This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, please contact your agent or the health plan.
Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711).
800-729-2422 Membership Department 800-445-2227 For all other group members, call the toll free number on the back of your ID card. Human Resources Human Resources Inquiries 866-977-7378 Regional Sales Offices (POS) Amarillo
7901 Wallace Boulevard
Amarillo, TX 79124 806-371-3000
800-403-4650 Austin
9442 Capital of Texas Highway, North
Suite 500, Arboretum Plaza II
Austin, TX 78759 800-336-5696 Beaumont
2615 Calder Street, Suite 700
Beaumont, TX 77702 409-896-0100 Corpus Christi
4444 Corona Drive, Suite 120
Corpus Christi, TX 78411 361-878-1600
800-442-1685 Dallas/Fort Worth
1001 E. Lookout Drive
Building B, 14th Floor
Richardson, TX 75082 800-399-5831 Houston
1800 West Loop Freeway South, Suite 600
Houston, TX 77027 713-354-7000
800-235-0796 Lubbock
3223 S. Loop 289
Suite 460
Lubbock, TX 79423 800-399-5831 San Antonio
17806 IH 10 West, Building 2, Suite 200
San Antonio, TX 78257 210-558-5100 Tyler
3800 Paluxy Drive, Suite 540
Tyler, TX 75703
800-259-3668 Claims and Correspondence Mail to: Blue Cross and Blue Shield of Texas
P.O. Box 660044
Dallas, TX 75266-0044 Supplier Registration Supplier Registration
Eighty percent of our health is shaped outside of the doctor’s office—by things like food security, housing stability and safe neighborhoods. Read how Blue Cross and Blue Shield companies are addressing these issues across the country.
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Reimagining Healthcare
As a healthcare partner to one-in-three Americans, the Blue Cross and Blue Shield Association is embracing the opportunity to improve lives across the United States, with President and CEO Kim Keck leading the effort.
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Tax credit extension protects affordable coverage for millions of Americans.
The 2022 Inflation Reduction Act will will extend Affordable Care Act (ACA) premium tax credits helping millions of Americans pay for health care.
Some employees may prefer to opt out of employer-sponsored medical coverage at UH, either because they prefer the coverage offered by their spouse's plan, or because they work for UH part-time and would like to seek a different plan on the open marketplace. Opting out can only be done within the first 30 days of employment or during the annual enrollment period in July. Individuals who purchase medical insurance through the open marketplace should be aware that they will need to file additional paperwork with their annual Federal Tax Return: Health Insurance Marketplace Statement
Persons who remain covered under HealthSelect are not subject to the additional filing requirements.
OptumRx Prescription Drug Coverage
OptumRx, an affiliate of UnitedHealthcare, is the prescription drug benefit manager for participants in HealthSelectSM of Texas.
You can create an online account on the OptumRX website to order and refill prescriptions. OptumRx has customer service representatives available at (866) 336-9371 (TTY 711).
Let’s say you need surgery with allowable costs of $20,000, and the following figures apply to your health insurance plan.
In your health insurance plan, you may have:
- a yearly deductible of $1,300
- coinsurance of 20%
- a yearly out-of-pocket maximum of $4,400
Now we will break down how those cost-sharing measures make an impact on the $20,000 medical bill.
- You pay the first $1,300 of covered medical expenses (your deductible).
- Your 20% coinsurance on the rest of the costs ($18,700) comes to $3,740.
- So your total costs would be $5,040. That’s $1,300 (your deductible) plus $3,740 (coinsurance).
- But your out-of-pocket maximum is $4,400. Your insurance company pays all covered costs above $4,400 — for this surgery and any covered care you get for the rest of the plan year.
What Are the Differences Between Premium, Deductibles, Coinsurance, and Copays?
Premium
A premium is the amount a member pays to an insurance carrier each month for their health care plan.
Deductibles
A deductible is an amount you pay for covered health care services before your insurance plan starts to pay for a portion of the costs.
For example, let’s say your deductible is $5,000. You will need to pay 100% of the first $5,000 of eligible medical costs before your plan starts paying for covered services.
Coinsurance
Coinsurance is the portion of eligible medical expenses that you will have to pay after you’ve met your deductible.
For example, if your coinsurance is 20%, you are responsible for paying 20% of your eligible medical expenses, and the plan will pay the remaining 80%.
Copay
A copay is a fixed amount that you pay for a health care service or prescription and can vary depending on the type of service. The health insurance plan will detail if there is a copay, what the amount is, and to which services it applies.
What Are Out-of-Pocket Maximums?
An out-of-pocket maximum is the most you will pay for eligible medical expenses during a policy period (typically a year). Amounts paid for the deductible, coinsurance, and copays count toward the out-of-pocket maximum. After you’ve reached your out-of-pocket max, your health insurance plan will pay 100% of the costs for eligible services covered in your health insurance plan.
How Do In-Network and Out-of-Network Benefits Work?
Health insurance plans have a network of care providers, hospitals, and facilities that they contract with to provide lower cost of care. In-network services are paid at a higher benefit level, which results in a lower cost to the covered individual. Out-of-network providers do not have a contract with the carrier, and typically result in higher costs to the individual.
What Are the Main Differences Between HMO and PPO Plans?
HMO (Health Maintenance Organization) plans typically require members to select a primary care physician (PCP) to coordinate care within the network. In order to see a specialist, members may need a referral from their PCP. Having care coordinated by a PCP may result in lower overall costs for the member. PPO (Participating Provider Option) plans do not require members to select a PCP, and in most cases, members can go to any provider within the network without a referral. This increase in flexibility may result in a higher overall cost for the member. Learn more about our small business PPO and HMO plans.
How Do Smart Networks Work?
A Smart network is a group of providers that encompass a specific geographical area, and is less broad than a standard PPO network. Plans with a smaller network typically have lower premiums.
What is Dental Insurance?
Dental insurance provides coverage for oral care, such as regular check-ups, orthodontics, oral surgery, and other dental services. Like health insurance, dental insurance includes networks, coinsurance, deductibles, and annual out-of-pocket maximums.