Q&A: Alternative Medical Plan Options and How It Affects You

Alternative Medical Plan Options and How It Affects You

A hot topic of conversation lately has been Texas school Districts of Innovation (DOI) researching alternative options to TRS ActiveCare. Many of these districts are looking for guidance from a knowledgeable insurance provider to understand requirements and the implementation process. It can be a confusing subject, so we are here to simplify it and answer a few of the most common questions we hear. In this article, we will discuss alternative medical plan options and how it affects you and your employees.

Q: What is a District of Innovation?

A: The 2015 Texas Legislature amended Chapter 12 of the Texas Education Code allowing school districts with at minimum an acceptable academic rating to innovate in several areas of the code that have hindered district goals. A DOI plan term is allowed to last up to five years and schools were allowed, after following a specific process, to include all or part of the areas of innovation prescribed by the amendment.

Q: Why would a district pursue options outside of TRS ActiveCare?

A: Many districts may not want to look at other options or alternative plans. For many districts, TRS ActiveCare will prove to be the most effective option to provide health care coverage to their employees.

The interest by districts into what these latest developments are all about stems from an interest in making certain that everything has been done to help employees access affordable and effective healthcare coverage. Schools have to compete for talented employees just like any other employer. They are competing with other area employers, as well as other school districts, and health insurance can be a serious consideration for that potential employee.

Q: How can First Financial Group of America help me?

A: First Financial has been involved in helping school districts with their self-funded medical plans for more than 30 years and we are here to help you through this process. We have been there for Texas schools and this latest initiative from day one and we have a solution for you today. Both El Paso ISD and Raymondville ISD are First Financial clients for Section 125 Cafeteria Plan and enrollment services. Therefore, we have been involved in facilitating and supporting districts with these latest DOI developments since their inception.

First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools.

  • We are proud to be partners with Dr. Maze and ESC Region 12 who have launched the Universal Benefits Consortium (UBC), a program that has leveraged buying power to provide a full suite of self-funded and fully-insured medical options. First Financial is the only TPA with access to the UBC, which means we are in the ideal position to assist you today.
    • We help districts request data from TRS and track the progress of that data being released.
    • We will provide a free evaluation of a district’s medical plan options.
  • Our Benefits Consulting division was specifically created to provide First Financial school districts with access to the best medical consulting partners and the most cost-effective solutions available. We will help with your claims data, your District of Innovation plan and provide a free consultation.

Q: When should I get started?

A: You can start any time. A District of Innovation plan is necessary to provide the basis for offering an alternative. This can take some time and should be in line with district goals and initiatives.

While a plan can be developed without claims data, it could help provide a district with the most accurate and informed options. As such, we take the approach of requesting information from TRS. Recently, TRS has begun providing districts with a process, by which they will be allowed to access their proprietary data.

Once you have looked at claims combined with good demographic data, it may prove TRS ActiveCare is the best option for the district. Many people we talk to are interested in moving forward with an alternative only if the district can offer something tangibly better than what is already available through TRS – not just an alternative for the sake of offering an alternative. That’s why it is helpful to discuss district goals and the process.

As a company involved from the start, First Financial will update you on the current state of affairs and provide you with the tools and information you need to be successful going forward.

To schedule an appointment, contact Scott Elgin, Texas State Manager, at scott.elgin@ffga.com.

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