How to Get Claims Data For Your District

With Senate Bill 1444, education employers have more flexibility in choosing health care for their employees. We're committed to ensuring you have the tools to make informed, strategic decisions. This way you control your future, your way.

To compare TRS-ActiveCare to other options in the market, you can request claims data. The data will show medical and prescription costs specific to your employees. This information can only be used for bidding out non-TRS group health plans.

It's vital information for your decision, especially if you choose to self-fund. It affects what you spend, and how other market plans will calculate premiums after year one or two.

Remember: The decision to leave TRS-ActiveCare is a five-year (minimum) commitment. Consider your options carefully.

What to Know

There’s no cost to a data request if the employer has participated in TRS-ActiveCare for the last 36 months
You can request data twice per state fiscal year (Sept. 1 – Aug. 31)
TRS will provide data within ten business days after receipt of the request

There are two options for your data request: Summary Health Information and De-Identified Data.

Critical information: Data can include Protected Health Information under federal and state laws, like the Health Insurance Portability and Accountability Act of 1996 (HIPAA). For the most detailed data, employers must develop and maintain certain documents. The documents must prescribe and restrict uses and disclosures of such information laid out by 45 CFR § 164.504(f).

You must complete a certification document to receive this type of data. Because it's federal policy, TRS can't answer questions or provide legal guidance about this certification.

Summary Health Information

This is the most detailed option. It provides 36 months of medical, pharmacy, and enrollment data. It includes high-cost claimant information. Employers must complete the Protected Health Information certification for this data.

Changes since 2021: We received feedback that many districts want expanded data to review before making a decision. In response, TRS added new fields. These include:

The name and script count of the top 100 most expensive drugs to the plan for each district. This includes whether the drug is considered specialty, brand, or generic.
The plan paid amount by month for medical spending by major category of spending (inpatient, outpatient, professional, other).
The top 10 facilities based on plan paid. This includes the top 10 for inpatient, outpatient, physician, and other categories for a total of 40 providers.

High-cost claimants are employees with $50,000+ in claims. This includes the plan year to date, and then the most complete plan year. See the self-funding guide to understand how these employees may be excluded from coverage after the first claims year.

To receive this data, employers must:

Login to the TRS reporting employer portal and download the claims data request form
Complete the Plan Sponsor Certification and Summary Health Information Request Form
Submit the form to the contact identified on the forms in the portal
Execute an agreement with the TRS designated entity to receive the data. See instructions on forms in reporting entity (RE) portal for requesting a copy of this agreement

The form will be available on the RE portal on Aug. 15, 2021. For issues logging into the RE portal, or to request the form before that date, please contact healthcarecomm@trs.texas.gov.

De-Identified Data

This option has less detailed data for employers who don't obtain the Protected Health Information certification. This means data will not tie to individuals but show in general sums.

It also won't include high-cost claimant specific reporting. Any rows with claims or enrollment information that could identify individuals will be blinded using de-identification rules developed by a HIPAA expert.

Based on prior requests from participating entities, particularly smaller entities, information in this de-identified format may have limitations in obtaining quotes. To receive this data, employers must:

Login to the TRS reporting employer portal and download the data request packet;
Complete the De-identified Health Information Request Form;
This information should be provided to the contact identified on the forms in the portal
Execute an agreement with the TRS designated entity to receive the data. See instructions on forms in reporting employer portal for this agreement

The form will be available on the RE portal on Aug. 15, 2021. For issues logging into the RE portal, or to request the form before that date, please contact healthcarecomm@trs.texas.gov.

Quick Questions

Can any employer who participates in TRS-ActiveCare request claims data?
No. An employer must have participated in TRS-ActiveCare for at least 36 months.

Does an employer have to pay for claims data?
No. TRS will provide claims data for free, as long as requests are in the outlined frequency.

How often can employers request claims data?
Twice per state fiscal year, which runs from Sept. 1 to Aug. 31.

How long will it take to get claims data?
Ten business days after TRS receives the request as outlined.

What type of data do employers have access to?
There are two types – Summary Health Information and De-Identified Data. Please read the designated sections for these for more details.

Summary Health Information has been expanded and updated as of Oct. 7, 2022.

See an example of what the report will look like here.

Where can employers get more information about Senate Bill 1444?
Visit our Initial Guidance webpage. Employers can also review our self-funding guide, which has information about what to expect if they leave TRS-ActiveCare.

Who should an employer contact for more information?
Send inquiries to healthcarecomm@trs.texas.gov. Employers can also contact their District Ambassador (DA) for guidance on how to get the information they want/need.