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ERS Sets 2019 Insurance Rates

by ERS staff

During its May 23 meeting, the ERS Board of Trustees approved rates for Plan Year 2019 (September 1, 2018 —August 31, 2019).

The following plans will have premium changes for PY19:

  • HealthSelectSM of Texas and Consumer Directed HealthSelectSM will increase less than 0.5%.
  • Health maintenance organizations (HMOs) will increase an average of about 5%.
  • State of Texas Dental ChoiceSM preferred provider organization (PPO) will increase about 4.5%.
  • The State of Texas VisionSM plan rates will decrease by 10%.

In addition, the Board approved the following benefits changes for PY19:

  • The annual in-network out-of-pocket maximum for all health plans will increase from $6,550 to $6,650 for individuals and from $13,100 to $13,300 for families.
  • Consumer Directed HealthSelect’s annual out-of-network out-of-pocket maximum will be eliminated effective January 1, 2019. The other plans do not have annual out-of-pocket maximums for out-of-network services.

Because the state pays 100% of health insurance premiums for eligible full-time employees, the changes to the health plan rates will affect part-time employees and employees who cover eligible family members.

In the State of Texas Dental Choice PPO:

  • the individual annual plan limit will increase from $1,500 to $2,000 for Basic and Major Restorative Services;
  • the individual lifetime plan limit for orthodontic services will increase from $1,500 to $2,000;
  • adults are added in the orthodontic benefits;
  • there will not be an exclusion for replacing a missing tooth; and
  • the calendar year maximum benefit for Basic and Major services for out-of-network service after the annual benefit maximum is reached will be eliminated. (The extended benefit for in-network services remains.)

In the State of Texas Vision plan:

  • the participant copay for an annual eye exam will decrease from $25 to $15 and
  • participants will be able to get their annual eye exam once each plan year, without waiting a full 12 months after their previous eye exam.

In the TexFlexSM plan:

  • the administrative fee holiday will continue in PY19, and participants will not be charged $1 per month per account;
  • the IRS has increased the flexible spending account contribution limits for TexFlex health care and limited flexible spending accounts from $2,600 to $2,650.

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