The Blue Essentials product is health care coverage that provides benefits only when services are received from providers in the Blue Essentials HMO network when prescribed, directed, or authorized by the member's Primary Care Physician (PCP) or the HMO. Members electing the Blue Essentials are required to choose a PCP from a network of contracting doctors in the Blue Essentials network. This doctor coordinates the member's care and helps the member make informed decisions, including recommendations for wellness and preventive care services. In addition, female members can receive specialized care from an OB/GYN from the same network as their PCP without a referral.
Blue Essentials HMO offers a wide range of benefits without financial surprises. Members will have a predictable copayment, no deductible, and no claims or other paperwork to file. Plans offered include varying copayment options including a differing office visit copayment when services are received from a PCP or specialist. The Blue Essentials product also includes Away From Home Care® (AFHC) Guest Membership coverage for members living out of the service area for at least 90 consecutive days.
The Blue Essentials network includes more than 451 hospitals and 38,000 providers statewide (Source: Internal PREMIER Reports, July 2009). By choosing Blue Essentials HMO, clients choose more than just a health plan. They’re choosing health coverage provided by Blue Cross Blue Shield of Texas, one of the most widely recognized health insurance companies in the state.
For more detailed information on the benefit designs available, covered benefits, services or supplies that are limited or excluded, general administration of the plan, or any other questions you may have regarding our products and services, please contact us for the phone number of the regional sales office near you.