Plan year deductibles reset for the New Year
2-minute read
Your prescription drug deductibles and any medical deductibles in the HealthSelectSM plans reset on Jan. 1.
You have to reach the deductible amount before the plan pays its share. Coinsurance and total out-of-pocket maximums also reset.
How much is my prescription drug plan deductible?
Except for Consumer Directed HealthSelectSM (which has one deductible covering both medical services and prescription drugs), all HealthSelect prescription drug plans have a $50 annual deductible per participant. Reminder: You should now use your Express Scripts prescription drug card.
How much is my medical plan deductible?
See the HealthSelect plan deductibles in the table below. The Health Plans Comparison Chart PDF on the ERS website shows the deductible and coinsurance amounts for the HealthSelect plans.
Keep in mind that eligible in-network preventive care is always covered at 100%, no matter which plan you’re in.
| If participant is enrolled in: | How much is the medical deductible? |
|---|---|
| HealthSelect of Texas® (your eligibility county on file with ERS is in Texas and you’re not eligible for Medicare) |
In-network: $0
Out-of-network: $500 per individual; $1,500 per family
|
| HealthSelectSM Out-of-State (your eligibility county on file with ERS is outside Texas and you’re not eligible for Medicare) |
In-network: $0
Out-of-network: $500 per individual; $1,500 per family
|
|
Consumer Directed HealthSelectSM high-deductible plan
NOTE: If you are enrolled in family coverage, you must meet the entire family deductible amount before non-preventive benefits are paid for any individual family member.
|
In-network: $2,100 per individual; $4,200 per family
Out-of-network: $4,200 per individual; $8,400 per family NOTE: Consumer Directed HealthSelect has a combined medical and pharmacy deductible, which means that the plan won’t pay anything for medical (except in-network preventive care) and prescription drug expenses until you meet the entire deductible.
|
How much is the 2024 out-of-pocket maximum?
The total 2024 in-network out-of-pocket maximums for the non-Medicare plans are $7,500 per individual and $15,000 per family. The out-of-pocket maximum protects participants from very high health costs over the calendar year. If the member’s or family’s eligible, in-network, out-of-pocket medical and pharmacy expenses (not including premiums) reach the out-of-pocket maximum, the health plan will pay 100% of eligible, in-network expenses for the rest of the year.