Please read the summary below provided by Blue Cross/Blue Shield:
PEEHIP Hospital Medical Coverage
(Coverage for Active Members and Non-Medicare-eligible Retirees)
Hospital Benefits (Administered by Blue Cross)
Inpatient Hospitalization: Services are covered in full for 365 days without a dollar limit.
Deductible: $200 for each admission. You are also responsible for the difference between private and semi-private accommodations and other non-medical items, such as TV, phone, etc. There will be an additional copay of $25 for days 2-5.
Preadmission Certification (PAC): All admissions will be subject to Preadmission Certification by completing a BLUE CROSS BLUE SHIELD OF ALABAMA PREADMISSION CERTIFICATION form. Emergency admissions must be certified by the first business day following the admission by calling 800.354.7412.
Inpatient Rehabilitation: Coverage in a rehabilitation facility limited to one admission per illness or accident; one per lifetime with a 60-day maximum. Precertification is required.
Outpatient Hospital Charges: $150 facility copay for outpatient surgery and $150 facility copay for medical emergencies and hemodialysis. There is no copay required for accident related services rendered within 72 hours after the accident.
Non-medical emergencies will be paid under major medical at 80% of the allowable charge after a $300 calendar year deductible.
Major Medical Benefits (Administered by Blue Cross)
Deductible: $300 deductible per person per calendar year; maximum of 3 deductibles per family per year or $900.
Coinsurance: After you pay the $300 deductible, the plan pays 80% of the Usual Customary Rates (UCR) of covered expenses for the first $2,000 and 100% UCR thereafter.
Covered Services: Physician services for medical and surgical care when you do not use a PMD physician; laboratory and X-rays, (outpatient MRI’s must be precertified); ambulance service; blood and blood plasma; oxygen, casts, splints and dressings; prosthetic appliances and braces; podiatrist services; physical therapy; allergy testing and treatments; semi-private room and other hospital care after basic hospital benefits expire.
Preferred Medical Doctor (PMD)
$5 Copay Per Test: Outpatient diagnostic lab and pathology (including pap smears).
$30 Copay Per Visit: Doctor’s office visits and consultations; one routine preventive visit each year for adults age 19 and over.
PPO Blue Card Benefits (Out-of-State Providers)
The Blue Card PPO program offers "PMD-like" benefits when members access out-of-state providers if the physician or hospital is a participant in the local Blue Cross PPO program in that state. This program allows members to receive PMD benefits such as well baby care, routine physicals and routine mammograms when accessing out-of-state PPO providers.
Non-Participating Hospitals and Outpatient Facilities
Currently there are no non-participating inpatient or outpatient facilities in Alabama. However, when choosing a hospital or outpatient facility located outside Alabama, you may want to consider checking with the facility first to determine if they are a Blue Cross and Blue Shield participating provider. With your health plan benefits, you have the freedom to choose your health care provider.
To maximize your coverage and minimize your out-of-pocket expenses, you should always use network providers for services covered by your health plan. Your out-of-pocket expenses will be significantly higher in a non-participating hospital or facility. When you choose a network provider, you don’t have to worry about extra out-of-pocket expenses.
If you receive medical treatment outside of the United States and the services are medically necessary, PEEHIP will pay primary under the major medical benefits. All PEEHIP deductible and coinsurance amounts and contract limitations will apply. The claims must be stated in U.S. dollars and filed with Blue Cross of Alabama.
Pharmacy Program (Administered by MedImpact)
Participating Pharmacy: When you choose a Participating Pharmacy you pay the following:
$6 for any covered generic prescription drug
$40 for any covered preferred brand drug (The preferred brand drug list can be found on the PEEHIP Web site at www.rsa-al.gov
$60 for any covered non-preferred brand drug
Approved maintenance drugs may be purchased up to a 90-day supply for one copayment of $12 for generic, $80 for preferred and $120 for non-preferred. The drug must be on the approved maintenance list and must be prescribed as a maintenance drug. First fill for a maintenance drug will be a 30-day supply.
Participating pharmacies will file all claims for you. Most major pharmacy chains in-state and out-of-state participate with the PEEHIP MedImpact prescription drug plan.
Members and covered dependents need to use Bioscrip for specialty medications.
The PEEHIP prescription drug plan includes Step Therapy, prior authorization, and quantity level limitations for certain medications.
Effective August 1, 2011, members pay the following copayment for generic prescription drugs purchased at any Walgreens’ pharmacy:
$7 for any covered generic prescription
$14 for approved 90-day supply for maintenance medications
All other copayments are the same as those charged at any participating pharmacy.
There are no benefits if you use a non-participating pharmacy in Alabama.
Coverage outside Alabama: You will file the claim and be reimbursed at the Participating Pharmacy rate less the appropriate copay.
In accordance with the Federal Health Care Reform Legislation, the following two changes have been made to the PEEHIP Hospital Medical Plan benefits:
PEEHIP will not impose a copayment or deductible expense for immunizations or preventive care.
PEEHIP will cover emergency services without the need for pre-authorization and will treat out-of-network ER benefits the same as in-network ER benefits.
Coverage is not provided for nursing home costs, vision and dental care (except accidental injuries), cosmetic surgery, hearing aids and experimental procedures.
Call toll-free 1-877-517-0020 or visit website at http://www.rsa-al.gov/TRS/trs.html
Call the main switchboard at 1-877-517-0020 and ask for a retirement counselor. The retirement counselor will be able to pull up your individual account information and provide details to you. You may also make an appointment for a face-to-face session with a retirement counselor at the RSA offices in Montgomery.
10 yrs of service at age of 60 or 25 years of service at any age.
Service retirement benefits are available to members who cease TRS-covered employment and meet minimum service and/or age requirements. The monthly retirement benefit is made for life without interruption unless there is a return to full-time employment with a TRS or ERS agency, or to temporary employment in excess of the limits to be described in Postretirement Employment.
A member is eligible to receive retirement benefits under either of the following conditions:
• He or she has at least 10 years of service credit and has attained the age of 60 Or
• After accumulating 25 years of service credit at any age.
A member is eligible to retire the first day of the month following attainment of age 60 with 10 years of creditable service or the first day of the month following attainment of 25 years of service credit. Members may only retire on the first day of any month they are eligible.
Effective with travel conducted on or after July 1, 2011, the IRS Standard Mileage Rate changed to 55.5 cents per mile. Troy City Schools will reimburse employees for mileage at the IRS Standard Mileage Rate for authorized/approved travel by personal vehicle at the new rate for travel beginning July 1, 2011.