Benefits

Staying in your health plan’s network will save you money

All ERS health plans are network-based, which means you’ll save money—sometimes a lot of money—if you see provider’s in your plan’s network.

HealthSelectSM medical plan participants have out-of-network benefits, but get the highest level of benefits when using in-network doctors, hospitals and other health care facilities for their care. When a health care provider is in-network, it means they have agreed to charge you a lower negotiated rate for health care. HealthSelect has more than 50,000 in-network health care providers across Texas.

If you’re a HealthSelect participant, you always have the choice to see any provider you would like, but if you choose a provider who is not within the HealthSelect network, you’ll pay more.

In HealthSelect, here are four ways you save money when using in-network providers for care:

  1. Preventive care you get from in-network providers is covered at 100%, depending upon physician billing and diagnosis. You have no out-of-pocket costs for in-network preventive care. If you are enrolled in HealthSelect of Texas®, you must have a primary care provider (PCP) on file with Blue Cross and Blue Shield of Texas (BCBSTX) to receive in-network benefits for preventive services. If you have not chosen a PCP after 60 days of being an active HealthSelect of Texas participant, out-of-network benefits will apply for any services you get—even from in-network providers.
  2. BCBSTX negotiates lower prices for care, also called the “allowable amount,” with providers in the HealthSelect network. In-network providers can’t balance bill you—which means that they cannot charge you more than the allowable amount for a service.
  3. You don’t have to pay a deductible for in-network services before your plan pays benefits if you are enrolled in HealthSelect of Texas or HealthSelectSM Out-of-State. If you’re enrolled in Consumer Directed HealthSelectSM, your in-network deductible is half the amount of the out-of-network deductible.
  4. You pay a copay and/or the lower in-network coinsurance level for health care. A copay is the set dollar amount you pay for certain covered services. Coinsurance is the percentage of allowable charges you must pay for some services. If you are enrolled in Consumer Directed HealthSelect, or if you get care from an out-of-network provider, you must meet your deductible before coinsurance applies.

Use Provider Finder to find in-network providers

When you need to search for in-network care, you can use Provider Finder to compare costs, get quality ratings for providers and find in-network providers in your area. Log in to Blue Access for Members to access Provider Finder.
Through Provider Finder, you can also participate in HealthSelectShoppERSSM, a new program that allows eligible HealthSelect participants to save money and earn incentives by shopping for in-network medical care and choosing lower-cost, quality care providers for certain medical services and procedures. Learn more about the program.

Call a BCBSTX Personal Health Assistant

It pays to stay in network. If you need help finding in-network care, call a BCBSTX Personal Health Assistant toll-free at (800) 252-8039, Monday–Friday 7 a.m. – 7 p.m. and Saturday 7 a.m. – 3 p.m. CT.

Source: ERS News About Your Benefits (October 2020)

 

 

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