The Final Health Care Reform Package

Report
Connecticut State
Teachers’ Retirement Board
Health Plan
Administered by
Stirling Benefits, Inc.
2014
 Governed by the Connecticut Teachers’
Retirement Board (TRB)
 Covering over 22,000 retired teachers
 Administered by Stirling Benefits
 Began service to TRB in 1996
 Service company, not an insurance company
 Based on the Blue Cross High Option
Plan funding comes from
three sources:
• Active teachers pay
1.25% of salary into the
health account,
• The state is responsible
for a third, and
• The retiree pays a third
1/3
Active
1/3
Retiree
1/3 State
of CT
TRB Subsidies
Retirees receive either:
Local Board subsidy


$110 per retiree or spouse per month
$220 per month if not eligible for Medicare
Or
TRB coverage subsidy


Two thirds (66%) of the cost of Medical & Rx
Once on the TRB plan, TRB no longer pays local board
TRB -- Who is eligible?
To obtain Medicare…
 Need 40 Quarters of Eligible Employment,
or…
 Married 10 years to someone who has 40
quarters


Part A -- Paid by Medicare
Part B -- Cost Share with Retiree
 Pre 1987 hires may not have 40 quarters
 TRB members don’t need Part D
Medical
Prescription
Dental
Vision and Hearing
TRB Plan Process
No
Network
No paper
claims to
file
Any provider
that accepts
Medicare
Claims paid by Medicare
first, then sent
electronically to Stirling
Benefits
TRB Medical
 Covers what Medicare allows
 Same as Blue Cross High Option
 No network, No Copayments,
 No Pre-Existing Condition Limitations
 No Individual Underwriting
 Picks up remainder after Medicare pays
 Coverage the same everywhere in the US
and Puerto Rico
Lifetime Maximums
 Unlimited maximum on Hospitalizations
 Unlimited maximum on Basic Medical
 Unlimited maximum on Prescriptions
 $1 M max on a small portion of remaining
claims (totaling about 3% of the total claims)


Applies to: out of country, extra 15% on unassigned
Medicare claims, extra 20 days of skilled nursing care
No member has ever come close to hitting the limit.
Assignment of Claims
 Medicare claims are either Assigned or Unassigned
 Assigned Claims (95% of all claims):
 Doctor agrees to accept what Medicare “allows” as full
payment
 Medicare and TRB plan pays the doctor
 Doctor guaranteed to collect 100% of what Medicare allows.
 Un-Assigned Claims (5% of all claims)
 Doctor may charge 15% more than “allowed”
 Medicare and TRB Plan pays Member
 Doctor must bill and collect from member
Examples of Claim Assignment
Doctor Charge
Medicare Allows
Medicare Pays
TRB Pays
15% Extra Billing
TRB Pays
Member Pays
Assigned claims
(95% of claims)
Un Assigned Claims
(5% of claims)
$130
$100
$80
$20
$0
$130
$100
$80
$20
$15
$12
$3
Shingles Vaccine Covered
 Effective 1-1-2013
 Plan
reimburses 80% of the cost of vaccine
 Up to total of $200 per person per lifetime
 Send proof of payment to Stirling Benefits
 TRB plan reimburses member by check
Out of Country
• In-Patient Hospital – 30 days at 100%
• Physician’s charges paid at 80%
• Non-Emergency Only
• 20% for services usually covered by Medicare
• Cannot be used for experimental procedures.
Rx Benefits
Administered by CVS Caremark
$250 Annual Deductible per Person
Maximum Out-of- Pocket is $1,000
($250 deductible + $750 of cost share)
100% for the remainder of the year
Retiree Payments for Rx
Generic
Drugs
Preferred
Drugs
NonPreferred
Acute
at Pharmacy
5%
20%
30%
Maintenance
at Mail Order
5%
20%
30%
Maintenance
at Pharmacy
10%
25%
35%
Dental
 $44.00 / Month (2014)
 Administered by Aetna Dental
$50
annual deductible
100% cleanings
80% basic restorative
50% Major Restorative
$2,000 annual maximum
Vision & Hearing
 $5.00 / Month
 Vision
Exams: $75 every 12 months
 $100 toward frames and $60 - $200 allowance for
lenses every 24 months, or $120 toward contacts every
12 months

 Hearing Aids: $750 every three years
 Administered by Stirling Benefits
Monthly Cost Per Person
2009 2010 2011 2012 2013 2014
Medical /
Rx
$99
Medical/Rx
$144
& Dental
Medical /
Rx /Dental
Vision &
Hearing
$112 $125 $124
$117
$97
$160 $174 $173 $160 $141
$149 $165 $179 $180 $165 $146
How Members Enroll
Complete one form per person
(Stirling or TRB website)
Send form with proof of Medicare to
TRB (not to Stirling)
Must be received by the 25th of the
second month preceding coverage
(25th of November for January 1st)
Cancel current Board of Education
coverage
For More Information…
 Stirling Benefits, Inc.
 20 Armory Lane, Milford, CT 06460
 (203) 876-1660, ext. 0,
www.StirlingBenefits.com
 Teachers’ Retirement Board
 765 Asylum Avenue, Hartford, CT 06105-2822
 (800) 504-1102, fax: (860) 622-2849, www.ct.gov/trb
 CVS /Caremark (800) 318-2572
 Aetna Dental
(855) 394-3874
 Medicare
(800) 772-1213 www.Medicare.gov

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