0. Connecticut State Teachers’ Retirement Board Health Plan
Administered by
Stirling Benefits, Inc.
2014
Stirling Benefits, Inc.

1. TRB Plan Governed by the Connecticut Teachers’ Retirement Board (TRB)
Covering over 22,000 retired teachers
Administered by Stirling Benefits
Began service to TRB in 1996
Service company, not an insurance company
Based on the Blue Cross High Option
Stirling Benefits, Inc.

2. TRB Plan Funding 1/3 Retiree 1/3 Active 1/3 State of CT
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
1/3 Retiree
1/3 State of CT
1/3 Active
Stirling Benefits, Inc.

3. Retirees receive either:
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
Stirling Benefits, Inc.

4. Must have Medicare Part A & Part B
TRB -- Who is eligible?
Retiree
Spouse
Surviving Spouse
Must have Medicare Part A & Part B
Stirling Benefits, Inc.

5. 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 quarters
TRB members don’t need Part D
Stirling Benefits, Inc.

6. TRB -- What’s Covered Medical Prescription Dental Vision and Hearing
Stirling Benefits, Inc.

7. Any provider that accepts Medicare
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
Stirling Benefits, Inc.

8. TRB Medical Covers what Medicare allows No network, No Copayments,
Same as Blue Cross High Option
No network, No Copayments,
No Pre-Existing Condition Limitations
No Individual Underwriting
Picks up remainder after Medicare pays
Coverage the same everywhere in the US and Puerto Rico
Stirling Benefits, Inc.

9. Lifetime Maximums Unlimited maximum on Hospitalizations
Unlimited maximum on Basic Medical
Unlimited 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.
Stirling Benefits, Inc.

10. 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

11. Examples of Claim Assignment
Assigned claims (95% of claims)
Un Assigned Claims (5% of claims)
Doctor Charge
$130
Medicare Allows
$100
Medicare Pays
$80
TRB Pays
$20
15% Extra Billing -
$15
$12
Member Pays $0 $3
Stirling Benefits - November 2007

12. Shingles Vaccine Covered
Effective
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
Stirling Benefits, Inc.

13. 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.
Stirling Benefits, Inc.

14. Rx Benefits 100% for the remainder of the year
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

15. Retiree Payments for Rx
Generic Drugs
Preferred Drugs
Non-Preferred
Acute
at Pharmacy 5%
20%
30%
Maintenance at Mail Order
Maintenance at Pharmacy
10%
25%
35%
Stirling Benefits - CAPSS

16. Dental $44.00 / Month (2014) Administered by Aetna Dental
$50 annual deductible
100% cleanings
80% basic restorative
50% Major Restorative
$2,000 annual maximum
Stirling Benefits, Inc.

17. Vision & Hearing $5.00 / Month Vision
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 years
Administered by Stirling Benefits
Stirling Benefits, Inc.

18. Monthly Cost Per Person
2009
2010
2011
2012
2013
2014
Medical / Rx
$99
$112
$125
$124
$117
$97
Medical/Rx & Dental
$144
$160
$174
$173
$141
Medical / Rx /Dental Vision & Hearing
$149
$165
$179
$180
$146

19. 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
Stirling Benefits, Inc.

20. For More Information… Stirling Benefits, Inc.
20 Armory Lane, Milford, CT 06460
(203) , ext. 0,
Teachers’ Retirement Board
765 Asylum Avenue, Hartford, CT
(800) , fax: (860) ,
CVS /Caremark (800)
Aetna Dental (855)
Medicare (800)
Stirling Benefits - CAPSS

21. Stirling Benefits, Inc.