HS Medicare Advantage PPO transition

FAQs about the New Insurer of the HealthSelectSM Medicare Advantage PPO

On January 1, 2021, the insurer for the HealthSelect Medicare Advantage preferred provider organization (MA PPO) will change from Humana to UnitedHealthcare.

This will not be UnitedHealthcare’s standard Medicare Advantage coverage. ERS will continue to decide what benefits are included in the plan. Costs not covered by Medicare will be covered in ERS’ wraparound coverage.

If you’re in the HealthSelect Medicare Advantage PPO, after the change happens on January 1, you will continue to get your health care and visit your doctor in much the same way you have been. You can go to the same providers, as long as those providers continue to accept Medicare. Covered health services and prescription drugs won’t change as a result of the move from Humana to UnitedHealthcare.

Starting January 1, the biggest differences will be:

  • You’ll use a new health plan ID card and will need to let your providers know you have new coverage.
  • You’ll have new customer service contacts.
  • If you pay a monthly health plan premium—for a dependent enrolled in HealthSelect Medicare Advantage, or because the state doesn’t pay 100% of your premium—you’ll pay less.
  • Documents like explanations of benefits (EOBs) might look different.
  •  Some value-added services, like post-surgery meal delivery and transportation to medical services, might change. You will still have access to SilverSneakers. (Note: Health plan administrators or carriers may discontinue or change their value-added programs at any time without notice.)

Right now, you don’t need to do anything different. The change isn’t happening until January 1, so you can continue to use your current health plan ID card and call Humana for any help you might need. Over the next few months, especially during Fall Enrollment, ERS, UnitedHealthcare and Humana will share detailed information about the change and any steps you might need to take. Please pay close attention to any mail, email or calls you get from ERS, UnitedHealthcare or Humana.

As long as your doctors and other providers continue to accept Medicare, you can keep seeing them after UnitedHealthcare becomes the HealthSelect MA PPO insurer.

No. The HealthSelect Medicare Rx prescription drug plan is not changing as a result of the medical plan change.

You are free to enroll in another Texas Employees Group Benefits Program health plan at any time. However, if you like your coverage in the HealthSelect Medicare Advantage

PPO, we encourage you to stay in the plan. You’ll continue to have the same great coverage and lower costs when UnitedHealthcare becomes the insurer on January 1.

UnitedHealthcare’s cost to administer the plan is significantly lower while maintaining the same benefits and standards for quality and service. These savings will help ERS and the state maintain health benefits for retirees and keep costs down for members. In fact, retirees who pay premiums will pay a lower monthly premium starting January 1, 2021, without any increases in other plan costs or changes in coverage.

Under state law, ERS regularly rebids its contracts for insurers and plan administrators. After accepting bids for the HealthSelect Medicare Advantage PPO contract, ERS staff carefully reviewed the costs and capabilities of each bidder. While cost is important, we also looked at each bidder’s claims processing, customer service, information security and other services. ERS staff scored each bidder and, based on the scores, made a recommendation to the ERS Board of Trustees. The Board approved UnitedHealthcare as the new insurer in its May 20 meeting.

ERS will provide much more information in the coming months. Until then, you can continue to use your health plan as you have been, and call Humana with questions about coverage and claims. Please don’t forget to pay close attention to any communications you might get from ERS, Humana and UnitedHealthcare.