Administered by Stirling Benefits, Inc.
2014
Connecticut State Teachers’ Retirement Board
Health Plan
TRB Plan
Governed by the Connecticut Teachers’ Retirement Board (TRB)
Covering over 22,000 retired teachersAdministered by Stirling Benefits
Began service to TRB in 1996 Service company, not an insurance company Based on the Blue Cross High Option
TRB Plan Funding
1/3 Retiree
1/3 State of CT1/3 Active
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
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?
Retiree Spouse Surviving Spouse
Must have
Medicare Part A & Part B
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 quartersTRB members don’t need Part D
TRB -- WHAT’S COVERED
Medical
Prescription
Dental
Vision and Hearing
TRB Plan Process
No Network
Any provider that accepts Medicare
Claims paid by Medicare first, then
sent electronically to Stirling Benefits
No paper claims to
file
TRB Medical
Covers what Medicare allows Same as Blue Cross High Option
No network, No Copayments, No Pre-Existing Condition
LimitationsNo Individual UnderwritingPicks up remainder after Medicare
paysCoverage the same everywhere in the
US and Puerto Rico
Lifetime Maximums
Unlimited maximum on HospitalizationsUnlimited maximum on Basic MedicalUnlimited 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
Assigned claims (95% of claims)
Un Assigned Claims (5% of
claims)Doctor Charge $130 $130Medicare Allows $100 $100Medicare Pays $80 $80TRB Pays $20 $2015% Extra Billing - $15TRB Pays - $12Member Pays $0 $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
Non-Preferred
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 / MonthVision
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 yearsAdministered by Stirling Benefits
Monthly Cost Per Person
2009 2010 2011 2012 2013 2014Medical /
Rx $99 $112 $125 $124 $117 $97
Medical/Rx & Dental $144 $160 $174 $173 $160 $141
Medical / Rx /Dental Vision & Hearing
$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) 318-2572Aetna Dental (855) 394-3874Medicare (800) 772-1213 www.Medicare.gov