July 1, 2012
Dear GBP Participant:
Community First Health Plans (CFHP) is pleased to be the Health Maintenance Organization (HMO) offered through the Texas Employees Group Benefits Program (GBP) in your service area for Plan Year (PY) 2013. CFHP is a locally owned and managed HMO based in San Antonio. What this means to you is that our corporate offices are right here, and the people responsible for the services you receive are your neighbors. The fact that we are a non-profit organization means revenues stay in your community and are used to improve our level of service to you.
To select a primary care physician (PCP) from the CFHP network, Click on "Provider Directory", then click on "Find a Physician" at the bottom of the page. Call CFHP at (210) 358-6262 or toll-free at (877) 698-7032 to let us know your choice. You can also request to change your primary care physician on our website by submitting a secure request through our secure member portal. Click on "contact us" then "send a secure request to Member Services."
- Enhanced vision benefit - Through an agreement with OptiCare, your vision benefit includes, in addition to the exam, the following:
Lenses (single, bifocal, trifocal, lenticular)
$125 allowance on frames
$125 allowance for fitting and contact lenses in lieu of glasses
A 15% discount on LASIK at LasikPlus
Features you add to the lenses are at an additional charge to you. A flyer with details on the enhanced benefit is included in the PY 2013 Annual Enrollment materials.
- Enhanced Travel Network - You and your covered family members have the option to see a First Health Network provider in an urgent or emergency care situation while traveling outside of the CFHP HMO service area. If you are in need of urgent or emergency care while you are traveling outside of the service area, you may contact First Health at (800) 226-5116 to locate a provider.
- Online Health Risk Assessment Program - We are pleased to once again offer members access to an online health risk assessment.
Medicare Benefits are 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, you must file claims with Medicare first. You are responsible for sending the Medicare explanation of benefits form to us for determination of CFHP benefits.
- In general, if you are an active, working employee, CFHP 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, CFHP 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, CFHP is the primary payer.
Medicare Part B - (Supplemental Medical Insurance)
- If you were retired and became Medicare-eligible before September 1, 1992, and you are enrolled in Medicare Part B, CFHP will provide benefits secondary to Medicare. If you are not enrolled in Medicare Part B, CFHP 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, CFHP 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 CFHP pays secondary benefits than an individual who is enrolled in Medicare Part B.
If the provider does not accept Medicare assignment, CFHP must pay the difference between the Medicare maximum allowable amount and the Medicare paid amount, less the appropriate copayment. CFHP requires providers to collect copayments.
IMPORTANT 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 2013 Plan Year. If you need further Medicare Part D clarification, please contact CFHP at (210) 358-6262, or toll-free at (877) 698-7032.
We look forward to being of service once again to the State of Texas and higher education employees, retirees, and dependents.
A. Greg Gieseman
President and CEO
*ERS cannot and does not guarantee the length of time that a specific type of "Value-Added" product shall be offered. Any questions or concerns about these products should be directed to the sponsoring HMO.
NOTE: CFHP has made every effort to provide accurate information about its products, services and provider networks. Because this information changes, you can verify information by calling our Member Services department.