HealthSelect participants: Plan Year 2023 starting soon

Plan Year 2023 for active employees and retirees not eligible for Medicare begins Sept. 1, 2022, and runs through Aug. 31, 2023. If you are a HealthSelectSM medical plan participant, here are some changes and reminders to help you make the most of your medical benefits.

Benefit changes and enhancements 

Let’s review some benefit changes you will see this year.

  • Colonoscopy benefits. Preventive care, including colonoscopies and stool-based screenings, are covered at no cost to you. Starting Sept. 1, 2022, follow-up colonoscopies and related services received after a positive screening will also be paid at no cost to you when you use in-network providers.

  • Diagnostic breast imaging benefits. Starting Sept. 1, 2022, for HealthSelect of Texas® and HealthSelectSM Out-of-State participants, in-network breast imaging services covered at no cost to you will include screening and diagnostic mammograms, ultrasounds and MRIs. Out-of-network services will continue to be covered at 40% after the annual deductible is met. Additionally, breast MRIs will no longer require prior authorization.  

If you are enrolled in Consumer Directed HealthSelectSM, you must meet your deductible before in-network diagnostic breast imaging services are covered at no cost. Out-of-network services will continue to be covered at 40% after the annual deductible is met.

  • Out-of-pocket maximum. Starting Jan. 1, 2023, the annual out-of-pocket maximum will increase to $7,050 for employee-only coverage and $14,100 for family coverage. The out-of-pocket maximum includes expenses you pay toward medical and prescription drug copays, coinsurance and deductibles (in-network deductibles apply only to the Consumer Directed HealthSelect plan). If you reach the out-of-pocket maximum before Dec. 31, 2023, the plan will pay 100% of your covered, in-network health costs through Dec. 31, 2023. 

Remember: it pays to stay in-network! There is no out-of-pocket maximum for out-of-network care. 

Tip: Did you know you can earn rewards through the HealthSelectShoppERSSM program? Learn more about eligibility and how to locate a rewards-eligible provider on the HealthSelectShoppERS webpage

Here are three things to keep in mind for the new plan year.

1. Choose a primary care provider. To get the most out of your HealthSelect of Texas benefits, 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 Blue Cross and Blue Shield of Texas (BCBSTX) Personal Health Assistant toll-free at (800) 252-8039 (TTY: 711) or by logging in to Blue Access for MembersSM and following these steps

Tip: In the HealthSelect of Texas plan, referrals are required 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 seeing 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, but we strongly recommend having a PCP to help manage your overall health.

2. New medical ID cards. The new Texas Consolidated Appropriations Act requires medical ID cards to include deductible and out-of-pocket maximum amounts. Beginning in September 2022, if you request a new medical ID card or download a temporary card in Blue Access for Members or the BCBSTX App or by calling a BCBSTX Personal Health Assistant, you’ll see these changes. All HealthSelect participants will receive a new medical ID card by the end of the year.

3. Blue Access for Members enhancement. Your Blue Access for Members account is getting a refresh. When you log in starting September 1, you may notice things look a bit different. The simplified new look will make it easier to find what you need within your account. Be sure to take the virtual tour when you log in after September 1, and stay tuned for more detailed information next month.

If you have benefit or wellness questions related to your HealthSelect medical plan, 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.