Non-Medicare (Pre-65) Benefits

Contact HR Customer Service  

Mailing Address
P.O. Box 839966
San Antonio, TX 78283-3966

Physical Address
Riverview Towers Building
111 Soledad, Suite 100
San Antonio, TX 78205

Phone
210.207.8705

Hours
Monday - Friday
7:45 a.m. - 4:30 p.m.

Contact HR Customer Service Email

What You Need To Know 

Complete details about the medical plan are available in the Summary Plan Document - Consumer Choice or the
Summary Plan Document - New Value. In the event of a discrepancy between any document and the official Plan Document, the Plan Document shall govern.

View the 2020 Retiree Benefit Matters for information about the retiree health care program, including premiums.

Summary of Benefits and Coverage

As part of the Patient Protection and Affordable Care Act, group health plans are required to provide you with an easy-to-understand summary about your health plan’s benefits and coverage. The new regulation is designed to help you better understand and evaluate your health care choices. 

The new forms include: 

  • A short, plain language Summary of Benefits and Coverage, or SBC 
  • A uniform glossary of terms commonly used in health insurance coverage, such as "deductible" and "co-payment" 

The SBCs for non-Medicare retirees are below: 

If you have any questions about your health plan, contact Human Resources Customer Service at 210.207.8705.

Eligibility/Dependent Eligibility

Eligible Retiree 

City of San Antonio employees who leave the City with at least 20 years of service or have five years of service and are 60 years of age are eligible for City of San Antonio retiree medical benefits as follows: 

  • Employees with a hire date prior to October 1, 2007 are eligible to enroll in a City retiree medical plan with a total combined premium subsidy of 67%. 
  • Employees with a hire date on or after October 1, 2007 are eligible as follows: 
    • 5-9 years of City service are eligible to participate with no City subsidy 
    • 10+ years of City service are eligible to participate with 50% City-subsidized premium 

Retirees who meet eligibility requirements for retiree medical benefits must enroll in a City retiree medical plan within 31 days from the date of separation from service.

Waiving medical coverage

Retirees also have the option to waive coverage. If a retiree chooses to waive coverage, they must do so at the time they separate from the City. Those who choose to waive coverage are allowed one opportunity to re-enter the City's plan at a later date, as long as they provide proof of continuous health insurance coverage.

The continuous coverage can be a spouse’s plan, employer plan, or individual plan and enrollment must be requested within 31 days of the loss of that coverage. Retirees may only enroll those dependents who were covered at the time coverage was waived and must return to the plan when you do; they will not be added to the plan at a later date. Those who do not enroll in retiree health insurance coverage at the time of separation and do not elect to waive coverage will not be allowed on the plan at any time.

Eligible Dependent

Dependents may be enrolled in City retiree health benefits if they were covered at the time of your retirement and you enroll them at the time of your initial retiree medical election. Dependents who continue to meet eligibility requirements will remain on the plan until you remove them, cease to make the required contribution, or the dependent no longer meets the eligibility criteria.

Retirees who waived coverage at the time of separation and are eligible to come back and enroll in a City retiree medial plan, may only enroll those dependents who were covered at the time coverage was waived. Dependents must return to the plan along with the retiree; they will not be added to the plan at a later date.

Selections made during Annual Enrollment will be effective for the upcoming plan year, January 1 through December 31. There are certain life events that can happen during the year that will allow you to change the level of coverage (retiree only, retiree plus one, or retiree plus two or more) for your health plan. 

Those life events are: 

  • Divorce, Annulment, Dissolution of a Domestic Partnership
  • Death of a dependent

You must notify the Employee Benefits Office within 31 calendar days of your life event and provide all required documentation in order for the changes in your coverage to take effect during the calendar year. If you fail to notify the Employee Benefits Office within 31 days and do not provide documentation, you forfeit any past premium refund.

Non-Medicare retirees can enroll in one of two (2) Preferred Provider Organization (PPO) health plan options administered by Blue Cross and Blue Shield of Texas. With the Consumer Choice and New Value health plans, you have the ability to see any physician or other health care professional from the Blue Cross and Blue Shield of Texas network, including specialists, without a referral. In addition, the coverage is the same for both plans; however, the amount you pay out-of-pocket varies from plan to plan. In-network preventive care services are covered at 100% for all four plans. 

Below is a a brief overview of each plan. Detailed information about your health plan options can be found on pages six (6) through 13 of the 2020 Retiree Benefit Matters guide. 

Consumer Choice (Consumer-Driven Health Plan) PPO 

No co-pays, deductible must be met before the health plan pays, lowest premium contribution 

In-Network Benefits

Retirees who choose in-network providers pay: 

  • Annual deductible of $2,000 for individual ($4,000 for family coverage)  
  • With this plan, there are no co-pays. You are responsible for 100% of the cost of health care services (ex: prescription medications, office visits, x-rays) until the deductible is satisfied. 
  • Once the deductible is satisfied, you pay 20% of discounted eligible expenses up to a maximum of $4,000 for an individual or $8,000 for family coverage per year. Amounts above this annual maximum are paid by the City at 100% of eligible expense. 
  • Consumer Choice allows you to save for future and pay for current qualified health care expenses with a Health Savings Account (HSA). The City will contribute $500 for a retiree-only plan and $1,000 for a family plan into your HSA. With an HSA, you own the funds in an HSA and they roll over from year to year, including interest. 
NEW! blue essentials hmo

Mid-level out-of-pocket expense, HMO network (Texas only), mid-level premium contribution 

In-Network Benefits
(out-of-Network Benefits not available)

Retirees pay: 

  • Annual deductible of $1,500 for individual ($3,000 for family coverage)  
  • Office visit co-pays: Primary Care - $25 Urgent Care - $75 Specialist - $45; These payments are not subject to the deductible or co-insurance, but they do count toward your out-of-pocket maximum. 
  • Once the deductible is satisfied, you pay 20% of discounted eligible expenses up to a maximum of $3,500 for an individual or $7,000 for family coverage per year. Amounts above this annual maximum are paid by the City at 100% of eligible expense. 
NEW VALUE PPO

Mid-level out-of-pocket expense, highest-level premium contribution 

In-Network Benefits

Retirees who choose in-network providers pay: 

  • Annual deductible of $1,500 for individual ($3,000 for family coverage)  
  • Office visit co-pays: Primary Care - $30 Urgent Care - $75 Specialist - $50; These payments are not subject to the deductible or co-insurance, but they do count toward your out-of-pocket maximum. 
  • Once the deductible is satisfied, you pay 20% of discounted eligible expenses up to a maximum of $3,500 for an individual or $7,000 for family coverage per year. Amounts above this annual maximum are paid by the City at 100% of eligible expense. 

Prescription Drug Benefit

The City’s prescription drug benefit, administered by CVS/caremark, provides you with access to a wide variety of drugs while helping to make the medications you need more affordable. You also have access to a wide variety of in-network pharmacies to fill your next prescription.

The prescription drug co-pays are below. For additional details, including information about the Automatic Generics, Value-Based Co-pays Program, and the convenience of the Mail Order Pharmacy Program, see pages six (6) and 14 of the 2020 Retiree Benefit Matters.

2020 Prescription Drug Plan
Tier New Value Co-Pays Value-Based Co-Pays
(Diabetes Medications)

30-day Retail

Tier 1 $10 $0
Tier 2  $35 $10
Specialty  $100 N/A

90-day Mail Order

Tier 1 $20 $0
Tier 2  $70 $20

Remember, Consumer Choice does not have co-pays. You are responsible for 100% of the cost of your medication until you reach your deductible. For IRS-approved maintenance medications you only pay 20% of the cost since these medications are not subject to the deductible. Click here for a complete list of these medications.

Retirees continue to have a voluntary vision plan benefit available to them. The City's vision plan benefit, administered by Davis Vision, provides you and your dependents with access to a national network of doctors and retail providers to help you care for your eyes. Eye exams, eyeglasses, and contacts are available to you at only the cost of applicable co-pays. To locate a vision provider near you or for additional information, log onto www.davisvision.com, click on the Members tab, and enter the 2471 (City's Client Code) in the Open Enrollment section. You can also call Davis Vision at 1-800-448-9372.

View page 18 of the 2020 Retiree Benefit Matters for additional vision plan details.

Frame Benefits and contact lens

With Davis Vision's Frame Collection, you have access to several designer and brand name frames (in lieu of contacts) at only the cost of applicable co-pays. For frames outside of the Davis Vision Collection, you are allowed a $130 retail allowance. In 2019, when you shop at a Visionworks store, you will receive a $155 retail allowance toward any frame. Plan eyewear includes a one-year eyeglass breakage warranty at no cost to you.

Contact lenses selected (in lieu of eyeglasses) from Davis Vision's Contact Lens Collection are covered in full.

Davis Vision Collection

To maximize your vision plan benefit, consider purchasing frames or contact lenses from the Davis Vision Collection. The Collection is available at most participating independent provider locations. Independent providers do not include retail stores such as Visionworks or Walmart. To locate a participating independent provider near you, visit www.davisvision.com.

Benefit Summary

Comprehensive Eye Exam - $10 co-pay, one exam per year

Eye Glasses Contacts
Frames (in lieu of contacts) Contacts (in lieu of eyeglasses)
Once per calendar year beginning January 1. Once per calendar year beginning January 1.
$130 retail allowance toward any frame from provider, plus 20% off balance³. $150 retail allowance toward non-Davis Collection Contact lenses, plus 15% off balance1.

Or

Visionworks Allowance: $155 retail allowance toward any frame from a Visionworks provider, plus 20% off balance. Any contact lenses from Davis Vision's Contact Lens Collection2

Or

Any Fashion or Designer frame from Davis Vision’s Collection¹ (value up to $195).
Contact Lens Evaluation, Fitting & Follow Up Care - Once per calendar year beginning January 1. Collection contact lenses covered in full, including fitting fee. Fitting fee is an additional charge minus 15% discount if Non Collection contact lenses².
One year eyeglass breakage warranty included at no additional cost.
Spectacle Lenses - Once per calendar year beginning January 1. For standard single-vision, lined bifocal, or trifocal lenses.
  • ¹For dependent children, monocular patients, and patients with prescriptions of 6.00 diopters or greater.
  • ²Davis Vision Collection is not available at retail providers. It is only available at participating independent provider locations.   
  • ³Additional discounts not applicable at Walmart or Sam’s Club locations.

Retirees now have the opportunity to participate in a voluntary dental benefit administered by Delta Dental. For detailed plan information, including a directory of dental providers, the enrollment form, premiums, and plan highlights, visit the
Delta Dental website. You can also call 1.800.422.4234 (DeltaCare DHMO) or 1.800.521.2651 (DeltaDental PPO).

DeltaCare Dental HMO administered by Delta Dental

The DeltaCare Dental HMO is a dental plan that provides comprehensive dental care when services are obtained from an in-network primary dentist. During open enrollment, select a dentist within a 35-mile radius of your zip code from the DeltaCare network to serve as your primary dentist.

With this plan, you are only responsible for the co-pays for any covered services you receive from your selected dentist. There are no deductibles, yearly maximums, or paperwork claims to file. Examples of common services and co-pays are listed below.

Description Procedure Code Co-Pay
Office Visit D0999 $5
Oral exam, x-rays, and fluoride treatment
Note: Fluoride treatment specific for children up to age 19.
N/A No Co-pay
Prophylaxis (teeth cleaning twice a year) D1110 No Co-pay
Periodontal scaling and root planning, per quadrant D4341 $40
Amalgam Fillings for one surface, anterior D2140 $5
Surgical extraction and erupted tooth D7210 $45
Root Canal – Endodontic Therapy, molar 
(excluding final restoration)
D3330 $280
Crown D2750 $295
Orthodontics for children and adults D8070 (children) / D8090 (adults) $1,700 / $1,900
Citident ppo administered by Delta Dental

The CitiDent PPO is a dental PPO plan that allows you to obtain care per the chart below from the dentist of your choice. Obtaining services from an in-network provider will lower your out-of-pocket costs.

COVERAGE TYPE IN-NETWORK      OUT-OF-NETWORK
Type A - Preventive Care (cleanings and oral exams) Covered at 100% $5
Type B- Basic Care (fillings, simple extractions, and periodontics) Covered at 100% No Co-pay
Type C- Major Care (bridges and dentures) Covered at 50% No Co-pay
Deductible (individual / family) $50 / $150 $40
Annual Maximum Benefit (per person) $1,200 $5