HealthSelect medical plan participants: Welcome to Plan Year 2024
Plan Year 2024 for active employees and retirees not eligible for Medicare began Sept. 1, 2023, and runs through Aug. 31, 2024. Whether you’re new to a HealthSelectSM medical plan or you’ve been enrolled for a while, we want to share some benefit changes for the new plan year and highlight ways you can make the most of your medical benefits.
Let’s review some benefit changes for the 2024 plan year.
As of Sept. 1, 2023, you and your covered dependents can get your diabetic supplies, including test strips and lancets, at the pharmacy through your HealthSelectSM Prescription Drug Program with a valid prescription from your health care provider. HealthSelect of Texas® and Consumer Directed HealthSelectSM medical plans will no longer cover those diabetic supplies. As a reminder, insulin and oral medications for controlling blood sugar are also covered under the HealthSelect PDP.
If you received these types of supplies from your medical plan prior to Sept. 1, 2023, Blue Cross and Blue Shield of Texas (BCBSTX) will notify you by letter in July.
You can call HealthSelect of Texas Prescription Drug Program customer care toll-free at (855) 828-9834 (TTY: 711), 24 hours a day, seven days a week with questions related to diabetic supplies and medications.
Note: If you use these diabetic supplies only for a continuous glucose monitor or insulin pump, you may still be able to get them through your HealthSelect medical plan benefits. To verify coverage and benefit details, call (800) 252-8039 (TTY: 711) toll-free to speak to a BCBSTX Personal Health Assistant.
Tip: You also have access to a team of BCBSTX clinicians who can help answer health questions, including questions about diabetes. Call (800) 252-8039 (TTY: 711) between 8 a.m. and 6:30 p.m. CT, Monday – Friday, and ask to speak with a clinician.
Effective Jan. 1, 2024, the out-of-pocket maximum for the HealthSelect of Texas® and Consumer Directed HealthSelect SM plans will increase to $7,500 for individual coverage and $15,000 for family coverage, which includes you and your dependents. The out-of-pocket maximum includes medical and prescription drug copays, coinsurance and deductibles (in-network deductibles apply only to the Consumer Directed HealthSelect plan). There is no out-of-network out-of-pocket maximum—another reason to choose in-network care.
A primary care provider (PCP) can help can help you get the most from your HealthSelect medical plan—and it’s required in HealthSelect of Texas.
If you’re in the HealthSelect of Texas plan, you must choose an in-network primary care provider (PCP).
- If you don’t name a PCP after your first 60 days in the plan, out-of-network costs apply to most services—even if they’re from an in-network provider—until you name a PCP. This includes preventive care and care from in-network providers and facilities. You can choose or change your PCP by calling a BCBSTX Personal Health Assistant toll-free at (800) 252-8039 (TTY: 711) or by logging in to Blue Access for MembersSM and following the steps.
- You must get referrals from your PCP to see most specialists. If you need to see a specialist during the 60-day grace period, be sure that your PCP is on file with BCBSTX and a referral is in place before you see the specialist. If you visit most specialists without a referral on file, you will get out-of-network benefits, even if the specialist is in-network.
Consumer Directed HealthSelect, HealthSelectSM Out-of-State and HealthSelectSM Secondary participants don’t have to choose a PCP or get referrals to specialists.
Tip: No matter which plan you enroll in, your PCP should be your first stop for preventive care each year. By scheduling annual checkups with your PCP and getting preventive screenings, you may be able to manage and prevent many health issues. Routine annual checkups help you stay healthy and even save money by avoiding costly health care services in the future.
HealthSelectShoppERSSM is an incentive program that allows you to save money and earn rewards in a TexFlexSM health care flexible spending account when shopping for certain medical services and procedures. Learn more about the program by visiting the HealthSelectShoppERS page on the HealthSelect website.
If you have questions related to your HealthSelect medical coverage and benefits, call a BCBSTX Personal Health Assistant toll-free at (800) 252-8039 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m. and Saturday, 7 a. m. – 3 p.m. CT. You can also communicate via secure chat and secure messaging Monday – Friday, 8 a.m. – 5 p.m., after logging into Blue Access for Members.