Tuesday, September 11, 2012

ERS studies employment benefits, updates healthcare transition FAQ

From the ERS of Texas

The 82nd Legislature directed the Employees Retirement System of Texas (ERS) to conduct an interim study of possible changes to the state benefits package. This study will help determine how the state can provide sustainable, competitive benefits for state employees and retirees. ERS will submit their recommendations to the Legislature on September 1. For more information about the study, visit the ERS Interim Benefits Study website.

On September 1, United HealthCare Services, Inc. will take over from Blue Cross Blue Shield (BCBS) as third-party administrator (TPA) for the self-funded HealthSelect of Texas health plan. United Healthcare, in its role as TPA, will negotiate provider reimbursements to best utilize limited plan dollars, pay claims, provide customer service, offer health-and-wellness programs and manage the HealthSelect provider network. On July 1, the Employees Retirement System (ERS) updated their website's list of frequently asked questions (FAQ) about the HealthSelect transition. The following is a partial list of new information from the July update.
  • Your primary care physician (PCP) is listed on your HealthSelect ID card. UnitedHealthcare will send you a letter confirming the current designated PCP for you and your covered family members, and if the PCP is in its network. If you need to designate a new PCP, call UnitedHealthcare toll-free at 866-336-9371 now, or visit their website below, so that your designation will be effective on September 1, 2012. If your PCP is not listed, check the provider search application at www.healthselectoftexas.com or call 866-336-9371 (TTY users call 711) because many PCPs have recently joined the network.
  • Referrals and hospital pre-authorizations will transfer from BCBS to United HealthCare if the referral or hospital pre-authorization is to a provider in the United HealthCare network and the referral does not expire before September 1, 2012. If the referral is to a non-network provider, members should ask their network primary care physician for a referral to a United Healthcare network specialist in order to receive network benefits.
  • If a member is receiving certain medical treatments, such as chemotherapy or prescheduled surgery, from a non-UnitedHealthcare network provider, the member must complete and submit a Transition of Care form, available in the Publications and Forms section at www.healthselectoftexas.com. In most cases, members have 90 days from September 1, 2012 to complete the treatment or surgery at the non-network doctor and still receive network benefits. Extensions may be possible for those receiving a transplant, undergoing bariatric surgery or dealing with a terminal illness.
  • Non-network and out-of-area deductibles and out-of-pocket maximums start over on January 1, 2013, and information will transfer from BCBS to United HealthCare automatically.
  • Acupuncture and eyeglasses are not covered by HealthSelect.
For more information, call United HealthCare HealthSelect Customer Service toll-free at 866-336-9371 or visit www.healthselectoftexas.com on the web.

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