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Resources
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 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 F Plan, 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 return, postage-paid envelope to return all of your forms to the benefits division before Dec. 31 for coverage to be effective Jan. 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 choose to disenroll from a Medicare plan at the first of any month. This includes changing from one Medicare plan to another. Here’s how to disenroll from a Medicare plan:
- 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 MA-plan enrollment or on May 1, 2010.
- Each person who wants to disenroll from a Medicare plan must complete a city of Houston Medicare Advantage 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 to 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.
Eligibility
You are eligible for coverage as a retiree under the benefits plans if you were covered when you retired and have been continuously covered by the city since retirement. If both 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 to age 25 if they qualify as your dependents for federal income-tax purposes
- 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
Medicare 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 BCBS HMO or PPO plan.
You may enroll your covered dependents in a Medicare plan on the first of the month after 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 Jan. 1, 2010, you may elect to return to the BCBS HMO or PPO within 90 days after enrolling, or on May 1, 2010.
Disenrolling
You may disenroll from your Medicare plan effective the last day of any month by submitting a city of Houston Medicare Advantage Disenrollment form. You must also complete a city of Houston Retiree Medical Election Form to reinstate HMO, PPO or another Medicare plan coverage. Request these forms from the benefits division, 888-205-9266 or 713-837-9400. You must re-enroll in the HMO or PPO within 31 days after your coverage ends in the Medicare plan.
You must continue getting your medical services through your Medicare Advantage plan until you are notified by the plan that your coverage has ended. That notice can take up to 60 days.
Primary-care physicians
Under TexanPlus, Texas HealthSpring, and KelseyCare Advantage HMO or POS, you must select a primary-care physician to coordinate your health care, just as in the BCBS 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.
Enrollment options
Change from one Medicare Plan to another Medicare Plan.
- Complete a City of Houston Medicare Plan Disenrollment Form.
- Complete a City of Houston Medicare Plans Election Form.
- Request your new plan to send you an enrollment packet – for each person who wants to enroll.
- For Medicare Supplement Plan F, also complete the UnitedHealthcare Medicare D election form.
- Complete and return the forms to the City of Houston by Dec. 31, 2009.
- Change from the BCBS HMO or BCBS PPO to a Medicare Plan.
Complete a City of Houston Medicare Plans Election Form.
- Request your new plan to send you an enrollment packet – for each person who wants to enroll.
- For Medicare Supplement Plan F, also complete the UnitedHealthcare Medicare D election form.
- Complete and return the forms to the City of Houston by Dec. 31, 2009.
Change from a Medicare Plan to the HMO or PPO
- Complete a City of Houston Medicare Plan Disenrollment Form.
- Complete a Retiree/Survivor Re-enrollment Form for the HMO or PPO plans
- Return the forms to the City of Houston By Dec. 31, 2009.
Helpful points
- Each person must complete a form to disenroll from a Medicare plan and a form to enroll in a Medicare Plan.
- MA Plans take the place of Original Medicare and your PPO or HMO.
- Medicare supplement plan F and UnitedHealthcare Medicare D plans will replace your HMO or PPO.
- Medicare supplement plan F will pay most Medicare-covered expenses that Medicare does not pay.
- If you re-enroll in the HMO or PPO, CMS will automatically re-enroll you in Original Medicare.
- If you disenroll from a Medicare Advantage Plan, you must continue receiving care from your MA plan until you are given notice that your disenrollment has been processed.
- Each family member may join a different Medicare Plan or one of you may remain in the HMO or PPO. Under-age 65 dependents may maintain coverage in your HMO or PPO.
- If you are enrolling in a Medicare Plan for the first time, attach a copy of your Medicare card to your application. Remember: When you join a Medicare Advantage Plan, it replaces your Medicare.
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