HealthSelect and The Consumer Directed HealthSelect of Texas plans are offered through ERS (Employees Retirement System). These plans are currently administered by Blue Cross Blue Shield of Texas. Coverage is effective the first day of the month following the 60th day of employment. Employee only coverage for full time employees is paid fully by the employer at no cost to the employee along with a $5,000 term life insurance policy for the employee. UNT pays 50% of all dependent medical coverage with the other 50% paid by the employee. Deductibles, coinsurance maximums and out-of-pocket maximums reset annually on January 1. For example, if you had previously met your coinsurance maximum of $2,000 this will reset to $0.00 again on January 1.
HealthSelectSM of Texas Medical Plan
HealthSelect of Texas is available to members of the Texas Employees Group Benefits Program (GBP), retirees under 65, and their eligible dependents.
Selecting a primary care provider
If you are enrolled in HealthSelect of Texas, you need to choose a primary care provider (PCP) to receive the highest level of benefits and keep your health care costs down. Your PCP serves as your first point of contact when you need non-emergency medical care.
Your PCP is responsible for coordinating your care, making referrals to see specialists, and writing orders for lab and imaging services. To receive in-network benefits, your PCP will need to submit a referral to Blue Cross and Blue Shield of Texas (BCBSTX) before your visit. If you do not have a referral on file before you see a specialist, you likely will pay more, because your visit will be considered out-of-network. Your specialist or lab services facility also must be in-network for you to receive in-network benefits. You can verify network status by calling a BCBSTX Personal Health Assistant toll-free at (800) 252-8039.
Select your PCP before getting care
You have 60 days from the effective date of your coverage to select a PCP. Once you make your PCP selection, all services must be coordinated through your PCP in order to receive in-network benefits. After 60 days, if you still have not selected a PCP, out-of-network benefits will apply for any services you receive.
You can select or change your PCP by calling a BCBSTX Personal Health Assistant toll-free at (800) 252-8039 or by logging in to Blue Access for Members:
- If you already have a Blue Access for Members account, log in using your username and password. Otherwise, register for Blue Access for Members following the instructions on the screen.
- Once you’re logged in, go to the “Doctors and Hospitals” tab.
- Click “Select Primary Care Physician.”
Consumer Directed HealthSelect
Consumer Directed HealthSelectSM is a high-deductible health plan paired with a health savings account (HSA). If you are enrolled in Medicare, you are not eligible for this plan. Consumer Directed HealthSelect has the same provider network as HealthSelect of Texas, which includes more than 50,000 providers throughout Texas. You do not need to choose a primary care physician. You will pay less for your health care if you see providers who are in the HealthSelect network.
You are responsible for paying the full cost of health care (except preventive care) and prescriptions until you reach your annual deductible of $2,100 per individual or $4,200 per family for in-network services and $4,200 per individual or $8,400 per family for out-of-network services. Deductibles reset on January 1 each year.
Prescription Coverage
The prescription program is administered by OptumRX and automatic for those enrolled in a medical plan. You will receive a separate prescription card to use at the pharmacy.
Deductibles, coinsurance maximums and out-of-pocket maximums reset annually on January 1. For example, you may pay more for a prescription in January than you had paid previously in December, due to the annual deductibles resetting January 1.
https://www.optumrx.com/oe_ers/landing
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