HMO Blue Texas Plan Features
See the Enrollment Guide (PDF, 778KB) for an overview of benefits and plan description of the HMO Blue Texas plan option.
For detailed information on HMO Blue Texas, including summaries of benefits and plan limitations and exclusions, review the Certificate of Coverage (PDF, 1.2MB).
Learn more about HMO Blue Texas coverage:
Direct Access to OB/GYNs
Emergency Care Anywhere You Go
Disease Management
24/7 NurseLine
Special Beginnings (Prenatal Program)
BlueCard Program (when traveling or living outside of Texas for less than 90 consecutive days)
Guest Membership (when temporarily living outside of Texas in a participating location for 90 days or more)
Prescription Drug Program administered by Prime Therapeutics
Direct Access to OB/GYNs
In addition to choosing a PCP, women may self-refer to a contracting OB/GYN in the same network as their PCP for all obstetrical and gynecological care. A woman may see her OB/GYN for an annual well-woman exam, or as often as needed to treat a gynecological condition, without a referral from her PCP.
Emergency Care Anywhere You Go
When you or a covered family member needs emergency care, go immediately to the nearest emergency facility. You don't need to try to find a network physician. However, be sure to have someone notify your PCP of any hospital admission or treatment you receive within 48 hours or as soon as possible.
Condition Management
HMO Blue Texas provides voluntary condition management programs designed specifically for those who have been diagnosed with asthma, diabetes, congestive heart failure, coronary artery disease, metabolic syndrome (high blood pressure, high cholesterol), lower back pain or end stage renal disease. When you enroll in one of the programs, you'll receive helpful information about your condition, at no out-of-pocket cost to you.
Condition management programs work together with your health plan, doctor and you to help identify the best way to manage your condition more effectively. Enrolling in a program can help:
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Decrease the intensity and frequency of your symptoms
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Enhance your self-management skills
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Minimize missed days at work
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Enrich your quality of life
Claims and pharmacy data review, preauthorization prior to a hospitalization or a physician referral are some of the factors that help determine if a condition management program is right for you. Blue Cross and Blue Shield of Texas will notify your doctor by letter if it finds that you would benefit by enrolling in a program.
Each program addresses your specific needs, based on the severity of your condition, complications and risk factors. If the severity of your condition is mild, you will receive:
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Coverage for targeted preventive screenings
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Seasonal mailings with educational materials related to your condition
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Annual contact calls to encourage medication compliance
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Tools to help you better self-manage your condition
If the symptoms of your chronic condition are moderate to severe, your program will be tailored to provide you with:
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Personalized self-management planning
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Regularly scheduled monitoring by a registered nurse
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24-hour-a-day telephone access to a specialty nurse
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An audio library of topics related to your condition, available by telephone around-the-clock
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Assistance in getting durable medical equipment covered under your health plan
Call 1-800-462-3275 to enroll or to find out more about how condition management programs can help you.
24/7 NurseLine
A staff of trained, experienced registered nurse counselors is available 24/7 to answer health care questions and provide information about a wide variety of health care issues and medical, non-emergencies. To talk to a nurse, call this toll-free number: 1-888-315-9473.
Special Beginnings®
Special Beginnings is a comprehensive prenatal program that helps mothers take better care of themselves and their babies. The program assesses pregnancy risk level and provides close monitoring through a series of calls from an experienced obstetrical nurse from pregnancy through six weeks after delivery. To enroll or ask questions about the program, call toll-free: 1-800-462-3275.
New! Enroll in Special Beginnings during your first trimester and receive a $50 Reward Card from Target when you complete the program after delivery.
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BlueCard Program
In an HMO, care that is not coordinated by your PCP is generally not covered. However, there may be times when you're traveling away from home and need urgent or follow-up care. The BlueCard Program can give you the ability to obtain health care services through a Blue Cross and Blue Shield-affiliated doctor or hospital when you are traveling outside of Texas. If you'll be traveling or living outside of Texas for less than 90 consecutive days and need care that can't wait until you get home, follow these steps:
1. Locate a contracting doctor, hospital or other provider by visiting the online BlueCard Doctor and Hospital Finder or call BlueCard Access at 1-800-810 BLUE (2583).
2. Call your PCP for referrals.
3. Schedule an appointment with the provider.
4. Present your HMO Blue Texas ID card.
5. Pay any copayments.
6. Talk to your PCP about any necessary follow-up care.
Guest Membership
Temporary off-site job? Kids away at school? If you or a covered family member will be temporarily living outside of Texas in a participating location for 90 days or more, you may be eligible for guest membership in a Blue Cross and Blue Shield-affiliated HMO. The benefits available, the amounts you pay for covered services and the requirements for accessing services while a guest member may not be identical to those under HMO Blue Texas. When you enroll and become an HMO Blue Texas member, you can call an Away from Home Care coordinator who will find a participating HMO near your temporary location and handle your application for guest membership. When you return home to your HMO Blue Texas service area, you will again access services under the HMO Blue Texas coverage. Refer to your HMO Blue Texas Certificate of Coverage for more information on guest membership.
