Benefits

ERS announces 2016-17 benefit plans and changes

The Employees Retirement System of Texas (ERS), which administers health and other insurance benefits for State of Texas employees, will hold its annual enrollment period for Plan Year 2016-2017 from July 24 to August 6, 2016.1 Prior to the annual enrollment period, ERS will mail a Personal Benefits Enrollment Statement to all benefits-eligible employees.

During the annual enrollment period, employees can make changes to their benefits portfolios without a qualifying life event. If you don’t want to change your benefits, don’t do anything. Your current benefits will remain the same for the upcoming academic year (9/1/2016 to 8/31/2017).

For your convenience, you may make changes to your benefits portfolio during the annual enrollment period of July 24 to August 6, 2016, in one of three ways:

  • Online 24/7 directly with ERS at www.ers.state.tx.us;
  • By calling ERS during normal business hours at (866) 399-6908 or;
  • Through Employment Services and Operations (ESO) by scheduling an appointment with Paula Jannett at x-8463 or jannettp@uhd.edu and completing the required 2016 Annual Enrollment Form.

Below is a summary of the plans covered by ERS and any applicable changes.


Medical Insurance

HealthSelectSM of Texas

  • Premium rates will increase by approximately 7.1%.
  • With Virtual Visits, HealthSelect of TexasSM participants and eligible dependents can consult with a licensed physician from their mobile device without leaving their home or office. This 24-hour online service can be used for a $10 co-pay to diagnose and treat such non-emergency medical conditions as sinus problems, sore throat, pink eye and bronchitis.
  • Real Appeal is a new online weight loss program available to eligible HealthSelect of Texas participants – employees and their covered dependents ages 18 and over – with a body mass index (BMI) of 23 or higher.
    • HealthSelect participants can now complete Health Risk Assessments by registering for Rally, a new online health management program. Log into your personal account at http://www.myuhc.com/hs, click the Health and Wellness tab and click on Rally to set up an account.

KelseyCare powered by Community Health Choice

  • No new service areas for KelseyCare powered by Community Health Choice.
  • An overall, out-of-pocket maximum limit of $6,550 for individuals and $13,100 for families will go into effect on September 1, 2016. This includes both medical and pharmacy deductibles, copays and coinsurance and is the maximum a member or a covered dependent will pay for medical and prescription costs in a plan year.
  • HMOs follow the plan year rather than the calendar year, so their out-of-pocket maximum will reset each September, while HealthSelect’s reset each January.

New-Consumer Directed HealthSelectSM  

  • Starting September 1, 2016, Consumer Directed HealthSelectSM will be available to employees. It includes two parts: (1) a high-deductible health plan (HDHP) and (2) a health savings account (HSA).
  • UnitedHealthcare will administer the HDHP part. The network will be the same as HealthSelectSM of Texas.
  • No referrals or PCP determination necessary.
  • Participants will be responsible for more out-of-pocket expenses, due to a large deductible, before the plan begins to pay for any health or prescription benefits, with the exception of preventive care.
  • Preventive services received from a non-network provider are subject to the deductible.
  • The plan deductibles and out-of-pocket maximums are based on the calendar year.
  • Once the deductible is met, the plan pays 80% for in-network and the participant pays 20%. For out-of-network, the plan pays 60% and participants pays 40%.

Deductibles

Plan Year 2017 deductible Individual coverage Family coverage
In-Network $2,100 $4,200
Out-of-Network $4,200 $8,400

Health Savings Account (HSA)

  • Optum Bank, a subsidiary of UnitedHealthCare Services, Inc., will administer the HSA program. Eligible participants are encouraged to open an HSA to prepare for out-of-pocket health care expenses and save money on income taxes.
  • Every month, the state will contribute a certain amount into the HSA of eligible participants, on a pre-tax basis. The participant can also contribute pre-tax money in to their own account up to the annual maximum set by the U.S. Internal Revenue Service (IRS) and use the funds to pay for any qualified out-of-pocket expenses incurred before and after the deductible is met. For tax year 2016, the annual maximum is $3,350 for individual account and $6,750 for family account.
  • Employees can make pre-tax contributions directly from their paychecks or post-tax contributions they can claim later when filing their income tax. Total annual contributions, both pre-tax and post-tax (including state contribution), cannot exceed the annual maximum.
  • Withdrawals or reimbursements from the account don’t have to be approved by the program administrator.
  • Participants will get a debit card from Optum Bank to pay for health expenses. Participants have access only to the amount of money that has accumulated in their account. Participants do not have access to money that has been pledged to be deposited in the future.
  • HSA funds cannot be used to reimburse health expenses incurred before the account was opened. So, it’s important for eligible participants to open an HSA as soon as possible after enrolling in Consumer Directed HealthSelect.
  • Funds earn interest, there are no maximum allowable carryover limits, and they are portable
  • There are tax penalties if funds are used for non-qualified expenses.
Health and prescription services Plan pays Participants pay
Annual maximum contribution $3,350 $6,750
Annual state contribution $540 $1,080
Annual  maximum participant contribution $2,810 $5,670

HSA Contribution Limits* for 2016

(September 1, 2016 – December 31, 2016)

Out-of-pocket maximums (All plans)

Calendar Year In-Network (Consumer Directed Health Select, Health Select of Texas and HMO) Out-of-Network 

(Consumer Directed Health Select only)

2016 Individual $6,450 Family $12,900 Individual $12,900 Family $25,800
2017 Individual $6,550 Family $13,100 Individual $13,100 Family $26,200

Tobacco User Fee

If you and/or a family member is enrolled in medical insurance and is certified as a tobacco user or has not certified as a non-user, you will pay additional fees. ERS requires that all participants who have turned 18 by September 1, 2016, certify whether or not they use tobacco. As a reminder, the monthly Tobacco User Fee is $30 per person, up to a maximum of $90 for covered dependents. A tobacco user is defined as a person who uses any form of tobacco, including cigarette, pipe, cigar or smokeless tobacco. If you have not certified, you will be prompted to certify during this enrollment period.

*Tobacco Premium Alternative

Tobacco users may be able to participate in an alternative to the Tobacco User Premium if it complies with their doctors’ recommendations. For more information about this alternative, review the ERS tobacco policy or contact ERS toll-free at (877) 275-4377.


Dental Plans

State of Texas Dental Choice Plan

  • Premium rates will increase by 9.6%.
  • There will be no changes to the plan.

Humana Dental DHMO Plan

  • There will be no plan or premium changes.

State of Texas Dental Discount Plan

  • There will be no plan or premium changes.

Note: The State of Texas Dental Discount Plan is not dental insurance but a discount program for dental services. Health coverage opt out credit does not apply to this plan.


State of Texas Vision Insurance Plan

Beginning September 1, 2016, ERS will offer a vision insurance plan. This is a self-funded insurance plan administered by Superior Vision Services, Inc. The plan includes coverage when using a network or contracted provider based on a co-pay.

  • Frames are at no cost to the member when the retail price is $150 or less, member pays 100% of the amount over $150 retail value.
  • Contact lens are covered in lieu of frames and glasses with an allowance of up to $150.
  • The Health Insurance Opt-Out Credit does not apply to the vision plan.
Service Co-pay
Routine eye exams, including dilation $25
Contact lens exams (standard fitting) $25
Single vision lens $10
Bi-Focal lens $15
Tri-Focal lens $20
Progressive lens $70

Optional Term Life

  • There will be no changes to the plan or premiums.
  • Some employees may see a premium difference if they have a salary or age category change as of September 1, 2016.
  • Evidence of Insurability (EOI) will still be required.

Basic Term Life, Dependent Term Life, and AD&D

  • There will be no changes to the plan or premiums.
  • Evidence of Insurability (EOI) will still be required.

Short Term and Long-Term Disability

  • There will be no changes to the plan or premiums.
  • Some employees may see a premium difference if they have a salary change as of September 1, 2016. Evidence of Insurability (EOI) will still be required.

TexFlex Flexible Spending Accounts (FSA)

Health Care Account

  • You will automatically be re-enrolled in at your same annual contribution level—unless you make a change during annual enrollment.
  • The maximum contribution is $2,550.
  • Participants can carry over $500 of unused health care account funds into the next year.
  • Participants who have $25-$500 left in their health care account on September 1, 2016 can use the money for all Plan Year 2016 eligible expenses.

Note: Current participants of health care FSA who plan to enroll in Consumer Directed HealthSelect, can no longer participate in TexFlex health care FSA. If they have a balance, we’ll automatically open an LFSA on August 31, 2016 so they can pay for their eligible dental and vision expenses.

Dependent Care Account

  • You will automatically be re-enrolled in at your same annual contribution level—unless you make a change during annual enrollment.
  • The maximum contribution is $5,000.
  • Participants have until December 31, 2016 to submit claims for Plan Year 2016 expenses incurred through the Grace Period ending November 15, 2016.
  • Not eligible to use the TexFlex debit card.

Limited Flexible Spending Account (LFSA)

Because Consumer Directed HealthSelect participants will get state contributions to their HSAs, they cannot have traditional health FSAs, like the health care reimbursement account offered through TexFlex. Participants may enroll in a Limited Flexible Spending Account (LFSA), which lets them set aside pre-tax contributions from their paycheck for eligible vision and dental care only.

  • The participant can elect a minimum of $180 up to a maximum $2,550 of annual contribution amount to be deducted pre-tax monthly, in equal amounts throughout the year from their paycheck.
  • Employees currently enrolled in TexFlex Health Care Accounts who enroll in Consumer Directed HealthSelect during Summer Enrollment will automatically have an LFSA opened for them if they have a balance in the FSA on August 31, 2016.
  • Participants with a TexFlex Health Care Account have until December 31, 2016 to file claims for eligible expenses incurred through August 31, 2016, to use the balance funds from Plan Year 2016 FSA.
  • Any funds balance between $25 and $500 in TexFlex Health Care Accounts will roll into LFSA on September 1, 2016. Any amount over $500 will be forfeited.

TexFlex Commuter Spending Accounts (CSA)

  • There are two types of CSAs, the parking account and the transit account.
  • The parking account pays for eligible parking expenses near workplace or at a location from which the employee commutes to work via public transit or vanpool.
  • The transit account pays for eligible public transit or vanpool expenses used to get to and from work, such as bus, train or subway expenses.
  • You can enroll in or change contributions to a parking or transit CSA during Summer Enrollment or any time throughout the year.
  • The maximum contribution amount for calendar year 2016 is:
    • $255 for the CSA parking account
    • $255 for the CSA transit account

Note: Since both accounts are pre-tax benefits, the IRS determines the maximum contribution amount and the limit may change from year to year.


Dependent Eligibility Verification

Employees who add dependents in GBP health coverage will be asked to provide documentation that those dependents are eligible for coverage. If the participants do not respond or send the required documents, all of their unverified dependents will lose all GBP insurance, including health, dental and dependent term life. Documents dated after the dependent was enrolled will not be accepted, even if the date is before the coverage begin date. This verification happens on an ongoing basis as employees add new dependents to their coverage.


Information Sessions “Get the Scoop”

Employment Services and Operations (ESO) will host two information sessions to summarize the changes in employee benefits for the upcoming plan year (9/1/16 to 8/31/17). These sessions are scheduled as follows:

Thursday July 14, 2016 2 – 3:30 p.m. Milam Room (Welcome Center)
Friday July 15, 2016 10 – 11:30 a.m. Milam Room (Welcome Center)

FY 2017 RATES

                                                            HealthSelectSM of Texas Full-Time Employee                        
 

 

Coverage

FY 16 Total Premium FY 17

Total Premium

FY 16 State Pays FY 17

State

 Pays

FY 16 Employee Pays FY 17

Employee Pays

Total Increase to Employee % Increase
Member Only $576.54 $617.30 $576.54 $617.30 $0.00 $0.00 $0.00 0.0%
Member & Spouse $1,237.02 $1,324.66 $906.78 $970.98 $330.24 $353.68 $23.44 7.1%
Member & Child(ren) $1,018.78 $1,090.90 $797.66 $854.10 $221.12 $236.80 $15.68 7.1%
Member & Family $1,679.26 $1,798.26 $1,127.90 $1,207.78 $551.36 $590.48 $39.12 7.1%
HealthSelectSM of Texas Part-Time Employee
Member Only $576.54 $617.30 $288.27 $308.65 $288.27 $308.65 $20.38 7.1%
Member & Spouse $1,237.02 $1,324.66 $453.39 $485.49 $783.63 $839.17 $55.54 7.1%
Member & Child(ren) $1,018.78 $1,090.90 $398.83 $427.05 $619.95 $663.85 $43.90 7.1%
Member & Family $1,679.26 $1,798.26 $563.95 $603.89 $1,115.31 $1,194.37 $79.06 7.1%
KelseyCare  Full-Time Employee
Member Only $483.98 $483.98 $483.98 $483.98 $0.00 $0.00 $0.00 0%
Member & Spouse $1,038.02 $1,038.02 $761.00 $761.00 $277.02 $277.02 $0.00 0%
Member & Child(ren) $854.94 $854.94 $669.46 $669.46 $185.48 $185.48 $0.00 0%
Member & Family 1,408.98 1,408.98 $946.48 $946.48 $462.50 $462.50 $0.00 0%
KelseyCare  Part-Time Employee
Member Only $483.98 $483.98 $241.99 $241.99 $241.99 $241.99 $0.00 0%
Member & Spouse $1,038.02 $1,038.02 $380.50 $380.50 $657.52 $657.52 $0.00 0%
Member & Child(ren) $854.94 $854.94 $334.73 $334.73 $520.21 $520.21 $0.00 0%
Member & Family 1,408.98 1,408.98 $473.24 $473.24 $935.74 $935.74 $0.00 0%
(New Plan) Consumer Directed HealthSelect of TexasSM  Full-Time Employee
Member Only N/A $617.30 N/A $617.30 N/A $0.00 N/A N/A
Member & Spouse N/A $1,289.30 N/A $970.98 N/A $318.32 N/A N/A
Member & Child(ren) N/A $1,067.22 N/A $854.10 N/A $213.12 N/A N/A
Member & Family N/A 1,739.22 N/A $1,207.78 N/A $531.44 N/A N/A
(New Plan) Consumer Directed HealthSelect of TexasSM  Part-Time Employee
Member Only N/A $617.30 N/A 308.65 N/A $308.65 N/A N/A
Member & Spouse N/A $1,289.30 N/A 485.49 N/A $803.81 N/A N/A
Member & Child(ren) N/A $1,067.22 N/A 427.05 N/A $640.17 N/A N/A
Member & Family N/A 1,739.22 N/A 603.89 N/A $1,135.33 N/A N/A

 

State of Texas Dental ChoiceSM Humana Dental DHMO Plan State of Texas Dental Discount Plan*
Coverage FY16 Total Premium FY17 Total Premium  Increase to Employee FY16 Total Premium FY17 Total Premium Increase to Employee FY16 Total Premium FY17 Total Premium Increase to Employee
Member Only $24.28 $26.61 $2.33 $9.59 $9.59 $0.00 $2.25 $2.25 $0.00
Member & Spouse $48.56 $53.22 $4.66 $19.17 $19.17 $0.00 $4.50 $4.50 $0.00
Member & Child(ren) $58.28 $63.86 $5.58 $23.01 $23.01 $0.00 $5.40 $5.40 $0.00
Member & Family $82.56 $90.47 $7.91 $32.59 $32.59 $0.00 $7.65 $7.65 $0.00

 

State of Texas Vision Plan
Coverage FY17 Total Premium
Member Only $6.69
Member & Spouse $13.38
Member & Child(ren) $14.38
Member & Family $21.07

 

 

 

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