Help for participants moving from an HMO to HealthSelectSM plans
Health maintenance organization (HMO) plans will no longer be offered through the Texas Employees Group Benefits Program (GBP) after August 31, 2021. All current HMO participants will be enrolled in HealthSelect of Texas®, administered by Blue Cross and Blue Shield of Texas (BCBSTX) effective September 1, unless you chose to enroll in Consumer Directed HealthSelectSM or HealthSelectSM Out-of-State, or waived GBP health coverage during Summer Enrollment.
To get the most out of your HealthSelect benefits, you must contact BCBSTX to name an in-network primary care provider (PCP). If you haven’t named 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.
Here are answers to some commonly asked questions about the transition:
1. Can I see a list of the in-network providers before September 1? Can I keep my current provider?
You can find in-network providers before your coverage effective date. To search for in-network providers, go to the Find a Doctor/Hospital tab on the HealthSelect website. Under “I'm looking for a doctor, hospital, or provider” click the button for the plan in which you are enrolling. You can also 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 for help finding providers.
More than 90% of HMO network providers participate in the HealthSelect network, so you will likely find that your current doctor is already in the network. If your current provider is not in the HealthSelect network, you can nominate them to the network.
2. Can I choose my PCP before September 1?
Yes. You can search for in-network providers and then call a BCBSTX Personal Health Assistant to name a PCP before September 1. This will help ensure that BCBSTX has a PCP on file for you and any covered dependents on your plan. If your current provider is in the HealthSelect network, you will still need to let BCBSTX know that he/she will be your PCP. Remember, you and your covered dependent(s) can have different PCPs.
You and any covered dependent(s) will get a new HealthSelect of Texas medical ID card in August 2021. If you chose a PCP after the cards have been issued, you will get a new medical ID card with your PCP listed.
3. When do my out-of-pocket maximums restart?
HealthSelect out-of-pocket maximums and deductibles restart on January 1 each year. For participants joining HealthSelect from an HMO, any previous spending for Plan Year 2021 through your HMO will carry over to your HealthSelect plan. This means that instead of ending August 31, your medical expenses through December 31, 2021, will continue to go toward your 2021 out-of-pocket maximum.
4. If I need a referral for care my PCP cannot provide, can I request a certain provider?
If you want to see a specific in-network specialist, you should discuss your choice with your PCP, who will submit the referral to BCBSTX for you.
Referrals are required under the HealthSelect of Texas plan. A referral is an order from your PCP that must be authorized through BCBSTX for you to see a specialist. For most services, you need to get a referral before you can get medical care from anyone except your PCP.
There will be a 90-day referral grace period for in-network specialist office visits for participants who are transitioning to HealthSelect of Texas from an HMO plan. This means transitioning participants will get in-network benefits if they see an in-network specialist between September 1 and November 30 without a referral on file with BCBSTX.
This does not apply to out-of-network specialist office visits.
After November 30, if you see a specialist without a referral on file, you will pay for your specialist visit at the out-of-network benefit level, even if your specialist is in-network.
After this initial grace period, if you don’t get a referral before you get services, your services will be considered out-of-network, and you will pay more, even if the provider is in your plan’s network. For help with referrals, you can also call a BCBSTX Personal Health Assistant.
5. What are my prescription drug benefits?
HealthSelect medical plans include coverage for prescription drugs. Learn more about HealthSelect Prescription Drug Programs at www.healthselectrx.com.
The prescription drug ID card is separate from the medical ID card. You may need to present your prescription drug ID card when filling a prescription.
6. Can I access Blue Access for MembersSM before September 1?
Yes. You can register for a Blue Access for Members account as soon as you get medical ID card in the mail. You will need to use your member ID number, which will be on your HealthSelect medical ID card.
For more information about HealthSelect of Texas benefits, visit www.healthselectoftexas.com.
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