Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

December 2016

BCBSTX New Health Benefit Plan ‘Blue Essentials AccessSM’ Offers More Options for Members

Effective Jan, 1, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) is offering a new benefit plan Blue Essentials Access, which is designed to give members access to the Blue EssentialsSM (formerly HMO Blue TexasSM) provider network of contracted physicians and hospitals throughout the state of Texas. This plan provides an alternative solution for members who are looking for cost savings while still having the freedom to choose in-network providers without selecting a primary care physician (PCP) or obtaining a referral to see a specialist. Also, emergency and urgent care is available when members go out-of-network or are traveling out of state.

Our growing selection of new benefit plan offerings reflects BCBSTX’s commitment to increasing access to affordable, quality health care services for our members in all 254 Texas counties.

The Blue Essentials Access plan is designed to:

  • Allow members the benefit option of “open access” within the Blue Essentials provider network where PCP selection and referrals are not required. 
  • Help manage costs and enable flexibility and customization, including features like predefined deductibles, coinsurance and copayments for certain health care services.
  • Provide members’ access to the statewide Blue Essentials network.

Reminder: The Blue Essentials benefit plan will maintain the same standard HMO features including:

  • Benefit plan design and benefits are not changing.
  • Members still being required to select a primary care physician and get referrals for services with in-network providers.
  • No out-of-network coverage, except for emergency services.
  • Support, tools and guidance to help members make informed decisions and the best use of their benefits. 

The updated Blue Essentials/Blue Essentials Access Preauthorization/Referral Requirements list is located in the General Reimbursement Information section of the BCBSTX provider website.

Please refer to Provider Finder® to assist you in finding contracted doctors or hospitals within the Blue Essentials network for the Blue Essentials and Blue Essentials Access benefit plans for your patients.

If you have any questions, please contact your Network Management Representative.