resource guide for your activecare 2 plan to know all your plan offers to help you choose wisely and...

Get to know all your plan offers to

help you choose wisely and live healthy

Resource Guidefor your ActiveCare 2 Plan

ActiveCare 2 Plan i

TABLE OF CONTENTS

3 LIVE HEALTHY!

3 100%preventivecarebenefits4 Join the Live Healthy America Challenge

5 BEGINNING RIGHT® MATERNITY PROGRAM

7 GETTING STARTED WITH YOUR ACTIVECARE 2 PLAN

7 Aetna ID card7 Out-of-pocket maximum

8 MEET AETNA

8 Aetna Health Concierge9 Aetna Navigator®10 Apps

11 YOUR PRESCRIPTION DRUGS

11 Caremark12 Fillingyourprescriptions

13 REACH YOUR WELLNESS GOALS

13 SimpleStepsToAHealthierLife®14 AetnaHealthConnections15 AetnaCareAdvocateTeam(CAT)15 Caremarkhealthandwellnesstools

16 SAVE WITH YOUR ACTIVECARE 2 PLAN

16 Know where to go16 Findandcomparecosts17 Talktoadoctorornursefromhome17 AetnaDiscounts

18 CONTACTS FOR HELP AND INFORMATION

19 ACTIVECARE 2 PLAN HIGHLIGHTS

iiActiveCare 2 Plan

ActiveCare 2 Plan1-800-222-9205—TRS-ActiveCareCustomerService

1-800-628-3323—TTYnumber

•Option1—Aetna(medical)8a.m.–6p.m.CT(Mon.–Fri.)

•Option2—Caremark(prescriptiondrug)24hoursaday,7daysaweek

ActiveCare 2 Plan 3

LIVE HEALTHY!

YourActiveCare2planismorethanjustbenefits.It’saresourceforhealthierliving,with tools,servicesandprogramstohelpyouandyourfamilyachieveyourwellnessgoals. Weinviteyoutolearnaboutwhat’savailabletohelpyoubethehealthiestyoucanbe.

Take advantage of your plan’s 100% covered preventive care benefitsGetroutinephysicalexamsandscreeningsthathelpcatchproblemsearly.They’recovered at100%—withnodeductible—whenyouusein-networkproviders.Examplesofpreventivecareincluderoutinescreenings,vaccinesandcheckupsforadultsandchildren,aswellascounselingtopreventillnesses,diseaseandotherhealthproblems.Theyalsoincludewomen’spreventivecareservices,suchascheckups,contraception,prenatalcare,lactationcounselingandmore.Forafulllistofcoveredpreventivecareservices,pleaserefertotheTRS-ActiveCareBenefitsBookletatwww.trsactivecareaetna.com.

benefitsTRS-ActiveCare

Everything you need to know about ActiveCare 1-HD, Select,

and 2 Health Plans

Effective September 1, 2016

booklet

ActiveCare 2 Plan 4

Live healthier 4 ways

1. Exercise regularly. Get30minutesofmoderate-levelactivitymostdays.

2. Quit smoking.Thehealthbenefitsbeginalmostimmediately.

3. Eat more fruits and vegetables. Shootfor5to9servingsdaily.

4. De-stress. Taketimeeachdaytomeditate,doyogaorsimplysitanddonothing.

Join the Live Healthy America Challenge Live Healthy Americaisan8-weekchallengebroughttoyoubyTRS-ActiveCareandAetna,andopentoanyTRSemployeeenrolledinaTRS-ActiveCaremedicalplan.Whenyoujoin,youcanputtogetherateamof2to10peopleorparticipateasateamofone.You’lltakepartinteamactivitiesandworkouts,settinggoalsandtrackingactivityminutesand/orweightlosssuccesses.You’llmakepositivechangesinyourhealthandlifeasyoutrackyourprogressdailyorweekly.

Bestofall,youcanwinprizesforyourteamandyourschool.Tolearnmoreandjointhechallenge,visitwww.trsactivecarelivehealthychallenge.com.

ActiveCare 2 Plan 5

BEGINNING RIGHT MATERNITY PROGRAM

Get your baby off to a healthy startYourActiveCare2plancanhelp.It’sanimportanthealthandwellnessresourceforyouandyour family–rightfromtheverybeginningoflife.

Coverage for your newbornThefirstweeksafteranewbabyarrivesareabusytime.Soit’sgoodtoknowthatyourActiveCare2 planwillautomaticallyprovidemedicalcoverageforyournewbornforthefirst31daysfollowing his/herdateofbirth.Youmustenrollyourchildwithin31daysafterhis/herdateofbirth.

Understanding your family benefitsIfyouwereenrolledasan“employeeonly”or“individual”beforethebirthofyourchild,yourcoveragestatuswillchangeonceyourchildisenrolled.Yourmonthlycontributionswillchange.Toseeyour familybenefits,gotowww.trsactivecareaetna.comandclick“2016-2017BenefitsBooklet.”

ActiveCare 2 Plan 6

Join the Beginning Right® Maternity Program Availabletoyouoryourcovereddependent,theBeginningRightMaternityProgramcanhelpgiveyourbabyahealthierstartinlife.Theprogramoffers:

• One-on-onesupportviaphonefromanobstetricallytrainednursewhocanprovideinformation,adviceandanswersonpregnancyandnewborn-relatedissuesandconcerns.

• APregnancyRiskSurveytohelpidentifyhealthissuesthatneedspecialattention.• APregnancyHandbook(availableinEnglishorSpanish)withhelpfulinformation,

resourcesandtipsforahealthierpregnancyandhealthierbaby.

Get your $100 Babies “R” Us® gift card:WhenyouoryourcovereddependentjoinsBeginningRightandcompletestheprogram(includingonepost-partumcallfromaprogramnurse),a$100giftcardfromBabies“R”Uswillbemailedtoyourhome.

TO GET STARTED: Call 1-800-272-3531orvisit www.trsactivecareaetna.com and log in to AetnaNavigator,thenclick“HealthPrograms”atthetopofyourhomepage.

ActiveCare 2 Plan 7

GETTING STARTED WITH YOUR ACTIVECARE 2 PLAN

HereareafewtipsandreminderstohelpasyougetstartedwithyourActiveCare2planforthe 2016–2017planyear.

Your Aetna ID cardYourAetnaIDcardisafamilycard;uptofivefamilymembersarelistedonthecard.Ifyouhavemorethanfourdependents,youmayhavereceivedanadditionalcardthatshowstheotherdependents.

Ifyouneedadditional,temporaryorreplacementcards,callTRS-ActiveCareCustomerService at 1-800-222-9205.

About the out-of-pocket maximumDesignedtoprotectagainstveryhighmedicalexpenses,theout-of-pocketmaximumlimitswhat youmustpayoutofyourownpocketforcareeachyear.

• The individual out-of-pocket maximum, $6,850,appliestoeachfamilymembercoveredbytheplan.Onceafamilymember’sexpensesreachhis/herindividualout-of-pocketmaximum,anyremainingexpensesarepaidat100%fortherestoftheyearforthatmember.

• Eachfamilymember’sexpensesaccumulatetowardthe family out-of-pocket maximum, $13,700.Oncetheout-of-pocketexpensesofanycombinationoffamilymembersaccumulatetothefamilyout-of-pocketmaximum,allfamilymemberswillbeconsideredtohavemettheirout-of-pocketmaximum.

ActiveCare 2 Plan 8

MEET AETNA

YourActiveCare2medicalplanisadministeredbyAetna.Aetnaoffersawiderangeofresources andservices—fromanationalprovidernetwork,tothelatestonlinetoolsandmobileapps,tothe servicesofaHealthConcierge.

There’salottoknowaboutyourplanandwhatitcandoforyouandyourfamily.

Usethesetwoimportantresourcestogetthemostoutofyourplanbenefits,servicesandprograms.

Call the Aetna Health Concierge – 1-800-222-9205For benefits and health care answers

Whenyouneedaquickanswer,someonetoexplainyourbenefitsorhelpgettingtherightcare,youhaveanadvocatededicatedtoyourhealthcareneeds.TheAetnaHealthConciergeisabenefitsandhealthexpertwhocanhelpyoubetterunderstandthedifferentpartsofyourplan.Callwithyourquestionsandlearnmoreaboutbenefits,providers,services,programsandtools.YourAetnaHealthConciergecanevenhelpyoufindtherightdoctorforyourconditionorproblem,andmakeanappointment.

Aetna Health Concierge 1-800-222-9205, option 5 Monday through Friday, 8 a.m. to 6 p.m.

ActiveCare 2 Plan 9

Register with Aetna NavigatorFor access to a world of online resources

AsanActiveCareparticipant,youwillhaveaccesstoonlinetools,providerlookups,costestimates andmuchmoreatAetnaNavigator,yoursecurememberwebsite.Itallstartswhenyouregister. Here’show:

• Have your Aetna member ID card ready• Visitwww.trsactivecareaetna.comandclick“LogIn/Register”onthehomepage• Followthesimpleprompts• Createyourusernameandpassword• Provideavalidemailaddressandagreetoreceiveelectronicinformationsothatyou

willstayuptodateoncoverageandclaimdetails

Need help registering?Usethe“AskAnn”linktoregister,retrieveapasswordandfind yourwayaroundthesite.

Onceyouareregistered,youcanvisitthewebsite24/7to:

• Confirmfamilymemberscoveredunderyourplan• Checkbenefitsandclaims• PrintanIDcard• Getcostestimatesformedicalproceduresandtreatments• TaketheHealthAssessment• ViewyourPersonalHealthRecord(PHR)• Usethe“ContactUs”linkonanypagetoemailAetnaMemberServices• GetstartedwithAetnawellnessprogramsanddiscounts

ActiveCare 2 Plan 10

Youcanalso:

Look up in-network providers. UseDocFind®,theonlineproviderdirectory,tofindin-network primarycaredoctors,specialists,urgentcarefacilities,hospitalsandmorenearyou.Goto www.trsactivecareaetna.comandclick“Findadoctororfacility”onthehomepage.Choosea providertypeorenteraname,specialty,procedureorconditioninthesearchbox.

REMEMBER: YoupaylessforcarewhenyouusedoctorswhobelongtotheAetnanetwork.Plus,they fileclaimsforyouandhandleanyadvanceapprovalsyoumayneedforcertaintypesofcare.Visitinganout-of-networkproviderforyourhealthcareneedscanhavesignificantfinancialimplicationsforyou.

Check your Personal Health Record (PHR).ThePHRisasecureonlinerecordofyourcare,withinformationgatheredfrommedicalandpharmacyclaims.Youcanseemedicalproceduresand servicesreceived,androutinecareprovided—bywhomandwhen.Youcanalsoenteryourowninformationsuchasprescriptionmedications,over-the-counterdrugsandnutritionalsupplements youuse.ThePHRalsoissuespersonalizedhealth-relatedalertsandrecommendations,andfeatureshealthandphysicalactivitytrackers.

Get the apps!

Aetna MobileletsyouuseamodifiedversionofAetnaNavigatoronyourmobiledevice.Finddoctors,showyourIDcard,checkclaims,contactMemberServicesandmore.TheAetnaMobileappworkswithAppleandAndroidmobiledigitaldevices.*

Getit:Text“Apps”to23862**ORvisitwww.aetna.com/mobile.iTriage®,tomakesenseofyourhealthcareoptions.Checkasymptom, lookupconditionsandprocedures,findtherightdoctororfacility,lookupERwaittimes,andmuchmore.Getit:TheappisfreeonGooglePlayTM or the App StoreSM.Youcanalsovisitwww.itriagehealth.com.Caremark app,forreal-time,secureaccesstoyourprescriptionsandpharmacyinformation.Youcanlookuppharmaciesnearyou,ororderprescriptionsusingmailorderservice,thencheckthestatusofyourorder.Youcanalsoviewyourpharmacyhistoryandcheckdrugcosts.UsetheapponyouriPhoneandAndroidphone.

Getit:Visitwww.caremark.com.Onthehomepage,lookfor“Checkoutourmobileapp!”andclick“Learnmoreandgettheappnow.”

Teladoc® app,totalktoaboard-certifieddoctor24/7/365.ThisappletsyouaccessallthebenefitsoftheTeladocserviceviaphone.Talktoadoctor anytime,anywhere.Turnto“SaveWithYourActiveCare2Plan”onpage16formoreaboutTeladoc.Getit:Visitwww.teladoc.com/mobileortext“GetStarted”to469-804-9918.TheMyQuestTM mobile app,toscheduleQuestDiagnosticsTMappointments,checklabresults,shareinformationandmore.AvailableforAppleandAndroiddevices.Getit:Downloadtheappatwww.questdiagnostics.com/myquest.

*AndroidandGooglePlayaretrademarksofGoogle,Inc.Apple,theApplelogoandiPhonearetrademarksofApple,Inc.,registeredintheU.S.andothercountries.AppStoreisaservicemarkofApple,Inc.

**Standardtextmessagingratesmayapply.

http://www.caremark.com

http://www.teladoc.com/mobile

http://www.questdiagnostics.com/myquest


YOUR PRESCRIPTION DRUGS

Meet CaremarkCaremarkistheadministratorofyourTRS-ActiveCarePlanprescriptiondrugbenefits.

ThroughCaremarkpharmacyservices,youcanordermaintenanceandspecialtymedicationsonlineor byphone,andhavethemdelivereddirectlytoyou.Youcanalsovisitwww.caremark.com/trsactivecare forhelpfulresourcesandinformation.

How to save on prescription drugs

Here are 4waystosaveonyourprescriptions:

1. Ask for generics first. Genericsarepharmaceuticallyandtherapeuticallyequivalentto brand-namedrugs,andcancostupto80%less.

2. Remember the preferred drug list. Ifagenericdrugisn’tavailable,askyourdoctortoprescribeadrugonyourplan’spreferreddruglist,ifappropriate.Youwillpaymorefora brand-name medication not onthepreferredlist.Gotowww.caremark.com/trsactivecare toseethepreferreddruglist.

3. Order 90-day suppliesofmaintenancemedicationstosavemoney.VisitaCaremarkRetail-PlusPharmacyorusetheCaremarkPharmacyformailservice.Youwillpaythesamecoinsuranceeitherway.Remember,ifyoufillmaintenanceprescriptionsatatraditionalnetworkpharmacy,youwillpaymoreforyourmedicationafterthefirstpurchase.

4. Fill short-term prescriptions(uptoa31-daysupply)ataCaremarkretailnetworkpharmacy.Youwillgenerallypaymoreforshort-termprescriptionsfilledoutsidetheCaremarkretailnetwork.


Filling your prescriptionsWhereyoucanfillyourprescriptiondependsonwhetheryouneedashort-term,maintenance orspecialtymedication.

Short-term medications aregenerallytakenforalimitedtimeandhavealimitednumberofrefills; forexample,anantibiotic.YoucanfillprescriptionsforthesemedicationsatanypharmacyintheCaremarkretailnetwork.

• Choosefrommorethan64,000networkpharmaciesnationwide,includingindependentand chainpharmacies.

• Find a participating pharmacy at www.caremark.com/trsactivecare.

TIP: Toavoidclaimspaperwork,bringyourprescriptionIDcardalongwhenyoupickupyourprescription.UseapharmacyintheCaremarkretailnetworktosavemoney.

Maintenance medicationsaretakenregularlyforchronicconditionssuchashighbloodpressure, asthma,diabetesorhighcholesterol.YouwillgenerallysavemoneybyusingtheCaremarkPharmacy (formailorders)oraCaremarkRetail-PlusPharmacyfortheseprescriptions.

Youhaveachoiceof4easywaystostartfillingmaintenanceprescriptions:

1.BringyourprescriptiontoanyCaremarkRetail-PlusPharmacy—findoneat www.caremark.com.

2.Completeandreturnthemail-serviceorderformavailableatwww.caremark.com/trsactivecare.

3.UsetheFastStart® tool found on www.caremark.com.

4.CallFastStartat1-800-875-0867.

Specialty medicationsaredrugsusedtotreatcomplexconditionssuchascancer,growthhormonedeficiencyorhemophilia.Theymaybeinjected,infused,inhaledortakenorally,andmayrequire specialhandling.YoucanfillprescriptionsforspecialtymedicationsthroughCVSCaremarkSpecialtyPharmacy.Tolearnmoreandgetstarted,callCaremarkConnect®toll-freeat1-800-237-2767orvisitwww.caremark.com/trsactivecare.


REACH YOUR WELLNESS GOALS

Takeadvantageofno-costprogramsandservicestoreachyourwellnessgoals,manageachroniccondition,stayhealthyduringpregnancyandmore.

Simple Steps To A Healthier Life Know your risks, improve your healthSimpleStepsToAHealthierLifeisanonlinehealthandwellnessprogramthatcanhelpyoureach goalssuchaslosingweight,eatinghealthierandevengettingabetternight’ssleep—stepbystep, atyourownpace.

Take the Health Assessment TheprogramstartswhenyoutaketheHealthAssessment,aquestionnairethatcoverstopicssuch ashealthhistory,lifestyleandhabits,andhealthscreenings.Injust15minutes,you’redone.


Get a health report and an action planOnceyou’vecompletedyourHealthAssessment,youwillgetasecureemailwithyourpersonalized actionplan.Thisreportoutlinesyourpersonalhealthrisksbasedonyouranswerstothequestionnaire.Italsorecommendsonlinehealthcoachingprogramsyoucanfollowatyourownpacetoreachyourwellnessgoals.

Theprogramsinclude:

• Be Tobacco Free:Gethelptoquittobaccoandstayquit.• Blood Pressure in Check: Moveyour“numbers”intoahealthierrange.• Diabetes Life:Learneffectivewaystomanageyourconditionandenjoybetteroverallhealth.• Eat Healthier: “Tryon”andadoptbettereatinghabits.• Get Active: Putmorephysicalactivityintoeachday.• Healthy Back: Knowaboutbetterwaystopreventbackpain.• Heart-Healthy Cholesterol: Takestepstoachievehealthiercholesterollevels.• Living Well with Asthma: Developandpracticehealthyhabitsthathelpyoubreathebetter.• Sleep Well: Learnstepstotakeduringthedayforabetternight’ssleep.• Stress Less: Findhealthierwaystorespondtodailypressuresandstress.• Weigh Less: Takesmall,concretestepstoreachyourhealthyweight.• Health in a Hurry: Gettipsandideastofitbetterhealthintoyourbusylife.

Youcanparticipateinanyoftheseprogramsbeforeorafteryoucompletethehealthassessment. Withineachprogram,youselectaJourney®thatfitsyourneeds,goalsandinterests.EachJourney includessmallstepsthathelpyoubreakdowngoalsintomoremanageableactions.

Secure and confidentialTheinformationyouprovideaspartofyourHealthAssessmentiskeptprivate.

TO GET STARTED: Go to www.trsactivecareaetna.comandlogintoAetnaNavigator.Onyour homepage,click“Iwantto...TakeaHealthAssessment”ontheleft-handmenu.

Aetna Health Connections Live healthier with a chronic conditionAetnaHealthConnectionsisaconditionmanagementprogramthatprovidesone-on-onesupport fromregisterednursesandotherhealthcareprofessionals.You’llgetinformation,coachingandmonitoringtohelpyouunderstandandfollowyourdoctor’streatmentplan,bettermanageyour conditionandavoidcomplications.

Theprogramcoversmorethan30conditions,includingasthma,highbloodpressure,diabetes, heartdisease,osteoporosisandmore.

TO GET STARTED: Ifyoucouldbenefitfromtheprogram’sservices,anAetnanursemaybeintouch. YoucanlearnmoreandenrollonlineatAetnaNavigator(registerfirstifyouhaven’talready— seepage9).Atthetopofyourhomepage,clickthe“HealthPrograms”tab.


Aetna Care Advocate Team (CAT) Get help to navigate the health care systemTheAetnaCareAdvocateTeam(CAT)isagroupoftrainednurseswhocanguideyouthroughthehealthcaresystem.Gethelptounderstandamedicalconditionorterm,learnabouttreatmentoptions,receiveexpertcoordinationofcomplexmedicalservicesandmuchmore.TotalkwithaCATcarecoordinator, callTRS-ActiveCareCustomerServiceat1-800-222-9205.

Caremark health and wellness tools Manage prescriptions, learn about medications and moreAt Caremark.com,youwillfindthelatesthealthnewsandtrends,informationonhealthconditionsanddiseases,andtoolstokeeptrackofyourprescriptions.Thesite’stoolsincludethefollowing:

• Email, phone and text alertsletyouknowaboutupcomingrefills,orderstatusandhealthupdates.• Caremark’s drug databasegivesyoudetailed

informationaboutprescriptionandover-the-countermedicines,andletsyoucheckforpossibledruginteractions.

• Information and tools at healthresources.caremark.com help you learn more about medicalconditionsandwaystobettermanageyourhealth.You’llfindarticles,videos,healthcalculators,asymptomchecker,amedicaldictionary,Caremark’sdruginformationcenter,dietcenterandmuchmore.

Patients Like Me®isanonlineprogramthatcombinessocialnetworkingandthelatestresearch-basedinformationtohelppeoplelivingwithchronichealthconditions.Whenyoutakepart,youconnecttoanetworkofsupportthatincludesmorethan400,000members.Youcanshareyourhealthexperienceswithothers,usemessageboards,accesstreatmentreportsandgettipsonmanagingyourconditionandimprovingyourqualityoflife.Theprogramaddressesover2,500healthconditions,soyouarelikelytofindsomeonewhohasasimilarcondition.

TO GET STARTED: Go to www.trsactivecareaetna.comandlogintoAetnaNavigator.Lookforthelinkto“PatientsLikeMe”onyourhomepage.


SAVE WITH YOUR ACTIVECARE 2 PLAN

Withthehelpofyourplan’stoolsandresources,youcanbejustassmartabout yourhealthcarespendingasyouarewithotherkindsofexpenses.Takeadvantage togetthecareandservicesyouneedforless.

Know where to goIn-network providerschargelower,negotiatedratesforActiveCareparticipants.Plus,yourshareofexpensesislowerwhenyoustayinthenetworkforcare.UseDocFindtosearchforin-networkprovidersnearyou(seepage10).

Quest DiagnosticschargeslowerratesforTRS-ActiveCareparticipants.Yourplanpays100%,deductiblewaived,whenQuestprovidesyourlabwork.

ER alternatives, likeurgentcarecentersandwalk-inclinics,arelow-costalternativeswhenyouneedpromptnon-emergencycare.UseDocFindtosearchforthesefacilitiesinyourarea.Savetheemergencyroomfortrue,life-threateningemergencies(examples:heartattack,stroke,uncontrolledbleeding).

Not sure where to go? Callthe24-HourNurseInformationLineat1-800-556-1555.

Find and compare costsThe Member Payment Estimatorcantellyouwhatatreatment,procedure,testorothermedicalservicewillcostbeforeyoureceiveit.Tousethetool,logintoAetnaNavigator,yoursecurememberwebsite,atwww.trsactivecareaetna.com.The“CostofCare”boxonyourhomepagehasthelinktotheMemberPaymentEstimator.

The Check Drug Costs toolletsyouknowhowmuchyouwillpaybasedonyourbenefitplanandyourprescriptiondosage.Tousethetool,gotowww.trsactivecareaetna.comandclickonthe“QuickAccessCaremark”linkonthehomepage.


Talk to a doctor or nurse from homeTeladoc letsyoutalkbyphonewithboard-certifiedgeneralpractitioners,internistsandpediatricians. YourTeladocdoctorcandiagnose,treatandcallinprescriptionsfornon-emergencymedicalproblemssuchascolds,flu,allergiesandothers.Thephoneconsultationfeeiscoveredbyyourplanat100%.Teladocisavailable24/7*at1-855-Teladoc (1-855-835-2362).

The 24-Hour Nurse Information Line — 1-800-556-1555 —isatoll-freeservicestaffedbyregistered nurseswhocananswerquestionsandprovidereliablehealthinformation.Gethelpdecidingwhereto seeknon-emergencycare.Askaboutamedicalcondition,procedureortreatment.Knowwhatyoucan doaboutaproblemuntilyou’reabletoseeadoctor.

Use your Aetna Discounts** to save money• Vision care,includingeyeglasses,contactlensesandsolutions,LASIKandothereyecareservices

andaccessories.• Hearing caresuchashearingaidsandhearingaidrepair,examsandmorethroughHearingCare

SolutionsandHearPO®.• Fitness memberships† andequipment.• Natural products and services,includingmassage,herbalsupplements,acupuncture,chiropractic

care,nutritionalcounselingandmore.• Weight management programs from Jenny Craig®,CalorieKing®andNutrisystem®.

Togetstartedwithyourdiscounts,logintoAetnaNavigatoratwww.trsactivecareaetna.com and clickHealthPrograms>Getdiscounts.

*Notavailableinallstates.

**Exclusionsandrestrictionsapply.†Notavailableatallclubs.


CONTACTS FOR HELP AND INFORMATION

Contact/Resource Telephone/Web Description

TRS-ActiveCare CustomerService

1-800-222-9205(TTY) 1-800-628-3323

ForanswersandinformationaboutyourTRS-ActiveCareplanbenefits,providers,IDcardsandotherplan-relatedneeds

Aetna Navigator (securememberwebsite)

www.trsactivecareaetna.com Tools,informationandotheronlineresourcestohelpyoumanageyourbenefits,healthandhealthcare

Aetna Health Concierge 1-800-222-9205 Personalhelpwithyourplan’sbenefitsandservices

AetnaCareAdvocateTeam(CAT)

1-800-222-9205 Experthelptonavigatehealthcareandthehealthcaresystem

Caremark 1-800-222-9205 (selectOption2)www.caremark.com/trsactivecare

Prescriptiondrugbenefitsandservices

CaremarkConnect 1-800-237-2767 Call CaremarkConnect to enroll in thebenefitsandservicesofCVSCaremarkSpecialtyPharmacy

Teladoc 1-855-TELADOC (1-855-835-2362)

Telephoneconsultationswith board-certifieddoctors

24-HourNurseInformation Line

1-800-556-1555 Answers,adviceandinformationfromregisterednursesonhealthcarequestions,problems andneeds

BeginningRight MaternityProgram

1-800-272-3531 One-on-onesupportforahealthierpregnancy,healthierbaby

QuestDiagnostics www.questdiagnostics.com Scheduleappointmentsonline24/7;findnearbylocations


ACTIVECARE 2 PLAN HIGHLIGHTS

Thechartbelowshowswhatyoupayforsomecommontypesofcoveredexpenses.Type/ of Service Network (you pay) Non-Network (you pay)Deductible (perplanyear)

$1,000individual $3,000family

Sameasnetwork

Out-of-Pocket Maximum (perplanyear;doesincludemedicaldeductible/anymedicalcopays/coinsurance/anyprescriptiondrugdeductibleandapplicablecopays/coinsurance)

$6,850individual $13,700family

Sameasnetwork

Doctor Office Visits $30copayforprimary $50copayforspecialist

40% after deductible

Preventive Care (seetheBenefitsBookletatwww.trsactivecareaetna.com foralistofpreventiveservices)

Planpays100%(deductiblewaived) 40% after deductible

Teladoc Physician Services Planpays100%(deductiblewaived) Not applicable

Diagnostic Lab Planpays100%(deductiblewaived)ifperformedbyQuestDiagnostics;youpay 20%afterdeductibleatotherlabs


High-Tech Radiology (CTscan,MRI,nuclearmedicine)

$100copayperserviceplus20%afterdeductible $100copayperserviceplus40%afterdeductible

Inpatient Hospital (facilitycharges)

$150copayperdayplus20%afterdeductible($750maximumcopayperadmission;$2,250maximumcopayperplanyear;preauthorizationrequired)

$150copayperdayplus40%afterdeductible($750maximumcopayperadmission;$2,250maximumcopayperplanyear;preauthorizationrequired)

Inpatient Hospital (physician/surgeonfees)

20% after deductible 40% after deductible

Outpatient Surgery $150copaypervisitplus20%afterdeductible $150copaypervisitplus40%afterdeductible

Bariatric Surgery (physiciancharges;onlycoveredifperformedat anIOQfacility)

$5,000copay(doesnotapplytoout-of-pocketmaximum)plus20%afterdeductible

Not covered

Ambulance 20% after deductible Sameasnetwork

Emergency Room (trueemergencyuse)

$150copayplus20%afterdeductible (copaywaivedifadmitted)

Sameasnetwork

Urgent Care $50copaypervisit 40% after deductible

Maternity Care (physiciancharges;doesnotincludelaboratorytests;hospital/facilitychargesarecoveredsame asinpatienthospitalfacilitycharges)

Initial Visit to Confirm Pregnancy $30copay Routine Prenatal Care Planpays100%(deductiblewaived) Delivery/Postnatal Care 20% after deductible


Mental Health/Behavioral Health/Substance Abuse Disorders

Outpatient Services $50copay Inpatient Services $150copayperdayplus20%afterdeductible($750maximumcopayperadmission;$2,250maximumcopayperplanyear;preauthorizationrequired)

Outpatient Services 40% after deductible Inpatient Services $150copayperdayplus40%afterdeductible($750maximumcopayperadmission;$2,250maximumcopayperplanyear;preauthorizationrequired)

Prescription Drugs Drugdeductible(perplanyear)

Nodeductibleforgenericdrugs $200perindividualforbrand-namedrugs

Sameasnetwork

Retail Short Term(upto31-daysupply) • Generic •Brand(preferredlist) •Brand(non-preferredlist)

$20 $40* $65*

Youwillbereimbursedtheamountthatwouldhavebeenchargedbyanetworkpharmacylessthe required deductible and copay

Retail Maintenance(afterfirstfill,upto31-daysupply) • Generic •Brand(preferredlist) •Brand(non-preferredlist)

$35 $60* $90*

Youwillbereimbursedtheamountthatwouldhavebeenchargedbyanetworkpharmacylessthe required deductible and copay

Mail Order and Retail-Plus(upto90-daysupply) • Generic •Brand(preferredlist) •Brand(non-preferredlist)

$45 $105* $180*

Not applicable

Specialty Drugs $200perfill(upto31-daysupply) $450perfill(32-dayto90-daysupply)

Not applicable

*Ifyouobtainabrand-namedrugwhenagenericequivalentisavailable,youwillberesponsibleforthegenericcopaymentplusthecostdifferencebetween thebrand-namedrugandthegenericdrug.


ThisguideprovidesanoverviewofthetoolsandresourcesavailableundertheActiveCare2plan.Foradetaileddescriptionofyourprogram,seeyourTRS-ActiveCareBenefitsBooklet.TheBenefitsBookletisavailableonlineatwww.trsactivecareaetna.comandistheofficialTRS-ActiveCarestatementonbenefits.TRS-ActiveCarebenefitswillbepaidaccordingtotheBenefitsBookletandotherlegaldocumentsgoverningtheprogram.

TRS-ActiveCareisadministeredbyAetnaLifeInsuranceCompany.Aetnaprovidesclaimspaymentservicesonlyanddoesnotassumeanyfinancialriskorobligationwithrespecttoclaims.PrescriptiondrugbenefitsareadministeredbyCaremark.


CCGTRS-0046AC2(10/16)

resource guide for your activecare 2 plan to know all your plan offers to help you choose wisely and...

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