Employees Retirement
System of Texas/Home

Dear state of Texas and Higher Education Employees/Retirees/Dependents:

The Employees Retirement System of Texas Board of Trustees has approved Valley Baptist Health Plans as a Health Maintenance Organization (HMO) option under the Texas Employees Group Benefits Program (GBP) for eligible State of Texas and higher education employees, retirees, and their dependents for the 2006 plan year.  Valley Baptist Health Plans is a locally owned and operated HMO, currently serving the healthcare needs of members in the Rio Grande Valley.  You have the option of selecting Valley Baptist Health Plans with no proof of good health or evidence of insurability required during Summer Enrollment 2005.

Valley Baptist Health Plans provides quality health care services to its enrolled members through a network of plan physicians, hospitals, pharmacies and ancillary providers.  All care for Valley Baptist Health Plans members is delivered through these contracted providers.  We also have arrangements with other local and non-local providers for those few services that may not be available from plan providers.  Through its network of physicians and other quality health providers, Valley Baptist Health Plans ensures you will have continuous access to quality health care services.  However, the continued participation of any single physician or provider cannot be guaranteed throughout the plan year.

Medicare 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 Valley Baptist Health Plans benefits.

• In general, if you are an active, working employee, Valley Baptist Health Plans 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, Valley Baptist Health Plans 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, Valley Baptist Health Plans 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, Valley Baptist Health Plans will provide benefits secondary to Medicare.  If you are not enrolled in Medicare Part B, Valley Health Plans 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, Valley Baptist Health Plans 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 Valley Baptist Health Plans pays secondary benefits than an individual who is enrolled in Medicare Part B.

   

IMPORTANT NEW NOTICE –

Medicare Part D – (Prescription Drug Coverage)

• Since the current pharmacy program provided by your health plan is as good as or better than the Medicare Part D program, ERS recommends you do not sign up for Medicare Part D for the 2006 Plan Year.
• If you need further Medicare Part D clarification please contact Valley Baptist Health Plans at (800) 829-6440    

Please note that it is your responsibility to ensure that all procedures are properly authorized in advance by Valley Baptist Health Plans and that payment of applicable copayments are made at the time services are rendered.

Informational materials, including a Provider Directory and drug formulary will be available during Summer Enrollment meetings, through your agency benefits coordinator or by calling the Valley Baptist Health Plans Member Services Department toll-free at (800) 829-6440 Monday through Friday, 8 a.m. to 6 p.m. (CST).

Each of us at Valley Baptist Health Plans looks forward to serving you in the
year to come.