HealthSelectSM Medicare Advantage, a preferred provider organization (MA PPO), administered by Humana, is a Medicare Part C plan, which replaces both original Medicare and other Texas State Employee Group Benefits Plan (GBP) health coverage as your primary and secondary coverage. You must continue to pay the Medicare Part B premium to the Social Security Administration (SSA), because you are still covered through Medicare. When you are retired, become Medicare eligible and enroll in Medicare Parts A and B, contact ERS with your Medicare information (located on your Medicare card) to be enrolled in HealthSelect MA PPO . The plan includes a comprehensive Part D prescription drug plan called HealthSelect Medicare Rx, administered by UnitedHealthcare®.
Enrollment in this plan also includes $2,500 of Basic Term Life Insurance.
- The plan has no yearly deductible or coinsurance, and covers your Medicare deductible. Most of your services are covered at 100%.
- You can visit any provider that accepts Medicare and is willing to bill Humana or you can find an in-network provider.
- The plan offers additional benefits, such as no cost gym memberships along with health and wellness programs available to all participants.
- You will receive two ID cards: one for medical and one for prescription drug benefits (HealthSelect Medicare Rx, administered by UnitedHealthcare.
Eligibility and Enrollment
Retirees, survivors, and their dependents are eligible for HealthSelect MA PPO if they meet the following eligibility requirements:
- at least age 65 or certified as disabled by the Social Security Administration (SSA),
- enrolled in Medicare Parts A (hospital) and B (other medical) coverage and
- living in the United States or Puerto Rico.
- Active employees
- Dependents (even if retired or certified as disabled by the SSA with Medicare) of active employees
- Persons under 65 (unless certified as disabled by the SSA and enrolled in Medicare)
- Persons living outside the United States or Puerto Rico
- Retirees who return to state employment (active or retiree benefits)
- Members and/or dependents who have end-stage renal disease (ESRD) and are still within their 30-month coordination period
Retirees, survivors, and dependents enrolled in Medicare Parts A and B will need to call ERS toll-free at (877) 275- 4377 with their Medicare information (located on their Medicare cards) to start the enrollment process into HealthSelect MA PPO.
If more than one person in a household is enrolled in Medicare, all Medicare-enrolled household members must be enrolled in the same GBP health plan.
For example, Rosie is retired. She and her spouse Mario are age 65 and enrolled in Medicare Parts A and B. She is enrolled in HealthSelect of Texas administered by Blue Cross Blue Shield of Texas as secondary coverage to Medicare and Mario is enrolled under the same plan, as Rosie’s dependent. Their daughter Gabriella lives with them is disabled and enrolled in Medicare. Rosie, Mario, and Gabriella must all be enrolled in the same GBP health coverage plan. Rosie cannot enroll in HealthSelect MA PPO while Mario and Gabriella stay with HealthSelect of Texas.
Freedom of movement
If you determine one plan may work better for you than the other, you can switch between HealthSelect MA PPO and your previous non-Medicare health plan or vice versa at any time during the plan year. You don’t have to wait until annual enrollment. Evidence of Insurability is never required to enroll in this plan.
A household of at least two people, where at least one member is enrolled in Medicare and one member is not eligible for Medicare.
The retiree is Medicare eligible but the dependent is not.
The retiree should enroll in Medicare Parts A and B and provide ERS with his or her Medicare information. While the retiree will be enrolled in HealthSelect MA PPO and HealthSelect Medicare Rx.,the dependent will remain on his or her current health and prescription drug plan.
When the dependent becomes Medicare eligible and signs up for Medicare Parts A and B, they will be enrolled in the same plan as the retiree.
For example, Rita and Gus are married and both are currently enrolled in HealthSelect of Texas. Rita is a state retiree who is 65 years old and enrolled in Medicare Parts A and B. Gus is also retired and is enrolled as Rita’s dependent, but he is 64 years old and not yet eligible for Medicare. Rita can enroll in the HealthSelect MA PPO while Gus stays enrolled in HealthSelect.
The retiree is not Medicare eligible, but the dependent is.
The retiree remains on his or her current health and prescription drug plan. The dependent should enroll in Medicare Parts A and B and provide ERS with his or her Medicare information to enroll in HealthSelect MA PPO and HealthSelect Medicare Rx.
When the retiree becomes Medicare eligible and signs up for Medicare Parts A and B, they will be enrolled in the same plan as the dependent.