As expected, the board of trustees of the Employers Retirement System of Texas has approved a number of changes intended to cope with a deficit of funds for the current biennium. The "design changes" (the subject of several previous posts) will entail increases in out-of-pocket costs for all participants in the Group Benefits Program for state and higher education employees and retirees.
Importantly, these adjustment are for short-term relief only. When the Regular Session convenes in January, lawmakers will likely make further adjustments that could be much more drastic. The cost of health care has risen dramatically and the Legislature faces a looming budget deficit of $10-18 billion. Many of the current hikes are designed to encourage low-cost options, such as seeing primary care physicians instead of specialists, and using generic drugs instead of name brands. The changes target the most costly areas of the plan: hospitalization, name brand drugs, and high-tech radiology.
Below is a summary, followed by a chart from ERS that offers more detailed information.
- No new deductibles.
- PCP office co-pays increase to $25.
- Specialist doctor office co-pays increase to $40.
- Annual coinsurance amounts (out-of-pocket expense) will increase to $2,000 from $1,000 for in-network, to $7,000 from $3,000 for out-of-network, and to $3,000 from $1,000 for out-of-area.
- Inpatient facility co-pays will increase to $150 per day (five day maximum) from $100 per day.
- No increase in outpatient facility co-pays.
- Emergency room co-pays will increase to $150 from $100.New urgent care facility copay will be half the cost of the current emergency room copay. A $50 copay will be added for use of urgent care clinics. Previously, the $100 emergency room copay was applied to urgent care clinic visits, making this a copay reduction.
- Prescription drug co-pays set at $15 for Tier I (which are primarily generic drugs), to $35 for Tier II (which are mainly preferred name brand drugs), and to $60 for Tier III (which are name brand drugs that often have cheaper alternatives).
- The deductible for all prescriptions will remain at $50.
- Chiropractic care coverage will be limited to 30 visits per year, with a maximum charge of $75.
- New $100 high-tech radiology co-pay (CTS scans, MRIs, and Nuclear Medicine). There will be no change to the 20 percent coinsurance for these services.
Here's the chart, in pdf format. Please note that, for Health Select coverage, the column on the left represents the cost to the state and the column on the right displays the cost to the participant. HMO coverage is also offered on the chart, for those who have that option on certain areas of the state.
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