Some health insurance cost-sharing started over with the new year

Some health insurance cost-sharing started over with the new year

January 9, 2019


In ERS health insurance plans, deductibles, coinsurance maximums and out-of-pocket maximums reset annually. In the HealthSelectSM plans, they start over on January 1. That means, for example, you might pay more for a prescription than you paid in December until you reach the $50 prescription drug deductible.

See the table below to learn more about prescription drug and medical deductible resets.

If participant is enrolled in: When does the deductible restart?
HealthSelectSM of Texas (your eligibility county on file with ERS is in Texas) 
- or -

HealthSelectSM Out-of-State (your eligibility county on file with ERS is outside Texas)

Not eligible for Medicare
In-network: There is no medical deductible to see in-network providers.

Out-of-network: The out-of-network medical deductible resets on January 1.

Prescription drug deductible starts over on January 1.
Consumer Directed HealthSelectSM In-network: The in-network, combined medical and prescription drug deductible resets on January 1.

Out-of-network: The out-of-network combined medical and prescription drug deductible resets on January 1.
HMOs
Community First Health Plans
Scott and White Health Plan or 
KelseyCare powered by Community Health Choice
There is no medical deductible.

Prescription drug deductible starts over on September 1.
HealthSelectSM Secondary (eligible for Medicare and retired, or a return-to-work retiree with retiree benefits) You do not have a medical deductible.

Prescription drug deductible starts over on January 1
HealthSelectSM Medicare Advantage administered by Humana or KelseyCare Advantage The deductible resets on January 1.

Prescription drug deductible starts over on January 1.