Plan Documents
The Summary of Benefits Coverage (SBC), provided separately from the Benefits Guide, summarizes the key features of our medical plans, including covered benefits, cost-sharing,
coverage limitations, and exceptions.
The Glossary of Health Coverage and Medical Terms will help you understand some of the most common language used in health insurance documents.
You may obtain a detailed description of coverage provisions including the Summary of Benefits Coverage (SBC) and the Glossary of Terms – both of which are available in English and Spanish – and/or the Summary Plan Document (SPD) from Human Resources & Risk Management (HRRM) Employee Benefits. They are also available on the Benefits & Wellness website at benefitsathctx.com/resources.
You may obtain a printed copy of the SBC or the Glossary of Health Coverage and Medical Terms at no charge by contacting the Benefits Division at 713-274-5500, or toll free at 866-474-7475 and it will be sent to you within seven business days.
Notice of Privacy Practices
This Notice describes how medical information about you may be used and disclosed and how you can request access to this information. Review it carefully.
This Notice is for participants and beneficiaries in the Plan.
As a participant or beneficiary of the Plan, you are entitled to receive this Notice of the Plan’s privacy practices with respect to your health information that the Plan creates or receives (your “Protected Health Information” or “PHI”). Our “Notice of Privacy Practices” was updated to comply with new changes to the Health Insurance Portability and Accountability Act (“HIPAA”) effective as of October 1, 2018.
This Notice is intended to inform you about how we will use or disclose your PHI, your privacy rights with respect to PHI, our duties with respect to your PHI, your right to file a complaint with us or with the Secretary of the United States Health and Human Services (“HHS”), and how to contact our office for further information about our privacy practices.
This Notice and the most updated “Notice of Privacy Practices” will be posted at benefitsathctx.com/resources, or you may request a copy by calling 713-274-5500.
COBRA Notification Obligations
The federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides group health insurance continuation rights to employees, spouses, and dependent children if they lose group health insurance due to certain qualifying events. Two qualifying events under COBRA require you, your spouse, or dependent children to follow certain notification rules. You are required to notify Harris County of a divorce or if a dependent child ceases to be a dependent child under the terms of the group health insurance plan.
Each covered employee, spouse, or dependent child is responsible for notifying Harris County within 60 days after the date of the divorce or the date the dependent child ceased to be a dependent, as defined under the terms of the Group Health Insurance Plan. Failure to properly notify Harris County within the required 60 days will forfeit all COBRA rights that may have arisen from these two qualifying events.
Notice of Wellness Program Participation
Harris County wellness programs and services are voluntary and available to all insurance-eligible employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program, you will be asked to complete a voluntary health risk assessment or “HRA” that asks a series of questions about your health-related activities andbehaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You may also be asked to complete a biometric screening, which will include a blood glucose and/or cholesterol test. You are not required to complete the HRA or to participate in the blood test or other medical examinations.
However, employees who choose to participate in the wellness program will receive a monetary incentive for completing specific actions and be eligible for the 2025 Healthy Actions Medical Plan. Although you are not required to complete the specific actions, only employees and covered spouses who do so will receive the incentives.
If you are unable to participate in any of the health-related activities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting Aetna at 800-228-6481.
The information from your HRA and the results from your biometric screening, if applicable, will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as health coaching. You also are encouraged to share your results or concerns with your own doctor.
PROTECTIONS FROM DISCLOSURE OF MEDICAL INFORMATION
We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and Harris County may use aggregate information it collects to design a program based on identified health risks in the workplace, Harris County Employee Wellness will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.
Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information is(are) a Aetna health coach(es) in order to provide you with services under the wellness program.
In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any days will forfeit all COBRA rights that may have arisen from these two qualifying events. data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you promptly in accordance with state and/or federal law.
You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate. If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact the Director of Harris County Human Resources & Risk Management or the Director's designee (713-274-5000). If you have questions or concerns about disclosures of your health information, please contact the County Attorney's Office at 713-755-5101.
Medicare
PARTS A & B
Medicare becomes the primary insurer when a retiree, or a dependent of a retiree, turns 65 or becomes eligible due to disability. Harris County medical benefits then become secondary to Medicare.
The Harris County Medical Plan coordinates its benefits with Medicare Parts A & B. Since Medicare is the primary insurance, it must pay benefits first before the Harris County Medical Plan will pay benefits. The Harris County Medical Plan will pay benefits as if Medicare Part B paid first even if you are not enrolled in Medicare Part B. This will cause a gap in your coverage if you do not enroll in Medicare Part B as a retiree.
NOTE: If you are actively at work upon attaining the age of 65, you do not need to purchase Medicare Part B. If your spouse’s primary insurance is the Harris County plan, they do not have to purchase Medicare Part B until you retire.
Active employees and their covered dependents who are eligible for Medicare may postpone enrolling in Medicare until the employee retires. Each employee and/or their dependent should make this decision based on their individual situation. Medicare will pay secondary to the Harris County Medical Plan for covered services if you do choose to enroll while actively employed. You should contact the Social Security Administration at 800-772-1213 if you have any questions concerning coordination of benefits between the Harris County Medical Plan and Medicare.
PART D
Harris County Medicare eligible employees and retirees should NOT enroll in Part D — Medicare Prescription Drug Plan. Enrollment in a Medicare Prescription Drug Plan is voluntary, but Harris County’s Medical Plan administered through Cigna typically provides more comprehensive prescription drug coverage. In addition, there is no coordination of benefits between Harris County’s medical plan and the Medicare Prescription Drug Plan; however, there will continue to be coordination with Medicare Parts A and B.
If you meet certain income and resource limits, Medicare’s Extra Help Program may assist in paying some of the costs of its prescription drug coverage. You may qualify if you have annual earnings of up to $21,870 ($29,580 for a married couple living together) and up to $16,600 in resources ($33,240 for a married couple living together).
If you don’t qualify for the Extra Help Program, your state may have programs that can help pay your prescription drug costs. Contact your State Health Insurance Assistance Program (SHIP) for more information at 800-252-3439. Remember that you can reapply for Extra Help Program at any time if your income and resources change.
For more information and assistance with your prescription drug costs, call Social Security at 800-772-1213 or visit socialsecurity.gov. If you or any of your covered dependents are eligible for additional coverage through Medicaid, you should contact 800-MEDICARE (800-633-4227) or visit medicare.gov to determine the best prescription drug option for you.
2023 Federal Income Tax Return
The Affordable Care Act requires Harris County to send an annual statement to all employees eligible for health insurance coverage describing the insurance available to them. The Internal Revenue Service (IRS) created Form 1095-C to serve as that statement.
This form will be mailed directly to your home address in early 2024.
WHAT YOU NEED TO DO:
- Provide the required information. We need specific information on people enrolled in the health plan in order to provide you a complete 1095-C. If we do not have accurate Social Security numbers on every dependent, the IRS may impose a penalty for non-compliance.
- Ensure that your mailing address is correct in the County’s payroll system so that you can receive your 1095-C. You will need information from your 1095-C to prepare your 2023 taxes.