ERS Approves Increased Health Care Costs
The ERS Board of Trustees approved a number of changes to the HealthSelect program that will increase many out-of-pocket health care costs beginning on September 1. HealthSelect participants will face higher copayments for prescription drugs, a doubling of the out-of-pocket maximum under the 20 percent coinsurance requirement, and other cost increases. Follow this link to see the HealthSelect plan changes. HMO participants will also see increased health costs, primarily because of new coinsurance cost sharing requirements that are comparable to HealthSelect. Finally, FirstCare will no longer be a participating HMO under ERS.
ERS Summer Enrollment Ends at 7 p.m. Friday, July 30
ERS has an annual summer enrollment period every year when qualifying employees and retirees can make changes to their benefit plans. This year’s enrollment period is July 5 through July 30. Changes must be made online by 7 p.m. Central Time, on Friday, July 30. Changes will be effective for the 2011 Plan Year which begins this September 1. For information on summer enrollment, follow this link.
With Health Care Costs Up, Some TPEA Tips to Lower Costs
Utilize the ERS TexFlex Benefit: State employees can significantly lower after-tax costs for medical services, prescription drugs and dependent day care by contributing to TexFlex, a tax exempt Flexible Spending Account. TexFlex allows you to pay for predictable or likely health care or day care costs with pre-tax dollars-- these include copayments, coinsurance costs, other non-covered medical and dental care, glasses, and over-the-counter drugs. Contributions to TexFlex are not subject to Social Security and federal income taxes, but are subject to “use it or lose it” requirements under federal law. TexFlex users in the 15 percent federal tax bracket can save almost 23 percent on the cost of eligible products, services and drugs, and will generally see an increase in take home pay. General information on TxFlex is available at http://www.ers.state.tx.us/texflex/default.aspx, anyone with regular or predictable health care costs that are not otherwise reimbursed should use the cost savings calculator at https://texas.payflex.com/mypayflex/savingsCalculator.htm.
Avoid Paying Retail Maintenance Fees for Prescription Drugs: Since 2003 ERS health plan participants have had to pay an additional fee when purchasing a 90 day supply of maintenance medications at a local retail pharmacy, rather than through the state’s mail order pharmacy program. The additional cost for each 30 day prescription due to the retail maintenance fee is $5 for Generics, $10 for Name Brand drugs, and $15 for Non-preferred drugs. Beginning June 1, you can now avoid these extra charges two ways; first, by using the ERS mail order drug program administered by CareMark, or secondly, by using a local retail pharmacy that is participating in the new ERS Extended Days (EDS) plan. HEB, K-Mart, Safeway and other pharmacy providers are participating in the EDS plan. Participating pharmacies are listed here.
Consider Low Cost Generic Drugs: Many large chain pharmacies have low cost generic lists that allow you to purchase a 30 day supply of certain generic drugs for as little as $4. Wal-Mart first popularized this approach, but most large chain pharmacies have an equivalent program.
Consider Therapeutic Substitution for Non-Preferred Drugs: Drugs are placed on the most expensive Non-preferred tier because there are other lower cost drugs that treat the same condition on the Name Brand list. While therapeutically equivalent drugs are not chemically the same, as are generic drugs, they can be equally effective in treating a condition or disease. Consult with your physician or pharmacist about possible therapeutic substitutions for any non-preferred drugs you currently use.
Avoid Using the Emergency Room: ERS significantly increased copayments for using an Emergency Room. While it is important that ERS participants receive appropriate care, experience has shown that most trips to the Emergency Room could be handled at an Urgent Care Facility for a fraction of the cost to you and the health plan. Familiarize yourself with the in-network Urgent Care Facilities in your area.
Use the HealthSelect 24/7 Nurseline: HealthSelect participants have free access to experienced nurses who you can consult with 24 hours a day, 7 days a week, at 1-888-334-9473.
Get Involved in the State’s Wellness Program: The best way to lower your health care costs is to maintain or regain good health. All state agencies have a wellness coordinator who oversees a variety of wellness offerings. HealthSelect and BCBS also have a comprehensive approach to help ERS plan participants, including financial and other incentives for participation. Start by taking the Health Risk Assessment available through HealthSelect.
TPEA Approves Legislative Agenda for 2011 Session
The membership of TPEA approved our Legislative Agenda for the 2011 Session at TPEA’s 63rd Annual Meeting in Austin on June 26. The specific agenda items are organized around four policy directives: Support equitable methods to resolve state’s budget deficit, preserve affordable ERS health benefits, improve standard of living for ERS retirees, and enhance state employee pay.
While TPEA will be guided by this agenda during the legislative session, the prospect of an unprecedented budget deficit for the State of Texas overshadows everything else. The LBB has publicly indicated the deficit could be as large as $18 billion. TPEA estimates the deficit will be in the $15 to $20 billion range. It’s important to emphasize that these estimates do not factor in the availability of funds in the state’s “Rainy Day Fund”, which is expected to have $8 to 10 billion available for use, although it requires a two thirds vote of the legislature to appropriate these funds.
In order to prepare for such a large deficit, state leaders ordered agencies to include in their Legislative Appropriations Request (LAR) for the next biennium plans to cut an additional 10 percent of general revenue from current biennial budgets, including the 5 percent reductions already imposed.
State employees should play close attention to the budget reduction plans submitted by your agency. State leaders are publicly saying that everything is on the table with regard to potential budget cuts, including employee furloughs, which is mandated time off without pay. Legislators also have limited flexibility with much of the state budget because of federal requirements, constitutional and statutory revenue dedications, and other restrictions as discussed in this article.
Despite Rumor, ERS Retirement Incentive VERY Unlikely
TPEA has received a high volume of inquiries about the possibility of the next legislature creating a retirement incentive for state employees. TPEA believes it is extremely unlikely this will happen. In the past, incentives were put in place to grant additional service credit or a temporarily increased retirement multiplier to induce employees nearing retirement age to retire. However, while the ERS retirement fund is generally in good condition, it is not considered “actuarially sound” under state law and TPEA believes any retirement incentive that increases costs to the ERS retirement fund would be illegal under current law. Key legislative leaders also believe the cash retirement incentive established in 2003 did not save the state money and hurt the ERS retirement fund. Contrary to any rumors you may hear, it is highly unlikely the next legislature will approve any type of retirement incentive.
Get Better Informed, Provide Your Home Email Address
TPEA has been working to inform state employees about relevant issues and concerns through our legislative update email program since 2003. TPEA takes pride in being the most reliable source of accurate and timely information on legislative developments and other concerns for active and retired state employees.
However, because this information is sent to your state email address, TPEA is necessarily constrained in the types of information and recommendations that we can provide. TPEA is therefore encouraging all interested state employees to provide their home email addresses, or other non-state email address, so that TPEA can offer you the full range of information we have available. TPEA will not sell or otherwise permit access to these addresses to any other party.
Follow this link to submit your home email address to TPEA.
Watch TPEA’s website www.tpea.org for special event announcements and to read about TPEA’s future schedule.