Eligibility and Enrollment |
Eligibility and Enrollment
How will my provider verify my eligibility if I don’t have an ID card?
Your provider may contact TRS-Care / Aetna Service Center at (800) 367-3636 to verify your medical coverage. You can also print a temporary ID card from the Aetna website. To print a temporary ID card, please register through the Aetna Navigator.
Your pharmacist may contact Caremark Customer Care at (866) 877-1555 to verify your prescription coverage. You can also print a temporary ID card from the Caremark website. To print a temporary ID card, please refer to the link below:
Will my spouse be eligible to enroll for TRS-Care at the time of my death?
Yes. However, your spouse must take action within the guidelines presented below: According to TRS-Care rules, the initial enrollment period in TRS-Care for a surviving spouse of an eligible retiree, or for a surviving spouse of a deceased active member, expires at the end of the later of: (1) the 31st day after the end of the month in which the retiree or the active member died; or (2) the 31st day following the date notice is sent to the surviving spouse. Notification will be sent to the eligible spouse at the individual’s last known address, as shown in the TRS-Care records. Please note that a surviving spouse may not cover a new spouse upon remarriage. See also “Surviving dependents” on page 45 of the Group Plan Booklet.
Upon my death as a disability retiree, will my surviving spouse have continuous coverage with TRS-Care if she was already enrolled as my dependent in TRS-Care?
Yes, a surviving spouse is eligible to continue TRS-Care coverage for as long as he/she lives and pays the premium.
How can a surviving spouse enrolled in TRS-Care cancel their TRS-Care coverage?
A surviving spouse enrolled in TRS-Care must send a written request to TRS-Care, 1000 Red River St., Austin, TX 78701, to cancel coverage.
Do my years in the Deferred Retirement Option Plan (DROP) count towards TRS-Care eligibility?
No, years in the DROP do not count toward TRS-Care eligibility.
How many days do I have to add a new dependent such as a new spouse, child, etc.?
The general time frame is 31 days from the event, but not all events are subject to the same time frame. For detailed information regarding your specific situation, refer to the “New Dependents” section on page 46 of the Group Plan Booklet.
Can I add my grandchildren, who live with me, to my plan?
Refer to the “Eligibility and Enrollment” section on page 44 of the Group Plan Booklet.
Why do I need to waive coverage on my spouse? They have their own insurance.
If you do NOT waive coverage on your spouse, you minimize the opportunity to add them to coverage later in the event your spouse loses their other coverage. If you waive coverage for a dependent of yours when he or she is initially eligible because he or she has other coverage, you may still be able to enroll your dependent (and yourself) later if your dependent has a Special Enrollment Event such as a loss of other coverage. To waive coverage you must, at the time you waive coverage for the dependent, indicate in writing (box 1C (spouse) or box 1D (children) of the form (TRS 700A ) the waiver and the reason for the waiver. Refer to the “Special Enrollment Events” section on page 45 and 46 of the Group Plan Booklet.
I have TRS-Care coverage as a surviving spouse. If I remarry may I add my new spouse to the coverage?
A surviving spouse of a deceased retiree or deceased active member who was eligible for TRS-Care may continue his or her own coverage but may not cover a new spouse upon remarriage.
If I divorce, may I continue coverage in TRS-Care for my ex-spouse?
No, your ex-spouse is no longer eligible as a dependent on your TRS-Care coverage. However, the ex-spouse is eligible for continuous coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). A request for COBRA coverage must be received by TRS-Care, 1000 Red River St., Austin, TX 78701, within sixty (60) days after the loss of eligibility for TRS-Care coverage.
How long can my children stay on my TRS-Care coverage?
Dependent coverage will continue as long as the monthly payment is made and the dependent remains eligible. Please refer to the “Eligibility and Enrollment” section on page 44 of the Group Plan Booklet.
How do I enroll in Medicare? Who do I contact?
You should apply for Medicare during your initial enrollment period for Medicare, which begins three months before the month of your 65th birthday. To enroll in Medicare, contact Social Security Administration at (800) 772-1213.
If I am not eligible for Medicare Part A how does that affect my TRS-Care coverage?
TRS-Care is your primary coverage for benefits that are covered by Medicare Part A (mostly inpatient hospital). You should use Network providers for the benefits or you will assume greater financial obligations for any Out-of Network inpatient hospital services.
Will I receive new TRS-Care ID cards when I become eligible for Medicare?
Yes, Aetna will issue you a new ID card. Caremark will not issue a new ID card because the prescription coverage will not change.
Will TRS-Care coverage become secondary when I am eligible for Medicare?
Yes, once you are eligible for Medicare your TRS-Care coverage becomes secondary. Please note that TRS-Care assumes and pays claims as if you have Medicare Part B, regardless of whether you have Medicare Part B or not. TRS-Care does not pay Medicare Part B claims as primary. Please refer to the TRS-Care Group Plan Booklet for expansive details.
Will I have an office visit co-pay when I become eligible for Medicare Part B?
No, the TRS-Care doctor office visit co-pay will no longer apply when a member becomes eligible for Medicare Part B. Medicare pays primary. Please note that TRS-Care assumes that you have Medicare Part B and pays claims as if you have Medicare Part B, regardless of whether you have Medicare Part B or not.
Why does my upgrade not go into effect when my Medicare goes into effect?
According to TRS-Care rules, your upgrade is effective on the first day of the month following your 65th birthday. Please review TRS-Care Rule 41.7.
Now that I am on Medicare, does my annual deductible for TRS-Care change to a January 1-December 31 plan year or does it stay in a September 1-August 31 plan year?
The annual deductible plan year for TRS-Care remains in a September 1–August 31 plan year.
What happens if I don’t purchase Medicare Part B?
If you do not purchase Medicare Part B when you become eligible, you will be responsible for the amount that Medicare Part B would have paid (80% of the charges) in addition to your coinsurance for the portion that TRS-Care pays as secondary payor.
I’m 65 years old and I told Aetna that I don’t have Medicare Part B. Why aren’t they paying my claims?
TRS-Care assumes that everyone age 65 and over has purchased Medicare Part B. TRS-Care pays your claims as if you have Medicare Part B, whether or not you have purchased it. If you do not purchase Medicare Part B, you will be responsible for the amount that Medicare would have paid (80% of the charges) in addition to your coinsurance for the portion that TRS-Care pays as secondary payor.
My TRS disability retirement has been approved. How does TRS-Care coordinate with my Medicare A & B coverage? Who is primary?
Medicare will pay as the primary coverage for participants with Social Security approved disabilities until a participant under age 65 is no longer disabled.
I have Medicare Part A only coverage and TRS-Care coverage. Which plan is primary?
Medicare Part A will become the primary coverage. Exceptions would be (1) actively employed participants and spouses of actively employed participants covered under a different group health plan and (2) some End Stage Renal Disease (ESRD) patients, where Federal guidelines require TRS-Care to be the primary carrier for a specified period of time.
When will I receive my TRS-Care ID cards following enrollment during an initial enrollment period or a Special Enrollment Event period?
Generally, cards are issued 2 to 3 weeks prior to the effective date of coverage. However, the issue dates may vary based on the timing of the receipt of your documentation.
Will the name(s) of my dependent(s) appear on my TRS-Care ID cards?
TRS-Care ID cards issued by Aetna will list the name of the retiree and the covered dependents. TRS-Care ID cards issued by Caremark will list the name of the retiree only.
If my TRS-Care ID cards are lost or stolen, how do I order new ID cards?
For your medical ID card, you can access the Aetna website at www.aetna.com and register for the Navigator or call TRS-Care / Aetna Service Center at (800) 367-3636.
For your prescription ID card, you can access the Caremark website or call Caremark Customer Care at (866) 877-1555.
How do I cancel myself, my dependents, and/or surviving spouse from my TRS-Care coverage?
If you are a retiree, please contact TRS-Care at (800) 223-8778 ext 6456 to obtain a cancellation form. For dependents and/or a surviving spouse, the request must be submitted in writing to TRS-Care; there is no special form for use by retirees to cancel dependents or surviving spouses.
Who determines when and how often our TRS-Care premium rates increase or decrease?
Premium rates for TRS-Care are reviewed on an annual basis. Recommendations concerning premium rates are presented to the TRS Board of Trustees for consideration, which makes the final determination on any premium rate increase or decrease.
How does TRS-Care work with TRICARE?
If you enroll in TRS-Care and are enrolled in TRICARE Military Healthcare, TRS-Care will consider benefits as the primary payor; TRICARE will consider benefits as the secondary payor.
I do not have internet access. How can I get a provider directory?
Contact TRS-Care / Aetna Service Center at (800) 367-3636 or click on the following link to access the provider directory:
Is there any coverage available after COBRA is exhausted for my dependent?
Aetna provides certain enrollees and their dependents the right to convert to an individual insurance policy when their coverage under TRS-Care ceases. For more information, contact Aetna at (866) 901-2922. It’s important that you take action before TRS-Care coverage ceases and request a copy of the “Notice of Conversion Privilege and Request” form.
My annuity payment is not large enough to cover the cost of the TRS-Care premium. How do I pay for it?
Aetna will bill you directly for your monthly TRS-Care premium.
Why wasn’t I notified that I didn’t send in my TRS-Care Enrollment Application (TRS 700A) insurance application?
If you were eligible for TRS-Care and we have not received the 700A form by the time the retirement application is received, we will remind you that you are eligible and should submit the 700A form as soon as possible. After your retirement has been finalized, no other notifications are sent to you.
I thought my TRS-ActiveCare coverage would remain in place after I retired, so I didn’t enroll in TRS-Care. Is that true?
No. TRS-Care is designed uniquely for retired Texas public school employees. It is separate and distinct from both the TRS Pension Trust Fund and from any program providing health care benefits to actively employed public school employees (including TRS-ActiveCare).
The TRS-Care “Highlights of the Plan Booklet” that you received in your retirement packet states that TRS-Care is a completely separate plan from TRS-ActiveCare.
How can I upgrade my TRS-Care coverage?
There are only two opportunities to later upgrade your TRS-Care coverage after your initial enrollment period. The first is when you reach age 65, provided you are already enrolled in TRS-Care the month of your 65th birthday. The second opportunity to upgrade coverage is if you experience a Special Enrollment Event.
Eligibility and Enrollment |