Benefits At A Glance-Cost Information
Medical Plan
|
TRS-Active Care Primary (HMO)
|
TRS-Active Care HD
(High Deductible)
|
TRS-ActiveCare Primary +
(Previously ActiveCare Select)
(Low Deductible HMO)
|
TRS-ActiveCare 2
(Closed to new enrollments)
|
|
Deductible |
$2,500 EE / $5,000 FAM |
$3,300 / $6,600 (In Network) $6,600 /$13,200 (Out of Network) |
$1,200 EE / $2,400 FAM |
$1,000/$3,000 (In Network) $2,000/$6,000 (Out of Network) |
|
Out of Pocket Maximum |
$8,050 EE / $16,100 FAM |
$8,300 / $16,600 (In Network) $20,500/$41,000 (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 |
$15 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) 40% 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 |
$49.00 |
$55.00 |
$92.50 |
$301.00 |
|
Employee + Spouse |
$479.00 |
$498.00 |
$569.50 |
$995.50 |
|
Employee + Children |
$225.50 |
$237.50 |
$301.50 |
$548.00 |
|
Employee + Family |
$656.50 |
$680.50 |
$778.00 |
$1215.00 |