New to TRS-ActiveCare FAQs

What are my monthly premiums?
Your district decides how much it will contribute toward your premium. Ask your Benefits Administrator what your final monthly premium will be after the district contribution.

When does my coverage begin?
The TRS‑ActiveCare plan year runs from September 1 through August 31. Your district can confirm your exact effective date.

When will I receive my ID card?
Once your coverage is active, you can view, print, email, or request your ID card through Blue Access for Members or the BCBSTX app. For mailing timing, check with your Benefits Administrator.

What should I do before my coverage starts?

• Review your plan options, check whether your providers are in network, and choose a PCP if you enroll in TRS‑ActiveCare Primary or Primary+.
• If you take prescription medications, try to refill them before your new coverage begins to help prevent any gaps during the transition.
   

How do I set up my account or access my benefits?
Create a Blue Access for Members account at the TRS‑ActiveCare BCBSTX site. You can also use the BCBSTX app to access your benefits on the go.
 

How do I view or use my digital ID card?
You can view, print, email, or request your ID card through Blue Access for Members or the BCBSTX app.

Can I make changes after I enroll?
Yes, but only if you have a qualifying life event or special enrollment event.
 

What counts as a qualifying life event?
Examples include marriage, birth or adoption, loss of coverage, divorce, death, and court order.
 

Are there any special enrollment rules for new districts?
Yes. New districts must have a 31-day initial active enrollment window.

Who should I contact if I have questions about my coverage?

• For enrollment and premium questions, contact your district Benefits Administrator.
• For help understanding and using your medical benefits, contact a Personal Health Guide at 1‑866‑355‑5999.
• For questions about your prescriptions, contact Express Scripts customer service at (844) 367‑6108.
   

Where can I go for help understanding my benefits?

• Use Blue Access for Members, Provider Finder, and the BCBSTX app to learn about and manage your medical benefits. You can also contact a Personal Health Guide for help understanding how your medical coverage works.
• For help with your prescriptions, use the Express Scripts TRS-ActiveCare website  or call Express Scripts customer service at (844) 367‑6108.

Do I need a referral to see a specialist?
Yes. TRS‑ActiveCare Primary and Primary+ require a referral from your PCP to see most specialists. TRS‑ActiveCare HD does not require PCPs or referrals.
 

Which specialists require a referral?
You do not need a referral for emergency care, OB/GYN care, physical therapy, or in-network behavioral health specialists. For other specialty care under Primary and Primary+, work through your PCP.
 

Do referrals from my previous plan carry over?

• No. Referrals do not carry over from your previous plan. If your TRS‑ActiveCare plan requires a referral, your provider will need to submit a new one.
• If you take medications that require prior authorization, those approvals do not carry over either. It’s a good idea to refill your prescriptions before your new coverage begins, since obtaining a new prior authorization can take time depending on your provider’s response.

Will my deductible and out-of-pocket maximum carry over from my previous plan?
No. Your deductible and out-of-pocket maximum do not roll over to TRS‑ActiveCare.

What is the best place to go for care (PCP, urgent care, emergency room, virtual care)?

• Use TRS Virtual Health for common issues such as allergies, asthma, colds, flu, minor illness, and minor injuries.
• Use urgent care when you need in-person help for a non-emergency.
• Use the emergency room for serious emergencies such as chest pain, stroke, heart attack, heavy bleeding, or sudden severe pain.

Can I use telehealth services?
Yes. TRS‑ActiveCare includes TRS Virtual Health through RediMD and Teladoc, and those services are available 24/7.

Can a telehealth provider act as my primary care provider or give referrals?
Teladoc does not replace your PCP. If you need a referral, work through your PCP. You may be able to request a referral through a virtual visit with your PCP, depending on how your PCP’s office handles referrals.

What happens if I need care outside the network?

• TRS‑ActiveCare Primary and Primary+ generally do not include out-of-network coverage, except in situations like emergency care.
• TRS‑ActiveCare HD includes out-of-network coverage and a nationwide network. However, you will usually pay more for out-of-network care, so it’s best to use in-network providers whenever possible.
   

What happens if my dependent is living out of state?

• TRS‑ActiveCare HD provides the most flexibility for dependents living out of state because it uses a nationwide network and includes out-of-network coverage.
• TRS‑ActiveCare Primary and Primary+ may have more limited coverage, so your dependent’s options can vary.
• For dependents living out of state, you will need to complete an Out-of-State Dependent Attestation Form.
• For help understanding how coverage works or what steps to take, contact a Personal Health Guide.
   

Are there any differences based on my district or region?
Yes. TRS‑ActiveCare is regionally rated, so total premiums vary by your employer’s ESC region. Your district also decides how much it will contribute toward your premium, so your final employee premium is district-specific.

How do prescription costs work under TRS‑ActiveCare plans?

• Prescription costs vary by plan. TRS‑ActiveCare Primary has the lowest premium and uses copays for some services and drugs before you meet the deductible.
• TRS‑ActiveCare Primary+ has the lowest deductible and copays for many services and drugs. It also includes a $200 prescription drug deductible for brand‑name drugs and a $500 out‑of‑pocket cap for specialty medications.
• TRS‑ActiveCare HD requires you to meet the deductible before the plan pays for most non‑preventive care, including many prescriptions.
   

What does it mean that pharmacy benefits are integrated with the medical deductible?

• For TRS‑ActiveCare Primary and TRS‑ActiveCare HD, most prescription drug costs count toward the same deductible as medical expenses. That means you generally must meet the combined deductible before most brand-name and specialty prescription cost-sharing applies.
• TRS‑ActiveCare Primary+ works differently. It has a separate $200 prescription drug deductible for brand‑name drugs and includes a $500 out‑of‑pocket cap for specialty medications.
   

Do I have to meet my deductible before prescriptions are covered?

• That depends on the plan and the drug. On TRS‑ActiveCare Primary and TRS‑ActiveCare HD, most brand-name and specialty drugs are subject to the deductible first, while some generic and preventive drugs may be covered before the deductible.
• On TRS‑ActiveCare Primary+, brand-name drugs are subject to a separate $200 prescription deductible, while generics are not.
   

Are any prescriptions covered before the deductible is met?
Yes. Certain prescription drugs are covered before you meet the deductible. Some preventive drugs and some generic drugs may also be covered before the deductible, depending on the plan.
 

Are preventive medications covered at $0?
Some preventive medications are covered at $0 when the plan’s criteria are met. The Preventive Drug List is updated over time to reflect current clinical guidance, federal requirements, and pharmacy standards.
 

Are generic medications treated differently than brand-name drugs?
Yes. Generic drugs are treated differently from brand-name drugs on some plans. For example, TRS‑ActiveCare Primary+ has a $200 prescription drug deductible that does not apply to generic drugs.
 

How does the pharmacy deductible differ across plans?

• TRS‑ActiveCare Primary does not use a separate pharmacy deductible. TRS‑ActiveCare Primary+ uses a $200 prescription deductible for brand-name drugs only.
• TRS‑ActiveCare HD does not use a separate pharmacy deductible because pharmacy costs are generally integrated with the medical deductible.
   

How can I estimate what my prescriptions will cost?
Use the Express Scripts participant site to review your drug coverage and estimate costs for your prescriptions. This tool can help you compare pricing and understand what you may pay under your plan.

Can I still use my current pharmacy?
Check whether your pharmacy is in network through the pharmacy tools available on the Express Scripts participant site.

How do I find an in-network pharmacy?
You can search for a pharmacy through Blue Access for Members or through the Express Scripts participant website.

Who can I contact for help with my prescriptions?

• For help with your prescriptions, contact Express Scripts customer service at (844) 367‑6108. Support is available 24/7 to help you with medication coverage, prior authorizations, and cost questions.
• You can also use the Express Scripts participant website to review your prescriptions, check coverage, and estimate costs.

Are GLP‑1 medications covered under TRS‑ActiveCare?
Certain GLP‑1 medications are covered for people with a diabetic diagnosis who meet plan requirements. Mounjaro and Trulicity are covered. Ozempic is not covered.
 

What conditions must be met for GLP‑1 medications to be approved?
You must show inadequate control of diabetes with two oral antihyperglycemic treatments or sodium-glucose transport protein 2 (SGLT‑2) therapy, with required documentation of at least a 30-day trial for each prerequisite medication.
 

What is required for prior authorization for GLP‑1 medications?

• For new districts joining TRS‑ActiveCare, prior authorizations do not transfer. All members will need a new prior authorization for GLP‑1 medications, even if they were previously approved under another plan.
• Your provider will need to submit a new prior authorization that meets the current plan requirements.
   

What documentation is required for new users?
New users must provide documentation of A1C, fasting blood glucose, or 2-hour blood glucose from the past 6 months, plus documentation of a 30-day trial with two other hyperglycemic products.

What documentation is required for existing users renewing approval?
Existing users renewing approval must provide documentation from the past 6 months showing clinical benefit from GLP‑1 therapy, such as stabilization or a decrease in A1C. Acceptable lab values include A1C, fasting blood glucose, and 2-hour plasma glucose.
 

Do GLP‑1 medications require step therapy?

• Yes. If you are a new user or new to TRS‑ActiveCare and have not tried at least two antihyperglycemic or SGLT‑2 medications, step therapy will be required before a GLP‑1 medication can be approved.
• You will also need to provide documentation, including recent A1C or blood glucose levels, to demonstrate medical need and monitor progress.
   

What medications must be tried before GLP‑1 medications are approved?

• Before a GLP‑1 medication can be approved, you must show that other treatments have been tried. This typically includes at least two antihyperglycemic medications, such as Metformin or oral sulfonylureas (for example, glyburide, glimepiride, or glipizide), or SGLT‑2 inhibitors like Jardiance or Farxiga.
• For medication-specific requirements or to confirm what applies to your situation, contact Express Scripts customer service at (844) 367‑6108.
   

Are there different requirements for injectable versus oral GLP‑1 medications?

• The clinical and approval requirements are generally the same for both injectable and oral GLP‑1 medications. In some cases, if all criteria are met, an oral option may be approved.
• Additional documentation may be required to support the use of an oral medication instead of an injectable.
   

Are all GLP‑1 medications covered, or are some excluded?

• Not all GLP‑1 medications are covered. Coverage is limited to specific medications that meet plan requirements. Currently, Mounjaro, and Trulicity may be covered if all criteria are met.
• Other medications may not be covered, so it’s important to confirm coverage and requirements with Express Scripts for your specific prescription.
   

Who can help me understand my medication options and costs?

• You can use the Express Scripts TRS-ActiveCare website to review your medications, check coverage, and estimate costs.
• For help with your specific prescriptions, contact Express Scripts customer support at (844) 367‑6108. Support is available 24/7 to answer questions and walk you through your options.