bcbs trs activecare Overview for Participants

As a participant in BCBS TRS ActiveCare, you're part of a program designed to provide affordable health insurance to Texas public school employees. BCBS TRS ActiveCare is a network of healthcare providers that offers discounted rates to participants.

The program is administered by Blue Cross and Blue Shield of Texas, a reputable health insurance company with a long history of serving the state. BCBS TRS ActiveCare has a network of over 60,000 providers statewide.

The program offers three different plans: ActiveCare 1, ActiveCare 2, and ActiveCare 3, each with varying levels of coverage and out-of-pocket costs.

Insurance coverage with BCBS TRS ActiveCare begins on September 1st, 2025. This means you'll have access to a wide range of benefits and services from that date onwards.

To get started with your insurance coverage, you can review the TRS Enrollment Guide for participants, which is available online. This guide will give you a comprehensive overview of what to expect from your insurance plan.

You can also find additional resources on the BCBS website, including a provider finder tool that allows you to search for doctors and hospitals in your network. The website is located at http://www.bcbstx.com/trsactivecare.

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Insurance coverage begins on September 1st, 2025.

You'll need to complete Participant Forms by this date to ensure you're covered. These forms are likely to be available through TRS Tools & Resources.

Doctors & Hospitals will be a part of your new insurance plan, so be sure to familiarize yourself with their network and policies.

Health & Wellbeing is a significant aspect of any insurance plan, and your new coverage will likely include resources to support this aspect.

Surprise Medical Bills can be a major concern, but your new insurance plan may offer protection against these unexpected expenses.

A Health Savings Account (HSA) may also be available to you, offering a tax-free way to save for medical expenses.

If you have a pre-existing condition, you may be required to undergo a Recommended Clinical Review before your coverage begins.

To help you understand your healthcare costs, you can use the MY HEALTHCARE COSTS WORKSHEET.

Navigating Referrals can be complex, but a helpful flier will be available to guide you through the process.

Learning how to Talk to Your PCP effectively is also crucial for getting the most out of your new insurance plan.

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Pearland ISD contributes $337 towards the monthly medical contribution.

TRS ActiveCare Medical & Pharmacy Insurance is a great option for those looking for affordable medical coverage. The plan has a lower monthly premium and lower copays for doctor visits before the deductible is met, making it a cost-effective choice.

You'll need to choose a Primary Care Provider (PCP) when you enroll, but you'll have a statewide network of providers to choose from, with no regional network boundaries.

Diagnostic labs, preventive care, and TRS Virtual Health visits are provided at no charge, which can help reduce your out-of-pocket costs.

Here are the coverage tiers and monthly increases for TRS-ActiveCare Primary:

TRS-ActiveCare Primary+ has the lowest deductibles, maximum out-of-pocket costs, and coinsurance rates. It has $15 copays for primary care and $0 TRS Virtual Health, making it a great option for those who want to minimize their out-of-pocket costs.

You'll still need to choose a PCP who's in the Texas network of providers, but you'll have the flexibility to see any specialist who's in the U.S. network of providers.

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TRC ActiveCare has a lower monthly premium and lower copays for doctor visits before your deductible is met, so you can lower your out-of-pocket costs sooner.

You'll have to choose a PCP with this plan when you enroll and you'll have a statewide network of providers to choose from.

Diagnostic labs, preventive care, and TRS Virtual Health visits are provided at no charge.

The TRS ActiveCare Primary plan has the lowest monthly costs, with $30 copays for primary care and $0 TRS Virtual Health.

Here are the coverage tiers and monthly increases for TRS ActiveCare Primary:

TRS is changing plan administrators for TRS-ActiveCare and TRS-Care plans. The changes will save the insurance plans hundreds of millions of dollars in the upcoming year.

The administration of TRS-ActiveCare will switch from Aetna to Blue Cross Blue Shield (BCBSTX) for active employees, effective September 1, 2020. The retiree change will begin January 1, 2021.

TRS-Care Medicare Advantage will move to UnitedHealthcare (UHC), from Humana, starting January 1, 2021. This change will not affect the benefits or providers for TRS-Care Medicare Advantage participants.

Your pharmacy benefits will remain the same, as CVS Caremark will continue to administer the pharmacy benefits for ActiveCare and TRS-Care Standard, and SilverScript will continue to administer the pharmacy benefits for TRS-Care Medicare Advantage.

BCBSTX has a broader provider network, and most ActiveCare and TRS-Care Standard enrollees' current providers are in the new network. However, it's too early to check on your specific doctor(s) yet.

TRS says 99% of the providers that TRS-Care participants use the most will be in the UHC network for the Medicare Advantage plan. This includes Houston Methodist Hospital, which was recently terminated by UHC, but Medicare Advantage plans are not affected by this termination.

Pearland ISD contributes $337 towards the monthly medical contribution, but it's worth noting that this is specifically for medical insurance, not pharmacy insurance.

TRS ActiveCare Medical & Pharmacy Insurance is available, but to learn more about pharmacy insurance, you'll need to review the TRS Enrollment Guide for participants.

Pearland ISD contributes $337 towards the monthly medical contribution, but pharmacy insurance details are not explicitly mentioned in this section.

TRS Medical Insurance Guide-2025-26 Plan Year is available for review, which may provide more information on pharmacy insurance.

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Coinsurance is the portion you pay for services after meeting your deductible, often a percentage of the costs. For example, you pay 20%, and the health care plan pays 80%.

A copay is the set amount you pay for a covered service when you get it, and the amount can vary by the type of service. In some plans, like TRS-ActiveCare Primary and TRS-ActiveCare Primary+, you'll have $30 copays for primary care and $15 copays for primary care in TRS-ActiveCare Primary+.

A deductible is the annual amount for medical expenses you must pay before your plan starts to pay its portion. For example, the deductible for Employee Only in TRS-ActiveCare Primary is $136 in 2023-2024.

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Emergency situations require immediate medical care and can result in serious harm or death. If you're in an emergency, you don't need a referral or a Primary Care Provider (PCP).

A generic drug is a prescription drug that's the generic equivalent of a brand-name drug on your health care plan's formulary and costs less than the brand-name drug. In the article, it's mentioned that TRS ActiveCare Medical & Pharmacy Insurance has a Health Savings Account (HSA) option, which can be used to save money on generic drugs.

The maximum out-of-pocket (MOOP) is the maximum amount you pay each year for medical costs. After reaching your MOOP, the plan pays 100% of allowable charges for covered services. For example, the MOOP for Employee Only in TRS-ActiveCare Primary is not specified, but it's mentioned that this plan has the lowest deductibles, maximum out-of-pocket costs, and coinsurance rates.

A Primary Care Provider (PCP) is the provider you choose to be your first contact for medical care. With some plans, your PCP coordinates all your medical care, including hospital admissions and referrals to specialists. In TRS-ActiveCare Primary and TRS-ActiveCare Primary+, participants (and spouses/dependents) will need a Primary Care Provider (PCP) who’s in the Texas network of providers.

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A referral is a written authorization from your PCP to get care from a different in-network provider, specialist, or facility. If you have a PCP, you may need a referral to see a specialist, but this depends on your health plan.

Here is a summary of the deductibles for different plans:

Note: These deductibles are for the 2023-2024 plan year and may change for the 2024-2025 plan year.

If you're currently receiving medical care from providers that aren't part of your new health plan's network, you'll need to make some adjustments.

You might be able to continue seeing your out-of-network providers at the in-network level of benefit for covered services, but this depends on the circumstances.

It's a good idea to request medical information from your current provider(s) to ensure a smooth transition.

You can continue to receive medical care from your current out-of-network provider at the in-network level of benefit for covered services, but you'll need to follow the plan's specific requirements.

Here are some key things to keep in mind about transitioning your care:

If you're a participant in BCBS TRS ActiveCare, you'll need to fill out various forms to manage your benefits. These forms can be found in the Participant Forms section.

You can download the Disabled Dependent Authorization Form in English or Spanish to authorize medical care for your dependent. The same form is available in both languages.

To enroll in or change your benefits, you'll need to complete the Enrollment, Change and Declination Form, which is available in both English and Spanish. You can also use this form to decline benefits.

Here are the various forms you may need to complete, organized by category:

These forms are all available in both English and Spanish to accommodate participants with different language preferences.

As a participant, you'll have access to a range of resources to help you navigate the system.

You can use Blue Access to check the status or history of a claim. This feature is especially useful if you're waiting to hear back about a specific treatment or procedure.

With Blue Access, you can also view and print Explanation of Benefits (EOBs) statements. These statements provide a detailed breakdown of your coverage and any out-of-pocket costs.

Blue Access allows you to search for an in-network health care provider, hospital, or pharmacy. This can save you time and hassle when trying to find a doctor or pharmacy near you.

Here are some specific tasks you can accomplish with Blue Access:

By using Blue Access, you'll have more control over your healthcare and be able to make informed decisions about your coverage.

As a participant, having access to the right forms can make a big difference in managing your benefits. You can find a variety of forms online to help you with different aspects of your coverage.

There are forms available in both English and Spanish, which is great for participants who may prefer to communicate in their native language. For example, the Disabled Dependent Authorization Form is available in both languages.

If you need to enroll, change, or decline your coverage, you can use the Enrollment, Change and Declination Form, which is also available in both English and Spanish.

If you need to file a medical claim, you can use the Medical Claim Form, which comes in different versions depending on whether you're filing a domestic or international claim. For domestic claims, there are two versions: one in English and one in Spanish. For international claims, there are also two versions: one in English and one in Spanish.

Some forms are specific to certain types of plans, such as the Member Rewards HCA Expense Form, which is available for TRS-ActiveCare Primary, TRS-ActiveCare Primary+, and TRS-ActiveCare 2 plans, as well as the TRS-ActiveCare HD plan.

Here are some of the participant forms available: