KelseyCare FAQs

KelseyCare Advantage Medicare HMO Discontinuation

Starting January 1, 2021, the Employees Retirement System of Texas (ERS) will no longer offer the KelseyCare Advantage Medicare health maintenance organization (MA HMO) to Medicare-enrolled participants through the Texas Employees Group Benefits Program (GBP). Current KelseyCare Advantage MA HMO participants who want to continue their health coverage through the GBP will have to be in a new health plan starting in 2021. The GBP offers two other high-quality health plans for current KelseyCare Advantage MA HMO participants.

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.

You do not need to do anything to be covered in a high-quality GBP health plan after December 31. ERS will automatically enroll you in the HealthSelectSM Medicare Advantage Plan, a preferred provider organization (MA PPO), effective January 1, 2021. To learn more about the HealthSelect MA PPO, please see Question 4 below.

You have other options if you do not want to join HealthSelect Medicare Advantage, but you must make a decision about your health coverage by December 31, 2020. If you do nothing, your coverage in the HealthSelect MA PPO will start January 1.
The GBP offers two statewide health plans for eligible Medicare-enrolled retirees, dependents and surviving dependents. Participants in the Houston area can choose one of them:
  • HealthSelect Medicare Advantage Plan preferred provider organization (MA PPO)—See Question 4 for more information about coverage in the HealthSelect MA PPO and how to enroll starting January 1.
  • HealthSelectSM Secondary, a HealthSelect of Texas plan®—This is not a Medicare plan. It pays secondary to Original Medicare. See Question 5 for more information regarding coverage in HealthSelect Secondary and how to enroll in it starting January 1.
Both GBP plans provide high-quality medical coverage and come with Part D prescription drug coverage at no additional cost to you. But there are important differences between the two plans, and both are different than the KelseyCare Advantage Medicare HMO. Differences include monthly premiums (if you pay premiums for your medical coverage or an eligible dependent’s medical coverage), medical coverage, possible out-of-pocket costs, access to certain providers and value-added programs.

Neither the HealthSelect MA PPO nor HealthSelect Secondary includes access to Kelsey-Seybold doctors, clinics, hospitals or other facilities. If you choose one of the two HealthSelect plans, you will have to find new doctors and other health care providers. The new health plan you choose can help you find new providers.
 
Keeping your GBP coverage: You can choose a health plan outside the GBP and still have GBP medical coverage, but it could affect how the GBP plan pays for your covered health benefits. You also might be able to keep your HealthSelect Medicare Rx prescription drug coverage, depending on if your non-GBP plan includes Part D coverage. If you want to enroll in a non-GBP health plan, you should be aware of the following:
  • If you enroll in a Medicare Advantage plan not offered through the GBP, you will lose your HealthSelect Medicare Advantage coverage, even if you have not opted out of  that coverage. The federal Centers for Medicare and Medicaid Services (CMS) does not allow participants to be enrolled in more than one Medicare Advantage plan at the same time. ERS will enroll you in HealthSelect Secondary, which is not a Medicare plan.
  • If your non-GBP health plan includes Medicare Part D prescription drug coverage, or if you enroll in a Part D prescription drug program not offered through the GBP, you will lose your HealthSelect Medicare Rx prescription drug coverage. CMS does not allow participants to be enrolled in more than one Part D plan at the same time. The GBP does not offer another prescription drug program for Medicare-eligible retirees, so you will no longer have access to any GBP prescription drug coverage.
Waiving your GBP coverage: You can waive your GBP health and prescription drug coverage starting January 1, 2021. You should think carefully about waiving GBP health insurance.

If you are thinking about enrolling in a plan not offered through the GBP, we encourage you to carefully compare any other plan you may be considering to the GBP plans. If you pay premiums for your or a dependent’s GBP health coverage, you might find that some non-GBP health plans have lower monthly premiums than the GBP plans, and other plans might offer access to your preferred providers. But the coverage in those plans might be different than the coverage in GBP plans. Consider each plan’s medical coverage, potential out-of-pocket costs, monthly premiums, Part D prescription drug coverage (and any additional premiums for that) and provider network.

Also, make sure you understand the consequences of waiving GBP health coverage. If you waive your GBP health insurance:
  • You will lose the Medicare Part D prescription drug benefits provided through the GBP, at no additional cost to you, as part of your overall health coverage. ERS does not offer “stand-alone” prescription drug coverage.
  • If the State of Texas currently pays all or part of your monthly premium, you will no longer get that premium contribution.
  • You cannot enroll your eligible dependents in GBP coverage if you are not enrolled yourself.
  • If you are a retiree, you cannot re-enroll yourself or any eligible dependents in ERS health coverage until Fall Enrollment 2021, with coverage starting in January 2022, unless you have a qualifying life event, such as loss of your other health insurance.
  • If you are a retiree, you will lose the $2,500 Basic Term Life Insurance that comes as part of your GBP health insurance enrollment.
  • If you are a survivor, you cannot re-enroll in GBP health coverage at any time, even during Fall Enrollment or if you have a qualifying life event. Survivors who waive GBP health insurance will permanently lose GBP health and prescription drug coverage, for themselves and any dependents.
  • You can still continue or begin enrollment in ERS’ optional insurance plans, including one of the two dental plans, State of Texas Vision, and/or optional and dependent life insurance. If you enroll in dental insurance or State of Texas Vision, you can also enroll your eligible dependents in the same plan(s). (Note: If you are a retiree applying for optional or dependent life insurance for the first time, you must submit evidence of insurability (EOI). Survivors are not eligible for life insurance.)
  • If you are a retiree with other group health insurance that is comparable to GBP health insurance, you might be eligible to opt out of your GBP health insurance and get credit toward certain other GBP plans. (Please note that Original Medicare is not considered comparable coverage.) Eligible retirees can sign up for the Health Insurance Opt-Out Credit to apply toward the premiums of certain optional GBP benefits, such as dental insurance or the State of Texas Vision plan. Learn more about the Opt-Out Credit.
To waive your GBP health coverage effective January 1, you must choose that option during Fall Enrollment or any time through December 31, 2020.
 
  • The HealthSelect MA PPO plan will be insured by UnitedHealthcare starting January 1, 2021. (Humana is the insurer through December 31, 2021.)
  • ERS designed the HealthSelect MA PPO especially for retirees of Texas agencies and higher education institutions.
  • Medical benefits: The HealthSelect MA PPO has no medical deductibles and typically no copays or coinsurance for medical services if you see providers who accept Medicare. You also will have out-of-network benefits in this plan, which you do not have under your current KelseyCare Advantage MA HMO coverage. See the Medicare health plans comparison chart for more information.
  • Provider network: You have the same level of in-network and out-of-network benefits in this plan as long as you see providers who accept Medicare. For the most convenience and no upfront costs, you should choose providers willing to bill UnitedHealthcare. (If you see a provider who will not bill UnitedHealthcare directly, you may have to pay for the cost out of pocket and then submit a claim to UnitedHealthcare for reimbursement.)
    • Kelsey-Seybold providers do not participate in this plan. Current KelseyCare Advantage MA HMO participants will need to find new providers. UnitedHealthcare can help you find new providers.
  • Pharmacy benefits: The HealthSelect MA PPO includes the same Part D prescription drug coverage, HealthSelectSM Medicare Rx, that ERS currently provides to KelseyCare Advantage MA HMO participants. If you choose to be enrolled in the HealthSelect MA PPO, you will stay enrolled in the HealthSelect Medicare Rx plan at no additional cost to you.
    • You will use the same prescription drug ID card you use now.
    • You will continue to have a $50 per participant per year prescription drug deductible that resets every January 1.
    • Your prescription drug coverage and costs under HealthSelect Medicare Rx will not change as a result of this transition.
  • Premiums: If you currently pay a premium—for yourself or a dependent—for your KelseyCare Advantage MA HMO coverage, your premium payment for the HealthSelect MA PPO will be less than what you pay now for the KelseyCare Advantage MA HMO. As long as you are enrolled in the HealthSelect MA PPO and if the state currently pays all or part of your premiums, you will continue to get the state’s premium contribution. See the Medicare premium rate sheet for specific premium and state contribution amounts.
  • Value-added benefits: There are many extra benefits available at no cost to you, including the popular SilverSneakers program. NOTE: Health plan carriers may discontinue or change their value-added programs at any time without notice.
  • Enrollment: You do not need to do anything to enroll. ERS will automatically enroll you in the HealthSelect MA PPO effective January 1 and you will stay enrolled in HealthSelect Medicare Rx.
  • HealthSelectSM Secondary is a HealthSelect of Texas® plan administered by Blue Cross and Blue Shield of Texas (BCBSTX). ERS designs the benefits and pays the share of each claim not paid by Medicare and the participant. HealthSelect Secondary is not a Medicare plan.
  • Medical benefits: You could have higher out-of-pocket costs in HealthSelect Secondary than in the HealthSelect MA PPO. HealthSelect Secondary has a $200 per person (or $600 per family) annual medical deductible and coinsurance. Once you meet the deductible, Medicare usually pays 80% of covered services. After Medicare has paid its portion, the HealthSelect Secondary plan usually pays either 70% of the plan’s allowable amount or the amount remaining to be paid on the claim, whichever is less. You (the participant) would be responsible for the rest. In most cases, HealthSelect Secondary pays secondary to Original Medicare. (Note: There may be times when HealthSelect Secondary pays primary to Original Medicare, such as for a service Medicare doesn’t cover.) See the Medicare health plans comparison chart for more information.
  • Provider network: In most cases, you have the same level of in-network and out-of-network benefits as long as you see a provider who accepts Medicare.
    • Kelsey-Seybold providers do not participate in this plan. Current KelseyCare Advantage MA HMO participants will need to find new providers. BCBSTX can help you find new providers.
  • Pharmacy benefits: HealthSelect Secondary includes the same Part D prescription drug coverage, HealthSelectSM Medicare Rx, that ERS currently provides to KelseyCare Advantage MA HMO participants. If you enroll in HealthSelect Secondary, you will stay enrolled in the HealthSelect Medicare Rx plan at no additional cost to you.
    • You will use the same prescription drug ID card you use now.
    • You will continue to have a $50 per participant per year prescription drug deductible that resets every January 1.
    • Your prescription drug coverage and costs under HealthSelect Medicare Rx will not change as a result of this transition.
  • Premiums: If you pay premiums for your or a dependent’s GBP health coverage, premiums for HealthSelect Secondary will be higher than what you currently pay for KelseyCare Advantage, and higher than premiums for the HealthSelect MA PPO. As long as you are enrolled in HealthSelect Secondary and if the state currently pays all or part of your monthly premiums, you will continue to get the state’s premium contribution. See the Medicare premium rate sheet for specific premium and state contribution amounts.
  • Value-added benefits: There are many extra benefits available at no cost to you. HealthSelect Secondary does not offer SilverSneakers. NOTE: Health plan carriers may discontinue or change their value-added programs at any time without notice.
  • Enrollment: If you want to enroll in HealthSelect Secondary starting January 1, 2021, you must choose it during Fall Enrollment or any time through December 31, 2020. You can change your health plan by logging in to your ERS OnLine account or by calling ERS toll-free at (877) 275-4377 (TTY: 711), Monday – Friday, 8 a.m. – 5 p.m. CT.
If you enrolled in HealthSelect Secondary or waived your GBP health coverage with ERS by December 31, 2020 but after November 13 (the end of Fall Enrollment), you may have gotten membership materials and an ID card from UnitedHealthcare, insurer of the HealthSelect MA PPO plan. This is due to when ERS and UnitedHealthcare process memberships after Fall Enrollment. You do not need to call.
  • If you enrolled in HealthSelect Secondary by December 31, 2020, you should get a welcome packet and HealthSelect of Texas ID card from Blue Cross and Blue Shield of Texas by late January.
  • If you enrolled in a Medicare Advantage plan not offered through the GBP and did not waive your GBP coverage, you should get a welcome packet and HealthSelect of Texas ID card from Blue Cross and Blue Shield of Texas within a few weeks of enrolling in the non-GBP plan.
Medicare-eligible retirees, survivors and dependents can change or waive their Texas Employees Group Benefits Program (GBP) health coverage at any time during the plan year.
  • Changing between GBP health plans: In most cases, participants will be re-enrolled in the health plan they had before. However, if you are a KelseyCare Advantage MA HMO participant, ERS will allow you to change from the HealthSelect plan you first enrolled in after we discontinued KelseyCare Advantage to the other HealthSelect plan.

    For example: You were a KelseyCare Advantage MA HMO participant who enrolled in HealthSelect Secondary starting January 1. After a few months, you decide the HealthSelect MA PPO would be better for you. Because ERS no longer offers the plan you were enrolled in before (KelseyCare Advantage), we will allow you to enroll in the HealthSelect MA PPO.
    To change between GBP health plans, you can log in to your ERS OnLine account or call ERS.

    If you change your GBP health plan and you cover a dependent who is also enrolled in Medicare, that dependent’s health plan will change, too. Dependents cannot be enrolled in a GBP plan if the retiree or survivor is not also enrolled, unless one is eligible for Medicare and the other is not. 
     
  • Waiving GBP health coverage: You can call ERS to waive your GBP health coverage. Your GBP coverage will end on the last day of the month you ask ERS to waive your coverage.

    If you are thinking about waiving your GBP health coverage, please read the information in the answer to Question 3 above, carefully compare the coverage in the health plan(s) you are considering and make sure you fully understand the consequences of waiving GBP health coverage.

    Although you can drop GBP coverage at any time:
    • retirees can re-enroll themselves and their eligible dependents only during the next Fall Enrollment period or if they have a qualifying life event, and
    • survivors cannot re-enroll in health coverage at any time, and would permanently lose their GBP health coverage.
ERS is your best source of information about the change and your options for GBP coverage. You can call ERS toll-free at (877) 275-4377 (TTY: 711), Monday – Friday, 8 a.m. – 5 p.m. CT.

Throughout late 2020 and possibly early 2021, current KelseyCare Advantage MA HMO participants will get information in the mail from ERS and one or both of the HealthSelect plans. Please pay close attention to any information you get from ERS, the HealthSelect Medicare Advantage MA PPO or HealthSelect of Texas. Information that comes from ERS and the HealthSelect plans will be clearly identified.

During Fall Enrollment (October 26 – November 13) and throughout your transition to a new health plan, ERS will help you understand how the change and your choices will affect you. When you get your Fall Enrollment packet in the mail in mid- to late October, please read the information carefully. In addition to the information in your packet, ERS, UnitedHealthcare and Blue Cross and Blue Shield of Texas will have webinars and phone sessions to help you understand the change and your health coverage options. You will find a schedule of webinars and phone sessions on the Fall Enrollment events page and in your Fall Enrollment packet.

For questions about coverage in the two HealthSelect medical plans available to you through ERS, you can call the plans toll-free or visit their websites:
In keeping with the budget set by the State of Texas for ERS programs, any optional health plan ERS offers must not have a higher plan cost than the basic plan. For Medicare-enrolled participants, the basic plan is the HealthSelect MA PPO. Under the new contract with UnitedHealthcare, monthly plan costs for the HealthSelect MA PPO, including prescription drug coverage, will be $179.04 per person starting January 1, 2021. This cost is significantly less than the current KelseyCare Advantage MA HMO plan cost, which is $254.24 per person, as well as the anticipated cost for Plan Year 2021. Because of the significant cost savings with the new UnitedHealthcare MA PPO contract, ERS cannot offer the Kelsey Care Advantage MA HMO plan to our Texas Employees Group Benefits Program (GBP) participants. (NOTE: The actual costs of the plans are listed in the rate tables for surviving dependents.)

We know changes like this can be hard for some people and we are working to ensure KelseyCare Advantage participants have the information they need.