New Plays / Overview Supplemental Plans
Health Plan Highlights Flexible Spending Account (HFSA)
Service Areas Section 125
Health Contributions Wellness
Prescriptions Rules of the Game
Dental Plan Highlights Insider's tips

 

Spotlight:
PPO annual deductible
The PPO plan has a calendar-year in-network deductible of $200 for individuals and $600 for families. The family maximum can be reached by a combination of all covered family members’ eligible expenses.
If you don’t reach your annual deductible by Sept. 30, a three-month carryover feature will help you in the following calendar year. Charges that apply to the annual deductible and that are incurred in October, November and December can be counted in the next year.

Contributions

The team budget

Health care, like sports, is a big-bucks world. And the costs nationwide keep going up. Each year, the city and its heavy hitters struggle to achieve the right balance of benefits and contributions. To keep the same top-of-the-order benefits employees, retirees and dependents enjoy, the city and plan members have to take on some of the increased costs.

In FY11, the city expects to spend $311 million for health care, up from $289 million last year. By slightly increasing copayments for doctor’s visits and some prescription medications and by creating a state-approved trust to save taxes on premiums paid by the city for health care, we’ve been able to contain the increase in premiums. Overall, premiums went up 5.07 percent this year in the HMO, compared to the 8 percent BCBSTX proposed. PPO contributions are going up 12 percent.

The city contributes 79 percent for active employees in the HMO and 73 percent for active and retired employees combined.

Here’s what that means to you:

  • HMO rates will increase 8 percent on average.
  • PPO employee contributions will increase about 22 percent on average.

Disease Prevention Discount Program
Tobacco use can really affect your game. Studies show tobacco users are more likely to have higher medical claims and are hospitalized longer. Smoking is a primary contributor to illnesses like heart, lung and pulmonary diseases that generally require long-term and costly medical intervention.

For those reasons and others, employees, retirees and their covered dependents who do not use tobacco receive a $25 discount each month. If you are paying the discounted premium and you cover a tobacco user, you could lose medical coverage.

Active employees biweekly contributions
  Wellness discount Tobacco user
HMO
From
To
From
To
Employee Only $18.13
$19.05
$30.63
$31.55
Employee + 1 $99.68 $108.08 $112.18 $120.58
Employee + 2 or more $122.39 $132.71 $134.89 $145.21
PPO and Out-of-area
From
To
From
To
Employee Only $124.80
$153.50
$137.30
$166.00
Employee + 1 $356.90 $432.30 $369.40 $444.80
Employee + 2 or more $460.61 $559.02 $473.11 $571.52

 

Monthly rate comparison

Company
(Predominant Plan)

Tier

Employee’s
contribution

Employer’s
contribution

City of Houston (HMO)

EE only

$38 $329

EE + family

$265 $898

Private local institution
(HMO)

EE only

$64 $337

EE + family

$411 $831

HISD (HMO)

EE only

$94 $139

EE + family

$444 $152

Harris County (PPO)

EE only

$0 $462

EE + family

$367 $829

Private Local company (PPO)

EE only

$110 $329

EE + family

$362 $918
Source: City of Houston annual health benefits survey, January 2010. City of Houston data effective 5/1/10. Other participants’ data valid through 2009 or 2009/2010 plan year. Amounts rounded to whole dollars.

 

A winning strategy - simple rules to keep health-care costs down

When you use your health-care benefits responsibly, we all win. Doing so keeps you healthy and helps keep the amount the city spends on health care down. That’s important, because the lower the city’s health-care costs, the lower your premiums. That’s a grand-slam deal.

How can you help keep health-care costs down? By following some simple rules:

    • Exercise at least 30 minutes a day, most days of the week. This could be as simple as walking the dogs, cleaning the house or walking the stairs instead of taking an elevator at work.
    • Give generic drugs a chance. They’re the same in dosage and effectiveness as brand-name drugs, but they’re cheaper for you and the city.
    • If you use tobacco, stop.
    • Research your illness to see if a trip to the doctor is necessary. Is it just a cold that will run its course? If so, those antibiotics the doctor might prescribe won’t do you any good.
    • Call the 24/7 nurse line at 800-581-0353.
    • Know your numbers. (Cholesterol, blood pressure, blood sugar, BMI and more.)
    • Watch your weight. Eat appropriate portions of the right kinds of foods.
    • If you need immediate care but your PCP’s office is closed, visit an urgent-care center instead. That can save you $110. (HMO emergency room visit: $150 - Urgent-care visit: $40)
    • Get your free annual well-man or well-woman exam, which can catch illnesses and diseases early.

 

 
 
 
 
 
 

Employee Guide | Retiree Guide | HFSA (SMART) Guide | Home | Mayor's Letter
Enrollment Materials | Important Dates | Contacts

 

If there exists a conflict between this Enrollment Guide Website and the official plan documents for each plan, the official plan documents will prevail. The city of Houston reserves the right to change, modify, increase or terminate any benefits.