1. Teachers’ Retirement Insurance Program (TRIP)
CMS Bureau of Benefits
Lesley Newsome
Supervisor
Medicare and Coordination of Benefits (COB) Unit

2. What Coverage is Included under TRIP?
Plans
TRIP Standard Plans
TRIP Medicare Advantage Plans
Benefits Choice
May 2016
TRAIL
October 15, 2016-November 15, 2016
OAP and HMO Plans
Teachers’ Choice Health Plan (TCHP)
(administered by Cigna)
Medicare HMO Plans
Medicare PPO
(administered by UnitedHealthcare)
Prescription and Behavioral Health Coverage

3. TRIP Standard Plans Standard Plans are for:
“New”members coming into the Program
Retirees that are not eligible for Medicare (64 years old and under)
Retirees that are enrolled in Medicare, but may have a dependent on the plan that is not enrolled in Medicare

4. TRIP STANDARD Plan Choices
HMO Illinois/BlueAdvantage HMO
Health Alliance HMO
Coventry OAP/Coventry HMO
HealthLink OAP
Changes can be made during the month of May
Plan year is July 1-June 30th
Teachers’ Choice Health Plan (CIGNA)

5. Standard PPO Plan Design
Teachers Choice Health Plan (TCHP-CIGNA)
Plan Year Deductible---$500 per enrollee
Additional Deductibles (in addition to the plan year deductible, do not apply to services covered by Medicare)
In-Network services are covered at 80% of the allowable amount
Out of Network service are covered at 60% of allowable amount
In-Network Out of Pocket MAX for covered services=$1, Individual
Out of Network Out of Pocket MAX for covered services=$4,400 Individual

6. HMO Plans No annual deductibles
Copayments required at the time of service
Primary Care Physician (PCP) coordinates care
Must stay in network (use PCP referrals)
Out-of-network provider services are not covered

7. How Much Does Standard Coverage Cost?
Type of Participant
Type of Plan
Not Medicare Primary
Under Age 26
Age 26 – 64
Age 65 and Above
Medicare Primary *
All Ages
Benefit Recipient
Managed Care
(includes HMO and OAP plans)
$75.65
$235.00
$320.18
$92.87
TCHP Plan
When managed care is
not available in county
$98.17
$277.09
$416.72
$110.11
$196.34
$554.16
$833.43
$220.21
Dependent Beneficiary
$302.72
$939.98
$1,280.68
$321.73**
When managed care is not
available in county
$392.68
$1,108.33
$1,666.86
$330.32**
$440.42
* Must purchase BOTH Parts A and B to qualify for lower premium.
** These Medicare Primary dependents receive a premium subsidy.
The above rates are FY17
Rate changes go into effect July 1st of each year

8. Prescriptions – Standard Plan Enrollees
Maximum medication fill at retail Pharmacy:
Coventry HMO= 30 day supply
OAP and TCHP= 60 days
HMO Illinois, Blue Advantage, Health Alliance HMO= 90 days
Mail Order medications:
OAP and TCHP =90 days for 2 copays (instead of 3)
HMO=90 days at discounted rate (varies)
TCHP ONLY-Prescription out of pocket maximum of $1, per plan year. Once met, plan pays 100% for the rest of the plan year for covered medications.

9. Medicare A=Yes! Medicare B=No
I am eligible for Medicare, am required to enroll in Medicare Part A and B?
Medicare A=Yes!
Medicare B=No
Enrolling in A and B=
lower monthly premium
eligible for TRAIL Medicare Advantage plan

10. TRIP Medicare Advantage (MAPD) TRAIL Plans
MAPD TRAIL Plans are for:
Retirees and all covered dependents are enrolled in Medicare Parts A and B (based on age or disability)
Medicare A and B enrollment is prior to 9/30/16
Reside in the United States

11. TRIP Medicare Advantage (MAPD) TRAIL Plan Choices
United HealthCare PPO
Humana Benefit Plan HMO/Humana Health Plan HMO
Health Alliance MAPD HMO
Coventry Advantra HMO
Changes can be made during October 15-November 15
Plan year is January 1-December 31

12. TRAIL PPO Plan Design (United Healthcare)
Plan year deductible-$250.00
Out of pocket maximum-$1,000.00
Most services are covered at 80%
(for services that Medicare would normally pay)
Coinsurance is 20% until out of pocket is met

13. HMO Plans No annual deductibles
Copayments required at the time of service
Primary Care Physician (PCP) coordinates care
Must stay in network (use PCP referrals)
Out-of-network provider services are not covered

14. How Much Does TRAIL Coverage Cost? FY17 Rates Not Yet Determined
Type of Plan
Coventry Advantra HMO
Health Alliance MAPD HMO
Humana HMO
UnitedHealthcare PPO
Member Rate
$38.99
$42.32
$42.31
$52.44
Dependent Rate
$116.95
$126.96
$126.93
$157.29
TRAIL enrollees must continue to pay Medicare Part B monthly premiums to maintain enrollment in the TRAIL plan. TRAIL coverage will term if an enrollee stops paying for Medicare Part B
The above rates are plan year 2016
(January 1 – December 31, 2016

15. Prescriptions – ‘TRAIL’ Members
Maximum medication fill at retail Pharmacy:
90 days
Coventry HMO and UnitedHealthcare 2 x
Health Alliance HMO 2.5 x
Humana HMO 3 x
Mail Order medications:
All plans
90 days for 2 copays

16. Does anyone remember this?
Custom Benefit Solution Online Enrollment System
Coming this FALL for the TRAIL Enrollment Period

17. What is the Custom Benefit Solution?
Online enrollment tool
Decision support tool
Easy to access
All member elections will be made on the ‘MyBenefits’ website, including:
Electing and changing carriers
Adding or dropping dependents

18. Custom Benefit Solution
All member elections made on Morneau Shepell website such as:
Adding or dropping Dependents
Electing and changing Carriers
Opt Out/In

19. Watch for more information
Notifications about changes will be coming this fall from Central Management Services in the mail

20. Websites to access information
Access to Program Books
Links to Carrier Websites