Welcoming HMO participants to HealthSelect
Health maintenance organization (HMO) plans will no longer be offered through the Texas Employees Group Benefits Program (GBP) effective September 1, 2021. All HMO participants who do not have Medicare as their primary insurer will be automatically enrolled in HealthSelect of Texas®, administered by Blue Cross and Blue Shield of Texas (BCBSTX), but can choose to enroll in Consumer Directed HealthSelectSM or waive their GBP health coverage during their Summer Enrollment phase.
The Employees Retirement System of Texas (ERS) is making this change because it found that continuing to offer HMO plans could result in an increase in health care costs, which could affect the state’s ability to provide health insurance over the long term. Last May, ERS’ Board of Trustees approved a recommendation to discontinue HMO options rather than rebid the HMO contracts that expire this year.
Scott and White Care Plans (SWCP) and Community First Health Plans (CFHP) participants should see little difference in medical and prescription drug benefits between the HMOs and HealthSelect of Texas, and in most instances, the HealthSelect of Texas benefits are better. The HealthSelect plans also offer a variety of benefits and value-added programs that weren’t available through HMO plans.
If you are currently enrolled in an HMO, here is what you need to know:
- Beginning September 1, 2021, you will be automatically enrolled in HealthSelect of Texas if you do not have Medicare as your primary insurer.
- If you don’t want to be enrolled in HealthSelect of Texas, you can enroll in Consumer Directed HealthSelectSM if you are not enrolled in Medicare or waive GBP health coverage during your agency’s or higher education institution’s Summer Enrollment phase.
Important information about primary care providers (PCPs)
HealthSelect of Texas requires you to have a PCP in the HealthSelect network to get in-network benefits. You will have to contact BCBSTX to name an in-network primary care provider (PCP). After your first 60 days in the plan, if you haven’t named a PCP, out-of-network costs will apply to most services—even if you get them from an in-network provider—until you name an in-network PCP. This means that you will pay more of the costs for PCP visits, including an out-of-network deductible and 40% coinsurance, rather than the $25 PCP copay. In addition, preventive care will not be covered at 100%, as it is when you designate an in-network PCP.
The HealthSelectSM network has more than 113,000 medical and mental health providers. More than 90% of HMO network providers participate in the HealthSelect network, and, if you are currently in an HMO, you will likely find that your current PCP is already in the network. HealthSelect participants do get coverage when they see out-of-network providers, but will pay more—sometimes a lot more—if they do.
To find out if a health care provider is in the HealthSelect network, you can use Provider Finder® or 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. If a provider is not in the network, you can nominate providers to the network.
Consumer Directed HealthSelect is a high-deductible health plan with a health savings account (HSA). You must meet an annual combined medical and pharmacy deductible before the plan pays for any care, except in-network preventive services. If you enroll in Consumer Directed HealthSelect, you do not have to have a PCP on file with BCBSTX or get referrals to specialists, but you may benefit from having a PCP. An in-network PCP can help you control costs. For example, if you get preventive care from an in-network provider, the care is covered at 100% and is not subject to the deductible.
One of the key benefits of Consumer Directed HealthSelect is the ability to save money, tax-free, for current or future health expenses in an HSA. The state will contribute to eligible employees’ and retirees’ HSAs: $45 a month ($540 a year) for individual coverage or $90 a month ($1,080 a year) for family coverage
Whichever HealthSelect plan you join, you and any covered dependent(s) will get a new HealthSelect medical ID card from BCBSTX in August 2021. If you will be in HealthSelect of Texas and choose a PCP during the upcoming Summer Enrollment period, the name of that PCP will be on your medical ID card.
Prescription drug information
HealthSelect insurance plans include coverage for prescription drugs. OptumRx administers the prescription drug program. Learn more about OptumRx at www.healthselectrx.com.
The prescription drug ID card is separate from the medical ID card. You and any covered dependent(s) will get a new HealthSelect Prescription Drug Program ID card from OptumRx in August 2021. You may need to present your prescription drug ID card when filling a prescription.
Other important information
Referrals are required under the HealthSelect of Texas plan for most services. You must have a referral on file with BCBSTX from your designated PCP before you can get medical care from anyone (except your PCP). If you don’t get a referral from your PCP before you get services, you will pay for those services at the out-of-network level.
HealthSelect participants do not need referrals for certain services, including: routine and diagnostic eye exams, OB/GYN visits, mental health counseling, chiropractic visits, occupational therapy and physical therapy, virtual visits, urgent care centers and convenience care clinics.
In some cases, BCBSTX must approve certain medical services and procedures before the plan will cover them. This is called a prior authorization. In general, your network PCP and other network providers are responsible for obtaining prior authorization before they provide these services to you. There are some covered health services, however, for which you are responsible for obtaining prior authorization. Prior authorizations are required for certain services in both HealthSelect of Texas and Consumer Directed HealthSelect.
For more information on referrals, prior authorizations, and covered services, 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.
Additional value-added benefits available through HealthSelect medical plans
Support for you and your family through Care Management Programs. Care management programs give you access to a team of dedicated clinicians who are available by phone to provide extra support and guidance with many mental and medical health concerns.
For general care questions, or if you aren’t sure where to go for care, you can get answers day or night by calling the 24/7 Nurseline at (800) 581-0368.
If you or your covered dependents are in a crisis situation, mental health counselors are available 24/7 at the same number you call for BCBSTX Personal Health Assistants.
HealthSelect can help you save time and money.
Virtual visits. You can connect with medical and mental health virtual visit providers via online video or by telephone anywhere a connection is available, through Doctor on Demand® and MDLIVE®. In-network medical and mental health virtual visits are covered at no cost to participants enrolled in HealthSelect of Texas, HealthSelect Out-of-State or HealthSelect Secondary. Consumer Directed HealthSelect participants will be required to meet their annual deductible before Virtual Visits are covered, subject to the coinsurance for those plans after deductible is met.
- HealthSelectShoppERSSM is an incentive program that allows you to save money and earn TexFlexSM flexible spending account (FSA) rewards when shopping for certain lower cost, high quality medical services and procedures.
- Blue365 discount program can provide savings to HealthSelect participants. With this program, you can save money on health and wellness products and services from top retailers that are not covered by your health plan.
Journey to wellness
- The Well onTarget® wellness portal gives you access to self-management programs, trackers and personalized coaching.
- Blue PointsSM rewards allows you to earn points for regularly participating in many different healthy activities, and you can redeem up to 17,325 points each year in an online shopping mall.
- The Fitness Program gives you discounted membership options to more than 11,500 gyms and fitness facilities as well as a digital-only membership option.
- Wondr HealthTM and Real Appeal® weight management programs can help you reach and maintain a healthy weight. Weight management programs are covered at no additional cost to eligible HealthSelect participants. You are eligible if you are an employee, retiree or dependent enrolled in a HealthSelect plan (excluding Medicare-primary participants), 18 or older, and have a BMI of 23 or higher.
For more information
If you have any questions about HealthSelect, you can visit the HealthSelect website or call a BCBSTX Personal Health Assistant.