Consumer Directed HealthSelect is a health plan option offered by the Employees Retirement System of Texas (ERS) to eligible State of Texas employees and retirees. Consumer Directed HealthSelect combines a high-deductible health plan (HDHP) with a health savings account (HSA) as an alternative to the HealthSelect of Texas point-of-service plan and the regional health maintenance organizations (HMOs). Consumer Directed HealthSelect is very different from HealthSelect of Texas and the HMOs. It has a much higher deductible, but it has lower monthly premiums. Consumer Directed HealthSelect also offers the benefit of a tax-free health savings account (HSA) for every eligible participant.

For more information on the HDHP and how the deductible works, please see questions 13-28 below.

For more information on the HSA, please see the HSA Frequently Asked Questions.
 

Please see the rates sheet for active employees or retirees specific premiums.

Yes. Like with HealthSelect of Texas and the HMOs, the State of Texas will pay 100% of the monthly premium for eligible full-time employees and eligible retirees, and 50% for their eligible family members.

For some retirees, the state’s premium contribution for any of the health plans is based on years of service.

Whether you spend less and save money with Consumer Directed HealthSelect depends on a number of things – including your and your family’s health, and your financial situation. Members who cover eligible dependents will pay lower monthly premiums in Consumer Directed HealthSelect. And the state will contribute to eligible members’ health savings accounts (HSAs) to help pay for any health expenses they might have. But Consumer Directed HealthSelect has a much higher annual deductible than the other plans, which means you could pay much more out of pocket. The deductible is the amount you would have to pay out of pocket before the plan starts to pay for any covered expenses, except for preventive services. (Preventive services, such as annual check-ups and vaccinations, are covered at 100%, even if you haven’t met the deductible yet.) So, even if you spend less on dependent premiums and get state contributions into an HSA, you could end up spending thousands of dollars out of pocket on health services and/or prescriptions before the plan begins to pay.

Blue Cross and Blue Shield of Texas, the third-party administrator of Consumer Directed HealthSelect and HealthSelect of Texas, has an interactive plan decision tool to help you decide which plan might be right for you.

This new health plan option is available to all State of Texas employees and retirees who are eligible for health insurance coverage and who are not enrolled in Medicare. But it’s important to know that, according to U.S. Internal Revenue Service (IRS) rules, not everyone is eligible to participate in a health savings account (HSA). Because the main benefits of Consumer Directed HealthSelect are the ability to lower taxable income and get state contributions through an HSA, you should make sure you’re allowed to participate in an HSA by talking with a financial or tax advisor.

In general, you cannot participate in an HSA if:

• You are covered by a non-HDHP, such as a spouse’s plan, that provides any benefits covered by your HDHP with Consumer Directed HealthSelect. Exceptions include coverage like vision or dental.
• You are enrolled in any part of Medicare (Part A, B, C and/or D).
• You are claimed as a dependent on someone else’s tax return.
• You receive benefits under TRICARE or TRICARE for Life.

• You have a health care flexible spending account (like a TexFlex health care account) in the same plan year. For information about enrolling in Consumer Directed HealthSelect if you have funds remaining in a TexFlex health care flexible spending account, please see question 26 in the HSA Frequently Asked Questions. 

The IRS does not allow people who are enrolled in Medicare to make or accept contributions to a health savings account (HSA). Because the main benefits of Consumer Directed HealthSelect are the ability to lower taxable income and get state contributions through an HSA, ERS is limiting eligibility only to people who can make and accept contributions to HSAs. (Members who become eligible for and enroll in Medicare while already enrolled in Consumer Directed HealthSelect should call ERS with their Medicare ID number to change health plans as soon as possible after enrolling in Medicare. After they enroll in Medicare, they can use funds already in their health savings accounts, but cannot add to them.)

Eligible State of Texas employees and retirees who are not eligible for Medicare can enroll in Consumer Directed HealthSelect during Summer Enrollment or during the plan year within 31 days of a qualifying life event (QLE). See the Life Events Overview page for a list of QLEs. To switch during Summer Enrollment, log in to your online ERS account during your enrollment phase, or talk to your agency’s or institution’s benefits coordinator.

 

Because out-of-pocket costs in Consumer Directed HealthSelect could be much higher than in HealthSelect of Texas or the HMOs, you should learn all you can about the plan and think carefully before changing to Consumer Directed HealthSelect. If you cannot afford thousands of dollars in upfront out-of-pocket costs before the plan starts paying for any covered health services and prescriptions (except preventive care), you probably should not enroll in Consumer Directed HealthSelect.

Blue Cross and Blue Shield of Texas, the third-party administrator of Consumer Directed HealthSelect and HealthSelect of Texas, has an interactive plan decision tool to help you decide which plan might be right for you.

During Summer Enrollment, you can change to HealthSelect of Texas or, if you live or work in an eligible county, to an HMO. You can change plans during the plan year if you have a qualifying life event (QLE), within 31 days of the QLE. See the Life Events Overview page for a list of QLEs.

You do not need to submit evidence of insurability (EOI, also called proof of good health) to change health plans.
 

If you switch from HealthSelect of Texas to Consumer Directed HealthSelect – or vice-versa – during the plan year, any out-of-pocket costs you’ve paid will apply to the out-of-pocket maximum in your new plan. (Please note that there is no out-of-network out-of-pocket maximum in HealthSelect of Texas.) Any amounts paid toward the out-of-pocket maximum in an HMO won’t transfer to Consumer Directed HealthSelect or HealthSelect of Texas, or vice-versa.

Changing from a high-deductible health plan like Consumer Directed HealthSelect to a non-HDHP plan, or vice versa, during the plan year could have an impact on your taxable income, depending on how much money is deposited in your health savings account before or after you change plans. In general, the maximum you can contribute to an HSA during the plan year is based on how long you participate in an HDHP. For more information, please see the in-depth HSA Frequently Asked Questions.

There are other things to consider, such as the ability to participate in a health care flexible spending account. You should carefully review IRS regulations, or talk to a financial or tax advisor to make sure you understand how changing from an HDHP to a non-HDHP (or vice versa) during the plan year can affect your HSA and taxable income.
 

In 2015, the 84th Texas Legislature’s passed House Bill 966, which required ERS to create a consumer-directed health plan including an HDHP and HSA program as an alternative to HealthSelect of Texas and the regional HMOs. As a result, ERS began offering Consumer Directed HealthSelect to eligible State of Texas employees and retirees on September 1, 2016.

More information about how the plan works is available on the Consumer Directed HealthSelect website.

Additional information, including a five-minute video explaining how the plan works and how it compares to the existing HealthSelect of Texas plan and the HMOs, is available on ERS’ Consumer Directed HealthSelect webpages for employees and retirees.

More information about the provider network is available on the HealthSelect provider page. Consumer Directed HealthSelect will have the same large national provider network as HealthSelect of Texas. The HealthSelect network includes tens of thousands of providers in Texas.

Blue Cross and Blue Shield of Texas, the third-party administrator of Consumer Directed HealthSelect and HealthSelect of Texas, has an interactive plan decision tool to help you decide which plan might be right for you.

More information about HSAs is available in the HSA Frequently Asked Questions.

High-deductible health plans (HDHPs) have higher deductibles than traditional insurance plans. For many people, a higher deductible can mean higher out-of-pocket costs – sometimes much higher. But the premiums for HDHPs often are lower than premiums for other types of health insurance. In addition, an HDHP can be combined with a health savings account (HSA) to allow members to pay for qualified out-of-pocket medical expenses while saving money on income taxes.

A deductible is the amount a participant must pay for covered health services and/or prescriptions – the full cost of services or prescriptions – before the plan begins to pay for anything except for preventive services. If you see a network provider, you will get the negotiated network rate, but that still will be higher (possibly much higher) than the copays or coinsurance in HealthSelect of Texas and the regional HMOs.

The Plan Year 2021 in-network deductible is $2,100 for individual coverage or $4,200 for family coverage. The Plan Year 2021 out-of-network deductible is $4,200 for individual coverage or $8,400 for family coverage. The deductible resets on January 1 each year.

Once you or your family meet the annual deductible, you will pay 20% of the cost of in-network services (the plan pays 80%) and 40% of the cost of out-of-network services (the plan pays 60%) until you or your family reach the annual out-of-pocket maximum. Once you reach the out-of-pocket maximum, the plan pays 100% of covered health services and prescriptions.

Yes. The plan deductibles and out-of-pocket maximums are based on a calendar year and start over every January 1.

Consumer Directed HealthSelect will have the same large national provider network as HealthSelect of Texas. The HealthSelect network includes tens of thousands of providers in Texas. To see if a doctor is in the HealthSelect network, visit BCBSTX’s provider finder.

The HMOs have smaller networks than HealthSelect, and the doctors in an HMO network might not be in the HealthSelect network.

No. Consumer Directed HealthSelect is different from HealthSelect of Texas in that participants won’t need to designate a primary care physician (PCP).

No. Consumer Directed HealthSelect Consumer Directed HealthSelect is different from HealthSelect of Texas in that it doesn’t require a referral to see a specialist.

Under Consumer Directed HealthSelect, you can see providers outside the network, but it will cost more in a few ways: 

• The cost of out-of-network services probably will be higher than the cost of in-network services, because you will not be able to take advantage of the plan’s negotiated network rates. Remember, you’ll be paying the full cost of non-preventive services – the plan will not pay anything – until you reach the deductible.
• After you reach the deductible, the plan will pay only 60% for out-of-network services – instead of 80% for in-network services. 
• Your deductible will be twice as high for out-of-network services. For the current in-network and out-of-network deductible amounts, see question 15 above. 

The HealthSelect network includes thousands of providers across the United States, with tens of thousands of doctors in Texas alone. You should be able to find a number of high-quality providers in the network, to help you save money.
 

The Employees Retirement System of Texas (ERS) manages all health plans offered through the Texas Employees Group Benefits Program (GBP), including Consumer Directed HealthSelect. Third-party administration for Plan Years 2018-23 is provided by Blue Cross and Blue Shield of Texas (BCBSTX).

Like in all ERS health plans, in-network preventive services such as annual check-ups, screenings and vaccines are covered at 100% in Consumer Directed HealthSelect, even if the deductible hasn’t been met.

If you go out of network for preventive services, you will have to meet the out-of-network deductible before the plan begins to pay anything. After you meet the out-of-network deductible, you will pay 40% of the full cost of out-of-network preventive services. For the current in-network and out-of-network deductible amounts, see question 15 above. 

Consumer Directed HealthSelect includes the same coverage and exclusions as HealthSelect of Texas, except for bariatric surgery. Consumer Directed HealthSelect does not cover bariatric surgery, while HealthSelect of Texas does.

In other ERS health plans, you have to pay a $50 per person prescription deductible before the plan starts to pay anything for prescription drugs. After you meet the deductible, you have a prescription copay of $10, $30 or $75, depending on the drug. That $50 per-person deductible is much lower than the deductible in Consumer Directed HealthSelect, which includes both prescriptions and medical care.

Under Consumer Directed HealthSelect, you have to pay the full cost of any prescription drugs until you meet the annual deductible. The full cost of a drug could be much higher than the copays in other ERS health plans. Some drugs could cost hundreds of dollars before the deductible is met. Once you do meet the deductible, you’ll pay 20% of the full cost of the drug at in-network pharmacies or 40% at out-of-network pharmacies. For the current in-network and out-of-network deductible amounts, see question 15 above.

You can check estimated costs for medical services by logging in to your Blue Access for Members account through the HealthSelect website. On the site, you can even compare costs between providers. You can also contact Blue Cross and Blue Shield of Texas at (800) 252-8039 (TTY: 711).

For prescription drugs, OptumRx has an online tool to check the coverage and estimated cost of prescription drugs before you meet Consumer Directed HealthSelect’s high deductible. To use the tool:

1. Visit HealthSelectRx.com.
2. Click on the Drug Pricing Tool tab at the top of the page.
3. From the Select your plan drop down menu, choose Consumer Directed HealthSelect Prescription Drug Program.
4. Provide the requested information.
5. Click Search

For information about the estimated cost after you meet your deductible, please call Optum Rx at (866) 336-9371 (TTY: 711).

To find out coverage and cost under HealthSelect of Texas, choose HealthSelect of Texas Prescription Drug Program from the drop down at step 3.

Like all ERS health plans, Consumer Directed HealthSelect has an annual out-of-pocket maximum that protects participants from catastrophic health costs. The annual out-of-pocket maximum is the most a participant will have to pay for in-network, eligible health and prescription drug expenses each year, not including the monthly dependent premium payment. Remember that the out-of-pocket maximum, like the deductible, is based on a calendar year and will reset every January 1.

For Calendar Year 2021, the annual out-of-pocket maximums for ERS’ non-Medicare Advantage plans are $6,750 for individual coverage and $13,500 for family coverage. 
 

If you get care from a provider who is not in the HealthSelect network, that provider may bill you for the portion of the charges that HealthSelect doesn’t cover, after you’ve paid any required copay, coinsurance and deductible. This is known as “balance billing.” It’s one way you may pay more if you see a provider who is not in the HealthSelect network.

You may be eligible to challenge a balance bill by requesting mandatory mediation between the provider and HealthSelect from the Texas Department of Insurance (TDI). To be eligible for mandatory mediation from TDI, the balance bill must be either:

• from an out-of-network hospital-based physician at an in-network hospital in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for medical services or supplies provided after September 1, 2015, 
• from an out-of-network hospital-based health care professional (in addition to physicians) at an in-network hospital in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for health care services, medical services or supplies provided after December 31, 2017, or
• from an out-of-network emergency care provider or facility in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for health care services, medical services or supplies provided after December 31, 2017.

To learn more or request mediation from the Texas Department of Insurance, call the TDI Consumer Help Line toll-free at (800) 252-3439 or visit http://www.tdi.texas.gov/consumer/cpmmediation.html.

Learn about how you can avoid balance billing from out-of-network providers at in-network facilities.