HealthSelect plan participants’ prescription drug deductibles and any medical deductibles restarted on January 1st. Participants have to reach the deductible amount before the plan pays its share. Coinsurance and total out-of-pocket maximums also started over.
How much is the prescription drug plan deductible?
Except for Consumer Directed HealthSelect (which has one deductible covering both medical services and prescription drugs), all HealthSelect prescription drug plans have a $50 annual deductible per participant.
How much is the medical plan deductible?
The Health Plans Comparison Chart on the ERS website shows the deductible and coinsurance amounts for HealthSelect of Texas and Consumer Directed HealthSelect.
Participants enrolled in HealthSelect of Texas (and your eligibility county on file with ERS is in Texas and you’re not eligible for Medicare):
- In Network: $0
- Out of Network: $500 per individual; $1,500 per family
Participants enrolled in HealthSelect Out-of-State (your eligibility county on file with ERS is outside Texas and you’re not eligible for Medicare)
- In Network: $0
- Out of Network: $500 per individual; $1,500 per family
Participants enrolled in Consumer Directed HealthSelect high-deductible plan
- In Network: $2,100 per individual; $4,200 per family (If you are enrolled in family coverage, the entire family deductible amount must be met before non-preventive benefits are paid for any individual family member.)
- Out of Network: $4,200 per individual; $8,400 per family (Consumer Directed HealthSelect has a combined medical and pharmacy deductible, which won’t pay anything for medical except in-network preventative care and prescription drug expenses until you meet the entire deductible.)
Eligible in-network preventive care is always covered at 100%, no matter which plan you are in.
How much is the annual out-of-pocket maximum?
The total annual in-network out-of-pocket maximums for HealthSelect’s non-Medicare plans are $7,050 per individual and $14,100 per family. The out-of-pocket maximum protects participants from very high health costs over the calendar year. If the member’s or family’s eligible, in-network, out-of-pocket medical and pharmacy expenses (not including premiums) reach the out-of-pocket maximum, the health plan will pay 100% of eligible, in-network expenses for the rest of the calendar year.
For information and assistance visit HealthSelect/BlueCross BlueShield of Texas website or call a BCBSTX Personal Health Assistant at (800) 252-8039 (TTY: 711), Monday – Friday 7 a.m. – 7 p.m. and Saturday 7 a.m. – 3 p.m.
Categories: Benefits