Skip To Main Content

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

 

$3,000 / $6,000 (In Network)

$5,500 /$11,000 (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

$7,500 EE / $16,300 FAM

 

$7,000 / $14,000

 (In Network)

$20,250/$40,500 (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

$10.50

$16.50

$48.00

$301.00

Employee + Spouse

$378.00

$394.00

$454.00

$995.50

Employee + Child(ren)

$162.00

$172.00

$225.50

$548.00

Employee + Family

$529.00

$549.50

$631.50

$1215.00