The HealthSelectSM of Texas and Consumer Directed HealthSelectSM medical plans are available to members of the Employees Retirement System of Texas (ERS) and their eligible dependents. Both plans include a comprehensive prescription drug program.
On September 1, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) will become the medical plan administrator for both plans. ERS sets the benefits and pays the claims, while BCBSTX manages the provider network, processes claims and provides customer service.
Both plans offer the same provider network, and preventive services provided by a network doctor – like annual check-ups and vaccinations – are covered at 100 percent, even if you haven’t met the deductible.
- HealthSelect has a large provider network of more than 50,000 doctors and other providers.
- You can go to any provider, but you will pay more if the provider is not in the HealthSelect network.
- To get the highest level of benefits you need to designate a primary care physician (PCP).
- You will need a referral from your PCP to receive in-network benefits. You do not need a referral to see OB-GYNs, or to see ophthalmologists or optometrists for routine and diagnostic eye exams.
- There is no annual medical deductible if you stay in the HealthSelect network.
- You are responsible for copayments for doctor and hospital visits and other medical services, such as outpatient surgery and high-tech radiology.
Consumer Directed HealthSelect is a high-deductible health insurance plan available to employees and retirees not eligible for Medicare. It is paired with a health savings account (HSA).
Consumer Directed HealthSelect has a lower monthly premium for dependent coverage, but a much higher deductible. The deductible is the amount you must pay out-of-pocket for covered health services and prescriptions before the plan begins to pay for anything except for preventive care. With this plan you could pay more upfront for health care services and prescriptions before you are eligible for coverage.
Here are some things to remember about Consumer Directed HealthSelect:
- You have access to the same large provider network as the HealthSelect of Texas plan.
- You do not need to select a primary care physician.
- You do not need a referral to see specialists.
- Your out-of-pocket costs could be much higher than in other plans.
- To help you pay for higher out-of-pocket costs, the plan allows you to participate in a tax-free health savings account (HSA) and receive monthly HSA contributions from the State of Texas.
- This plan is not available to participants who are eligible for Medicare.
- Preventive services provided by a network doctor – like annual check-ups and vaccinations – are covered at 100 percent, even if you haven’t met the deductible.