2017 Benefit Option Highlights of Blue EssentialsSM
Earlier this year, Blue Cross and Blue Shield of Texas (BCBSTX) announced the name change of the HMO Blue TexasSM network to Blue EssentialsSM. BCBSTX appreciates your participation in the Blue Essentials network, and is excited to share additional information about a few of the health plans with access to the Blue Essentials network.
The growing selection of new benefit plan offerings providing access the Blue Essentials network reflects BCBSTX's commitment to increasing access to affordable, quality health care services for our members in all 254 Texas counties. The Blue Essentials network will be coupled with plan designs that help manage costs and allow for flexibility and customization, including features like predefined deductibles, coinsurance and copayments for certain health care services. Below, we've provided highlights of three health benefit plan options that access the Blue Essentials network.
Blue Essentials
- Help members manage costs as they are required to select a primary care physician and get referrals for services with network providers.
- There is no out-of-network coverage, except for emergency services.
- Customer support and reference tools are available to help guide members with making informed decisions with regard to their benefits.
- Emergency and urgent care is available when members are traveling out of state.
Blue Essentials Access
- As of Jan. 1, 2017, this new benefit plan option allows "open access" within the Blue Essentials provider network where a primary care physician selection and referrals are NOT required, offering opportunities to 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 or obtaining a referral to see a specialist.
- Emergency and urgent care is available 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.
Below is a quick reference guide to the health plans with access to the Blue Essentials Network:
| Benefit Plan/Product Name | Network Code | Network | MidMarket & Large Market Availability | Retail & Small Group Availability | Network Coverage | PCP Required | Referral Required | OON Benefits | Plan Design |
| Blue EssentialsSM | HMO | Blue Essentials | 51-150 Fully Insured; 151+ Fully Insured & Self-Insured/ASO |
N/A | Statewide | Yes | Yes | No | HMO |
| Blue Essentials AccessSM | HMO | Blue Essentials | 51-150 Fully Insured; 151+ Fully Insured & Self-Insured/ASO |
N/A | Statewide | No | No | No | HMO Open Access |
| HealthSelectSM of Texas | HME | Blue Essentials | ERS – Eff 9/1/17 | N/A | Statewide | Yes (for in-network benefit level) |
Yes (for in-network benefit level) |
Yes | POS |
| Consumer Directed HealthSelectSM | HME | Blue Essentials | ERS – Eff 9/1/17 | 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 or contact your Network Management Representative for more information.
Continue to watch for additional information regarding Blue Essentials in future editions of the Blue Review newsletter and on our website at bcbstx.com/provider.
