When HealthSelect becomes your health plan
HealthSelect gives you real freedom of choice
HealthSelectSM of Texas is available in all Texas counties and gives you freedom of choice. When you need medical care, you can choose to see doctors and specialists that are part of the HealthSelect network of providers or those that are not. HealthSelect is administered by Blue Cross and Blue Shield of Texas (BCBSTX).
You can use your HealthSelect plan like an HMO by choosing a network primary care physician (PCP) to direct your care.
HealthSelect's large network of service providers-doctors, specialists, labs and hospitals-lets your PCP refer you to network providers. This will help you get the care you need at the lowest cost. If you stay in the network, you have no deductible.
Selecting a primary care physician
HealthSelect has a large network of providers. You will need to select a PCP. You may select your PCP during Summer Enrollment by using the Provider Finder for HealthSelect or by calling BCBSTX toll-free at (800) 252-8039.
You will see your new PCP's name on the HealthSelect ID card you receive in the mail. If you see a message that says No PCP selected, you will need to contact BCBSTX to pick a PCP.
Existing Referrals or Pre-Certifications
Do you have a referral for a specialist with your current health care plan? If so, you will need to get a new referral (or pre-certification) for HealthSelect specialists from your new primary care physician (PCP), even if you select the same PCP.
Do you need transitional benefits?
Are you being treated now for any of the conditions listed below? Is one of your dependents? Is your provider part of the BlueChoice network? If not, you may be allowed to continue treatment with your health care provider while your care is switched to a BlueChoice provider. You are eligible for transitional benefits when you are currently receiving treatment for the conditions listed below and you apply before September 1, 2009.
Eligible conditions:
- prescheduled surgery to be performed on or after September 1, 2009,
- acute care following trauma or recent surgery,
- chemotherapy (in current course of treatment),
- psychiatric treatment (transitional referral limited to maximum of 60 days),
- third trimester of pregnancy as of September 1, or
- terminal illness.
To apply for the transitional benefits, you must complete a transitional benefits form. You can request this form from HealthSelect by calling Blue Cross and Blue Shield of Texas (BCBSTX) Customer Service at (800) 252-8039. Or you can get the form on the HealthSelect website. Go to www.bcbstx.com/hs/forms.htm. Make sure you apply for transitional benefits before September 1, 2009.
Claims payments based on allowable amounts
All claims payments are based on the BCBSTX allowable amounts. See the out-of-pocket charts and prescription drug copayment chart for information. Providers who contract with BCBSTX—BlueChoice and ParPlan—must accept your copayments and allowable amounts as payment in full. They cannot bill you the difference between their charges and the allowable amount.
If you use a provider (physician, hospital, lab, radiology, pathology, anesthesiologist, etc.) who does not have a BlueChoice or ParPlan contract with BCBSTX, you will have to pay your copayments and any charges over the BCBSTX allowable amount.
HealthSelect and Medicare
If you are retired and over 65 years of age, Medicare is the primary payer of your health care benefits. HealthSelect is the secondary payer. Make sure you have purchased Medicare Part B and see physicians who accept Medicare, so that most or all of your health care services and supplies are paid for with the coordination of benefits between Medicare and HealthSelect. View our section on What you should know about Medicare for more information.
Contact information
For questions concerning HealthSelect services provided on or after September 1, 2009, call BCBSTX Customer Service at (800) 252-8039
