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 |