HMO plans no longer offered starting Sept. 1

March 08, 2021
scott and white care plans logoScott and White Care Plans (SWCP) and Community First Health Plans (CFHP) will no longer be offered in the Texas Employees Group Benefits Program (GBP) starting September 1.

Central Texas and San Antonio-area HMO participants who are not enrolled in Medicare will have the option to enroll in HealthSelect of Texas® or Consumer Directed HealthSelectSM. Both plans are administered by Blue Cross and Blue Shield of Texas (BCBSTX) and have prescription drug coverage administered by OptumRx. HMO participants enrolled in community-first logoMedicare can choose the HealthSelectSM Medicare Advantage Plan preferred provider organization (MA PPO), insured by UnitedHealthcare, or HealthSelectSM Secondary, administered by BCBSTX. UnitedHealthcare administers prescription drug coverage in both those plans. Current HMO participants can also choose to waive GBP health coverage. Changes will be effective September 1, 2021.

Why this change is happening

The Employees Retirement System of Texas (ERS) is responsible for maintaining high-quality, cost-efficient health coverage for employees, retirees and their families. ERS found that continuing to offer HMO plans likely would cause overall GBP health plan costs to increase, which could affect the state’s ability to provide health insurance over the long term. Last May, ERS’ Board of Trustees approved a recommendation to discontinue HMO options rather than rebid the HMO contracts that expire this year.

Impact on participants

SWCP and CFHP members should see little difference in medical and prescription drug benefits between the HMOs and HealthSelect plans, and in most instances, the HealthSelect benefits are better. Most HMO network providers—more than 90%—participate in the HealthSelect network, and most current participants will not need to find a new provider. Those who do will have a much larger network of providers and pharmacies to choose from, and their new plan will help them find the right provider. Retirees and dependents enrolled in Medicare can see any provider who accepts Medicare and who is willing to see them. Unlike the HMOs, HealthSelect plans cover medical and prescription drug services from out-of-network providers, although HealthSelect of Texas and Consumer Directed HealthSelect participants will pay more if they go out of network. 

Watch for more information

ERS and plan administrators will provide more information to current HMO participants in the coming weeks and throughout the summer. In the meantime, visit the ERS website for FAQs and details about the HealthSelect of Texas, HealthSelect Secondary, Consumer Directed HealthSelect and HealthSelect Medicare Advantage plans.