If your employer is new to TRS-ActiveCare and your employees need to get to know the plan, they can reference these frequently asked questions to help them get started.
Eligibility and Enrollment
Enrollment Basics
Check with your district Benefits Administrator for your enrollment dates. New districts use an initial active enrollment window.
Enroll through your district’s enrollment process. Contact your Benefits Administrator for instructions on how to enroll and which system your district uses.
Contact your district Benefits Administrator. They will provide instructions and help you complete your enrollment or make any changes to your coverage.
Costs and Coverage
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.
The TRS‑ActiveCare plan year runs from September 1 through August 31. Your district can confirm your exact effective date.
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.
Before Coverage Begins
- 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.
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.
You can view, print, email, or request your ID card through Blue Access for Members or the BCBSTX app.
Changes and Special Elections
Yes, but only if you have a qualifying life event or special enrollment event.
Examples include marriage, birth or adoption, loss of coverage, divorce, death, and court order.
Yes. New districts must have a 31-day initial active enrollment window.
Help and Support
- 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.
- 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.
Medical Questions
Finding In-Network Doctors and Facilities
- Use Provider Finder to check whether your doctors and facilities are in your plan’s network.
- TRS‑ActiveCare Primary and Primary+ have a statewide network. TRS‑ActiveCare HD uses a nationwide network and includes out-of-network coverage.
Use Provider Finder through Blue Access for Members to search for doctors, hospitals, and pharmacies in your plan’s network.
If you enroll in TRS‑ActiveCare Primary or Primary+, you must choose a PCP. Even if your plan does not require a PCP, it is still a good idea to have one.
Your PCP helps manage your care and can refer you to specialists when needed. If you enroll in TRS‑ActiveCare Primary or Primary+, you can find a PCP in Provider Finder and enter the PCP ID during enrollment.
Referrals and Specialists
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.
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.
- 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.
Coverage and Costs
No. Your deductible and out-of-pocket maximum do not roll over to TRS‑ActiveCare.
Care Options
- 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.
Yes. TRS‑ActiveCare includes TRS Virtual Health through RediMD and Teladoc, and those services are available 24/7.
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.
Special Situations
- 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.
- 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.
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.
Pharmacy Questions
Prescriptions and Transition
- Some prescriptions may still be valid when you switch plans. However, any prescription that requires a prior authorization will not transfer. Your provider will need to submit a new prior authorization for those medications.
- Be sure to give your pharmacy your new insurance information and confirm your prescription status with Express Scripts if you have questions.
You may not need a new prescription in every case, but you should confirm with your pharmacy and Express Scripts for your specific medication.
No. If your medication requires prior authorization, you must get a new prior authorization from your provider.
- If your medication requires prior authorization, try to fill it right before your new coverage begins so you have time to complete the new prior authorization process without a gap in treatment.
- It’s also a good idea to call Express Scripts at (844) 367‑6108 to confirm your medication status and understand any next steps.
Costs and Coverage
- 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.
- 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.
- 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.
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.
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.
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.
- 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.
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.
Pharmacies and Support
You can search for a pharmacy through Blue Access for Members or through the Express Scripts participant website.
- 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.
GLP-1 and Specialty Medications
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.
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.
- 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.
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.
- 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.
- 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.
- 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.
- 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.
- 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.