The high-deductible health plan (HDHP) part of Consumer Directed HealthSelectSM is very different from the other Texas Employees Group Benefits Program (GBP) health plans in that it has high annual deductibles for both in-network and out-of-network coverage. The deductible is the amount you owe for covered health services or prescriptions before the plan begins to pay for anything except for preventive services.
- Preventive services – like annual check-ups and vaccinations – are covered at 100%, even if you haven’t met the deductible.
- Out-of-pocket costs could be much higher than in HealthSelect of Texas and the HMOs. To help you pay for higher out-of-pocket costs, the plan allows you to participate in a tax-free health savings account (HSA).
- No primary care physician (PCP) is required.
- You don't need a PCP referral to see a specialist.
- The HDHP is administered by UnitedHealthcare and has the same large, nationwide provider network as HealthSelect of Texas. You can go to out-of-network providers, but you will pay more.
- People eligible for Medicare cannot participate in Consumer Directed HealthSelect.
Calendar Year Deductibles and Out-of-Pocket Maximums for 2017 (January 1 – December 31, 2017)
|| Family Coverage
|Annual in-network deductible
|Annual out-of-network deductible
|Annual in-network, out-of-pocket maximum*
|Annual out-of-network, out-of-pocket maximum*
*Out-of-pocket maximums are based on federal regulations and might change from year to year.
Once you meet the deductible, the plan pays a percentage of health expenses:
- 80% for in-network health and prescription services (you pay 20%) and
- 60% for allowable out-of-network health and prescription services (you pay 40%).
Visit the Consumer Directed HealthSelect website