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Am I required to select one physician for all my primary health care needs? |
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Yes. Each enrollee selects a personal primary care physician from the list of participating physicians. If you cover your dependents, you will also need to select a primary care physician for each family member. Your primary care physician may be an internist, a family practitioner, general practitioner or a pediatrician for children. Your physician will be qualified to handle most of your health care needs. However, if specialty care is required, you will be referred to a specialist. |
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How do I select a primary care physician? |
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To select a primary care physician, check your provider directory or use Provider Finder®, our Internet-based provider directory. Provider Finder® gives you access to computerized maps and driving directions to physicians, specialists and hospitals within the HMO network. To access Provider Finder, visit our Web site at www.bcbstx.com/ut. You may also call Customer Service for assistance in selecting a primary care physician. |
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Can I see my OB/GYN without a referral? |
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Yes. You have direct access to OB/GYNs in the HMO network. If you need specialty care, your OB/GYN may refer you to a specialist. |
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What do I do if I need to see a specialist? |
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Your primary care physician can provide most of your health care needs. However, if after evaluation your primary care physician determines that the services of a specialist are necessary, the appropriate level of care you receive will be coordinated by your primary care physician. Services provided by a specialist require a referral from your primary care physician in order to be covered. |
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How do I add a child or spouse to the plan? |
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Newly acquired dependents due to marriage, birth or adoption may be added within 31 days after the qualifying event. Contact your employee benefits representative within 31 days after you have a change such as marital status, birth or adoption of a child, or if you retire or get other health care coverage. |
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May I change my primary care physician? |
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Yes. You may change your physician if necessary. To change your primary care physician or that of a family member, contact your employer and complete the proper form or simply call Customer Service. The change becomes effective the first day of the month after the change request form is received by the HMO. You will receive a new ID card listing your new physician. |
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If I travel outside the service area, what benefits are available? |
A: |
If you are traveling outside of Texas and need to get care, you may be able to obtain service through a Blue Cross and Blue Shield-affiliated HMO. This service to you and your covered dependents includes urgent care and guest membership. There are three types of guest membership:
- Long-term traveler - Subscribers are eligible with a minimum of 90 days to a maximum of 180 days.
- Student - Dependents of subscribers attending school outside the service area are eligible and there is no maximum time limit.
- Families apart - The spouse and/or dependent of the subscriber is eligible with no maximum time limit.
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| Please note: If you travel to an area that does not have a Blue Cross and Blue Shield HMO, there will be no coverage (except for Emergency care). If you are outside the country and require medical care, you are covered for emergency services only. |
For more information about guest membership,
call 1-888-522-2396.
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What should I do if I have additional questions? |
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You can refer to your Certificate of Coverage which you will receive after you enroll, or you can call HMO Customer Service toll free at 1-888-322-2379. Customer Service representatives will be able to answer your benefit questions or concerns, help you make primary care physician selections or changes, and provide you with information regarding how to access care through the HMO plan.
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