Health Plan Highlights For the past decade, the city of Houston has offered high-quality health coverage with a rock-bottom price tag for employees. And despite soaring health-care costs, employees will continue to enjoy a stellar plan that remains affordable. Thanks to the determination in our negotiations with HMO Blue Texas, we were able to reduce a possible 24% cost increase down to 13% for May 2005. With the one-year cost for the city’s health plans for FY06 reaching $225 million, a few changes are necessary to keep the plans affordable for employees, retirees and the city. City employees and retirees have long enjoyed one of the finest health plans in the United States, with quality, accessible, affordable health care. The city has worked hard to keep the payments affordable and the plans responsive to your needs. But with medical inflation continuing in double digits, this is becoming more and more difficult. Health benefits costs continue to skyrocket across the country and all businesses are feeling the pinch, but the city continues to work hard to provide employees and retirees with quality, accessible, and affordable health care. Thanks to the determination in our negotiations with HMO Blue Texas, we were able to reduce a possible 24% cost increase down to 13% for May 2005. With the one-year cost for the city’s health plans for FY06 reaching $225 million, a few changes are necessary to keep the plans affordable for employees, retirees and the city. To keep the plans affordable, we have targeted two areas for modification. Details of those changes are explained in this Enrollment Guide. Our philosophy has always been to try to keep changes to your contributions as low as possible, and look to certain plan features for modification - instead of passing along large contribution increases every year. If you don’t use the plan much, the plan changes won’t affect you much. People who use the plans more will carry a larger portion of plan costs.
The HMO Blue Texas HMO and PPO are still the plans of choice. The HMO requires that all of your medical care be directed by your primary care physician (PCP) and you can only use network providers (except for emergency care.) The PPO allows for more flexibility, with no gatekeeper and an out-of-network option, but you will pay greater contributions, copayments, and coinsurance than in the HMO. The PPO plan was introduced in May 2004, and received about the same enrollment as the previous Point of Service plan - 4% of employees and retirees. It provides a larger network of physicians in Houston and the US, but requires greater cost-sharing from participants. Plan Feature Changes
The following plan features are effective May 1, 2005. Refer to the plan document for covered benefits and exclusions. Click here to download a comprehensive comparison.
Two New Medicare Advantage Plans
TexanPlus Texas (866) 556-4607 HealthSpring (800) 846-2098
Medicare Advantage Plan Highlights
Medicare Advantage Plan Comparison The following plan features are effective May 1, 2005. Refer to the plan document for covered benefits and exclusions. Click here to download a comprehensive comparison.
The following documents provide detailed information to help you with your consideration of the PPO plan. This official PPO plan document supersedes all information printed here.
Which payments apply to the annual maximum that you pay each year?
This chart is a partial listing of PPO doctor groups. Many doctors contract independently with the PPO. For a complete list, go to www.bcbstx.com and search by doctor name or by zip code.
*Physicians in these groups may be in the PPO through independent contracts instead of through the IPA. The chart below presents several considerations in making your choice between the HMO and PPO plans.
See medical rates for employees. See medical rates for retirees. See Medicare Advantage Plan rates for retirees.
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