About Texas School Health Benefits Program (TSHBP)

  • Plan HighlightsEnrollment Guide | TSHBP Rates | HealthSmart Provider Finder

    The Texas Schools Health Benefits Program 1s a regionally rated program developed for Texas school districts. Our purpose is to support the school children of Texas. We do this by providing health benefit solutions to our dedicated teachers, administrators, and support staff so they can concentrate on what they do best - teaching and supporting our kids. It is our desire to increase member health and well-being and provide tools necessary to identify and manage the health of each and every member.

    The TSHBP is proud to offer a variety of plans and benefits to meet school district needs. Plans for 2021-22 include our High Deductible Health Plan (HDHP) and our CoPay Plan (CPP). Both plans are designed so members can easily navigate through their health medical needs.

    TSHBP plans are available for school district employees who are employed by participating districts and are active, contributing TRS members.

What's New in 2021-2022

  • NEW Plan Enhancements

    Out-of-Network Coverage
    TSHBP will be offering Out-of-Network Coverage beginning September 1, 2021. This enhancement will maximize access to Physician and Ancillary services with little additional cost.

    No Rate Increase!

    For the 2021-2022 Plan Year, rates will not increase for the TSHBP HD and Co-Pay Plans. Visit your group's Employee's Benefits Portal for more information about rates.

    NEW Plan Benefit

    Virta - Type 2 Diabetes Program
    Virta is a medically supervised, research-backed treatment that reverses type 2 diabetes, meaning that patients can lower their blood sugar and Ale, all while reducing diabetes medications and losing weight.

Coverage HD Plan: In-Network Coverage HD Plan: Out-of-Network Coverage CoPay Plan: In-Network Coverage CoPay Plan: Out-of-Network Coverage
Network HealthSmart - National N/A HealthSmart - National N/A
Plan Deductible Feature Deductible, then Plan pays 100% Deductible, then Plan pays 100% Copayments, then Plan pays 100% Copayments, then Plan pays 100%
Individual/Family Deductible $3,000/$9,000 $3,500/$9,500 $3,500/$10,500 $4,000/$11,000
Individual/Family Maximum Out-of-Pocket $3,000/$9,000 $3,500/$9,500 $3,500/$10,500 $4,000/$11,000
Virtual Health - Teladoc $30 per consultation $30 per consultation $0 per consultation $0 per consultation
Primary Care Deductible, then Plan pays 100% Deductible, then Plan pays 100% $35 copay $40 copay
Specialist Deductible, then Plan pays 100% Deductible, then Plan pays 100% $35 copay $40 copay
Urgent Care Facility Deductible, then Plan pays 100% Deductible, then Plan pays 100% $50 copay $75 copay
Hospital Emergency Room Deductible, then Plan pays 100% Deductible, then Plan pays 100% $500 copay $500 copay

TSHBP High Deductible Highlights

    • Significantly lower premium rates compared to the TRS-ActiveCare HD plan
    • Lower out-of-pocket maximums since a member-only have to meet their deductible (no coinsurance)
      • TSHBP HD - $3,000
      • TRSAC HD - $7,000
    • Telehealth at a $30 Consultation Fee
    • All eligible prescriptions are paid at 100% after the deductible

TSHBP Co-Pay Highlights

    • A unique plan that members pay only copayments for service. All copayments apply to the deductible
    • Lower out-of-pocket maximums since a member-only have to meet their deductible (no coinsurance)
      • TSHBP CoPay - $3,500
      • TRSAC Primary - $8,150
    • Telehealth at $0 Copay
    • $0 copay for generic drugs at CVS, HEB, Wal-Mart, Sam's, and Costco ($10 copay at other network pharmacies)

HOW DOES TSHBP COMPARE TO TRS?

  • Our unique embedded deductible health plans offer members lower out-of-pocket maximums, bringing substantial savings without sacrificing care or quality.

  • Have Questions?

    Call us at (800) 583-6908 or visit your benefits website for more information.

  • Both TSHBP Plans Includesmiling woman in glasses

    • A large National network to provide physician and ancillary services access to all members
    • No primary care provider required or referral to a specialist. A member can use any provider in the network
    • A Care Coordinator service (personal concierge) to support members with all their medical needs and specifically assist them with all facility care
    • Specialty drugs over $670 (30 day supply) are not covered, but the plan offers Patient Assistance and Co-Pay assistance
    • A patient advocate to help members with any balance bill and to pay the bill on the members behalf if necessary
    • Preventative Services are paid at 100% and all copays and deductibles are waived

HEALTH INSURANCE RATES - TSHBP

TSHBP HDHP Monthly Rate District Monthly Contribution Employee Monthly Contribution Semi-Monthly Employee Contr.
Employee Only $348.00 $335.00 $13.00 $6.50
Employee and Spouse $985.00 $335.00 $650.00 $325.00
Employee and Children $664.00 $335.00 $329.00 $164.50
Employee and Family $1295.00 $335.00 $960.00 $480.00
Emp & Fam (Spouse is Educator) * $1295.00 $670.00 $625.00 $312.50
TSHBP CoPay Monthly Rate District Monthly Contribution Employee Monthly Contribution Semi-Monthly Employee Contr.
Employee Only $391.00 $335.00 $56.00 $28.00
Employee and Spouse $1115.00 $335.00 $780.00 $390.00
Employee and Children $765.00 $335.00 $430.00 $215.00
Employee and Family $1475.00 $335.00 $1,140.00 $570.00
Emp & Fam (Spouse is Educator) * $1475.00 $670.00 $805.00 $402.50
  • * Employee and spouse both work for Angleton ISD/one covers family other waives

WHAT ARE CARE COORDINATORS?

  • The Care Coordinators act as a personal concierge for all TSHBP plans and members, and their job is to support the member as their healthcare advocate. Watch the below video to learn more.