Deductibles for HealthSelect plans restarted January 1
Your prescription drug deductibles and any medical deductibles in the HealthSelectSM plans restarted on Jan. 1.
You have to reach the deductible amount before the plan pays its share. Coinsurance and total out-of-pocket maximums also started over.
How much is my prescription drug plan deductible?
Except for Consumer Directed HealthSelectSM (which has one deductible covering both medical services and prescription drugs), all HealthSelect prescription drug plans have a $50 annual deductible per participant.
How much is my medical plan deductible?
See the HealthSelect plan deductibles in the table below. The Health Plans Comparison Chart on the ERS website shows the deductible and coinsurance amounts for the two non-Medicare HealthSelect plans. (See the Health Plan Comparison Chart for participants enrolled in Medicare.)
Keep in mind that eligible in-network preventive care is always covered at 100%, no matter which plan you’re in.
| If participant is enrolled in: | How much is the medical deductible? |
|---|---|
| HealthSelect of Texas® (your eligibility county on file with ERS is in Texas and you’re not eligible for Medicare) | In network: $0 Out of network: $500 per individual; $1,500 per family |
| HealthSelectSM Out-of-State (your eligibility county on file with ERS is outside Texas and you’re not eligible for Medicare) | In network: $0 Out of network: $500 per individual; $1,500 per family |
| Consumer Directed HealthSelectSM high-deductible plan NOTE: If you are enrolled in family coverage, the entire family deductible amount must be met before non-preventive benefits are paid for any individual family member. |
In network: $2,100 per individual; $4,200 per family Out of network: $4,200 per individual; $8,400 per family NOTE: Consumer Directed HealthSelect has a combined medical and pharmacy deductible, which means that the plan won’t pay anything for medical (except in-network preventive care) and prescription drug expenses until you meet the entire deductible. |
| HealthSelectSM Secondary (for Medicare-eligible return-to-work retirees with retiree benefits) | In network and out of network: $200 per individual; $600 per family |
| HealthSelectSM Medicare Advantage Plan, preferred provider organization (MA PPO, for retirees enrolled in Medicare Parts A and B) | No deductible for in-network or out-of-network services |
How much is the annual out-of-pocket maximum?
The total annual in-network out-of-pocket maximums for the non-Medicare plans are $7,050 per individual and $14,100 per family. The out-of-pocket maximum protects participants from very high health costs over the calendar year. If the member’s or family’s eligible, in-network, out-of-pocket medical and pharmacy expenses (not including premiums) reach the out-of-pocket maximum, the health plan will pay 100% of eligible, in-network expenses for the rest of the year.