2015 Summer Enrollment:Former COBRA Unmarried Child Page: 3
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2015 Summer Enrollment I ERS I 3
HEALTH INSURANCE
Your health insurance options
During Summer Enrollment, you can enroll in or
switch medical coverage to HealthSelect or, if
you live or work in an eligible area, to an HMO.
If you enroll in a new health plan other than
Scott & White Health Plan or KelseyCare
powered by Community Health Choice, don't
forget to select a primary care physician (PCP).
Once you've enrolled, your health plan will mail
a new ID card to you. Don't use your new card
until September 1. If you don't get your ID card
by September 1, contact your health plan.
HEALTH BENEFIT
CHANGES -
EFFECTIVE
PLAN YEAR 2016
HealthSelect of Texas
Total network out-of-pocket
maximum changes
- For PY16, the total network out-of-pocket
maximum is $6,450 per individual. This is for
both in-area and out-of-area plans.
" There is an individual limit of $6,450 per
individual, which means that you will not
owe more than $6,450 for out-of-pocket
expenses. Once you reach $6,450 in total
network out-of-pocket expenses for the year,
services are paid at 100%.
" Starting January 1, 2016, the total network
out-of-pocket maximum will include medical
and pharmacy deductibles, coinsurance and
copays. It does not include premiums.
Mental health benefits
- The copay for a mental health office visit is
reduced from $40 to $25.
Other benefit enhancements
- Referrals will no longer be required to see
ophthalmologists and optometrists.HEALTH MAINTENANCE
ORGANIZATIONS (HMOS)
HMO service areas
If you live or work in a covered HMO service area, you
may choose to enroll in that plan.
HMOPla Srvie AeaCouis-Community First San Antonio
Health Plans areaKelseyCare
powered by
Community
Health Choice
Scott & White
Health PlanHouston area
Central and
West Texas
areasAtascosa, Bandera, Bexar,
Comal, Guadalupe, Kendall,
Medina and Wilson
Brazoria, Fort Bend,
Galveston, Harris and
Montgomery
Austin, Bastrop, Bell,
Bosque, Brazos, Burleson,
Burnet, Coke, Coleman,
Concho, Coryell, Crockett,
Falls, Freestone, Grimes,
Hamilton, Hill, Iron,
Kimble, Lampasas, Lee,
Leon, Limestone, Llano,
Madison, Mason, McCulloch,
McLennan, Menard, Milam,
Mills, Reagan, Robertson,
Runnels, San Saba,
Schleicher, Somervell,
Sterling, Sutton, Tom Green,
Travis, Walker, Waller,
Washington and WilliamsonKelseyCare powered by
Community Health Choice
Starting September 1, 2015, KelseyCare powered by
Community Health Choice (KelseyCare powered by
CHC) will be available to eligible participants in the
Houston area.
During Summer Enrollment, you can visit the KelseyCare
powered by CHC website for more information,
including:
" covered services,
" list of providers near you,
- what drugs are covered,
- appointment scheduling and
- after-hours nurse hotline.
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Employees Retirement System of Texas. 2015 Summer Enrollment:Former COBRA Unmarried Child, pamphlet, Summer 2015; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth839249/m1/3/: accessed May 14, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.