HMOs no longer offered in the Texas Employees Group Benefits Program (GBP) starting September 1
Starting September 1, Scott and White Care Plans (SWCP) and Community First Health Plans (CFHP) plans will no longer be offered in the Texas Employees Group Benefits Program (GBP). Central Texas and San Antonio-area HMO participants who do not have Medicare as their primary insurer will be automatically enrolled in HealthSelect of Texas® administered by Blue Cross and Blue Shield of Texas (BCBSTX) beginning September 1, 2021. Current non-Medicare-primary HMO participants who don’t want to enroll in HealthSelect of Texas may choose Consumer Directed HealthSelectSM or waive GBP health coverage. HealthSelect of Texas and Consumer Directed HealthSelect both have prescription drug coverage administered by OptumRx. A member who waives GBP coverage and has other group health insurance that is comparable to GBP health insurance may be eligible for the Health Insurance Opt-Out Credit. You can make your choice during your Summer Enrollment phase.
Why this change is happening
The Employees Retirement System of Texas (ERS) is responsible for maintaining high-quality, cost-efficient health coverage for employees, retirees and their families. Continuing to offer HMO plans likely would cause overall GBP health plan costs to increase, which could affect the state’s ability to provide health insurance over the long term. Last May, the ERS Board of Trustees approved a recommendation to discontinue HMO options rather than rebid the HMO contracts that expire this year.
Impact on participants
SWCP and CFHP participants should see little difference in medical and prescription drug benefits between the HMOs and HealthSelect plans, and in most instances, HealthSelect benefits are better. Most HMO network providers—more than 90%—participate in the HealthSelect network, and most current participants will not need to find a new primary care provider (PCP).
Those who do need to find a PCP will have a much larger network to choose from, and their new plan will help them find the right provider. The HealthSelect pharmacy network is larger, too. And, unlike the HMOs, HealthSelect plans cover medical and prescription drug services from out-of-network providers, although HealthSelect of Texas and Consumer Directed HealthSelect participants will pay more if they go out of network.
HealthSelect of Texas, the plan ERS will automatically enroll HMO participants in unless they make another choice, requires all participants to choose a PCP and get referrals to see some specialists. Participants who enroll in Consumer Direct HealthSelect don’t need to choose a PCP, but will benefit from seeing an in-network PCP. A PCP knows you and your medical history, and often can help you make good health care choices. (See "Choose a Primary Care Provider" to learn more.)
Watch for more information
ERS and plan administrators will provide more information to current HMO participants in the coming weeks and throughout the summer. In the meantime, visit the ERS website for details about the HealthSelect of Texas and Consumer Directed HealthSelect plans.