Serving Our Members in 2019
A Message from Our President
August 09, 2019
At Blue Cross and Blue Shield of Texas (BCBSTX), we know that health care coverage means more than just having access to health insurance. Buying health insurance and going to a doctor or hospital — even with insurance — can cause financial strain for many households.
That’s why our commitment to Texans extends to investing in solutions that will lead to a long-term, affordable path for the future of your health. Our members have already begun to see progress through some of our investments and initiatives in our state
- We’re working with local doctors and other health care partners to influence the price we pay for care and make sure our members get effective and appropriate services in the right settings.
- Social determinants or other factors outside the health care system can play a big role in a person’s cost of care. We will continue collaborating with our long-standing network of community partners to help provide our members with access to transportation and healthy food. This includes piloting foodQ, a nutritional delivery service in 15 Dallas ZIP codes determined to be food desserts.
- Our new project with Texas A&M University Health Science Center will support collaborative care and healthy communities by identifying and implementing solutions to health care challenges facing rural and underserved communities in our state.
- We’re collaborating with 10 key research institutions across Texas to research the critical issues created by gaps and fragmentation that lead to a high cost health care system. The projects will focus on a range of health care challenges, including topics such as behavioral health and vaccine adherence.
This year, BCBSTX celebrates 90 years of serving Texans. As a customer-owned organization, we celebrate the members who make our health care coverage possible. From newborn babies to World War II veterans to Hurricane Harvey victims, BCBSTX members have been through it all. It’s been our honor to walk alongside them.
I encourage you to visit our Newsroom to learn more and keep up with the latest updates and progress we’re making that could impact you and your family. We look forward to introducing new member-centered programs, forging deeper partnerships with our communities and care providers and, as always, standing with our members in sickness and in health.
Dr. Dan McCoy
President, Blue Cross and Blue Shield of Texas
Affordable Care Act (ACA) 2018 Medical Loss Ratio (MLR) Rebates
Aug. 05, 2019
What Is the ACA’s MLR?
In general, the ACA’s MLR is the percentage of insurance premium dollars that a health insurer spends on health care services and expenses reported as activities to improve health care quality.
The ACA set MLR standards for health insurers. The ACA’s MLR standard for the large group market is 85%. The ACA’s MLR standard for individual and small group markets is 80%.
If an insurer’s MLR doesn’t meet or exceed the ACA’s MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.
Blue Cross and Blue Shield of Texas (BCBSTX) will provide MLR rebates in the Texas individual market because we didn’t meet or exceed the ACA’s MLR standard in that market in 2018.
We will provide MLR rebates in the Texas individual market by Sept. 30, 2019.
BCBSTX met or exceeded the ACA’s MLR standards in the Texas small group and large group markets in 2018. As a result, no MLR rebates will be provided in those markets for 2018.
For more information, please read Key Questions About the ACA’s MLR.
Health Coverage Remains in Place for Blue Cross Blue Shield Federal Employee Program® (FEP®)
Jan. 09, 2019
Health care coverage for members of the Blue Cross Blue Shield Federal Employee Program (FEP) remains in place and active during the government shutdown. Eligible FEP members can also contact Blue Cross and Blue Shield of Texas if they have a Qualifying Life Event, such as the birth of a baby that allows them to change their coverage or add eligible individuals to their policy.
We remain committed to the health and wellbeing of our members and want them to know that they will continue to have full access to their health care coverage during this time.
Transition to Wellbeing Management for Many Employer Groups
Jan. 01, 2019
On Jan. 1, six million employer group customers will transition to Wellbeing Management. This new program replaces Blue Care Connection®, our previous health management and wellness offering. Wellbeing Management is a new holistic approach to health and wellbeing using integrated, multidisciplinary teams to help manage a member’s care comprehensively throughout their health journey.
The program also provides expanded digital solutions for members to become more engaged in their health. By focusing on whole person health, Wellbeing Management provides us with a better understanding of our members, so we can help connect them with the quality, affordable health care they need. For questions or to learn more, contact your customer advocate at the number on the back of your health insurance card.
Annual Drug List Updates for Employer Groups
Jan. 01, 2019
Each year, the Blue Cross and Blue Shield of Texas prescription drug lists for our employer group customers are reviewed and updated. Drugs can be added or removed from the lists due to pharmaceutical industry changes and to make sure the medications on the drug list are safe, effective and affordable.
It’s important to note that generic equivalents are available for most medications excluded from a drug list. Members should discuss any medication concerns with their doctor or pharmacist.
First quarter changes for most non-regulated employer group plans go into effect on Jan. 1, 2019. Affected members were sent a letter detailing the updates.
Changes and effective dates may depend on group funding type (fully insured/self-funded), plan renewals and the specific prescription drug list the group has selected.
Texas Judge Rules Individual Mandate Unconstitutional. Nothing Changes for Our Members.
Dec. 16, 2018
You may be aware that a federal judge in Texas ruled that the individual mandate was unconstitutional, and that the entire Affordable Care Act was invalid. For now, nothing changes; current and 2019 coverage remains in place for our members and employers.
We expect this decision to be appealed, and for the litigation process to continue for a period of time. We are currently reviewing the decision and will keep you updated on any next steps.
Meanwhile, Blue Cross and Blue Shield of Texas continues to work with state and federal regulators and legislators to ensure a stable and affordable health insurance market that is accessible to all Americans regardless of health status.