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HealthSelect of Texas and Related Plans

HealthSelectSM of Texas

HealthSelect of Texas is available to members of the Texas Employees Group Benefits Program (GBP), retirees under 65, and their eligible dependents.

Designating a primary care physician

If you are enrolled in HealthSelect of Texas (In-Area), you need to choose a primary care physician (PCP) to coordinate your health care.

Your PCP is responsible for managing referrals to see specialists. If your visit requires a referral, your PCP must submit the referral request to Blue Cross and Blue Shield of Texas before your appointment with the specialist. If you do not have a referral on file before you see a specialist, you will pay more, because your visit will be considered out-of-network.

You can select or change your PCP or review your referral information by logging in to your Blue Access for MembersSM (BAMSM) account or by calling a Personal Health Assistant toll-free at (800) 252-8039.

Find a doctor, hospital or other provider in the HealthSelect network.

Information about HealthSelect of Texas plan benefits Learn more pdf documents.

HealthSelectSM Out-of-State

HealthSelect Out-of-State is available only to active employees, retirees not enrolled in Medicare, and their eligible dependents living or working outside the state of Texas.

If you move outside Texas, please contact ERS to update your address so that you can be enrolled in HealthSelect Out-of-State. Change your address and eligibility county by logging into your ERS online account, contacting your Benefits Coordinator, or calling ERS directly. If you live in Texas but have an eligible dependent living in another state, contact a Personal Health Assistant to move your dependent to HealthSelect Out-of-State.

Find a doctor, hospital or other provider in the HealthSelect Out-of-State network.

Information about HealthSelect Out-of-State plan benefits Learn more pdf documents.

HealthSelectSM Secondary

HealthSelect Secondary is available to retirees and their eligible spouses and dependents enrolled in Medicare. The benefits are coordinated with Medicare primary.

Find a doctor, hospital or other provider in the HealthSelect Secondary network.

Information about HealthSelect Secondary plan benefits Learn more pdf documents.

If you are trying to decide which plan to enroll in, use this Plan Decision Tool.

Help Me Choose

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The following plans are available to you as a State of Texas agency or institution employee or retiree not enrolled in Medicare. 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: In all plans, network preventive services are covered at 100%. All plans also have an annual 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.

HealthSelectSM of Texas:

  • Point-of-service health plan with lower out-of-pocket costs at time of service (copays and coinsurance)
  • No medical deductible for network services
  • Higher monthly dependent premium
  • Requires primary care physician (PCP) selection and referrals to see specialists
  • Pay less by staying in the large, statewide network

Consumer Directed HealthSelectSM

  • High-deductible health plan with access to a portable, tax-free health savings account (HSA)
  • Plan pays for nothing except preventive services (such as annual checkups and recommended vaccinations) until you have paid the combined annual medical/prescription deductible amount: $2,100/person, $4,200/family network; $4,200/person, $8,400/family non-network
  • Once you've met the annual deductible, you pay a percentage of the costs (coinsurance, not set copays) for prescriptions and non-preventive services
  • To help pay for health care expenses, the State of Texas makes monthly contributions to your HSA: $45/person ($540 annually), $90/family ($1,080)
  • Save money on taxes by making your own HSA contributions
  • Slightly lower monthly dependent premiums
  • Does not require a PCP selection, no referrals needed to see specialists
  • Pay less by staying in the large, statewide network

Regional health maintenance organizations (HMOs): Available only in certain Texas counties

  • Lower out-of-pocket costs at time of service (copays and coinsurance)
  • No medical deductible for network services
  • Lower monthly dependent premiums
  • Limited, regional networks
  • No coverage for non-network services (you pay 100%), except emergency services

Please note that HealthSelect of Texas Out-of-State coverage is available to participants not enrolled in Medicare 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), HealthSelect Secondary or regional HMOs. We will provide additional information regarding all plans once you complete the plan selection exercise.

Help Me Choose

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Are you retired and do you qualify for Medicare?

Help Me Choose

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Do you live or work in one of the following Texas counties, and are you thinking about joining an HMO?

  • Austin
  • Atascosa
  • Bandera
  • Bastrop
  • Bell
  • Bexar
  • Bosque
  • Brazoria
  • Brazos
  • Burleson
  • Burnet
  • Comal
  • Coryell
  • Falls
  • Freestone
  • Fort Bend
  • Galveston
  • Grimes
  • Guadalupe
  • Hamilton
  • Harris
  • Hill
  • Kendall
  • Lampasas
  • Lee
  • Leon
  • Limestone
  • Llano
  • Madison
  • McLennan
  • Medina
  • Milam
  • Mills
  • Montgomery
  • Robertson
  • San Saba
  • Somervell
  • Travis
  • Walker
  • Waller
  • Washington
  • Williamson
  • Wilson

Help Me Choose

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The 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 non-network services, except for emergency care. PCP referrals may also be necessary in an HMO. For more information on the HMOs, please visit: https://ers.texas.gov/Active-Employees/Health-Benefits/HMOs.

Help Me Choose

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Do you live in Texas?

Help Me Choose

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Will you be covering any dependents on the plan?

Help Me Choose

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If 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.

Help Me Choose

×

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.

Help Me Choose

×

My/our use of health care and prescriptions can be described as

Heavy

The combined value of what I/we pay and what the plan pays for network health care and prescriptions is high. I am likely to reach the annual network out-of-pocket maximum of $6,550 per person/$13,100 per family or the annual non-network deductible of $13,100 per person/$26,200 per family. (Note: Out-of-pocket maximums include deductible, copays and coinsurance. They do not include monthly premiums.)

Moderate

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.

Light

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.

Help Me Choose

×

I am willing to risk paying an annual deductible of $2,100 per person or $4,200 per family for network care if I or my dependents become ill or injured. Note: Even though your plan would start September 1, your deductibles are based on the calendar year and reset January 1 of each year. Deductibles are much higher for non-network care.

Help Me Choose

×

Here are some things to know about Consumer Directed HealthSelect:

  • You have access to the large, statewide HealthSelect provider network.
  • You do not need to select a primary care physician (PCP).
  • You do not need a referral to see specialists.
  • If you cover dependents, your premiums will be lower than HealthSelect of Texas premiums.
  • Your out-of-pocket costs at the time of service could be much higher than in other plans.
  • To help you pay for higher out-of-pocket costs, the plan allows you to participate in a tax-free health savings account (HSA) and receive monthly HSA contributions from the State of Texas. You can also contribute additional money, tax-free, to your HSA.
  • Preventive services provided by a network doctor – like annual check-ups and vaccinations – are covered at 100%, even if you haven't met the deductible.

Help Me Choose

×

Based on your selections, you might prefer the following plan:

HealthSelectSM of Texas

The HealthSelect of Texas point-of-service plan usually has lower upfront out-of-pocket costs. You must choose a network primary care physician (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 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.

Highlights for HealthSelect of Texas include:

  • No deductible for network care
  • Annual deductible for non-network care: $500 per person / $1,500 per family
  • Network preventive care covered at 100%
  • Network PCP required
  • Referrals to most specialists required
  • Network PCP office visit: $25 copay
  • Network specialist office visit: $40 copay (with active PCP referral)
  • Copay and/or coinsurance for most other covered services, including urgent care, outpatient surgery, and hospital stay

Annual network out-of-pocket maximum to protect you from catastrophic health costs: $6,550 per person / $13,100 per family (There is not an annual out-of-pocket maximum for non-network care.)

Help Me Choose

×

Based on your selections, you might prefer the following plan:

Consumer Directed HealthSelectSM

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 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 tax-free, to your HSA. 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 physician (PCP) or get referrals to specialists. But you will save money if you use providers in the HealthSelect network.

Highlights for Consumer Directed HealthSelect include:

  • Lower dependent premiums
  • Network annual deductible:
    $2,100 per person / $4,200 per family
  • Non-network deductible:
    $4,200 per person / $8,400 per family
  • No PCP required
  • No referrals to specialists required
  • Network preventive care covered at 100%
  • Monthly employer contributions to a portable health savings account (HSA): $45 for member / $90 for family
  • Ability to save money on federal income taxes and build savings by contributing to your HSA
  • Annual out-of-pocket maximum to protect you from catastrophic health costs: Network $6,550 per person / $13,100 per family; non-network: $13,100 per person / $26,200 per family

Help Me Choose

×

Based on your selections, you might prefer the following plan:

HealthSelectSM of Texas – Out-of-State

The HealthSelect Out-of-State benefits are available for active employees, retirees not enrolled in Medicare, and eligible family members living outside of Texas.

These benefits are similar to HealthSelect of Texas, but you do not need to choose a primary care physician (PCP) or get referrals to see specialists. You will pay more if you use providers that are not in the network. HealthSelect Out-of-State benefits also have lower upfront out-of-pocket costs, copays for doctor's office visits, urgent care, and outpatient surgery, and there is no deductible as long as you stay in the network.

Highlights for HealthSelect of Texas Out-of-State include:

  • In-Network $0 deductible
  • Out-of-Network deductible
    $500 per person /
    $1,500 per family
  • Preventive care covered at 100%
  • $25 PCP office visit copay (In-Network)
  • $40 Specialist office visit copay (In-Network)
  • Combination of either copay or co-insurance for most other covered services including urgent care, outpatient surgeries, etc
  • In-Network out-of-pocket maximums
    $6,500 per person /
    $13,100 per family
  • No Out-of-Network out-of-pocket maximum

Help Me Choose

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HealthSelect of Texas Secondary Plan

If you are retired and eligible for Medicare, you might be eligible for one of the following coverage options:

  • HealthSelect Medicare Advantage
  • HealthSelect Secondary
  • KelseyCare Advantage HMO, if you live in certain Houston-area counties
  • Regional HMOs, if you live in certain Texas counties

When you become eligible for Medicare and enroll in Medicare Parts A and B, ERS will automatically enroll you in HealthSelect Medicare Advantage, administered by Humana.

In most cases, you can choose to stay in the plan you were in before you enrolled in Medicare. If you live in an eligible Houston-area county, you can enroll in the KelseyCare Advantage HMO. If you stay in HealthSelect of Texas, your coverage will change to HealthSelect Secondary.

For most people, HealthSelect Medicare Advantage or KelseyCare Advantage offer lower out-of-pocket costs, lower dependent premiums (if applicable) and more value-added services.

Please visit the Medicare section of the Retirees Health Benefits page for more information regarding your health coverage options.

Help Me Choose

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Will you be covering any dependents on the plan?

Help Me Choose

×

If 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.

Help Me Choose

×

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.

Help Me Choose

×

My/our use of health care and prescriptions can be described as

Heavy

The combined value of what I/we pay and what the plan pays for network health care and prescriptions is high. I am likely to reach the annual network out-of-pocket maximum of $6,550 per person/$13,100 per family or the annual non-network deductible of $13,100 per person/$26,200 per family. (Note: Out-of-pocket maximums include deductible, copays and coinsurance. They do not include monthly premiums.)

Moderate

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.

Light

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.

Help Me Choose

×

I am willing to risk paying an annual deductible of $2,100 per person or $4,200 per family for network care if I or my dependents become ill or injured. Note: Even though your plan would start September 1, your deductibles are based on the calendar year and reset January 1 of each year. Deductibles are much higher for non-network care.

Help Me Choose

×

Here are some things to know about Consumer Directed HealthSelect:

  • You have access to the large, statewide HealthSelect provider network.
  • You do not need to select a primary care physician (PCP).
  • You do not need a referral to see specialists.
  • If you cover dependents, your premiums will be lower than HealthSelect of Texas premiums.
  • Your out-of-pocket costs at the time of service could be much higher than in other plans.
  • To help you pay for higher out-of-pocket costs, the plan allows you to participate in a tax-free health savings account (HSA) and receive monthly HSA contributions from the State of Texas. You can also contribute additional money, tax-free, to your HSA.
  • Preventive services provided by a network doctor – like annual check-ups and vaccinations – are covered at 100%, even if you haven't met the deductible.

Help Me Choose

×

Based on your selections, you might prefer the following plan:

HealthSelectSM of Texas

The HealthSelect of Texas point-of-service plan usually has lower upfront out-of-pocket costs. You must choose a network primary care physician (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 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.

Highlights for HealthSelect of Texas include:

  • No deductible for network care
  • Annual deductible for non-network care: $500 per person / $1,500 per family
  • Network preventive care covered at 100%
  • Network PCP required
  • Referrals to most specialists required
  • Network PCP office visit: $25 copay
  • Network specialist office visit: $40 copay (with active PCP referral)
  • Copay and/or coinsurance for most other covered services, including urgent care, outpatient surgery, and hospital stay

Annual network out-of-pocket maximum to protect you from catastrophic health costs: $6,550 per person / $13,100 per family (There is not an annual out-of-pocket maximum for non-network care.)

Help Me Choose

×

Based on your selections, you might prefer the following plan:

Consumer Directed HealthSelectSM

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 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 tax-free, to your HSA. 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 physician (PCP) or get referrals to specialists. But you will save money if you use providers in the HealthSelect network.

Highlights for Consumer Directed HealthSelect include:

  • Lower dependent premiums
  • Network annual deductible:
    $2,100 per person / $4,200 per family
  • Non-network deductible:
    $4,200 per person / $8,400 per family
  • No PCP required
  • No referrals to specialists required
  • Network preventive care covered at 100%
  • Monthly employer contributions to a portable health savings account (HSA): $45 for member / $90 for family
  • Ability to save money on federal income taxes and build savings by contributing to your HSA
  • Annual out-of-pocket maximum to protect you from catastrophic health costs: Network $6,550 per person / $13,100 per family; non-network: $13,100 per person / $26,200 per family

Help Me Choose

×

Will you be covering any dependents on the plan?

Help Me Choose

×

If you are covering dependents on your plan, Consumer Directed HealthSelect has lower premiums than HealthSelect Out-of-State. But there are other important factors to help you 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.

Help Me Choose

×

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.

Help Me Choose

×

My/our use of health care and prescriptions can be described as

Heavy

The combined value of what I/we pay and what the plan pays for network health care and prescriptions is high. I am likely to reach the annual network out-of-pocket maximum of $6,550 per person/$13,100 per family or the annual non-network deductible of $13,100 per person/$26,200 per family. (Note: Out-of-pocket maximums include deductible, copays and coinsurance. They do not include monthly premiums.)

Moderate

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.

Light

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.

Help Me Choose

×

I am willing to risk paying an annual deductible of $2,100 per person or $4,200 per family for network care if I or my dependents become ill or injured. Note: Even though your plan would start September 1, your deductibles are based on the calendar year and reset January 1 of each year. Deductibles are much higher for non-network care.

Help Me Choose

×

Here are some things to know about Consumer Directed HealthSelect:

  • You do not need to select a primary care physician
  • You do not need a referral to see specialists
  • Your out-of-pocket costs could be much higher than in other plans
  • To help you pay for higher out-of-pocket costs, the plan allows you to participate in a tax-free health savings account (HSA) and receive monthly HSA contributions from the State of Texas
  • Preventive services provided by a network doctor – like annual check-ups and vaccinations – are covered at 100%, even if you haven't met the deductible

After careful review, I've decided that Consumer Directed HealthSelect...

Help Me Choose

×

Based on your selections, you might prefer the following plan:

HealthSelectSM of Texas – Out-of-State

HealthSelect Out-of-State benefits are available for participants -- active employees, retirees and eligible family members -- living outside of Texas and not enrolled in Medicare.

These benefits are similar to HealthSelect of Texas, but you do not need to choose a primary care physician (PCP) or get referrals to see specialists. HealthSelect Out-of-State benefits also have lower upfront out-of-pocket costs than Consumer Directed HealthSelect (including copays and/or coinsurance for doctor's office visits, urgent care and outpatient surgery), and there is no deductible as long as you stay in the network.

Highlights for HealthSelect Out-of-State include:

  • No deductible for network care
  • Annual deductible for non-network care: $500 per person/$1,500 per family
  • Network preventive care covered at 100%
  • Network PCP office visit: $25 copay
  • Network specialist office visit: $40 copay
  • Copay and/or coinsurance for most other covered services, including urgent care, outpatient surgery, hospital stay, etc.
  • Annual network out-of-pocket maximum to protect you from catastrophic health costs: $6,500 per person/$13,100 per family (There is not an out-of-pocket maximum for non-network care.)

Help Me Choose

×

Based on your selections, you might prefer the following plan:

Consumer Directed HealthSelectSM

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 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 tax-free, to your HSA. 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 physician (PCP) or get referrals to specialists. But you will save money if you use providers in the HealthSelect network.

Highlights for Consumer Directed HealthSelect include:

  • Lower dependent premiums
  • Network annual deductible:
    $2,100 per person / $4,200 per family
  • Non-network deductible:
    $4,200 per person / $8,400 per family
  • No PCP required
  • No referrals to specialists required
  • Network preventive care covered at 100%
  • Monthly employer contributions to a portable health savings account (HSA): $45 for member / $90 for family
  • Ability to save money on federal income taxes and build savings by contributing to your HSA
  • Annual out-of-pocket maximum to protect you from catastrophic health costs: Network $6,550 per person / $13,100 per family; non-network: $13,100 per person / $26,200 per family

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

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