July 1, 2006
Dear State of Texas and Higher Education Employee/Retiree/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/dependents for the 2007 plan year.FirstCare is a locally owned health maintenance organization, currently serving the health care needs of 22,800 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 proof of insurability required during the State's Summer Enrollment period from July 24 through August 18, 2006.
For the 2007 plan year, there are no benefit or copayment changes.For a listing of the benefits offered, please refer to the FirstCare Benefit Summary, 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 yourbenefits coordinator or call the FirstCareCustomer Services Department toll free at (800) 884-4901 Monday through Friday 8 a.m. to 6 p.m.Retirees may contact the Employees Retirement System for assistance.
If you are age sixty-five (65) or older, benefits will be coordinated 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 afterFirstCare pays secondary benefits than an individual who is enrolled in Medicare Part B.
- 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 the 2007 Plan Year.
- If you need further Medicare Part D clarification please contact FirstCare at (800) 884-4901 or 12940 N Hwy 183, Austin, TX 78750.
- If the provider does not accept Medicare assignment FirstCare must pay the difference between the Medicare maximum allowable and the Medicare paid amount, less the appropriate co-payment.
FirstCare provides quality 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 quality health care services.
Should you have any questions regarding coverage or benefits provided by FirstCare, please contact us at (800) 884-4901 or 12940 N Hwy 183, Austin, TX 78750.You can also access our website through www.ers.state.tx.us. Each of us at FirstCare look forward to serving you again in the year to come.
