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