HMO Departure FAQs for Medicare-enrolled retirees

At their May 20, 2020 meeting, the ERS Board of Trustees approved ERS staff’s recommendation not to proceed with the HMO bidding process when the current contracts expire on September 1, 2021. The Board agreed with ERS staff that it is in the best interest of the GBP and its contributing employers and members to discontinue HMO participation in the GBP. You will stay enrolled in SWCP and CFHP through August 31, 2021.

ERS understands that changes like this can be hard for some members. We put a great deal of thought into the decision, and will work to make the transition as easy as possible for our members. For more information about why this change is happening, please see the “Why is this change happening?” section in the HMO decommissioning webpage on ERS website.

Yes. Medicare eligible retirees should enroll in both Medicare Part A and Part B.

If you are not enrolled in Medicare Parts A and B, you will be responsible for the portion of the medical expenses that Medicare would have paid (typically 80%). The HealthSelectSM Secondary, administered by Blue Cross and Blue Shield of Texas (BCBSTX), pays your claims as if you have Medicare Parts A and B, whether or not you enroll. Contact the Social Security Administration now to determine your next opportunity to enroll in Medicare Parts A and B.

Visit www.ssa.gov or call the Social Security Administration toll-free at (800) 772-1213 (TTY users call (877) 325-0778.)

If you or your dependent(s) are enrolled in Scott and White Care Plans (SWCP) or Community First Health Plans (CFHP), are Medicare eligible and have not given ERS your Medicare information—Medicare Beneficiary Identifier (MBI), Part A and Part B effective dates and your residential address - you will need to do so by July 30, 2021. Once we have your Medicare information, you will be automatically enrolled in the HealthSelectSM Medicare Advantage preferred provider organization (MA PPO) Plan (HealthSelect MAPPO) and the HealthSelect Medicare Rx, beginning September 1. HealthSelect MA PPO and HealthSelect Medicare Rx are both administered by UnitedHealthcare®.

You can submit your Medicare information through your ERS OnLine account or by calling ERS toll-free at (877) 275-4377 (TTY: 711) 8 a.m. – 5 p.m., Monday to Friday. When prompted by the menu, say “Medicare Number.” Then provide your Medicare information to the representative.

With your Medicare information, ERS will enroll you in the HealthSelect MA PPO and HealthSelectSM Medicare Rx plans beginning September 1. Please contact ERS as soon as possible, before July 30.
You can provide the Medicare information at any time, but if you want your HealthSelect MA PPO and Medicare Rx coverage to start on September 1, it is very important for us to get your Medicare information by July 30.

If ERS does not have your Medicare information and you do not contact us by July 30, you will automatically be enrolled in HealthSelectSM Secondary, administered by Blue Cross and Blue Shield of Texas (BCBSTX), for coverage beginning September 1. The HealthSelect Secondary plan has higher monthly premiums for retirees whose premiums aren’t paid 100% by the state, and for dependent and survivor coverage. In addition, out-of-pocket costs are higher in this plan.

ERS has mailed a letter to all current HMO participants who are Medicare eligible and do not have their Medicare information on file with us. They should have received the letter by mid-July. Please open any mail with the ERS logo on the envelope to see if you should call us with your Medicare information, or submit it through your ERS OnLine account.

Only those who receive the letter need to provide ERS with their Medicare information. If you didn’t get a letter from us, it means we already have your Medicare information.

ERS will automatically enroll all Medicare-enrolled retirees who are currently in SWCP or CFHP and who have their Medicare information on file with ERS by July 30 into HealthSelect MAPPO, even if they opted out of this plan before. If you have previously declined the HealthSelect Medicare Rx plan, you will need to contact ERS to enroll.

If Medicare information is not provided by July 30, ERS will automatically enroll Medicare-eligible participants enrolled in HealthSelect Secondary effective September 1, 2021. HealthSelect Secondary has potentially higher costs than the HealthSelect MA PPO.

HealthSelect MA PPO is a Medicare Part C plan, which covers most medical services for retirees and their eligible dependents. This includes doctor visits, hospital stays, medical care, urgent care and wellness programs. Some of the important features of the plan are:
Providers: With this plan, you have the flexibility to see providers in-network or out-of-network as long as they accept the plan, participate in Medicare, and agree to treat you. Your benefits are the same for in-network and out-of-network medical services. The only difference is in-network providers and facilities file your claims directly with UnitedHealthcare. If you see an out-of-network provider, you may have to pay charges upfront and submit claims to UnitedHealthcare for reimbursement.

You do not need a referral to see a specialist in this plan, but your doctor may have to get a prior authorization from UnitedHealthcare for certain services.

To see if your doctor is in UnitedHealthcare’s network or to find an in-network provider, use the Provider Finder search tool on the plan website. You can also search Medicare.gov's list of providers to confirm if your provider accepts Medicare.

Deductibles and copays: There’s no annual deductible —including no Medicare deductible or coinsurance—and lower monthly premiums for eligible dependents and survivors. You will have a $0 copayment for PCP visits, specialist visits, urgent care, emergency room services, inpatient hospitalization and outpatient surgery.

Premiums: If you pay monthly health plan premiums for yourself and/or a Medicare-enrolled dependent, you probably will pay a lower premium for the HealthSelect MA PPO than you currently pay for the HMO or will pay for HealthSelect Secondary. You can see plan premiums through December 31, 2021.

Prescription drug coverage: Prescription benefits for HealthSelect are through the HealthSelectSM Prescription Drug Program administered by UnitedHealthcare. Medicare-enrolled retirees and their Medicare-enrolled dependents are automatically enrolled in the HealthSelect Medicare Rx plan when they enroll in either HealthSelect MA PPO or HealthSelect Secondary. This is included with your automatic enrollment in the HealthSelect plans, unless you have declined HealthSelect Medicare Rx before You can purchase your prescriptions at one of the pharmacies in-network with UnitedHealthcare. You may purchase your long-term medications by mail or at an Extended Day Supply (EDS) retail pharmacy.

Just like with your HMO, you will have a $50 annual prescription deductible. However, in your new plan, the deductible will start and reset on January 1.

Note: When your new drug coverage starts on September 1, the $50 Medicare Part D deductible for PY21 will apply for any prescriptions you fill between September 1 and December 31. The deductible resets on January 1, 2022.

You may get a letter about your prescription coverage from ERS or UnitedHealthcare.

If you previously declined HealthSelect Medicare Rx to get prescription coverage through your HMO, please contact ERS by July 30th if you’d like to be re-enroll starting September 1. If you request to enroll later than July 30 your effective date may be different. You can call us toll-free at (877) 275-4377 (TTY: 711) 8:00 a.m. – 5:00 p.m. CT, Monday - Friday.

ID cards: You will get separate ID cards for the HealthSelect MA PPO medical plan and the HealthSelect Medicare Rx prescription drug plan, even though both are administered by UnitedHealthcare. When you get your new ID cards in August, please review them carefully to make sure your personal information is correct. If it’s not, please log in to ERS OnLine or call ERS toll-free at (877) 275-4377 (TTY:711), Monday to Friday 8 a.m. - 5 p.m. CT

Dependent coverage:

  • If your dependent is enrolled in Medicare and we have their Medicare information on file, we will automatically enroll them in HealthSelect MA PPO Plan and HealthSelect Medicare Rx.
  • If your dependent is enrolled in Medicare and we don’t have their Medicare information on file, we will automatically enroll them in HealthSelect Secondary. Premiums and out-of-pocket costs will be higher than they would be in HealthSelect MA PPO Plan.
  • If your dependent is eligible for, but not enrolled in Medicare, we will automatically enroll them in HealthSelect Secondary. Premiums and out-of-pocket costs will be higher than they would be in the HealthSelect MA PPO Plan.
  • If your dependent is not eligible for Medicare, we will enroll them in HealthSelect of Texas, which comes with HealthSelect Prescription Drug Program. There’s a $50 annual prescription deductible which starts and resets on January 1.

Extra benefits: These programs are offered at no additional cost to enrollees in the MA PPO plan, in addition to your covered medical and prescription benefits. They include programs such as SilverSneakers®, a popular no-cost gym membership; a medical alert monitoring system; other wellness programs; no-cost transportation to medical appointments; and, for those who qualify, in-home assistance. (Note: Health plan administrators or carriers may discontinue or change their value-added programs at any time without notice.)

All Texas Employees Group Benefits Program (GBP) health plans offer comprehensive coverage at a reasonable cost. As a retiree enrolled in Medicare, you can switch from the Medicare Advantage plan (HealthSelect MA PPO) to the non-Medicare Advantage plan (HealthSelect Secondary) at any time of the year, by contacting ERS.

As explained in Question 2, HealthSelect Secondary is a non-Medicare Advantage plan which generally costs more than HealthSelect Medicare Advantage. The monthly premiums are higher for retirees whose premiums aren’t paid 100% by the state, and for dependent and survivor coverage. You can learn more about the plan on ERS webpage and the plan website.

Here’s the Plan Year 2021 premium rate sheet and health plan comparison chart to learn the difference in coverage and costs between the two plans.

Both SWCP and CFHP will be available for several months after September 1 to answer any questions you may have and support your transition to HealthSelect plan. The plan websites, your account information and the ERS dedicated call center will be available as follows:

HMO Participant's online account Plan website Call center
SWCP To see claims for service before September 1, 2021 Available through August 31, 2022 (800)321-7947
CFHP Available through February 28, 2022 Available through August 31, 2022

Through February 28, 2022: 
(210) 358-6262; 

Starting March 1, 2022: (210) 358-6070

ERS, your HMO and/or HealthSelect will send you information in the coming months. Be sure to read any information they send in the mail or email.

Don’t forget to update your mailing and email addresses by logging in to your ERS OnLine account, to make sure you don’t miss any important information.

  • Visit the ERS website: See the health benefits page and the web page with information about HMO participants moving in to HealthSelect on the ERS website, to learn more about the HealthSelect plans.
  • Join a UnitedHealthcare webinar or phone session from August through October: Beginning August, UnitedHealthcare will hold monthly webinars and phone sessions with information about HealthSelect MA PPO medical and prescription drug coverage and the extra benefits it offers. UnitedHealthcare will give a short presentation, then take your questions. You can see a schedule of the sessions on the plan website and register for one or more sessions.
  • Call the health plan or ERS:
Health plans
Plan Insured/Administered by Website Phone 
HealthSelect Medicare Advantage PPO UnitedHealthcare www.HealthSelect-MAPPO.com Toll-free (855) 853-0463
TTY: 711)
Monday – Friday,
7 a.m. – 7 p.m. CT; 
Saturday,
7a.m. – 3 p.m. CT
HealthSelect Secondary Blue Cross Blue Shield of Texas www.healthselectoftexas.com Toll-free (800) 252-8039
(TTY: 711)
Monday – Friday,
7 a.m. – 7 p.m. CT;
Saturday,
7 a.m. – 3 p.m. CT
HealthSelect Medicare Rx
(for HealthSelect MA PPO and HealthSelect Secondary plans)
UnitedHealthcare https://www.uhcretiree.com
/ers/home.html
Toll-free (866) 868-0609
(TTY: 711),
Monday – Friday,
7 a.m. – 7 p.m. CT;
Saturday,
a.m. – 3 p.m. CT
HealthSelect Prescription Drug Program
(for dependents who are not enrolled in Medicare)
OptumRx® www.HealthSelectRx.com Toll-free (855) 828-9834
(TTY: 711),
24 hours a day,
7 days a week
SWCP   ers.swhp.org/ For claims and coverage information through August 31, call toll-free (800) 321-7947,
Monday – Friday,
7 a.m. – 7 p.m. CT
CFHP   members.cfhp.com For claims and coverage information through August 31, call (210) 227-2347,
TTY (210) 358-6080,
Monday – Friday,
8 a.m. – 5 p.m. CT 
ERS   www.ers.texas.gov Toll-free (877) 275-4377
(TTY: 711),
Monday – Friday,
8 a.m. – 5 p.m. CT

 

SilverSneakers trademark disclaimer: SilverSneakers is a registered trademark of Tivity Health, Inc. © 2021Tivity Health, Inc. All rights reserved.

Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.