Health insurance Opt-Out Credit
If you can certify that you already have other health
insurance that is equal to or better than coverage
offered through ERS, you can sign up for a monthly
health insurance Opt-Out Credit of up to $60 for full-time
employees and $30 for part-time employees.
You must be eligible for the state contribution toward your
health insurance premium to qualify for the Opt-Out Credit.
This credit must be applied to your dental insurance,
vision insurance and/or Voluntary Accidental Death &
Dismemberment insurance premiums. It cannot be applied
to premiums for the State of Texas Dental Discount plan.
The health insurance Opt-Out Credit is not available if:
" your only other insurance is Medicare,
- you have health insurance coverage through ERS as a
dependent or
- you receive a state contribution for other insurance
coverage.
IMPORTANT: If you waive or opt-out of your health plan, you give up your prescription coverage and will
no longer have Basic Term Life insurance coverage. If you lose your other health insurance coverage, it
is considered a qualifying life event, and you may enroll in health coverage offered through ERS if you
sign up within 31 days of losing your other health insurance coverage.
HealthSelect of Texas and
Consumer Directed HealthSelect
No matter where you live or work, you can choose between
HealthSelect of Texas and Consumer Directed HealthSelect
for coverage for yourself and eligible dependents. Both
plans have access to a network of more than 50,000
health providers in Texas and include a comprehensive
prescription drug program administered by OptumRx.
HealthSelect provides you with comprehensive benefits and
access to programs and tools that can help you and your
dependents improve your health and well-being.
While ERS sets all plan benefits and pays the claims,
Blue Cross and Blue Shield of Texas (BCBSTX) manages
the provider network, processes claims and provides
customer service.
To learn more about HealthSelect benefits and coverage go
to www.healthselectoftexas.com.
You can also call a BCBSTX Personal Health Assistant
toll-free at (800) 252-8039, Monday - Friday from 7 a.m.
to 7 p.m. CT, and Saturday from 7 a.m. to 3 p.m. CT.
HtHealthSelect of
Texas is a point-
of-service health insurance plan. You do not have to meet
a deductible amount before the plan begins to pay if your
provider is in the HealthSelect network.
In-network
Out-of-network
$0
$500
$0
$1,500
*Deductibles reset on January 1. If you go out of network for care, you'll
have to meet the deductible, and it will start over on January 1.
You are responsible for copayments for doctor and hospital
visits and other medical services.
There is usually coinsurance on hospital stays and procedures
like outpatient surgery. For example, if you have outpatient
surgery at an in-network facility, you will owe 20% of the
overall cost.
To save money, you need to designate a primary care
physician (PCP) in the HealthSelect network.
If you live and work in Texas, you need a referral from your
designated PCP to see an in-network specialist to receive in-
network benefits. If you do not get a referral from your PCP,
you could pay more for your treatment, even if the provider
is in the HealthSelect network. However you do not need a
referral for the following services:
" eye exams (both routine and diagnostic),
- OB/GYN visits,
" mental health services,
- chiropractic visits,
" occupational therapy, speech therapy and physical
therapy and
" virtual visits, urgent care centers and convenience
care clinics.
See the Health Plans Comparison Chart on pages 8-9.
4 1 ERS 1 2018 Summer Enrollment
