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Preparing to Serve Our Members In 2018

Aug. 01, 2017

A Message from Our President

As the debate on health care delivery continues in Washington, D.C., health insurance remains in the spotlight. We know health insurance matters in the lives of Texans. That's why Blue Cross and Blue Shield of Texas (BCBSTX) stays committed to expanding access to affordable health coverage.

Our goal is to provide health coverage in all 254 Texas counties. To do so, we must provide access to affordable care even as health care and drug costs continue to grow at an unsustainable rate.

At this time each year, we enter our peak period of preparing to sell, renew and implement health insurance products for employers, Medicare recipients and individual customers. This is in addition to supporting new and continuous year-round Medicaid program enrollments in some areas. We work hard to meet the expectations of our members all year long.

BCBSTX is expected to be a leader in health care. To that end, and with an eye toward the future, we commit to the following:

  • We're refreshing our product offerings with new solutions to help existing and prospective members manage their health and wellness. This requires BCBSTX to submit our products and rates to appropriate regulatory agencies each year. We communicate immediate and potential changes to our customers so they have enough time to understand their coverage options and what might change for them. In Texas, we are offering Virtual Visits through MDLIVE®. The new offering aligns with our -focus on affordability of care and is a solution that can cost our members less out of pocket than an urgent care clinic or emergency room (ER).
  • We're readying our operations to sell those products and take care of our members. At least 65% of our business is effective as of January 1 each year, and we're focused on preparing ourselves for this peak period of activity. We are investing in technology and operational models that will create a more personalized experience based on unique customer needs. For instance, our Benefits Value Advisor is available to help members find pricing that cuts down risk and upfront financial investment.
  • We're advocating for consumers by negotiating contracts with doctors, hospitals and pharmacies that focus on results and quality medical practices. No other insurer contracts with more providers in Texas. We’re also putting important data directly in the hands of doctors to help them make the appropriate treatment and business decisions. In Texas, we advocated for laws that protect Texas health care consumers from the excessive charges associated with freestanding ERs. Senate Bill 507 allows PPO plan holders to challenge the runaway charges of some physicians, other health care professionals and freestanding ERs. BCBSTX also supported House Bill 3276 that requires independent freestanding ERs to better inform patients of the emergency room’s participation in insurance networks. This bill will help cut surprise bills and unwanted financial burdens.
  • We're advocating at the federal and state level for those market factors needed to stabilize premiums for the long term and create choice and innovation in our markets.
  • We've implemented a new $10-million community investment plan to impact two major Texas public health issues, Chronic Kidney Disease (CKD) and Chronic Obstructive Pulmonary Disorder (COPD). The program will help raise awareness around the prevention and early detection of two conditions greatly impacting the life span, quality of life and productivity of Texans.

As we navigate all of these moving parts and routine business cycles, we will continue to do everything in our power to stand with our members and our communities. This commitment is what makes us Blue Cross and Blue Shield of Texas, and it is why our company has weathered change for nearly 90 years.

Dr. Dan McCoy
President, Blue Cross and Blue Shield of Texas


RECENT DEVELOPMENTS

Health Care is Complicated, Understanding Individual Insurance Rates

Blue Cross and Blue Shield of Texas filed proposed rates and products in the individual marketplace with the hopes of continuing to offer quality, cost-effective coverage to Texas in 2018.

On August 1, the federal government released the rates from insurers across the country who submitted 2018 products in the individual insurance market. While this may be the subject of conversation and media attention, it’s important to keep a few things in mind:

  • Rate submission and review is an annual process and necessary to participate in the individual marketplace.
  • Rates should be viewed in context, or include, any premium assistance for those who may receive subsidies. Actual out-of-pocket costs will differ based on the financial assistance consumers receive from the government to offset their total monthly premium cost.
  • There is still a lot of uncertainty on the rules and regulations of the individual market for 2018. Our 2018 product pricing reflects that uncertainty and the associated risks that exist within this marketplace. We will continue to work with legislators, regulators and other stakeholders toward getting the necessary certainty around issues like the continued funding of cost-sharing reductions ("CSRs") and mechanisms that encourage broad and continuous coverage.
  • Our rates also account for keeping pace with escalating health care costs and the growing use of that care. If we want to control premiums, then we must focus on the cost of care and the amount of care being used.

It is important to note that while we have submitted rates, our level of participation has not yet been finalized. If we receive regulatory certainty within an acceptable time frame we will review and, where appropriate, adjust our rates if time allows.

Please continue to visit this page for updates to our 2018 products and services in the individual marketplace.