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Want to join the game?

You may change plans during the Medicare-plan annual enrollment in December (for Jan. 1) or annual open enrollment in the spring (for May 1), or you may elect to join a Medicare plan on the first of any month. For coverage to be effective on the first of the next month, HR’s benefits division must receive your application before the end of the previous month.

Electing a Medicare plan

• Request an enrollment packet from Aetna, TexanPlus, Texas HealthSpring, KelseyCare Advantage or UnitedHealthcare.
• Enrollment forms will be in the packet.
• Each person must complete, sign, date and return all copies of an enrollment application and statement of understanding for the plan you elected. If you elect Medicare supplement plan F, you must also complete the UnitedHealthcare Part D prescription-drug enrollment form.
• You must also complete the city of Houston Medicare plan enrollment form. This form will keep your dependents’ coverage in the HMO or PPO in place, and it will help ensure you pay the correct health-care premium. Keep the last page for your records.
• Use the city of Houston postage-paid return envelope to return all of your forms to the benefits division before April 30 for coverage to be effective May 1, 2010. If you don’t use the envelope, the address is:
  
  • City of Houston
    Human Resources Department, benefits division
    P.O. Box 248
    Houston, TX 77001

Disenrolling from a Medicare plan
You may disenroll from your Medicare plan effective the last day of any month by submitting a city of Houston Medicare plan disenrollment form. This includes changing from one Medicare plan to another. Here’s how to disenroll:

• Decide if your dependent or you want to elect a different city-sponsored Medicare plan, or if you want to re-enroll in the HMO or PPO plan, you can do so within 90 days of Medicare plan enrollment or on Jan. 1, 2011.
• Each person who wants to disenroll from a Medicare plan must complete a city of Houston Medicare plan disenrollment form. The retiree must complete a city of Houston retiree medical election form to reinstate HMO, PPO or another Medicare plan coverage for any dependents or themselves. Request these forms from the HR benefits division, 888-205-9266 or 713-837-9400. If a person wants to elect another Medicare plan, request the enrollment application from the benefits division or request the new plan send an enrollment packet for each person who wants to enroll.
• Send all completed forms to:
  
  • City of Houston
    Human Resources Department, benefits division
    P.O. Box 248
    Houston, TX 77001

The benefits division must receive your forms by the end of the month for coverage to be effective on the first of the next month.

You must continue getting your medical services through your Medicare plan until you are notified by the plan that your coverage has ended. That notice can take up to 60 days.

Eligibility
You are eligible for coverage as a retiree under the benefits plans if:

• you are covered by a city medical plan
• you filed the proper paperwork to opt out of a city plan

If you and your spouse retired from the city, you may be covered as a retiree or as a dependent — but not both. Dependents may be enrolled under only one parent or guardian.

The eligibility criteria remain the same. Your eligible dependents are defined as one of the following:

• Your legal spouse
• Unmarried natural or adopted children to age 25, if they qualify as dependents for federal income-tax purposes
  
• Children to age 25 over whom you have legal guardianship or legal foster care if they qualify as dependents for federal income-tax purposes
  
• Grandchildren and stepchildren to age 25 if they qualify as your dependents for federal income-tax purposes and live with you
  
• Disabled dependents over age 25 who are incapable of self-sustaining employment because of mental or physical handicap. The dependent must be primarily dependent on you for more than 50 percent of financial support and covered before age 25
  
• Unmarried dependent children who lose Medicaid coverage may be enrolled under the retiree’s medical plan within 31 days after Medicaid coverage is lost. They may be covered to age 25 if they qualify as your dependents for federal income-tax purposes
  
• Dependents for whom a court order has been received requiring the employee or retiree to provide health care coverage, provided benefits receives the court order within 31 days after issuance. After a divorce, an ex-spouse is not eligible. A divorce decree may not be amended to require a retiree to cover an ex-spouse under a city medical plan

Mental Health Parity
The Federal Mental Health Parity and Equity Act requires HMO plans to remove time limitations from treatment of mental health and substance abuse. Starting May 1, out-patient and in-patient services will be treated like any other medical condition.

HMO

• The 30-day in-patient limitation for mental illness will be removed.
• The three series of treatments of chemical dependency will be removed.
• The 20 office visits per calendar year limitation will be removed.

In-patient and out-patient copayments, including those for PCPs and specialists, will remain the same: out-patient copayment is $25 per visit; in-patient coinsurance is 20 percent of cost.

PPO

• The 30 outpatient visits per calendar year will be removed.
• The three series of treatments of chemical dependency will be removed.
• The 30-day in-patient limitation for mental illness will be removed.

In-patient and out-patient copayments, coinsurance and the plan’s deductible remain the same: Out-patient is the office copayment plus 20 percent; in-patient is $500 copayment plus 20 percent.

In June 2010, you should expect to receive a new benefits summary that will provide details of these improved benefits.

 

Medicare plans rules to know

Enrolling
Your Medicare-covered dependents and you can each choose the Medicare plan that is best for you, or both of you can be covered under the same plan.

If your dependents are not eligible to participate in a Medicare plan, they may continue coverage under their BCBSTX HMO or PPO plan.

You can enroll your covered dependents in a Medicare plan on the first of the month in which they become eligible: (1) they become covered under Medicare Parts A and B at age 65; (2) they are under age 65 but become disabled and get Medicare Parts A and B, except for Medicare supplement plan F.

If you enroll in a Medicare plan May 1, 2010, you may elect to return to the BCBSTX HMO or PPO within 90 days after enrolling, or on Jan. 1, 2011.

Primary-care physicians
Under TexanPlus HMO, and Texas HealthSpring you must select a primary-care physician to coordinate your health care, just as in the BCBSTX HMO. Check each plan’s provider directory. Your doctor might be in its network.

The Medicare supplement insurance plan allows you to go to any doctor nationwide who accepts Medicare assignment. The Aetna PFFS plan allows you to select any doctor or specialist who accepts Medicare assignment and Aetna’s PFFS plan. Call your doctor. He/she might already have these arrangements in place.

Returning to Original Medicare
Remember, all the Medicare plans, except the Medicare supplement plan, take the place of your Medicare and your HMO or PPO. If you re-enroll in the HMO or PPO, you are also re-enrolled in Original Medicare.

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