This chart provides a comparison of the Retiree HRA and Retiree HSA Options for participants who are not eligible for Medicare.
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Retiree HRA Option1 |
Retiree HSA Option1 |
Scott & White Health Option |
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Total Possible Medical Option Incentives You May Earn2 in 2019 for 2020 |
You Only: $625 |
You Only: $975 |
N/A |
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In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
In-Network |
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Deductible |
$1,500 |
$3,000 |
$1,800 |
$3,600 |
$500 |
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Coinsurance maximum3 |
$2,800 |
$5,600 |
$3,000 |
$6,000 |
$2,500 |
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Out-of-pocket maximum3 |
$4,300 |
$8,600 |
$4,800 |
$9,600 |
$3,000 |
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You Pay |
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Preventive care |
40% after deductible |
40% after deductible |
$0, no deductible |
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Doctor office visits |
20% after deductible |
40% after deductible |
20% after deductible |
40% after deductible |
$20 copay |
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Most other eligible expenses except prescription drugs |
20% after deductible |
40% |
20% after deductible |
40% |
10% after deductible |
(1) Claims must be filed within one year of date of service.
(2) Starting in 2019, any incentives earned will be paid to you in the form of a paper check from Oncor. The money can be used for any expenses, and is not limited to health care expenses. Incentives paid are subject to ordinary income tax.
(3) If you are enrolled in the Retiree HSA and have individual coverage (the “You Only” coverage category), you must meet the individual deductible each year before the option starts paying benefits. If you have family coverage (the “You and Spouse,” “You and Children” coverage category), you must meet the family deductible before the option starts paying benefits, even if only one family member has claims. However, an individual will be responsible for no more that $4,800 in out-of-pocket maximum expenses.
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Retiree HRA |
Retiree HSA Options |
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Prescription Drug (Rx) Coverage |
In-Network |
In-Network |
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Rx deductible |
$200 |
Included in medical deductible |
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Coinsurance/copay maximum |
$2,000 (excludes Rx deductible) |
Included in medical out-of-pocket maximum |
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Retail (up to a 30-day supply) |
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> Value/preventive generic > All other generic > Preferred brand name(2) (3) > Non-preferred brand name(2) (3) |
$5 copay(1). $10 copay(1) 30% up to $100 max after Rx deductible 40% up to $120 max after Rx deductible
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$5 copay(1) 20% after annual option deductible 20% up to $75 max after annual option deductible 20% up to $120 max after annual option deductible |
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Mail order (up to a 30-day supply) |
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> Value/preventive generic > All other generic > Preferred brand name(2) (3) > Non-preferred brand name(2) (3) |
$10 copay(1) $20 copay(1) 30% up to $200 max after Rx deductible 40% up to $240 max after Rx deductible . |
$10 copay(1) 20% after annual option deductible 20% after annual option deductible, up to $150 annual max 20% after annual option deductible, up to $240 annual max |
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Lifetime maximum medical and Rx benefit |
Unlimited |
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(1) No deductible.
(2) If you are taking a brand name prescription with a generic equivalent and do not switch to the generic, you will pay the generic copayment, plus the difference between the price of the generic and brand name drug.
(3) If a brand name drug (preferred or non-preferred) is less than the maximum copay, you pay the total cost of the prescription.
Maintenance Prescriptions
Maintenance prescription drugs must be filled through the CVS mail order program or at a local CVS pharmacy. You may have up to three grace fills on your current prescriptions before this rule takes effect.
The plan covers three 30-day fills of medications you take regularly at any pharmacy in the CVS network. After that, you can choose to have 90-day supplies of your long-term medications delivered by CVS Caremark Mail Service Pharmacy or pick them up at any CVS Pharmacy+ (including those inside Target stores).
After three fills, you can continue to receive 30-day supplies of long-term medications at any network pharmacy. You must first contact CVS at the number on your prescription card to opt-out of 90-day refills.
Questions? Visit caremark.com or call CVS using the number on the back of your member ID card