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Did you know that prices for the same quality medical services can differ by thousands of dollars within the same region and health plan network?
That's why you have Member Rewards, a program that rewards you for choosing a cost-effective, trusted provider for services like MRIs, CT scans, colonoscopies, and mammograms.
Providers who are highly rated for quality, cost-efficient care and appropriate treatment plans have a Top Performing Physician badge in Provider Finder. Below you can see how much you’re rewarded per specialty service. This growing list of reward-eligible specialties includes1:
PCP
Surgical
Medical
*One reward per calendar year is given for seeing a PCP.
**Members can receive one reward for seeing a quality specialist and two rewards for going to a quality specialist at a cost-effective, reward-eligible facility per calendar year.
1. Reward-eligible specialties are subject to change.
If you have TRS-ActiveCare Primary, TRS-ActiveCare Primary+ or TRS-ActiveCare 2, you can use the reward that’s deposited into your Health Care Account for future copays, coinsurance and other medical expenses.
If you have TRS-ActiveCare HD, you can use the reward that’s deposited into your Health Care Account for incurred dental and vision expenses. Once expenses are incurred, fill out this HCA reimbursement form.
An HCA is a health care spending account linked to Member Rewards. Funds are deposited into an HCA after you complete a Member Rewards-eligible procedure and BCBSTX pays your claim and verifies its eligibility.
If you have TRS-ActiveCare Primary, TRS-ActiveCare Primary+ or TRS-ActiveCare 2, you can use HCA funds for:
After your medical claim is submitted, BCBSTX determines what it will pay the provider. This process is referred to as claims adjudication.
As part of this process, the Member Rewards’ funds you earn are put into an HCA that will apply toward your future coinsurance or copays.
Most services process automatically when your medical claim is processed. However, if you need reimbursement that does not occur automatically, you’ll need to complete the TRS-ActiveCare Member Rewards Expense form.
Claims will be processed within 30 days. Once the claim is processed, the funds will be issued within 45 days.
If you have TRS-ActiveCare HD, you can use HCA funds for:
Once you incur vision and dental services, fill out the Member Rewards HCA limited purposes reimbursement form and include a copy of the original receipt for reimbursement.
Please note that TRS-ActiveCare HD has it's own reimbursement form. Make sure you are using the form that says Claim Form for TRS-ActiveCare Member Rewards Limited Purpose Health Care Account (HCA) Expenses at the top.
Please call a PHG at 1-866-355-5999, 24 hours a day, seven days a week, if you have questions or need assistance.
To check your Member Rewards balance, you can call a Personal Health Guide at 1-866-355-5999, 24 hours a day, seven days a week. You can also log in to BAM.
In-network facilities can charge different amounts for the same procedures. For example, Provider A may charge $29 for an X-Ray of the Chest and Provider B may charge $102 for an X-Ray of the Chest.
Going to a cost-effective facility, like Provider A, saves your health plan money and helps lower the cost of health care in your area. So, through Member Rewards, your health plan passes some of the savings to you.
The reward is based on the amount of savings each facility offers. It’s compared to other facilities in the zip code and area you’re searching. Higher savings = higher rewards.
For example, you can earn up to $500 in rewards for a CT Scan of the Abdomen and up to $150 in rewards for a mammogram. Rewards vary by procedure, location and facility. Once you begin your search for a procedure in Provider Finder, you’ll see the amounts listed. You can earn up to $599 total per year.
You can shop for a procedure anytime. In some cases, you get an order from a doctor to have a same-day procedure like an MRI. As long as you shop and identify the location as reward eligible before getting the procedure, you can earn a reward.
There are many cost-effective options. A few examples include:
For a complete list of covered medical services, log in to Provider Finder.
A physician who is highly rated for quality, cost-efficient care and appropriate treatment plans. They’re identified in Provider Finder with a green badge that says Top Performing Physician.
Don't see an answer to your question? Review this list of FAQs. You can also download this handy Member Rewards flyer.
A Personal Health Guide can also help you find a reward-eligible provider or answer questions about Member Rewards. Call a PHG at 1-866-355-5999 or chat in the BCBSTX App.
BCBSTX has set up a Health Care Account for all TRS-ActiveCare participants eligible for Member Rewards. This HCA is separate from your district’s Flexible Spending Account or your Health Savings Account.
Top performing providers are identified using an evidence-based data and analytics program that measures physician performance based on their efficiency, appropriateness and quality compared to their peers.
You can use the “Top Performing Physician” badge to help when you choose your provider. Please consider all relevant information and consult with your Primary Care Provider when selecting a specialist.
BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.