliate provider networks

44. 44 New for 2010-2011  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 Coverage Category2010-2011 Employee Only$351.36 Employee and Spouse$870.48 Employee and Child(ren)$558.82 Family$874.02

45. 45  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 New for 2010-2011

46. 46 2009-20102010-2011 Deductible $100 per individual no family maximum Deductible $250 per individual $500 per family A family of four can save $100! Out-of-Pocket Maximum $3500 per individual no family maximum Out-of-Pocket Maximum $3000 per individual $6000 per family A family of four can save $8,000! Lifetime Maximum Unlimited Lifetime Maximum $2 million The plan included various levels of copayments for each service in addition to the annual deductible. Benefits are simplified to now include a flat copayment after deductible. Ex. 20% copayment for outpatient ER visits 10% copayment for inpatient services New for 2010-2011

47. 47 Abilene Region Provider Network 47 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 510 Abilene, 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

48. 48 Amarillo Region Provider Network 48 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# 12019 Amarillo, TX 79101 (806) 356-5265 Come visit us and meet the staff. 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

49. 49 Lubbock Region Provider Network 49 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# 9 Lubbock, TX 79407 (806) 784-4300 Come visit us and meet the staff. 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

50. 50 Waco/ Bryan-College Station Region Provider Network 50 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 # 404 Waco, 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

51. 51 Why Choose FirstCare?  We have experience with TRS-ActiveCare benefits. In fact, we cover more than 11,000 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 FirstCare representative is available in your area to answer questions.  FirstCare values Texas teachers, administrators, and school employees. We are proud to serve you.

52. 52 You may submit your questions or comments via e-mail to cservice@firstcare.com You can also write or call customer service at: FirstCare Health Plans 1901 West Loop 289 Suite #9 Lubbock, TX 79407 800-884-4901 http://www.trs.state.tx.us/trs-activecare Contact Us

53. Scott & White Health Plan HMO Plan Option

54. 54 Service Area Hospital Locations

55. 55 Hospital Providers Central Texas Hospitals  Parkview Regional Hospital-New!  Limestone County Medical Center  Burleson St. Joseph Health Center  Coryell Memorial  Glen Rose Medical Center  Goodall-Witcher Healthcare  Grimes St. Joseph Health Center  Hamilton General Hospital  Hillcrest Medical Health Center  Johns Community Hospital  King’s Daughter’s Hospital  Lakeside Hospital  Llano Memorial Hospital  Madison, St. Joseph Health Center  Metroplex Hospital  Providence Health Center  Richards Memorial Hospital  Rollins Brook Community Hospital  Scott & White Healthcare-Round Rock  Scott & White Hospital  St. Joseph Regional Health Center  The Hospital at Westlake Medical Center  Trinity Medical Center 55

56. 56 Hospital Providers West Texas Hospitals  New! Ballinger Memorial Hospital Ballinger, TX  Shannon Medical Center San Angelo, TX  Reagan Memorial Hospital Big Lake, TX  Coleman County Medical Ctr. Coleman, TX  Schleicher County Medical Ctr. El Dorado, TX  Kimble Hospital Junction, TX  Lillian M. Hudspeth Memorial Hospital Sonora, TX  Concho County Hospital Eden, TX 56

57. 57 What’s New for 2010-2011  Our plan still has a $0 medical deductible  We reduced the annual out-of-pocket maximum from $3,000 down to $2,000 for an individual –Copays and medical expenses count toward your out-of-pocket max  The family out-of-pocket maximum remains unchanged at $6,000  Your annual prescription drug benefit is now unlimited! –We removed the annual cap, which was previously set at $4,000 per person 57

58. 58 What’s New for 2010-2011 (cont’d)  We reduced the primary care office visit copay to $20 per visit — last year it was $25  The specialty office visit copay is now $35 per visit  For allergy serum you pay 20%  Outpatient surgery, $100 copay plus 20% 58

59. 59 $0 Medical Deductible, $20 PCP Office Visit See Enrollment Guide for full list of benefits. BenefitCopay Medical Deductible$0 Primary Care Physician$20 Specialist Office Visit$35 Preventive Care$0 Outpatient Surgery Facility$100 copay plus 20% Inpatient Hospital$100 copay per day ($500 max) plus 20% Emergency Room $100 copay per visit plus 20% ($100 copay waived if admitted within 24 hours) Urgent Care$40 copay per visit plus 20% Out-of-Pocket Maximum $2,000 individual/$6,000 family

60. 60 Unlimited Rx Benefit Prescription Drugs Retail (up to 34-day supply Mail Order (up to 90-day supply) Rx MaximumUnlimited Rx Deductible Applies to brand and non-preferred $50 Generic$5$10 Preferred Brand*30% after deductible Non-Preferred Brand50% after deductible Non-Formulary greater of $50 or 50% after deductible N/A *If a brand-name prescription is dispensed when a generic is available, a copay of 50% applies after deductible

61. 61 Scott & White Health Plan Accolades  Scott & White Health Plan has been named one of the Highest Ranked Health Plans in Texas by U.S. News & World Report 1 for the fifth year in a row. 2  Scott & White Health Plan has also earned an “Excellent Accreditation” from the National Committee for Quality Assurance (NCQA) for both Commercial and Medicare products (2000-2009)  This is our 10th consecutive year with “Excellent Accreditation.”  The NCQA is a private, not-for-profit organization that evaluates how well a health plan operates along with the results it delivers to members in terms of care, service and efficiency. 1 U.S. News/NCQA America’s Best Health Plans 2009-10. “America’s Best Health Plans” is a trademark of U.S. News & World Report. 2 Previous rankings posted on www.usnews.com. 61

62. 62 Find a Provider Online – www.swhp.org 62

63. 63 Login to MyPlan

64. 64 Online Lifestyle Management Programs  Balance –Weight Management  Overcoming Binge Eating – Compulsive Eating  Breathe –Smoking Cessation  Care for Your Health –Chronic Condition Guidance  Relax –Stress Management  Overcoming Depression –Depression Guidance  Care for your Back – Back Care  Overcoming Insomnia –Sleep Problems  Move –Physical Activity  Nourish –Healthy Eating  Succeed –Health Risk Assessment 64

65. 65 Personalized Service 65 24-hour Nurse Advice Line  1-800-975-6612  Available to all SWHP members VitalChat  Instant Message with a nurse online and have your questions answered Customer Service Advocate  1-800-321-7947

66. 66 Simple Helpful Honest 66 We are Texas Friendly

67. Valley Baptist Health Plans HMO Plan Option

68. 68 Service Area  Rio Grande Valley  Counties –Cameron –Hidalgo –Starr (partial) –Willacy  Provider Network –More than 870 providers –12 hospitals Valley-wide Valley Baptist Health Plans

69. 69 Valley Baptist Health Plans  Low deductibles  No claim forms  No preexisting condition limitations  Controllable costs

70. 70 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  99% member satisfaction (employer group survey)  97% of our providers would recommend our plan to their patients (provider survey)

71. 71 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

72. 72 Valley Baptist Health Plans What’s New for 2010-2011  Approximately 9.0% premium decrease  $2 million lifetime maximum  New copays for outpatient services, ER, ambulance and urgent care

73. 73 Valley Baptist Health Plans BenefitCopay PCP office visit$25 Specialist office visit$35 Preventive care$25 PCP/$35 Specialist Outpatient surgery facility20% after deductible Inpatient hospital20% after deductible Emergency room20% after deductible (waived if admitted) Urgent care$75 copay (deductible waived) Out-of-pocket maximum$3,000 maximum (individual) $6,000 maximum (family)

74. 74 Valley Baptist Health Plans Prescription Drugs Retail (up to 30-day supply) Mail Order (up to 90-day supply) Generic$10$30 Preferred Brand$30$90 Non-Preferred Brand$60$180 Maximum plan year prescription benefit is $10,000 per individual

75. How to Enroll 2010-2011 Plan Year

76. 76 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

77. 77 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.

78. 78 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)

79. 79 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

80. 80 Enrollment  Enrollment Periods for 2010-2011 Plan Year: –April 19 - May 21 (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

81. 81 Preexisting Condition Waiting Period and Creditable Coverage  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  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 of 63 or more consecutive days  Pre-x waiting period may be reduced by creditable coverage Exception: If a participant has been covered by TRS-ActiveCare at any time since 2002, pre-x may apply if employee is hired by another participating district/entity (or rehired by same district/entity)

82. 2010-2011 Plan Year Cost for Health Coverage

83. 83 Monthly Cost for Coverage  See page 27 of Enrollment Guide  $225 in district/entity and state funds to help pay for coverage

84. 84 Cost of Coverage (Cont’d) 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 100% benefits sooner PPO Plans ActiveCare 1-HDActiveCare 1 Coverage CategoryTotal Cost Employee Only$262$297 Employee and Spouse$642$677 Employee and Child(ren)$409$474 Employee and Family$840$746 Family Deductible$2,400$3,000 Family Out-of-Pocket Maximum $7,400$9,000

85. 85 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

86. 86 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, 2011 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

87. 87 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

88. 88 Your TRS-ActiveCare ID card will be mailed to your home  Enroll by May 19 to receive ID card by September 1  ActiveCare 1-HD, 1, 2 and 3 –All enrollees, including existing plan participants, will receive new ID cards –New! Separate cards for medical and prescription drugs Blue Cross and Blue Shield of Texas Medco  HMO plans –All HMO participants will receive new cards (except for Valley Baptist Health Plans) –Each individual covered under the plan will receive a card

89. 89 Enrollment Support Dedicated Customer Service  ActiveCare 1-HD,1, 2 or 3866-355-5999 (Blue Cross and Blue Shield of Texas and Medco)  FirstCare Health Plans 800-884-4901  Scott and White Health Plan800-321-7947  Valley Baptist Health Plans800-829-6440

90. 90 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

91. Questions Thank you for attending