Things to Consider for Medicare-covered Retirees

These are important things you need to consider before making your enrollment decisions.

Value added services
Tools to help you make your decision
Eligibility
  Dependent Audit
How to enroll or disenroll
City of Houston Health Fair

Which plan is right for me?

This is a lot of new and exciting information you should consider to make this importan decision. We have provided the following information for you to use in making your decision:

Comparison of network physicians
To see if your physicians and hospitals are in a specific network you can contact TexanPlus at (866) 556-4607 or Texas HealthSpring at (800) 846-2098. TexanPlus has a “Doctor Finder” on its Web site at www.sctexas.com, and Texas HealthSpring has a directory posted on its Web site at www.texashealthspring.com. All questions regarding physicians, facilities, drugs and benefits should be directed to the customer service departments at the phone numbers listed to the right.

Physician Group
HMO Blue Texas

TexanPlus

Texas HealthSpring
Independent Physicians
X
X
X
Kelsey-Seybold Clinic
X
X
  
Memorial Clinical Associates
  
X
  
PeopleFirst
X
  
  
Renaissance
X
  
X
SEMNet Physicians Org.
  
X
  
Village Family Practice
  
X
X
Total PCPs 1,760 410 439
Total Specialists 6,238 2499 659
Total Physicians 7,998 2,909 1,098

 

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Comparison of network hospitals
Listed below are just some of the hospitals in the HMOBTX, TexanPlus and Texas HealthSpring networks. In an emergency, you may seek treatment at any hospital; however, you may be transferred to a network facility as soon as your condition is stabilized.

Hospital
HMO Blue Texas

TexanPlus

Texas HealthSpring
CHRISTUS St. John
    
X
X
CHRISTUS St. Joseph
X
X
X
Kingwood Medical Center
X
  
X
M.D. Anderson Cancer Center
X
  
  
Memorial Hermann Hospital Syst.
X
X (11 facilities)
X (2 facilities)
Methodist Hospital
X
  
X (3 facilities)
Park Plaza
X
  
X
St. Luke’s - Woodlands
  
X (Kelsey only)
  
St. Luke’s Episcopal Hospital
X
X (Kelsey only)
  
Spring Branch Medical Center
  
  
X
Twelve Oaks
  
  
X
West Houston Medical Center
X
  
X
Women’s Hospital of TX
X
  
  

 

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Comparison of network pharmacies
Below is a list of many familiar network pharmacies. Others are available, so check online or call customer service for a complete listing of all pharmacies and their locations.

Pharmacy
HMO Blue Texas

TexanPlus

Texas HealthSpring
CVS
X
X
X
HEB
X
X
X
Kelsey Seybold
X
X
  
Kroger
X
X
X
Randalls
X
X
X
Sam’s Club
X
X
X
Target
X
X
X
Wal-Mart
X
X
X
Walgreens
X
X
X

 

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Value added services

Listed below are value added services for both Medicare Advantage plans. When making your healthcare decision, take into account these unique bonus features.

  Texas HealthSpring
Free rides to plan-approved health facilities such as doctor’s appointments, hospitals and pharmacies. Up to 30 one-way or 15 round trips per calendar year.
Silver Sneakers fitness benefit provides access to health clubs with classes specifically designed for seniors. Full use of free weights, treadmills and other equipment.
Discount hearing services provide up to a 30% discount for hearing aids from selected providers.
Other services include a newsletter, disease management, and wellness services.
Careington Dental Discount Services provide 20 - 50% savings on most dental procedures, 20% discount on specialty services, cosmetic dentistry, and teeth whitening, included if you use Careington Providers.

 

  TexanPlus
Careington Dental Discount Services provide 20 - 50% savings on most dental procedures, 20% discount on specialty services, cosmetic dentistry, and teeth whitening, included if you use Careington Providers.
HearPO hearing discount services provide a 30% discount on hearing exams, up to 62% savings on hearing aids at participating providers, discounts on repairs and batteries, and access to the latest digital technology.
ElderCare services provide wellness assessments, someone to work with you to identify elder-care needs, on-going support for maintaining an independent quality of life, significant discounts on senior housing alternatives and additional care services.
Other services include health education classes, newsletter and disease management.


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Medicare Advantage Plans: Tools to help you make your decision

This is a lot of new and exciting information you should consider to make this importan decision. We have provided the following information for you to use in making your decision:

Chart of network physicians
Chart of network hospitals
Chart of network pharmacies
Summary of plan features
Contribution chart
Prescription benefits chart
Service areas
Comparison of benefits chart
Prescription formularies

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Eligibility

You are eligible for coverage under the benefits plans if you were covered when you retired and have been continuously covered after retirement. If both you and your spouse retired from the city, you may be covered as an retiree or as a dependent — but not both. Dependents may be enrolled under only one parent or guardian.

Your eligibility for the Medicare Advantage plans is based on five requirements. Click here for more information.

Eligible Dependents are your:

Legal spouse,
Unmarried natural or adopted children up to age 25, if they qualify as dependents for federal income tax purposes,
Children up to age 25 over whom you have legal guardianship or legal foster care if they qualify as dependents for federal income tax purposes,
Grandchildren under age 25 if they qualify as your dependents for federal income tax purposes,
Disabled dependents over age 25 who are incapable of self-sustaining employment because of mental retardation or physical handicap. The dependent must be primarily dependent on you for more than 50 percent of financial support and covered before age 25.

 

Dependent Audit

Later in the year, you will receive information about a dependent audit to be conducted by the city’s Benefits Division. The purpose of the audit is to verify the eligibility of each of your covered dependents. You will soon receive a letter listing:

Who can be covered by the city’s benefits plan, and
Whom you are currently covering on these plans.

Open enrollment is the time to review your family status and drop or add dependents. There’s no point in paying for someone who is ineligible. You will be asked to provide documentation to verify your relationship.

 

 

Important note: When your dependents become ineligible they will be dropped from coverage. You must submit a status change form within 31 days.

You will receive a refund of the premiums you paid for coverage only from the date of your notification.

If they are not dropped on time, they are still ineligible for coverage. You will not get a full refund, and you may be responsible for any claims incorrectly paid on their behalf.

 


You can get a status change form from the City of Houston Benefits division. Call (713) 837-9300.

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How to enroll or disenroll

Keeping the HMO or PPO
If you or your Medicare-covered dependent does not want to join TexanPlus or Texas HealthSpring, you do not need to do anything. You will keep your HMO or PPO.

You may change plans during the annual open enrollment, or you may elect to join TexanPlus or Texas HealthSpring on the first of any month. For coverage to be effective on the first of the next month, the Benefits Division must receive your application before the end of the previous month.

Electing either TexanPlus or Texas HealthSpring

Enrollment forms are in your enrollment packet.
Each person must complete, sign, date, and return all copies of an “Enrollment Application and Statement of Understanding” for the plan he/she elects.
Each person must complete the “Working Aged Survey,” if included, from your enrollment packet.
You must also complete the “City of Houston Medicare Advantage Plans Enrollment Form.” This form will keep your dependents’ coverage in the HMO or PPO in place, and it will help ensure that you pay the correct health-care premium. Keep the last page for your records.
Use the City of Houston return, postage-paid envelope to return all of your forms to the Benefits Division.

How to enroll
Complete the forms and return no later than Apr. 30, 2005. Changes will be effective May 1, 2005. Use the postage-paid envelope in your packet to return the forms. If you don’t use the envelope, the address is:

City of Houston
Human Resources Department, Benefits Division
611 Walker, 4th floor
Houston, TX 77002

Forms received after Apr. 30, 2005, will be effective the first day of the following month.

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City of Houston
Health Fair

Thursday
April 21, 2005
9 a.m. to 2 p.m.

 
 

 

 

Important note:
If you are enrolled in the medical, dental or supplemental insurance plans and don’t want to make any changes - don’t do anything. Your coverage will remain in effect through April 30, 2006.

Important note: For medical and dental plans, only new enrollees will receive new ID cards for May 1, 2005. Your current ID card has no expiration date. If you need additional or replacement ID cards, order them through the provider, as usual.

 
   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   
     

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