| BCBSTX Announces New Health Insurance Options for Individuals and Small Businesses
Individual Network Options In anticipation of the upcoming open enrollment season, Blue Cross and Blue Shield of Texas (BCBSTX) introduces its 2016 individual and small group health insurance coverage. Beginning Nov. 1, 2015, Texas residents can choose from coverage options that best fit their varying needs. BCBSTX will again offer its Blue Advantage (BAV) HMOSM to individual members both on and off the Health Insurance Marketplace. Individual members are anyone who buys their own insurance that is not provided by an employer or through a government program (Medicare, Medicaid or CHIP). In addition, BCBSTX will offer the new Blue Advantage PlusSM HMO plan with added Point of Service (POS) benefits to individual members both on and off the Health Insurance Marketplace. This new HMO utilizes the Blue Advantage HMO network of doctors and hospitals while still having out-of-network benefits. The BAV and BAV Plus plans will be offered in all 254 counties across the state. BCBSTX will transition individual members who had Blue Choice PPOSM in 2014 and 2015 to the BAV Plus plan if they do not select a different plan during open enrollment, which opened on Nov. 1. Many of our BCBSTX members will NOT be impacted by this change, including: - Patients covered by large and small employer groups
- Patients with individual coverage who have grandfathered plans (Grandfathered plans are plans that existed on March 23, 2010, when the Affordable Care Act became law.)
- Patients covered by Medicare and Medicaid.
BCBSTX has always been dedicated to helping our members access quality care at the right time, resulting in the best possible outcomes. Managed care, like an HMO, makes health care simple. In each of the offered plans, members will select a primary care physician (PCP) to best coordinate their health care. We will work with impacted members and their provider to minimize the impact of this change to their ongoing care. However, BCBSTX will not provide extended authorizations for the Texas PPO on/off exchange past Dec. 31, 2015. We understand that some of your impacted patients may be undergoing a complex course of treatment under your care (cardiology, cancer, pediatrics, pregnancy, etc.). We realize this type of care is critical, and we encourage you and your patients to contact BCBSTX with your questions through the phone numbers below. Our member advocates will work closely with your patients to create a personalized transition of care plan. Member Customer Service: 888-697-0683
Pre-Authorization: 855-462-1785
Behavioral Health: 800-729-2422 Please see below for specific product names that will be offered to individual members on and off the Health Insurance Marketplace in Texas: - Blue Advantage (BAV) HMO (Offered on the Health Insurance Marketplace in Texas and on the SHOP)
- Blue Advantage Plus HMO Point of Service (POS) (Offered on the Health Insurance Marketplace in Texas)
Plan Name | Product Type | POS Y/N? | Plan Name | Product Type | POS Y/N? | Blue Advantage Bronze HMO 006 | HMO | N | Blue Advantage Plus Bronze 103 – One $0 PCP Visit | HMO | Y | Blue Advantage Bronze HMO 105 – Two $40 PCP Visits | HMO | N | Blue Advantage Plus Silver 102 – Three $0 PCP Visits | HMO | Y | Blue Advantage Silver HMO 102 | HMO | N | Blue Advantage Plus Gold 101 | HMO | Y | Blue Advantage Silver HMO 103 | HMO | N | Blue Cross Blue Shield Basic 103, a Multi-State Plan | HMO | Y | Blue Advantage Gold HMO 101 | HMO | N | Blue Cross Blue Shield Solution 102, a Multi-State Plan | HMO | Y | Blue Advantage Security HMO 100 | HMO | N | Blue Cross Blue Shield 101, a Multi-State Plan | HMO | Y | Blue Advantage Gold HMO 111 | HMO | N | Blue Advantage Plus Bronze 104 | HMO | Y |
Small Business Health Options Program (SHOP) Options
BCBSTX will continue to offer the Blue Choice PPO to small group members on the Small Business Health Options Program (SHOP). Small Group members will also still have access to our Blue Advantage HMO product. As a reminder, the terms of your BCBSTX agreements apply to plans offered on and off the SHOP. The terms of the agreement also require providers to offer their services to a BCBSTX member, regardless of where they purchased their coverage.
Please see below for specific product names that will be offered to small businesses on and off the SHOP in Texas: Plan Name | Network Name | Blue Choice Gold PPO 020 | Blue Choice | Blue Choice Gold PPO 001 | Blue Choice | Blue Choice Silver PPO 003 | Blue Choice | Blue Choice Bronze PPO 005 | Blue Choice | Blue Choice Bronze 006 | Blue Choice | Blue Advantage Gold HMO 014 | Blue Advantage | Blue Advantage Gold HMO 015 | Blue Advantage | Blue Advantage Silver HMO 004 | Blue Advantage | Blue Advantage Silver HMO 003 | Blue Advantage | Blue Advantage Bronze HMO 006 | Blue Advantage | Understanding the Options
Our 2016 offerings reflect our commitment to expanding coverage to millions of uninsured in Texas by offering flexible health care options to meet our members’ needs. Your patients can learn about providers who are participating in our networks in their area by viewing our Provider Finder® on bcbstx.com. Providers who do not currently participate but would like to participate in our networks may initiate the contracting process through the BCBSTX provider portal on bcbstx.com/provider. BCBSTX offers choices across three “metallic” health care coverage levels (bronze, silver and gold) for both the BAV HMO and BAV HMO Plus. All metallic coverage levels include essential health benefits and prescription drug coverage. Health care coverage varies depending on the amounts our members want to pay. - Bronze level products have the lowest monthly premium but may also have the highest out-of-pocket costs. Typically the plan covers 60 percent of care and the member pays 40 percent.
- Silver level products have a slightly higher monthly premium than bronze but offer richer benefits. In many cases, the plan pays 70 percent, while the member pays 30 percent.
- Gold level products have the highest level of benefits but also a higher monthly premium. The plan pays approximately 80 percent and the member pays approximately 20 percent.
BCBSTX provides a wide range of services and online tools to help renewing members make informed health decisions. - Provider Finder: Members can select the best network provider for their needs based on location, as well as view industry-respected third party quality indicators, costs and patient-submitted reviews on an easy-to-navigate website.
- Blue Access for MembersSM: Members can access information on their policy, including status of claims, alerts, temporary ID cards and more. This also includes Blue Access MobileSM, which allows members to find a doctor, hospital or urgent care facility in addition to benefit information.
- 24/7 Nurseline: Members can speak with registered nurses about health concerns, common health information and tips and advice on where to go to receive necessary care.
You can also contact your Network Management Representative with any questions. BCBSTX Provider Relations
Office Locations | Telephone Number | Fax Number | Austin | 512-349-4847 | 512-349-4853 | Corpus Christi | 361-878-1623 | 361-852-0624 | Dallas, East Texas | 972-766-8900 /
800-749-0966 | 972-766-2231 | El Paso | 915-496-6600, press 2 | 915-496-6611
915-469-6614 | Houston, Beaumont | 713-663-1149 | 713-663-1227 | Lubbock, Amarillo | 806-783-4610 | 806-783-4666 | Midland, Abilene, San Angelo | 432-620-1406 | 432-620-1428 | San Antonio | 361-878-1623 | 361-852-0624 | |
