Be Prepared for 2023

Use these steps and make the most of your health care coverage.
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Take Us With You

Wherever you are, get the care that works for you.

Know Your Health Plan

Here are some details to know about your health plan. Remember, when you visit a doctor outside of your plan’s network, you may pay more or all of your bill.
  • HMO
    Health Maintenance Organization
  • HMO Plus
    Point of Service
Health Maintenance Organization

Primary Care Provider (PCP)

You’ll need to select a PCP for your care. This is the one doctor who arranges your care and refers you to specialists.

Find an in-network doctor

Prior Authorization

Some services may require prior authorization (pre-approval.)1 Ask your doctor about this so you’re sure who handles this step.

Get details on prior authorization

Plan Network

You’ll need to visit a health care provider in your plan’s network. If you don’t, you’ll pay for most of or the full cost of your care.

Compare cost examples

Preventive Care Services

Some screenings, like your Annual Exam, are included with your health plan at no additional cost.

Schedule your annual exam

HMO Plus
Point of Service

Primary Care Provider (PCP)

You may need to select a PCP. This is your main doctor who sets up your care and refers you to specialists.

Find an in-network doctor

Prior Authorization

You don’t need referrals to visit specialists, but you may need prior authorization (pre-approval).Check with your doctor on this step before getting care.

Get details on prior authorization

Plan Network

You can go to the health care provider of your choice.  Remember, you’ll pay less on health care costs when getting care in your plan’s network.

Compare cost examples

Preventive Care Services

Your health plan lets you get screenings and services, like your Annual Exam, for no additional out-of-pocket costs.

Schedule your annual exam

Find the Right Care

Your primary care provider (PCP) should be your first call when you don't feel well. But, based on your symptoms, you have options for where to get care.

Your Doctor
Get regular care

The person you see for regular checkups or sickness. 

Examples:Fever, colds and flu

24/7 Nurseline
Ask questions

A toll-free number to call for general health-related questions and advice on care options.2 

Examples:Headaches, dizziness or what to do if your child is sick

Virtual Visits
Request a virtual doctor visit on your device

A live, non-emergency medical or behavioral health doctor visit by phone, online video or mobile app.3 

Examples:Allergies, depression or pink eye

Retail Clinic
Get care if your doctor isn’t available

A place to get walk-in, non-emergency care if your doctor isn’t available.4 

Examples:Minor injuries, pain or sore throat

Urgent Care
Get immediate, non-emergency care

A place to get urgent medical attention when your health or life isn't at risk.

Examples:Cuts that need stitches, sprains or animal bites

Emergency Room (ER)
Get emergency care

A place to get emergency care if your health or life is at risk.

Examples:Heart attack, heavy bleeding or broken bones

Get Annual Preventive Care

Know how to find problems early, set goals and track your progress.

Preventive Screenings

Keep your health information up-to-date each year with screens for:

  • Diabetes
  • Cholesterol
  • Heart disease
  • Body Mass Index (BMI)

Some screenings, like your Annual Exam, may be offered at no cost to you if you stay in-network. 

Schedule your annual exam

Preventive Services

Other preventive services that may have no out-of-pocket costs are:

  • Immunizations and vaccines
  • Weight loss programs
  • Ways to stop smoking
  • Maternity and well-child visits

Remember it's important to talk with your doctor about your lifestyle and any life changes.

Learn more about preventive care services

Caring for Your Well-Being

Making sure you’re well mentally and emotionally is part of staying healthy. Help is available for you.

Seeking Emotional Care

Log in to check your Plan Benefit Book to see covered mental health services with your health plan.

Finding Helpful Providers


There are many kinds of mental health experts you can visit. 

Understand Your Pharmacy Benefit

Knowing how your pharmacy benefits work can help lower your prescription drug costs.
  • Review Covered Drugs
  • Ways to Save
  • Other Pharmacy Tips
Review Covered Drugs
Find out if your prescription drug is covered to prevent any surprises at the pharmacy.

Check if your drug is on the 2023 Drug List.

Consider Generic Drugs

Ask your doctor about generic drug options.

Ways to Save
Just like with health care coverage, your pharmacy costs may depend on where you fill your prescriptions.

Generally, you’ll pay lower copay or coinsurance costs if you go to an in-network pharmacy.

When you visit a Preferred Pharmacy Network (PPN), you’ll get the lowest copay or coinsurance amounts.

Other Pharmacy Tips
Always talk to your doctor or pharmacist about any questions or concerns.

For some drugs, you may need to meet certain criteria before coverage can be approved.

Review your prescription plan materials.

Enjoy Member Discounts

With Blue365®, you may save on products and services outside of what your health plan covers.5 

More Resources and Contacts

1 Prior Authorization not required in certain circumstances, such as emergency or urgent situations. 

2 The 24/7 Bilingual Nurseline may not be available with all plans. Check your benefits booklet for details.

3 Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe. Behavioral Health service is limited to interactive audio/video (video only), along with the ability to prescribe in all states. Service availability depends on location at the time of consultation.

Virtual Visits, Powered by MDLIVE may not be available on all plans. Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations, and exclusions. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services.

MDLIVE operates and administers the virtual visit program and is solely responsible for its operations and that of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission.

Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

4 Visiting a Retail Clinic may not be covered with all plans. Check your benefits booklet for details. 

5 Blue365 is only available to Blue Cross and Blue Shield of Texas (BCBSTX) members with active health plan coverage. Members who do not have an active health plan with BCBSTX will not be able to register on the Blue365 website.

The relationship between Blue365, its vendors and BCBSTX is that of independent contractors. Blue365 is a discount program available to BCBSTX members who have medical coverage with BCBSTX. This is NOT insurance. Some of the services offered through Blue365 may be covered under your health plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card for specific benefit information under your health plan. Use of Blue365 does not affect your premium nor do costs of Blue365 services or products count toward your plan deductible, calendar year or lifetime maximums. Discounts are only available through participating vendors.

BCBSTX does not guarantee or make any claims or recommendations regarding the services or products offered by Blue365 and its vendors. You may want to consult with your physician prior to use of these services and products. Services and products are subject to availability by location. BCBSTX reserves the right to discontinue or change this discount program at any time without notice.