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Frequently Asked Questions

  • What is a copayment (copay)?
    A copay is the amount paid at the time of service for certain medical services and prescription drugs. Copays do not apply to deductibles or out-of-pocket maximums. For UT SELECT, when using in-network providers, the office visit and preventive care copays depend on whether the doctor is a family care physician (FCP) or a specialist.
  • What is the difference between a family care physician (FCP) and a specialist?
    Family care means care provided by family practitioners, internists, OB/GYNs and pediatricians. All other physicians are specialists.
  • What is a deductible?
    A deductible is the amount of out-of-pocket expense that must be paid for health care services by the covered person before becoming payable by the health care plan. UT SELECT features a "plan year" deductible. The plan year begins September 1 and ends August 31 of the following year.
  • What does out-of-pocket maximum mean?
    When a person reaches the plan's out-of-pocket maximum, UT SELECT then pays 100% of any eligible expenses for the rest of the plan year. The amounts include the deductible. Copays will continue to apply after the out-of-pocket maximum is met.
  • What is coinsurance?
    Coinsurance is the percentage of medical expenses that you and the plan share. For example, when using in-network providers, UT SELECT pays 80% of the allowed amount and you pay 20% of the allowed amount after the deductible is met.
  • What are transitional benefits?

    If a person is currently seeking care or undergoing a course of treatment from an out-of-network provider at the time coverage goes into effect, that person may request ongoing care with that provider for a period of time. To continue receiving the highest level of benefits, a transitional care request form must be completed and approved. The form is available from the website. The form may be mailed or faxed; instructions for submitting the request are on the form.

    IMPORTANT – If you are already seeing a network provider, you do NOT need to complete the transitional care request form.

    All requests are subject to approval.

    If the transitional care request is approved, the person may continue to see their out-of-network provider and receive the in-network level of benefits. However, the patient may be billed for charges exceeding the Blue Cross and Blue Shield of Texas allowable amount.

    If the transitional care request is denied, the person may continue to see their out-of-network provider, but benefits will be paid at the out-of-network level.