When you have an emergency, appropriate medical treatment should be obtained immediately.
Emergency Care for Participants Under Age 65
For medically necessary emergency care during the first 48 hours, services will be paid at the network level. You will pay a $150 emergency room copay, plus 20% of the allowable amount.
If treatment is received after the first 48 hours of an emergency, you must get a referral from your primary care physician (PCP) to receive network benefits. If you do not get a referral from your PCP, you will receive non-network benefits paid on the BCBSTX allowable amount.
For information on how to access care, and for the definition of a medical emergency, refer to your Benefits Book.
Emergency Care for Retirees Age 65 and Over
For retirees with Medicare Primary (Parts A&B): Once your annual Medicare and HealthSelect deductibles are met, Medicare pays 80% of covered services and HealthSelect will coordinate to pay secondary.
For retirees who retired prior to September 1, 1992, and for services not covered by Medicare: Once your HealthSelect deductible is met, HealthSelect pays 70% of covered services and you pay 30%.
If you have been admitted to the hospital from the emergency room, and have exhausted your Medicare Part A benefits, you must call the BCBSTX Preauthorization Department within 48 hours of your admission to get your hospital stay preauthorized. If you cannot make the call yourself, have your doctor or a family member call for you. If you do not get your stay preauthorized, you will have to pay an additional penalty deductible.
For information on how to access care, and for the definition of a medical emergency, refer to your Benefits Book.
Ambulance Services
HealthSelect pays benefits for ambulance services received at the time of an emergency and when determined to be medically necessary by BCBSTX.
Benefits are paid based on the billed amount.
There are no benefits available for ambulance services unless a patient is transported to the nearest hospital equipped and staffed to treat the condition.
Emergency Care Received Outside of Texas and the United States
For emergency care received outside of Texas or the United States, you will receive network benefits for the first 48 hours.
For care received after the first 48 hours of the emergency, an out-of-plan referral may be requested to continue to receive network benefits. Your PCP may request this referral.
For non-emergency care, benefits are paid at the non-network benefit level on the allowable amount.
By using BCBS contracting providers, you will not be required to file claims and cannot be held responsible for charges above the allowable amount. Locate contracting providers outside Texas or outside the United States.
