Employees Retirement System of Texas (ERS)
Fall Enrollment 2020-21
Community First Health Plans (CFHP) is pleased to be the Health Maintenance Organization (HMO) offered through the Texas Employees Group Benefits Program (GBP) in your service area for Plan Year (PY) 2021. CFHP is a locally owned and managed HMO based in San Antonio.
Below is a list of helpful documents and an audio presentation to better understand the benefits we offer you as an ERS Member.
Community First Health Plans offers a wide range of health care benefits for you and your family that you can trust.
For more information about how your health plan works, please read the Member Handbook and your Certificate of Group Health Coverage.
If you need further assistance, please call our Member Services department at (210) 358-6262 or (877) 698-7032. Hours of Operation: Monday – Friday, 8:30 a.m. – 5 p.m., CST
Envolve Vision Providers
Envolve is the vision provider for Community First Health Plans. What this means to you is an extensive list of ophthalmologists, optometrists, and eyewear stores for your family’s vision needs. Please be aware that this network is subject to change. An updated list will always be available on this page. In addition to your routine eye exam, eyewear is available with a $125 plan allowance every 24 months when purchased through a participating Envolve provider. Please see Envolve flyer to learn more.
ERS cannot and does not guarantee the length of time that a specific type of “Value-Added” product shall be offered.
Any questions or concerns about these products should be directed to the sponsoring HMO.
- Envolve Vision Providers
- PY 2021 Envolve Information
- PY 2020 Envolve Information
- FramesDirect.com Claim Form
Mental Health Benefits
Participants have network mental health benefits. Simply choose a network mental health provider and make an appointment. You can find a network provider by logging into your online account or calling us at (210) 358-6262 or toll-free at (877) 698-7032 (TTY: (210) 358-6080). Representatives are available Monday – Friday, 8:30 a.m. – 5 p.m. CT
Review the Benefits Fact Sheet for information on costs.
You may also log on to the member portal and access online educational mental health related resources at no cost.
Looking for more information? Click here for access to Community First’s secure member portal and other helpful resources.
Continuity of Care Coverage
Member ID Card
The ERS Supplemental Information form is used to designate a primary care physician (PCP). Please note, they are NOT enrollment forms and do NOT verify eligibility.
There are two forms: one for employees and the other for retirees. PLEASE BE SURE TO READ THE INSTRUCTIONS ON THE BACK OF THE FORM BEFORE COMPLETING.
Supplemental Information Form – Active Employees
Supplemental Information Form – Retirees
Your health plan includes a three-tier prescription drug benefit, which is administered by Community First Health Plans and our Pharmacy Benefit Manager (PBM), Navitus Health Solutions, in accordance with the plan design specified by the Employees Retirement System of Texas (ERS). This means you have can use a robust network of both local and national pharmacy chains for your prescription medications.
Prescription Discount Card
Mail Order Prescriptions
Navitus Participating Pharmacies
Health and Wellness are important to Community First Health Plans. Our Preventive Health and Disease Management department provides a variety of avenues to educate and remind members of preventive measures they can take. Community First is committed to collaborating with our members, health care providers and contracted vendors in improving the health of our members.
If you have asthma, you are not alone. In the United States, asthma affects about 25 million people. Asthma is a chronic lung condition that causes inflammation and swelling of the airways, sensitivity to things that make swelling worse (dust, tobacco smoke, animal dander), and decreased airflow in the lungs. It can affect your activity level, productivity, rest, and attendance at work or school. There is no cure for asthma, but you can learn to manage it so you can maintain a normal activity level and minimize the need for emergency treatment. Our AsthmaMatters Program was developed to provide you with some of the tools you need to prevent chronic and troublesome symptoms and improve your well-being. Members who have asthma are encouraged to complete a health survey. Based on the results, you will be enrolled in the asthma program that is right for you. Educational information is mailed to all AsthmaMatters participants throughout the year. Other aspects of our program help our members who have had difficulty controlling their asthma. These may include a peak flow meter and video, as well as a recommendation to attend an asthma education program.
Our goals are to help you:
- Understand the causes or triggers of your asthma;
- Have normal or near-normal lung function;
- Participate in physical activity without having asthma symptoms;
- Decrease the frequency and severity of flare-ups;
- Promote restful sleep; and
- Increase your quality of life.
Five essentials for good asthma control
- Learn as much as you can about asthma
- Identify and avoid things that make your asthma worse
- Monitor asthma symptoms and peak flow values
- Take asthma medicines as prescribed by your doctor
- Have an action plan to help you handle an asthma flare up
At times, our personal problems may seem too big to handle on our own. These issues and feelings can affect us at school or work, leading to problems on the job or causing stress and illness. Our family life and personal relationships can also be affected. Our Behavioral Health staff is available to provide information and help you choose a professional counselor or doctor who can help you with any of the following topics:
Community First Behavioral Health staff can help you determine the type of behavioral health assistance you may need. Outpatient counseling services available include individual, couple, family, and group counseling. For those who need more intensive treatment, services available include:
- Intensive outpatient
- Partial hospitalization
- Inpatient hospitalization
- Residential treatment
If you are experiencing a chronic mental health condition or require coordination of multiple services, our Behavioral Health staff can assist you with case management services.
Our Case Management staff is available to assist members who have a chronic health condition which requires health care services from several different providers. Community First Case Managers work with you, your family members, your doctors, and other members of your health care team, to be sure you are getting the type and level of care you need. They are available to help you understand your condition, planned tests and procedures, treatment options, and answer health care benefit questions. Community First Case Managers are able to:
- Determine your needs;
- Coordinate care with your doctors and therapists;
- Develop a plan of care that is updated as often as needed;
- Assist in ordering special equipment and supplies;
- Coordinate behavioral health services;
- Initiate home health care;
- Assist with access to community programs;
- Evaluate additional needs; and
- Track your progress over time or changes in your condition.
The goal of the Case Management Program is to ensure members have access to the most efficient and effective health care services they need to promote the highest quality of life possible.
If you are among the 26 million Americans who have diabetes, learn all that you can about your disease. People who take an active role in learning about diabetes are the most successful in preventing or delaying diabetes complications.
When you enroll in the Diabetes in Control Program, you will receive ongoing information on topics such as:
- Controlling your blood sugar;
- Tips for talking to your doctor;
- Routine diabetes screening tests;
- Your role in understanding diabetes and preventing complications;
- Blood sugar testing and supplies; and
- What to do when you are sick.
As a member of Community First, you may be eligible to attend diabetes education classes. Topics include:
- Take control of your diabetes;
- Learn all you can about diabetes;
- Get regular checkups;
- Check blood sugars at home;
- Exercise regularly;
- Maintain your recommended weight (even a small weight loss helps control your diabetes);
- Take care of your skin and feet;
- Follow a meal plan;
- Take medication if necessary.
Healthy Expectations Maternity Program
The first and most important step to having a healthy baby is beginning prenatal care early, as soon as you know that you are pregnant. Through our Healthy Expectations Program, health educators and nurses work with you and your doctor to provide information and answer questions about your pregnancy. A short questionnaire helps us develop an action plan that is right for you and track your progress. Free, informal classes are held throughout the Bexar County area. You will receive information about:
- Doctor visits and tests;
- Your baby’s growth;
- The upcoming delivery;
- Tips for caring for yourself after delivery; and
- Your newborn’s needs.
If you are experiencing problems during your pregnancy, you may enroll in the Healthy Expectations Program. Nurses are available by telephone to answer your questions and give you the added support you may need at this special time.
Register for Your Member Portal
Community First’s Portal is an interactive secure website offered by our health plan for members. Easily navigate through all of your health plan needs here.
- Request a replacement ID card
- Request a PCP change
- Check claim status
- Send a complaint
- and more
Frequently Asked Questions
Do you have a question? Take a look at the answers to some of our most frequently asked questions (FAQs). Members may also submit a secure question to us by logging into our secure member portal.
Do I have access to professional mental health counseling?
Community First’s behavioral health staff includes professional counselors that are ready to help. Contact them if you’d like to talk with someone about anxiety, grief, depression, stress, eating disorders, emotional and physical abuse, and much more. Call us or log in to your Member Portal for more information.
How do I access mental health resources?
As a Community First member, you have access to online mental health related resources at no cost to you. Log into your member portal, then click on “Health Library” to access these educational pieces on anxiety, depression and life balance.
How do I change my Primary Care Physician?
Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032 and a representative can help you designate a new primary care physician. You can also request to change your primary care physician on our website by submitting a secure request through our secure member portal. Click on “contact us,” then “send a secure request to Member Services.”
Is a referral or authorization required to see a specialist?
Although Community First does not require a referral to see a specialist, some specialists require a referral from your PCP in order to see you. You should check with your PCP if a referral is required to see a particular specialist. Additionally, some services require a pre-authorization from Community First before you receive services. Your PCP will take care of this request for you. You can call Member Services to find out if a certain service requires authorization. Services that do not require a referral are:
- Behavioral health services
- OB/GYN services
- Vision exams from an optometrist and ophthalmologist
- Family planning services
Call Member Services if you need assistance finding a provider or with scheduling an appointment at (210) 358-6262 or toll-free at (877) 698-7032.
What emergency, after hours, and urgent care services are available?
Emergency care includes those health care services you receive in a hospital emergency room or comparable facility to evaluate and stabilize medical conditions, including behavioral health conditions. These conditions are of a recent onset and severity (such as severe pain) that require immediate attention.
In a medical emergency, call 9-1-1 or go to the nearest emergency room. Call your primary care physician as soon as possible after you get care so that he or she can help you arrange follow-up care.
Urgent medical care is when you are sick or hurt, and need help within 24 hours to keep from getting worse. You should call your Primary Care Physician, who will direct you based on your symptoms. You may also call Member Services. We have a nurse advice line, available 24 hours, 7 days a week. They can give you guidance based on your situation.
After Hours Care
Illnesses and injuries sometimes occur after normal office hours. If you get sick or injured after hours, you should call your primary care physician. He or she has made arrangements to have their calls answered 24 hours a day, 7 days a week. You can also call Member Services. We have nurses who can help you 24 hours a day, 7 days a week. The nurse might refer you to an urgent care center, the hospital emergency room, or to a doctor who is open after routine office hours. The nurse might also give you home advice. Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032.
What services are available when I am outside Community First's service area?
Basic benefits: Only emergency care services are covered outside the Community First’s network and/or service area, unless medically necessary covered services are not available through Community First’s network of participating providers, or in the case of court-ordered dependent coverage.
If medically necessary covered services are not available through Community First’s participating providers, Community First may allow, upon the request of a participating provider, an authorization to see a non-participating provider.
As a value-added service, we are pleased to offer members an Enhanced Travel Network to access urgent care while traveling. You and your covered family members have the option to see a First Health network provider in an urgent care situation while traveling outside of the Community First HMO service area. If you are in need of urgent care while you are traveling outside of the service area, you may contact First Health at (800) 226-5116 to locate a provider.
Use of a First Health provider in an urgent care or emergency situation outside the service area may decrease your out of pocket costs, including balance billing. Balance billing means that the non-participating provider bills you for the portion of the charges not paid for by Community First.
How do I file a complaint?
If you have a complaint, please call us at (210) 358-6262 or toll-free at (877) 698-7032. A Community First Member Services Representative can help you file a complaint. You may also send us a secure request on our website to tell us about your problem. Most of the time, we can help you right away or at the most within a few days. You can file a complaint with the Texas Department of Insurance (TDI) at any time.
You can contact TDI at:
Texas Department of Insurance
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
What do I do if I am a new member?
Once you have chosen Community First, your next step is to select who will provide the majority of health care services to you and your covered dependents. Your primary care physician (PCP) will be the one you call when you need medical advice, when you are sick, and when you need preventive care such as immunizations. Each member may select his or her own PCP. You will select a PCP from Community First’s extensive network of family or general practitioners, internists, and pediatricians. The selection of a PCP is crucial for immediate access to acute and preventive care. In the event that you do not choose a PCP when you enroll, Community First will select one for you and notify you by mail. Click here for a list of physicians and providers in the Community First network. You can also call our Member Services department at (210) 358-6262 or toll-free at (877) 698-7032 for assistance.
What do I do if I get a bill?
Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032 for assistance. We can help you figure out what to do. Be sure to have a copy of the bill in front of you when you call.
Please note, some Community First in-network facilities (hospitals, emergency clinics, outpatient clinics, ambulatory surgical centers, or other facility providing health care services) may have a facility-based physician or a facility-based health care practitioner, such as a radiologist, an anesthesiologist, a pathologist, an emergency department physician, or a neonatologist that is not included in the network. Community First pays these providers under a fee schedule. These non-participating facility-based physicians and non-participating facility-based health care practitioners may balance bill the enrollee, which means receiving a bill from a provider for the reminder of the charges billed by the provider, for amounts not paid by the enrollee’s health benefit plan (Texas Insurance Code §1456.001,003).
What is my ERS health plan group number?
The ERS health plan group number is 0010180000. This information can also be found on your Community First Health Plans member ID card.
When can I expect my 1095-B form?
Community First will mail 1095-B forms to participants in late February. If you have questions about your Community First coverage, please call Member Services at (210) 358-6262 or toll free at (877) 698-7032.
When can I expect to receive my 1095 form to report insurance coverage for filing my tax return?
Community First mails 1095 forms to University Family Care Plan, ERS, and small group commercial members in late February. If you have questions about your Community First coverage, please call Member Services at (210) 227-2347 or toll free at (800) 434-2347.
If you are a Community First member or network provider, you can communicate with us through our secure Web portal.