Health Benefits

Health Benefits for Retirees

Retiree health benefits are offered through the Texas Employees Group Benefits Program (GBP) and are available to most State of Texas retirees and their eligible dependents. You need at least 10 years of service credit with an agency or higher education institution that participates in the GBP to be eligible for GBP retiree insurance. Health plan options for retirees are based on Medicare enrollment and where the retiree lives. When a retiree becomes eligible for Medicare and enrolls in Medicare Parts A and B, they will need to call ERS to be enrolled in a Medicare Advantage plan and a Part D prescription drug plan. 

All health plan options are listed in the table below. Some are available only to retirees enrolled in Medicare. 

Options for Medicare-enrolled retirees

After a retiree enrolls in Medicare Parts A and B, the next step is to call ERS and provide the information on their Medicare card. This will begin the enrollment process into HealthSelectSM Medicare Rx (Part D prescription drug plan), administered by UnitedHealthcare, and if the retiree chooses, the HealthSelectSM Medicare Advantage Plan preferred provider organization (MA PPO) Plan, currently insured by Humana. This plan will be insured by UnitedHealthcare beginning January 1, 2021.
  • Retirees enrolled in Medicare who live in the Houston area have the option of the KelseyCare Advantage  Medicare HMO (MA HMO), but only through December 31, 2020. This plan will not be part of the GBP starting January 1, 2021.
  • Medicare-eligible retirees can choose to stay in HealthSelect of Texas®, but their coverage will change to HealthSelectSM Secondary. HealthSelect Secondary has higher dependent and tiered premiums, and higher out-of-pocket costs than the Medicare Advantage plans.
  • Medicare retirees can participate in a non-Medicare Advantage HMO if they live in the HMO’s service area.
  • Medicare retirees cannot make or receive contributions to a health savings account (HSA) and therefore should not be enrolled in Consumer Directed HealthSelectSM.

Health plan premium rates

The State of Texas pays for at least part of most retirees’ monthly health care rates (or premiums). This is called the state contribution. If the state doesn’t pay 100% of the premium, the retiree pays the remainder out of his or her annuity. The state’s contribution is based on available funding provided by the Texas Legislature and depends on three things:  

  • whether the retiree was a full-time or part-time employee at the time of retirement,
  • whether the retiree had at least five years of employment at a State of Texas agency or higher education institution on September 1, 2014 and
  • how many years the retiree worked for the State of Texas.

Learn more about “tiered” retiree insurance contributions.
See health plan comparison charts and premium rate sheets (including “tiered” rates)

IMPORTANT NOTICE ABOUT INSURANCE: Health and other insurance benefits for employees and retirees are subject to change based on available state funding. The Texas Legislature determines the level of funding for such benefits and has no continuing obligation to provide those benefits beyond each fiscal year.

Learn more about health coverage for retirees

HealthSelect of Texas<sup>®</sup> (not enrolled in Medicare)

HealthSelect of Texas® (not enrolled in Medicare)

A network-based point-of-service plan administered by Blue Cross and Blue Shield of Texas available to participants who live in Texas and are not enrolled in Medicare. You choose a primary care provider (PCP), get referrals for specialists and save money by using in-network providers. HealthSelect of Texas includes comprehensive prescription drug coverage administered by OptumRx.

HealthSelect<sup>SM</sup> Out-of-State (not enrolled in Medicare)

HealthSelectSM Out-of-State (not enrolled in Medicare)

Available to participants not enrolled in Medicare who live outside Texas. In this network-based preferred provider organization (PPO) administered by Blue Cross and Blue Shield of Texas, you’ll save money by using in-network providers. It includes comprehensive prescription drug coverage administered by OptumRx.

Consumer Directed HealthSelect (not enrolled in Medicare)

Consumer Directed HealthSelect (not enrolled in Medicare)

A network-based, high-deductible PPO available nationwide to participants not enrolled in Medicare, administered by Blue Cross and Blue Shield of Texas. You do not need referrals to specialists, but will save money by using in-network providers. The program includes comprehensive prescription drug coverage administered by OptumRx. The state makes monthly contributions to an eligible member’s Optum Bank health savings account (HSA).

Health maintenance organizations

Health maintenance organizations

HMOs are available only to members who live in certain Texas counties, and their eligible dependents. HMOs are network-restricted health plans. Each HMO includes comprehensive prescription drug coverage administered by the HMO. In addition to traditional HMOs in central Texas and the San Antonio area, there is a Medicare Advantage HMO in the Houston area. 
Please note: HMO's will not be part of the GBP offerings as of September 1, 2021:

HealthSelect Medicare Advantage (Medicare only)

HealthSelect Medicare Advantage (Medicare only)

For participants enrolled in Medicare Part A and Part B, HealthSelect Medicare Advantage replaces both original Medicare and other GBP coverage as your primary and secondary coverage. This plan also covers the Medicare deductible and includes Medicare Part D prescription drug coverage administered by UnitedHealthcare.

HealthSelect Secondary (Medicare only)

HealthSelect Secondary (Medicare only)

HealthSelect Secondary is available only to participants enrolled in Medicare. It is available nationwide and is administered by Blue Cross and Blue Shield of Texas. Medicare is the primary payer, HealthSelect Secondary pays most of the rest of any approved medical expenses, with the member picking up the remainder. It includes Medicare Part D prescription drug coverage administered by UnitedHealthcare.