Dear State of Texas and Higher Education Employees/Retirees/Dependents:
The Employees Retirement System of Texas Board of Trustees has approved SHA, L.L.C., d.b.a. FirstCare, as an HMO option in the Texas Employees Group Benefits Program (GBP) for eligible State and Higher Education employees retirees and their dependents for the 2009 plan year. FirstCare is a locally owned health maintenance organization, currently serving the health care needs of approximately 25,000 State and Higher Education employees, retirees and their dependents. You have the option of making changes to your FirstCare coverage with no health questions asked or evidence of insurability required during the Summer Enrollment period from July 28 through August 22, 2008.
Effective September 1, 2008:
- Maxor Plus becomes our Prescription Benefit Manager for Amarillo and Lubbock Service Areas.
- Express Scripts Inc. remains our Prescription Benefit Manager for Abilene and Waco Service Areas.
Value-Added services
(ERS cannot and does not guarantee the length of time that a specific type of “Value-Added” product shall be offered. Any questions or concerns about these products should be directed to the sponsoring HMO.)
- NurseLine Services with 24-7 access to answer your medical questions.
- Diabetic Supplies for a reduced copayment (10%) when using a preferred vendor.
- Glucometer for no copayment when using a preferred vendor.
- Preferred Glucose Meter and Diabetic Test Strip vendors are Bayer HealthCare and Lifescan, Inc.
For a complete listing of the benefits offered, please refer to the FirstCare Evidence of Coverage, which is linked from the ERS website, www.ers.state.tx.us. If you are an active employee and do not have internet access, you may obtain a copy through your Benefits Coordinator or call the FirstCare Customer Service Department toll free at (877) 514-8996, Monday through Friday, 8 a.m. to 6 p.m.
Retirees may contact the Employees Retirement System for assistance at (877) 275-4377.
If you are age sixty-five (65) or older, benefits will be coordinated with Medicare as follows:
Medicare Part A - (Hospital Insurance)
- If you have been diagnosed with end stage-renal disease, benefits will be determined in accordance with Medicare guidelines for members with end stage renal disease.
- When Medicare benefits are primary, claims must be filed with Medicare first. You are responsible for sending the Medicare explanation of benefits form to us for determination of FirstCare benefits.
- In general, if you are an active, working employee, FirstCare is the primary payer for you and your dependents.
- If you are a GBP retiree enrolled in Medicare Part A, Medicare is the primary payer, FirstCare will pay the Medicare Part A deductible, and you will be responsible for any copayments.
- If you are a GBP retiree not enrolled in Medicare Part A, FirstCare will be the primary payer.
Medicare Part B - (Supplemental Medical Insurance)
- If you were retired and became Medicare-eligible before September 1, 1992 and are enrolled in Medicare Part B, FirstCare will provide benefits secondary to Medicare. If you are not enrolled in Medicare Part B, FirstCare will pay primary benefits.
- If you were retired and became Medicare-eligible on or after September 1, 1992 regardless of your Medicare Part B status, FirstCare will provide benefits secondary to Medicare Part B.
- If you choose not to enroll in Medicare Part B, you may have greater out-of pocket expenses after FirstCare pays secondary benefits than an individual who is enrolled in Medicare Part B.
Medicare Part D - (Prescription Drug Coverage)
- The current pharmacy program provided by FirstCare is as good as or better than the Medicare Part D program, therefore ERS recommends you do NOT sign up for Medicare Part D for 2009.
- If you need further Medicare Part D clarification please contact FirstCare at (877) 514-8996 or 12940 N Hwy 183, Austin, TX 78750.
FirstCare provides health care services to its enrolled members through a large network of plan physicians, hospitals, pharmacies and ancillary providers. All care for FirstCare members is delivered through these contracted providers. We also have arrangements with other local and non-local providers for those few services which may not be available from plan providers. Through its large network of physicians and other quality health care providers, FirstCare ensures you will have continuous access to health care services.
Should you have any questions regarding coverage or benefits provided by FirstCare, please contact us at (877) 514-8996 or 12940 N Hwy 183, Austin, TX78750
. You can also access our website through www.ers.state.tx.us. Each of us at FirstCare looks forward to serving you again in the year to come.
