The County of El Paso sponsors a health care plan that is administered by a Third Party Administrator (TPA). As part of the plan, the County develops and maintains a Summary Plan Description (SPD) which describes the Medical, Dental, and Prescription Drug (Pharmacy) Benefits, as well as employee rights and responsibilities. The SPD is a guide to the benefits, provisions, and programs offered by the health care plan.

Each year, the plan is reviewed by staff and the County’s Risk Pool Board and recommendations are made to the Commissioner’s Court during the end of the year budget sessions.  After approval of the budget and with the assistance of the Human Resources Department, County Attorney’s Office, HUB Health Consultants, and Aetna Life Insurance, the changes are reviewed for compliance with the Affordable Care Act and inserted into an updated Health and Dental Summary Plan Description for the following year.         

The 2020 Health and Dental Summary Plan Description includes the following changes: 

• Revised and/or added language to ensure plan is in full compliance with the Health Care Reform.

• Revised language with regards to the elimination of the Buy Up plan option.

• Revised language showing the elimination of the 90 day service waiting period.

• Revised and/or added language to clarify Medicare Eligibility for retiree and/or their dependents coverage and eligibility.

• Added language regarding In-Network coverage in Mexico for members enrolled in the Core plan.

• Added benefit coverage language for Habilitative physical, occupational and speech therapy.

The County’s Health and Dental Summary Plan Description for 2020 were reviewed by the County Attorney’s Office (2020-0394)

The County’s Medical Plan is funded through the Risk Pool Fund.  Fiscal impact is determined by individual use of the medical benefits while on the health care plan.

IS-HEALTH-HEALTH/DENTAL CLAIMS

COIS-5001-0000000-431-10-10000-0001-00000-540007-

June 4, 2018, Item#16, Commissioners Court approved the restatement of the Health and Dental Summary Plan Description Contract No. 2018-0269

August 12, 2019, Item #14, Commissioners Court approved the restatement of the Health and Dental Summary Plan Description Contract No.2019-0410