ERS Guide for Active Employees Page: 3
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CHANGES FOR PLAN YEAR 2011
Current
Effective September 1 2010
YOUR COPAYS
Office VisitsHealthSelect $20 PCP/$30 Specialist HealthSelect $25 PCP!$40 Specialist
HMOs $30 PCP/$40 Specialist HMOs $25 PCP/$40 Specialist
HealthSelect has coinsurance for some services HealthSelect and HMOs have coinsurance
for some services
In-Patient Hospitalization
$ 100 a day up to $500 max--up to 5 days $150 a day up to $750 max--ap to 5 days per stay,
per stay, plus coinsurance plus coinsurance
for HealthSelect for HealthSelect and HMOs
Out-Patient
$100aday $100aday
plus coinsurance for HealthSelect plus coinsurance for HealthSelect and HMOs
Emergency Room
$ 100 plus coinsurance for HealthSelect $ 150 plus coinsurance for HealthSelect and HMOs
Urgent Care Clinic
Starting June 1, 2010, you have a $50 copay per visit to an Urgent Care Clinic
plus coinsurance for HealthSelect and HMOs-save money by not going to an ER
Prescription Drugs up to a 30-day supply
$10-Tier I $15-Tier I
$25-Tier 2 $35-Tier 2
$40-Tier 3 $60-Tier 3
COINSURANCE
(Your share of service costs)
Maximum Amount Paid by Participant
HealthSelect NetworkCalendar year-$1,000
HEALTHSELECT MEMBERS WILL
BE ABLE TO GET MAINTENANCE
MEDICATIONS AT RETAIL WITH
NO EXTRA FEE
Through the new Extended Days Supply
(EDS) Network, HealthSelectsM of Texas
members who use certain retail pharma-
cies can now buy a 31- to 90-day sup-
ply of maintenance drugs with no retail
maintenance fees. See chart below. This
option is available at pharmacies that
have agreed to match the health plan's
mail service cost. Among the participating
pharmacies are HEB, Sears/Kmart, Safe-
way (including Tom Thumb and Randall's),
and a number of independent pharmacies.
A full list of participating pharmacies is
available on the Caremark website, www.
caremark.com/ers, or call Caremark at
(888) 886-8490.Calendar year-$2,000
HealthSelect Non-Network
Calendar year-$3,000 Calendar year-$7,000
HealthSelect Out-of-Area (over age 65 retiree or out-of-state residents)
Calendar year-$1,000 Calendar year-$3,000
HMOs
Plan year-None Plan year-$2,000
Additional plan cost changes:
" High-Tech Radiology (CT scan, MRI, Nuclear Medicine) - $100 copay (new) plus coinsurance.
Copay does not apply when you are a hospital inpatient or during an emergency room visit.
" For HealthSelect--Limits annual visits and lowers maximum benefit per visit for chiropractic
care.
PLAN YEAR 2011 PRESCRIPTION DRUG COPAY CHART
Participating Retail, Non- Participating Retail, HealthSelectsm of Texas Extended
Maintenance Drug Copay Maintenance Drug Copay Days Supply (EDS) NetworkEach participant must pay 'a $50 annual deductible owing copy pan year, September I to August 31).
Tier I $15 for up to a 30-day supply
Tier 2 $35 for up to a 30-day
supply'
Tier 3 $60 for up to a 30-day
supply'$15 copay + $5 maintenance
fee for up to a 30-day supplyUp to a 90-day supply for 3 copays
$35 copay + $10 maintenance Up to a 90-day supply for 3 copays'
fee for up to a 30-day supply'$60 + $15 maintenance fee for
up to a 30-day supply'Up to a 90-day supply for 3 copays1
Up to a 90-day supply
for 3 copays
Up to a 90-day supply
for 3 copays'
Up to a 90-day supply
for 3 copays'1 If generic is available and you choose to buy the name brand drug, you will pay the generic copay plus the cost difference between the name brand
and the generic drug.
Note: If you go to a pharmacy that is not in the retwork, you will be reimbursed 60% of the lesser of the amount you pay for the prescription, minus
your copay OR the average wholesale price of the drug, plus a dispensing fee, minus your copay. Deductible will be subtracted if not met.
Annual Enrollment 2010Mail order
3
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Employees Retirement System of Texas. ERS Guide for Active Employees, pamphlet, 2010; (https://texashistory.unt.edu/ark:/67531/metapth654610/m1/3/: accessed April 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.