The Employees Retirement System of Texas (which administers health insurance benefits for community and technical college educators) has distributed the following update via its e-mail news letter. Those who live in the North Texas area will want to pay particular attention to the final portion of this message. For additional information please visit the ERS Web site.
HealthSelect Deductible and Coinsurance Maximum Start Over in January
Your HealthSelect of Texas deductibles and coinsurance maximums are based on the calendar year, January 1 to December 31. At the start of each calendar year, participants are responsible for any applicable deductible or coinsurance amounts. These amounts do NOT carry over from the previous calendar year.
Dental Choice Plan EOBs Show Deductible Credit
If you are a State of Texas Dental Choice Plan (PPO) participant, any covered dental expenses that applied to your deductible during the last three months of 2010 will apply to your 2011 deductible. You can see your Carryover Credit deductible on the EOB you receive after obtaining services.
The “accumulations toward deductibles,” which starts in October of the prior year, means you don’t have to satisfy a deductible at the end of one year and a deductible at the start of another year. For Plan Year 2011, it will run from October 1, 2010 to December 31, 2011. For example, if you have individual coverage and meet the $50 out-of-network deductible for Diagnostic and Preventive services in November 2010, you would not have to pay a deductible for these expenses again until January 1, 2012. You can see the deductible on the EOBs you receive from HumanaDental. This carryover also applies to your combined deductible for Basic and Major Services.
Providers Could Leave HealthSelect Network
Those in the North Texas area will find the following message of particular interest.
Blue Cross and Blue Shield of Texas (BCBSTX) is negotiating terms for a new contract with Texas Health Resources (THR) in North Texas. THR’s current contract expires on December 31, 2010. If the two sides do not reach an agreement, about 145 THR physicians—as well as all THR hospitals and outpatient facilities—will not participate in HealthSelect of Texas or ParPlan beginning January 1, 2011.
The negotiations have been under way since July. If BCBSTX and THR are unable to reach an agreement, THR will be considered out-of-network for HealthSelect participants. BCBSTX will work with physicians in the area to help participants find other hospitals and facilities in the network, with minimal disruption of services. HealthSelect participants can elect to stay with a THR doctor or hospital, but if they do, they will have to pay higher out-of-pocket costs.
Many other network providers are available in North Texas. Participants can visit the HealthSelect website, or call (800) 252-8039 to find the one that is right for them. ERS supports BCBSTX in these negotiations. The State and the HealthSelect Plan cannot afford to pay increased costs. If the limited health care budget dollars go to pay providers more, there is less money for everyone else.
It is important to remember that BCBSTX negotiates regularly with dozens of providers to ensure their costs remain acceptable to ERS. HealthSelect is a self-funded plan, which means that every dollar that the plan pays to physicians, hospitals, and other health care providers comes from a fund built through contributions from you and your employer, not BCBSTX. When BCBSTX holds provider costs down, every dollar saved is a dollar in benefits that our participants get to keep.
HealthSelect participants who utilize THR providers can visit www.bcbstx.com/hs/providerterm.htm to learn more about selecting a new primary care physician, referrals for specialty care, inpatient and outpatient services, and emergency care.