Benefits

Annual Benefits Open Enrollment begins July 9

The moment you’ve been waiting for is nearly here! ERS Annual Enrollment for Plan Year 2015 runs from July 9 – 21.

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 2018-2019 from July 9 to July 21, 2018. Prior to the annual enrollment period, ERS will mail a Personal Benefits Enrollment Statement to all benefits-eligible employees.

IMPORTANT NOTICE ABOUT INSURANCE: Health and other insurance benefits for employees are subject to change based on available state funding. The Texas Legislature determines the level of funding for such benefits and has no continuing obligation to provide those benefits beyond each fiscal year.

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 (9/1/2018 to 8/31/2019).

For your convenience, you may make changes to your benefits portfolio during the annual enrollment period of July 9 to July 21, 2018, in one of three ways:

Reminder: It pays to stay in the network! All health plans are network-based, which means participants will pay less if they see an in-network provider. Participants should make sure a provider is in their plan network before scheduling visits or procedures. Even if a hospital is in the network, doctors and other providers who practice at that hospital may not be.

Medical Insurance

HealthSelectSM of Texas

  • Premium rates will increase by approximately 0.05%.
  • The total in-network out-of-pocket maximums are increasing from $6,550 to $6,650 for individuals and $13,100 to $13,300 for families.
  • HealthSelect of Texas participants must designate a primary care provider (PCP).
  • OptumRx will continue to administer the HealthSelect Prescription Drug program.

KelseyCare powered by Community Health Choice

  • Premium rates will increase by approximately 0.08%.
  • For Plan Year 2019, the total out-of-pocket maximum for all health plans will increase from $6,550 to $6,650 for individuals and from $13,100 to $13,300 for families.
  • KelseyCare powered by CHC is a HMO available to employees and eligible dependents in limited Texas counties (Brazoria, Fort Bend, Galveston, Harris and Montgomery).
  • No new service areas were designated for KelseyCare powered by Community Health Choice.

Consumer Directed HealthSelectSM  

  • Premium rates will increase by approximately 0.05%.
  • The total in-network out-of-pocket maximums are increasing from $6,550 to $6,650 for individuals and $13,100 to $13,300 for families.
  • Effective January 1, 2019, Consumer Directed HealthSelect will no longer have an out-of pocket maximum for out-of-network care and services.
  • No referrals or PCP determination necessary.
  • This is a high-deductible health insurance plan paired with a health savings account (HSA). The monthly premium is a little lower than HealthSelect of Texas, but participants must pay the full cost of their care (with the exception of preventive care, such as annual checkups and vaccinations) until participants meet the annual deductible. (See deductible amounts below.) This includes non-preventive doctor visits, prescriptions, hospital stays and any other type of health service or product that is not preventive.
  • If employees enroll in Consumer Directed HealthSelect, participants need to open a HSA as soon as possible so state contributions and other funds can be deposited into the account.
Plan Year 2019 Deductible* Individual Coverage Family Coverage
In-Network $2,100 $4,200
Out-of-Network $4,200 $8,400

*Deductibles run on a calendar-year basis and will reset on January 1, 2019.

Health Savings Account (HSA)

  • Optum Bank will continue to administer the health savings account (HSA) program.
  • Participants can use their HSA funds for qualified medical expenses for themselves, their spouses and their eligible dependents. The IRS definition of qualified medical expenses.
  • Participants can also make pre-tax contributions to their HSA through payroll deductions. The IRS sets the maximum contribution amount each year. The annual maximum contribution limit for 2019 is $3,500 for individuals and $7,000 for families.
  • The HSA balance carries over from one year to the next, there is no use-it-or-lose-it rule and account holders can keep the funds if participants change health plans or leave state employment.
  • The state’s contribution to every eligible member’s HSA is $540 a year for an individual or $1,080 for a family. For some people, it could be a great way to save money and lower their taxable income. But participants will be responsible for all of their non-preventive health care costs until they meet the annual deductible
  • Once employees open an account, they will get a debit card from Optum Bank to pay for health expenses. Participants will have access only to the amount of money that has accumulated in their HSA but not funds pledged to be deposited in the future. Employees should review IRS guidelines or consult a tax advisor to make sure participants are eligible to participate in a HSA.

Dental Plans

State of Texas Dental Choice Plan

  • Premium rates will increase by 4.5%.
  • The individual maximum benefit will increase from $1,500 to $2,000 for Basic and Major Restorative services.
  • The individual lifetime Maximum Benefit for Orthodontic services will increase from $1,500 to $2,000 for orthodontic care.
  • There is no age limit for those accessing Orthodontic services
  • Once the calendar year maximum benefit for Basic and Major services is met, the plan will pay 40% of covered services for the remainder of the calendar year for in-network dental providers only.

Humana Dental DHMO Plan

  • There will be no plan or premium changes.
  • Employees and covered dependents enrolling in the DHMO must select a primary care dentist (PCD) to receive benefits.

State of Texas Dental Discount Plan

  • There will be no plan or premium changes.
  • 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

  • Premium rates will decrease by 10%.
  • The member’s copay for an annual eye exam will decrease from $25 to $15
  • Participants can have their annual eye exam at any time during the plan year. There will no longer be a 12-month waiting period.
  • Effective September 1, 2018, the health insurance Opt-Out Credit can be applied toward State of Texas Vision, in addition to dental and AD&D insurance.

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, 2018.

Basic Term Life, Dependent Term Life & AD&D

  • There will be no changes to the plan or premiums.

Short-Term & Long-Term Disability

  • Short-term and long-term disability insurance carrier remains Reed Group Management LLC (ReedGroup).
  • Some employees may see a change in their premium if they have a salary change as of September 1, 2018.

TexFlex Flexible Spending Accounts (TexFLex)

TexFlex, administered by WageWorks, Inc., is a flexible spending account (FSA) and a commuter spending account that lets participants set aside money from their paychecks, pre-tax, to use for eligible out-of-pocket expenses. The TexFlex program including commuter spending account, is available to all benefits-eligible active employees.

There are three types of the TexFlex FSAs: the health care account, dependent care account and the limited flexible spending account (LFSA). The LFSA is only available to employees enrolled in Consumer Directed HealthSelect with a health savings account (HSA).

  • There is an administrative fee holiday for Plan Year 2019 for both health care and dependent care accounts.
  • Participants will not have to pay the $12 annual administrative fee for each account.
  • FSA participants can use the debit card at no cost this year.

Health Care Account

  • The maximum annual election increases from $2,600 to $2,650 in Plan Year 2019.
  • TexFlex annual elections will remain the same in Plan Year 2019, unless participants make a change to their elections during Summer Enrollment.
  • Participants can continue to carryover up to $500 of unused health care account funds into the next year.

Dependent Care Account

  • The maximum annual election remains at $5,000 in Plan Year 2019.The maximum contribution is $5,000.
  • Employees TexFlex annual elections will remain the same in Plan Year 2019, unless participants make a change to their elections during Summer Enrollment.
  • Participants continue to have a Grace Period through November 15, 2018, in which participants can use their Plan Year 2018 funds.

Limited Flexible Spending Account (LFSA)

  • The maximum annual election increases from $2,600 to $2650 in Plan Year 2019.
  • Only employees enrolled in Consumer Directed HealthSelect can enroll in an LFSA.
  • The TexFlex limited flexible spending account (LFSA) lets participants set aside money on a pre-tax basis—for both themselves and their eligible dependents to pay for dental and vision expenses only.
  • The annual minimum election for PY18 is $180 ($15 per month) and a maximum of $2650.

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

FY2019 Rates

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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