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

June 2017

2017 Blue EssentialsSM Benefit Option Highlights

Earlier this year, Blue Cross and Blue Shield of Texas (BCBSTX) announced the name change of their HMO Blue TexasSM network to Blue Essentials. BCBSTX appreciates your participation in the new network and is excited to share additional information about a few health plans with access to the network.

The Blue Essentials network will be coupled with plan designs that help manage costs, and allow flexibility and customization like predefined deductibles, coinsurance and copayments for certain health care services. Below are highlights of three health benefit plan options that access the Blue Essentials network.

Blue Essentials

  • Helps members manage costs because they are required to select a primary care physician and get referrals for services with network providers.
  • No out-of-network coverage, except for emergency services.
  • Provides emergency and urgent care when members are traveling out of state.
  • Offers customer support and reference tools to guide members with making informed decisions about their benefits.

Blue Essentials AccessSM

  • Allows “open access” within the Blue Essentials provider network where primary care physician selection and referrals are NOT required (as of Jan. 1, 2017). This access gives opportunities to contracted physicians and hospitals throughout the state of Texas.
  • 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 or obtaining a referral to see a specialist.
  • Offers emergency and urgent care when members go out of network or are traveling out of state.
HealthSelectSM of Texas and Consumer Directed HealthSelectSM Plan Design

  • Beginning Sept. 1, 2017, BCBSTX will administer HealthSelect of Texas and Consumer Directed HealthSelect for the Employees Retirement System of Texas (ERS). Eligible participants will access care through the Blue Essentials provider network in all 254 counties in Texas.

Our Blue Essentials network serves commercial employer groups in the state of Texas and we're pleased to offer it to support the HealthSelect product for ERS participants starting Sept.1, 2017.

Health Plans with Access to the Blue Essentials Network

Benefit Plan/Product Name

Network Code

Network

Mid- and Large Market Availability

Retail and Small Group Availability

Network Coverage

PCP Required

Referral Required

Out of Network Benefits

Plan Design

Blue Essentials

HMO

Blue Essentials

51-151 Fully Insured; 151+ Fully Insured & Self-funded/ASO

N/A

Statewide

Yes

Yes

No

HMO

Blue Essentials Access

HMO

Blue Essentials

51-151 Fully Insured; 151+ Fully Insured & Self-funded/ASO

N/A

Statewide

No

No

No

HMO Open Access

HealthSelect of Texas

HME

Blue Essentials

ERS – Effective 9/1/2017

N/A

Statewide

Yes
(for in-network benefit level)

Yes
(for in-network benefit level)

Yes

POS

Consumer Directed HealthSelect

HME

Blue Essentials

ERS – Effective 9/1/2017

N/A

Statewide

No

No

Yes

Open Access HDHP/HSA

Please note: If you are currently a participating provider in the Blue Essentials (formerly HMO Blue Texas) provider network, no action is required on your part. However, if you would like to be contracted for the Blue Essentials provider network, please go to the Blue Essentials Network Participation page on BCBSTX’s provider website or contact your Network Management Representative.

Watch for additional information regarding Blue Essentials in future editions of this newsletter and on BCBSTX’s provider website.