What is a copayment (copay)?
A copay is the amount paid at the time of service for certain medical services and prescription drugs. Copays do not apply to deductibles or out-of-pocket maximums. For UT SELECT, when using in-network providers, the office visit and preventive care copays depend on whether the doctor is a family care physician (FCP) or a specialist.
What is the difference between a family care physician (FCP) and a specialist?
Family care means care provided by family practitioners, internists, OB/GYNs, and pediatricians. All other physicians are specialists.
What is a deductible?
A deductible is the amount of out-of-pocket expense that must be paid for health care services by the covered person before becoming payable by the health care plan. UT SELECT features a "Plan Year" deductible. The plan year begins September 1 and ends August 31 of the following year.
What does out-of-pocket maximum mean?
When a person reaches the plan's out-of-pocket maximum, UT SELECT then pays 100% of any eligible expenses for the rest of the plan year. The amounts include the deductible. Copays will continue to apply after the out-of-pocket maximum is met.
What is coinsurance?
Coinsurance is the percentage of medical expenses that you and the plan share. For example, when using in-network providers, UT SELECT pays 80% of the allowed amount and you pay 20% of the allowed amount after the deductible is met.
What happens if services are not preauthorized?
Blue Cross and Blue Shield of Texas will review the medical necessity of your treatment prior to the final benefit determination. If the treatment or service is not medically necessary, benefits will be denied. There is a $250 penalty for failure to preauthorize a medically necessary admission to a non-network hospital. The penalty will be deducted from any benefit payment that may be due for the admission. The penalty is in addition to the deductible or out-of-pocket maximum.
Is there a time limit for preauthorizing hospital admissions?
All inpatient admissions should be preauthorized at least two working days before admission, or, in the case of an emergency, within 48 hours after admission.
