The following plans are available to you as a State of Texas agency or institution employee or non-Medicare-eligible retiree. Throughout this exercise, we will ask you simple questions to help guide you to make the best decision for your health care benefits. Please note: On all plans, in-network preventive services are covered at 100%. All plans also have an annual in-network out-of-pocket maximum to protect you from catastrophic health costs.
For more information on key features of ERS health plans, go to https://ers.texas.gov/Benefits-at-a-Glance/.
For detailed information on covered services, see ERS' Health Plans Comparison Chart at https://ers.texas.gov/Active-Employees/Health-Benefits.
Please note that HealthSelect Out-of-State coverage is available to active employees, non-Medicare-eligible retirees and their eligible dependents living or working outside Texas. Unless noted, the information in this exercise does not apply to people enrolled in Medicare Parts A and B, who can participate in Medicare Advantage plans (not covered in this exercise), or HealthSelect Secondary. We will provide additional information regarding all plans once you complete the plan selection exercise.
HMOs have lower dependent premiums and low out-of-pocket costs. They also offer access to a dedicated network that coordinates care. The networks are smaller than the statewide HealthSelect network and limited to certain regions. There is no coverage for out-of-network services, except for emergency care. PCP referrals may also be necessary in an HMO. For more information on HMOs, please visit: https://ers.texas.gov/Active-Employees/Health-Benefits/HMOs.
Continue to other health plan optionsIf you are covering dependents on your plan, HealthSelect of Texas will have higher premiums than Consumer Directed HealthSelect. But there are other important factors to help decide which plan is best for your finances and health needs. Please continue to learn more about the plans and which might best meet your and your family's needs.
Select the statement that best describes you. Keep in mind that the deductible is the amount you have to pay out of pocket before the plan pays for anything except preventive care.
1. I have a savings cushion or have enough money left over after I pay my bills that I can afford to pay an annual deductible of $2,100 per person or $4,200 per family for in-network health care and prescriptions.
2. I spend most of my paycheck on necessities each month, and I need to be able to predict what my monthly expenses will be. A big out-of-pocket expense would be a problem for me.
The combined value of what I/we pay and what the plan pays for in-network health care and prescriptions is high. I am likely to reach the annual in-network out-of-pocket maximum of $7,500 per person/$15,000 per family for the 2024 calendar year. (Note: Out-of-pocket maximums include deductible, copays and coinsurance. They do not include monthly premiums.)
My/our use of health care and prescriptions is between light and heavy. I/we do not have complex illnesses or conditions that require regular doctor visits. We also don’t expect any major procedures in the upcoming plan year (September 1 – August 31). We usually visit a doctor four to six times a year for basic continuing care for example, colds or infections, minor allergic reactions and minor injuries, in addition to preventive services.
My/our use of health care and prescriptions is light and mostly limited to preventive care. I/we do not anticipate procedures in the upcoming plan year (September 1 - August 31). I/we rarely visit the doctor.
Choose Heavy Choose Moderate Choose LightI am willing to risk paying an annual deductible of $2,100 per person or $4,200 per family for in-network care if I or my dependents become ill or injured. Note: Even though your plan would start Sept 1, your deductibles are based on the calendar year and reset Jan 1 of each year. Deductibles are much higher for out-of-network care. For family coverage, there is an individual out-of-pocket maximum of $7,500 and a family maximum of $15,000 for the 2024 calendar year. No one within the family will have to pay more than $7,500 in out-of-pocket expenses for the 2024 calendar year.
The HealthSelect of Texas point-of-service plan usually has lower upfront out-of-pocket costs. You must choose an in-network primary care provider (PCP) to coordinate your care, including getting referrals to specialists. HealthSelect of Texas has slightly higher dependent premiums, but does not have a deductible if you stay in the network and get necessary referrals. You will pay more if you use providers that are not in the HealthSelect network, or if you see a specialist without a referral from your PCP – even if the specialist is in the network.
Consumer Directed HealthSelect is a high-deductible health plan paired with a tax-free, portable health savings account (HSA). It has a slightly lower monthly dependent premium. The annual in-network deductible for an individual is $2,100; the annual deductible for a family (member plus at least one family member) is $4,200. The higher deductible means you could pay more in out-of-pocket costs for health care services and prescriptions. For eligible participants, the State of Texas contributes to your HSA each month: $45 ($540 per year) for an individual, $90 ($1,080 per year) for a family. You can also contribute your own money to your HSA, tax-free. You can use the money in your HSA to pay for eligible health expenses (defined by the IRS), such as your deductible and coinsurance costs. Or you can save the money as long as you want. Your HSA can even be used as an investment account once your balance reaches a certain amount.
With Consumer Directed HealthSelect, you have access to the same large provider network as in the HealthSelect of Texas plan, including tens of thousands of doctors, hospitals and other providers across Texas. You don’t have to choose a primary care provider (PCP) or get referrals to specialists. But you will save money if you use providers in the HealthSelect network.