UnitedHealthcare® administers the HealthSelect Medicare Rx (PDP) plan. If you became eligible for Medicare during the year, please follow ERS’ instructions for enrolling in this plan.
Learn about the enrollment process»
Get an overview of your plan benefits and costs, and find detailed information about additional coverage and benefit services.
HealthSelect Medicare Rx (PDP)
provided through Employees Retirement System of Texas
Deductibles, copayments, coinsurance, tiers, Medicare prescription drug plans, costs, covered prescriptions, generic and brand-name drugs. Tier 3 $100 copayment/ prescription; deductible does not apply N/A Non-Preferred Brand Tier 4 50% coinsurance up to a maximum of $1,000 per prescription; deductible does not apply N/A CCI/HMO/Gold Tiered/BS SG (01/2021) 75091CT1140001 Effective Date: 1/2021 CompassHMOTi126807 CT H05057217 / MA H05257218 Compass HMO Tiered Copay/Coins.
View 2021 plan details
- Plan Guide(PDF)(1.1 MB)
Includes:- Summary of Benefits
- Drug List
- Additional Drug Coverage(PDF)(69.6 KB)
- Comprehensive Formulary(PDF)(583.1 KB) Updated 5/2021
- Evidence of Coverage(PDF)(1.3 MB)
Prescription drug costs
HealthSelect Medicare Rx has tiered copays. Many generics medications are in Tier 1 and have the lowest copay. Many name-brand drugs are in Tier 2 and have a higher copay. Tier 3 drugs have the highest copay and are generally non-preferred medications. Please see the copay chart below for more information.
Benefits and costs | HealthSelect Medicare Rx (PDP) |
|---|---|
Prescription Drug Deductible Amount | $50 deductible |
Standard Retail Cost-Sharing | Up to a 30-day supply non-maintenance Tier 1: $10 copay Tier 2: $35 copay Tier 3: $60 copay Up to a 30-day supply maintenance Tier 1: $10 copay Tier 2: $45 copay Tier 3: $75 copay |
Extended Days Supply (EDS) Retail Pharmacy and In-network Mail Order | Up to a 31 - 60-day supply Up to a 61 - 90-day supply |
Mail Order Cost-Sharing | Up to a 31 - 60-day supply Up to a 61 - 90-day supply |
Prescription drug lookup
Find out if the prescription drugs you take are covered by your plan. You'll need your prescription information, dosage and frequency. Use this tool to determine your prescription's copay tier:
- See if my medication is covered »
Drug list
Your plan can help you save money on prescription drugs. Medicare and your plan pay part of your drug costs, and you pay the rest. View the drug list with thousands of brand name and generic prescription drugs.
Prescription drug materials
- Plan Guide(PDF)(1.1 MB)
Includes:- Summary of Benefits
- Drug List
- Additional Drug Coverage(PDF)(69.6 KB)
For instructions on how you can submit your prescription to the mail order pharmacy, please review the mail order brochure(PDF)(272.5 KB) (which includes the mail order form). Some participating HealthSelect Medicare Rx retail pharmacies are part of the Extended Days Supply (EDS) Retail Pharmacy and In-network Mail Order and will fill a long-term medication (31- to 90-day supply) at the same co-pay as the mail order pharmacy. For a listing of the pharmacies in this network, please click on the EDS Pharmacy List (PDF)(161.8 KB).
Pharmacy network
There are more than 67,000 pharmacies in our network. See if your pharmacy is in network»
Additional benefits information
- Medication Therapy Management Program»
- Prescription Drug Transition Process»
- Help with Medicare Prescription Drug Costs»
How to Register(PDF)(734.0 KB)
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FAQs (119.9 KB)
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Va Tiered Copay
PDF (Portable Document Format) files can be viewed with Adobe® Reader®. If you don’t already have this viewer on your computer, download it free from the Adobe Web site.
Our provider would like to know whether we can derive real-time benefit information on claim coverage reliant on visit number limitations. For instance, if an request came in for a member who has coverage for 5 visits, and already has had 6 visits, could the response alter the co-pay to reflect they've exceeded their limit?
I found RFI #719 which is very similar. Using that as a basis for, the first five visits for a service type code are subject to one co-pay amount and visits that exceed five have a different co-pay
The EB and HSD segments could be displayed:
EB*B**98****20*****N~ (Co-Pay 20, OON)
HSD***VS**31*5~ (Visits Not Exceeded 5)
Tiered Copayment Medication Structure
EB*B**98****40*****N~ (Co-Pay 40, OON)
HSD***VS**30*5~ (Visits Exceeded 5)
Va Tier Copay
Would this be correct?
Yes, this information can be included on the 5010 271 response. The proposed response is close, but would require one more EB loop and some slight changes.
If it can be determined what tier based on visits used should be returned to the provider the response would include segments as follows:
EB*B**98***27*20*****N~ (Co-Pay $20 per visit, OON)
HSD***VS**31*5~ (Visits Not Exceeded 5)
If it cannot be determined what tier based on visits used should be returned to the provider the response would include segments as follows:
EB*B**98***27*20*****N~ (Co-Pay $20 per visit, OON)
HSD***VS**31*5~ (Visits Not Exceeded 5)
EB*B**98***27*40*****N~ (Co-Pay $40 per visit, OON)
HSD***VS**30*5~ (Visits Exceeded 5)
Note: EB04 and EB05 should always be included to note which plan in the response this set of benefit information applies to. It was omitted from this example because there are not sufficient details in the request to know what to include.
Tiered Copayment
EB*B**98***27*40**99*6**N~ (Co-Pay $40 per visit, OON, 6 visits used)
HSD***VS**30*5~ (Visits Exceeded 5)