Non-Medicare Retirees Health Plans
The City of Fort Worth is pleased to offer you two options for your health insurance coverage: the Basic Plan and the Consumer Choice Plan.
How Your Health Insurance Plans Work
All health insurance plans give you the freedom to choose your doctor or health care facility. Your cost for care depends partly on the plan choice you have made, whether the expense is covered by the plan and whether you choose a Premium Tier 1, in-network or out-of-network provider.
The Provider Network
The network of doctors and facilities can provide care for you and your covered dependents. The providers in the network provide a wide range of services, from the basic and routine care (general practitioners, pediatricians, internists) to more specialized care (OB/GYN, cardiologists, urologists) to health care facilities (hospitals, physical therapy facilities, skilled nursing facilities).
To find in-network providers in your area, you can use the online provider directory. If your preferred doctor is not in the network, you will need to find a provider who is in the network or pay out of pocket. There is no coverage for providers who are out of network.
Sharing the Cost
You share in the cost of your care by either paying a copayment or meeting a deductible and coinsurance for covered expenses. The amount of your cost will depend on the plan choice you have made.
Copayments (Apply to the Basic Plan)
A copayment (copay) is a flat fee for a covered expense. When a copay applies to a given expense, you do not need to meet the annual deductible for that expense. You pay the copay at the time you receive the covered service or supply. Examples are shown in the Benefits at a Glance chart.
The Annual Deductible
The annual deductible is the amount of covered expenses you must pay each calendar year for certain expenses before the plan begins to pay benefits. The deductible applies to certain types of expenses, such as:
- Office visits if on the Consumer Choice plan
- Outpatient surgery
- Inpatient hospital care
- MRIs and CT scans
- Outpatient X-ray or lab performed in a hospital
- Durable medical equipment
- Prescription plan
For expenses that do not have a copay, you must meet the annual deductible, then the plan pays a percentage of the expenses and you pay the rest. Your share of the expense is called your coinsurance. For example, if the plan pays 80 percent of an expense, your coinsurance is 20 percent.
Each of our health plans limit the amount of money you will have to pay out of pocket in a plan year. This is your out-of-pocket maximum. It includes the copays, deductible, coinsurance and the deductible and copays for the prescription drug plan. Once you have reached the out-of-pocket maximum, the plan pays 100 percent of your covered expenses for the rest of the plan year.
Your Prescription Drug Benefits
The health plan offers prescription drug benefits that help you and your family save on both short and long term medication needs.
How it works:
You can fill a short term prescription, up to a 30 day supply, at any retail pharmacy in the network. When you pick up your medication for a network pharmacy, after you have met the deductible, you will pay a copay if on the Basic plan or coinsurance if you are on the Consumer Choice plan.
You can obtain a 90 day supply of long term, maintenance medications through the plan’s mail order service.
When you use a network pharmacy, you pay the lowest amount when your doctor prescribes a generic drug, a higher amount for a preferred or brand name drug on the Plan’s formulary list and the highest amount for a non-preferred or a brand name drug not on the formulary list. The formulary is a list of preferred drugs that includes both brand name and generic drugs. It is designed to provide access to quality, affordable outpatient prescription drug benefits.
City of Fort Worth CareToday Near Site Clinic
New Patient Line: 817-566-7453
Near Site Clinic: 817-566-7466
909 Ninth Ave., Suite 300
Fort Worth, TX 76104
Fort Worth Employees Retirement Fund
Employee Assistance Program
Aetna Resources for Living
Healthy Challenge Wellness Program
Phone: 888-VIVERAE (888-848-3723)
Employee Discounts & Tickets