Benefits » Benefits At A Glance-Cost Information

Benefits At A Glance-Cost Information

 

Medical Plan

TRS-ActiveCare Primary (HMO)

TRS-ActiveCare HD

(High Deductible)

 

TRS-ActiveCare Primary +

(Previously ActiveCare Select)

(Low Deductible HMO)

 

TRS-ActiveCare2

(Closed to new enrollments)

Deductible

$2,500  EE / $5,000 FAM

 

$2,800  / $5,600  (In Network)

$5,500 /$11,000  (Out of Network)

$1,200 EE / $3,600 FAM

 

$1,000/$3,000 (In Network)

$2,000/$6,000 (Out of Network)

Out of Pocket Maximum

$8,150  EE / $16,300 FAM

 

$6,900  / $13,800  (In Network)

$20,250/$40,400 (Out of Network)

$6,900  EE / $13,800 FAM

 

$7,900/$15,800 (In Network)

$23,700/$47,400 (Out of Network)

Primary Care Office Visit

$30 Copay

Full Cost until the deductible is met

$30 Copay

 

$30 Copay (In Net)

40% After Deductible (Out of Network)

Specialist Office Visit

$70 Copay

Full Cost until the deductible is met

$70 Copay

 

$70 Copay (In Net)

400% After Deductible (Out of Network)

Retail Pharmacy copay/coinsurance (up to 31 day supply)

Integrated w/Medical - Brand

$15/$45 – Generic

30% after deductible- Preferred

50% after deductible - Non Preferred

30% after deductible- Specialty

 

Integrated w/Medical - Brand

20% after deductible – Generic

25% after deductible – Preferred

50% after deductible – Non Preferred

20% after deductible - Specialty

$200 Brand Deductible

$15/$45 - Generic

25% after deductible - Preferred

50% after deductible - Non Preferred

20% after deductible - Specialty

 

$200 Brand Deductible

$20/$45 - Generic

25% - Preferred

50% - Non Preferred

20% - Specialty

Employee Only

$0

$0

$42.50

$263.00

Employee + Spouse

$351.00

$367.00

$400.50

$905.50

Employee + Child(ren)

$149.00

$160.00

$193.50

$491.00

Employee + Family

$460.50

$479.50

$573.50

$1108.00