HMOs will not be available in Plan Year 2022
Scott and White Care Plans (SWCP) and Community First Health Plans (CFHP) will no longer be offered in the Texas Employees Group Benefits Program (GBP) starting September 1.
Employees and non-Medicare retirees enrolled in SWCP or CFHP will be automatically enrolled in HealthSelect of Texas®, administered by Blue Cross and Blue Shield of Texas (BCBSTX) and will have their prescription drug coverage administered by OptumRx on September 1, 2021. During Summer Enrollment, these participants can also choose to enroll in Consumer Directed HealthSelectSM, waive GBP health coverage or select the Health Insurance Opt-Out Credit if they have other group health insurance comparable to GBP health insurance.
Medicare retirees enrolled in SWCP or CFHP will be automatically enrolled in HealthSelectSM Medicare Advantage Plan preferred provider organization (MA PPO), insured by UnitedHealthcare with prescription drug coverage administered by UnitedHealthcare on September 1, if ERS has the retiree’s Medicare information on file by July 30. These participants can also choose to enroll in HealthSelect Secondary (administered by BCBSTX,) waive GBP health coverage or select Health Insurance Opt-Out Credit if they have other group health insurance comparable to GBP health insurance (Medicare does not count as comparable health coverage). If we do not have the retiree’s Medicare information by July 30, we will enroll that retiree in HealthSelect Secondary on September 1.
Why is this change happening?
ERS is responsible for maintaining high-quality, cost-efficient health coverage for employees, retirees and their families. ERS found that 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, ERS’ Board of Trustees approved a recommendation to discontinue HMO options rather than rebid the HMO contracts that expire this year.
Impact on participants
In-network benefits in HealthSelect of Texas are largely the same—and in some cases, better—than in your HMO. In addition, the HealthSelect plans cover out-of-network services, although participants usually pay more for out-of-network care. Most HMO network providers—more than 90%—participate in the HealthSelect network, and most current participants will not need to find a new provider. Those who do will have a much larger network of providers and pharmacies to choose from, and their new plan will help them find the right provider. Unlike the HMOs, HealthSelect plans cover medical and prescription drug services from out-of-network providers. However, HealthSelect of Texas and Consumer Directed HealthSelect participants will pay more if they go out of network.
If you are an HMO participant, you will need to designate a primary care provider (PCP) and get referrals to see some specialists if you enroll in HealthSelect of Texas. PCP designation and referrals are not required for Consumer Directed HealthSelect Participants. If you want to know if your current providers are in the HealthSelect network, use the Provider Search Tool or call HealthSelect of Texas customer service toll-free at (800) 252-8039 (TTY: 711), Monday – Friday from 7 a.m. - 7 p.m. CT and Saturday 7 a.m. - 3 p.m. CT.
More information coming soon
ERS and plan administrators will provide more information to current HMO participants in the coming weeks and throughout the summer.