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Dear State of Texas and Higher Education Employee/Retiree/Dependents:
The Employees Retirement System of Texas Board of Trustees has approved
Valley Health Plans as an 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 2005 plan year.
Valley Health Plans is a locally owned and operated health maintenance
organization, currently serving the healthcare needs of members
in the Rio Grande Valley. You have the option of selecting Valley
Health Plans with no health questions asked or proof of insurability
required during the “Summer Enrollment” period.
Any State of Texas employee who retired on or after September 1,
1992, or retiree who has attained the age of sixty-five (65) on
or after September 1, 1992 shall be required to purchase Medicare
Part B.
If you are age sixty-five (65) or older, benefits will be coordinated
as follows:
• Valley Health Plans will be primary for you and your spouse,
if you are actively employed.
• Medicare Part A and/or Part B will be primary when you are
no longer actively employed.
If you have been diagnosed with end-stage renal disease, benefits
will be determined in accordance with Medicare guidelines.
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 Health Plans
benefits.
Please note that it is your responsibility to ensure that all procedures
are properly authorized in advance by Valley Health Plans and that
payment of applicable copayments are made at the time services are
rendered.
Valley 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 Health Plans
members is delivered through these contracted providers. We also
have arrangements with other local and non-local providers for those
few services which may not be available from plan providers. Through
its network of physicians and other quality health providers, Valley
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 2005 plan year.
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 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 Health Plans looks forward to serving you in
the year to come.
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