Connecticut State Teachers` Retirement Board

Connecticut State
Teachers’ Retirement Board
Health Plan
Administered by
Stirling Benefits, Inc
2013
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 join 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
Claims paid by Medicare
first, then sent
electronically to Stirling
Benefits
Any provider
that accepts
Medicare
TRB Medical
—  Covers what Medicare allows
¡  Same as Blue Cross High Option
—  No network, No Copayments,
—  No preexisting Condition limitations
—  No individual underwriting
—  Picks up remainder after Medicare pays
—  Coverage the same everywhere in the US
and Puerto Rico
Claim Examples under Medicare
Under Medicare, doctors either accept assignment (agree to accept
Medicare allowance as full payment) or do not accept assignment (can
charge up to 15% more than Medicare allows).
Assigned claims
Un Assigned Claims
Doctor Charge
$130
$130
Medicare Allows
$100
$100
Medicare Pays
$80
$80
TRB Pays
$20
$20
15% Extra Billing
-
$15
TRB Pays
-
$12
$0
$3
Member Pays
New for 2013
—  Shingles vaccine covered
¡  80 % - maximum reimbursement $200
—  Aetna dental members offered discounts
¡  Discounts for some gym memberships, weight loss
programs, hearing devices, acupuncture,
chiropractic, vitamins, herbal and nutritional
supplements
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% benefits 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%
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 hit $100,000 under the $1M
limit, much less $1M
¡ 
Dental
—  $43.00 / Month
—  Administered by Aetna Dental
¡  $50 annual deductible
¡  100% cleanings
¡  80% basic restorative
¡  50% Major Restorative
¡  $2,000 annual maximum
—  In or Out-of-Network coverage
Vision & Hearing
—  $5.00 / Month
—  Vision
¡  Exams:
$75 every 12 months
¡  $100 toward frames and $60 - $200 allowance for
lenses every 24 months
¡  $120 toward contacts per calendar year
—  Hearing Aids: $750 every three years
‘09
‘10
‘11
‘12
2013
Medical / Rx
$99
$112
$125
$124
$117
Medical/Rx
& Dental
$144
$160
$74
$173
$160
Medical / Rx
Dental Vision
& Hearing
$149
$165
$179
$180
$165
How members enroll
Fill out 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 (May 25 for July 1)
Cancel current Board of Education coverage
For More Information…
—  Stirling Benefits, Inc.
¡  20 Armory Lane, Milford, CT 06460
¡  (203) 876-1660, ext. 0,
StirlingBenefits.com
—  Teachers’ Retirement Board
¡  765 Asylum Avenue, Hartford, CT 06105-2822
¡  (800) 504-1102, fax: (860) 525-6018, www.ct.gov/trb
—  CVS CareMark
—  Aetna Dental
(800) 318-2572
(855) 394-3874
—  Medicare
(800) 772-1213 Medicare.gov
Who’s on what plan?
Local School
Plan
TRB Plan
Under age 65
6,235
74
65 or older
9,755
19,225
Total
16,992
19299
Source: 2012 TRB Cavanaugh Macdonald Actuarial Report As of July 1, 2012
Ø Governed by the Connecticut Teachers’
Retirement Board (TRB)
Ø Administered by Stirling Benefits
Ø  Began service to TRB in 1996
Ø  Service company, not an insurance company
Ø  Based on the Blue Cross High Option