Blue Cross Blue Shield of Texas 2023 Plan Guide

BlueCross BlueShield of Texas 2023 Plan Guide

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Texas Plans

On and Off Exchange

What’s new:

MyBlue Health is expanding to include: Collin, Denton, Tarrant, El Paso, Hidalgo, and Cameron counties
Nine new plans offered in 2023 (5 Bronze, 2 Silver and 2 Gold), including eight CMS Standardized plans with four prescription drug payment level tier
New dental 1c option available

BCBSTX Access:

Health plans on and off exchange in every county
Comprehensive, year-round coverage
High-quality, efficient networks with focus on preventive care

Affordability:

Affordable plan options
Monthly payments as low as $0 for qualified on exchange applicants

Stability:

Serving Texas communities for more than 90 years.
In the nine years of ACA open enrollment, BCBSTX has been proud to offer multiple qualified health plans in every county across Texas.

Blue Advantage HMO & Blue Advantage Plus plans/networks are available statewide. MyBlue Health plans available in Dallas and Harris Counties.

HMO Plans

Just like 2021, and continuing an industry-wide trend (no major carriers offer PPO plans in Texas), BCBSTX only offers HMO plans in 2022. However, Blue Advantage Plus plans offer some out of network benefits, unlike traditional HMOs.

HMOs help keep upfront costs low
Tax credits and cost-sharing assistance may be available to help lower premiums and out-of-pocket costs
Managed care on a personalized level with care coordinated by one doctor
Physician care extenders – allows physician assistants and advanced registered nurse practitioners to be PCPs

Perks

Helpful Resources 24/7

Cost Estimator Tool on Blue Access for Members
SmartER Care Options – member education campaign on choices for non-emergency care

Mobile App

Easy-to-use BCBSTX App – find a doctor, see payment options, access electronic ID card and more
Access your claims, coverage and deductible information
Access your temporary digital member ID card
Secure login with Face ID (iOS only) and Fingerprint ID

Blue365

Blue365 member discount program – members save on health club and gym memberships, weight loss programs, dental products and much more

COVID-19 Friendly Resources

24/7 Virtual Visits
24/7 Nurseline (English and Spanish)

Health Plans

Blue Advantage HMO Plans:

6 Bronze, 4 Silver, 4 Gold

Network: Blue Advantage HMO (BAV)
Approximately 372 hospitals and 97,234 providers
New plans:
- Blue Advantage Bronze HMO: 702, 704, 707
- Blue Advantage Silver HMO: 705
- Blue Advantage Gold HMO: 706
Helps keep costs lower and more predictable
Personalized with a primary care provider (PCP) who coordinates all health care

Blue Advantage Plus:

6 Bronze, 4 Silver, 2 Gold

Network: Blue Advantage HMO
Approximately 372 hospitals and 97,234 providers
Greater flexibility
Leverages the HMO network
Some out-of-network benefits available
Blue Advantage Plus Bronze: 704, 707
Blue Advantage Plus Silver: 705
Blue Advantage Plus Gold: 706

MyBlue Health:

1 Bronze, 1 Silver, 1 Gold

Network: MyBlue Health^SM (BFT)
Approximately 45 hospitals, 24,947 providers**
Now available in Collin, Denton, Tarrant, El Paso, Hidalgo, and Cameron counties
Retail members who choose a MyBlue Heath Select PCP will have a $0 copay for any scheduled PCP visit
Select PCP collaborations for the following areas include: Austin: Community Care and Lone Star Circle of Care; Dallas and Houston: Sanitas Medical Centers; and San Antonio: CentroMed
Local, face-to-face BCBSTX Customer Service at Sanitas Medical Centers in Dallas and Harris countie

*Estimates as of 6/1/2021

**Estimates as of 7/21/22. These numbers don’t include network providers and hospital in the expansion counties. During open enrollment, members who enroll in MyBlue Health plan will be able to choose their Select PCP for 2024 through Provider finder.

BCBSTX - Popular Hospital Network Guide

Hospital	Included in Advantage HMO Network?
Doctors Hospital At Renaissance (Edinburg)	YES
University Health System (San Antonio)	NO
Medical City Hospital (Dallas)	YES
Memorial Hermann Hospital (Sugar Land)	YES
Mother Frances Hospital (Tyler)	NO
Scott & White Hospital (Round Rock)	NO
North Austin Medical Center (Austin)	YES
Seton Medical Center (Austin)	YES
Hill Country Memorial Hospital (Fredericksburg)	YES
Texas Health Harris Methodist (Fort Worth)	YES
UT Southwestern Medical Center (Dallas)	NO
Memorial Hermann Texas Medical Center (Houston)	YES
St. Lukes Episcopal Hospital (Houston)	YES
Baylor University Medical Center (Dallas)	YES
The Methodist Hospital (Houston)	YES

Contracted Health Systems by Network

Market Name / BCBSTX Network	Blue Advantage Network	MyBlue health hmo
Abilene	Hendrick Medical Center	N/A
Amarillo	Ardent Health Services	N/A
Austin-Round Rock	Baylor Scott & White, HCA Southwest, Seton Healthcare	HCA Southwest
Beaumont-Port Arthur	CHRISTUS, Steward Health	N/A
Bryan-College Station-Lufkin	Baylor Scott & White, Catholic Health Initiatives	N/A
Corpus Christi	CHRISTUS, HCA Southwest	N/A
Dallas	Baylor Scott & White, HCA North, Methodist	HCA North, Methodist
El Paso	HCA Southwest, Tenet	PSN Services
Forth Worth-Arlington	Baylor Scott & White, HCA North, Methodist, Texas Health Resources	HCA North, Methodist
Greenville-Denton	Baylor Scott & White, CHRISTUS, HCA North, LifePoint, Texas Health Resources	N/A
Houston	Catholic Health Initiatives, Memorial Hermann, Methodist Houston, Steward, Tenet	Catholic Health Initiatives, Harris County Hospital District HCA Southwest, Steward, Tenet
Kileen-Temple-Waco	Baylor Scott & White, Providence Health Alliance, Seton	N/A
Laredo-McAllen	HCA Southwest, Prime, Tenet, Universal Health Systems	HCA Southwest
Lubbock	Surgery Partners	N/A
Odessa-San Angelo	Hendrick MC, Shannon Clinic, Steward	N/A
Pasadena-Bellaire	Catholic Health Initiatives, HCA Southeast Memorial Hermann UTMB	Catholic Health Initiatives, HCA Southeast
San Antonio	CHRISTUS, HCA Southwest, Tenet	HCA Southwest
Texarkana-Tyler-Longview	Baylor Scott & White, CHRISTUS, Steward UT Health East Texas	N/A
Victoria	Community Health Systems, Seton	N/A
Wichita Falls	Kell West Regional, United Regional, Clay County Memorial Hospital, Texas Health Resources	N/A

BCBSTX Dental/Vision Plans

Members currently enrolled MUST re-enroll for 202. Check out our dental plan guide. or quote, enroll, and apply for more enhanced dental plans

BlueCare Dental

Coverage for cleanings, preventive services and much more
Preventive dental services deductible waived
New lower-cost 1c family plan offered

Pediatric Vision Benefits

Offers one exam, frames or contacts at $0/no cost on most plans

Pediatric Vision Benefit

Prescription & Pharmacy

BCBSTX switched from a 4 tier formulary to a 6 tier formulary in 2019.

• Most plans have six prescription drug payment level tiers: preferred generic, non-preferred generic, preferred brand, non-preferred brand, preferred specialty, non-preferred specialty
• Standardized plans have four prescription drug payment level tiers: generic, preferred brand, non-preferred brand, and specialty
• All plans include a drug list and Preferred Pharmacy Network**

BCBSTX also offers ways for you to save time and money on your prescriptions.

Cost savings: You may pay less when you choose generic medicines from our drug list. You also may save when you get up to a 30-day supply of a covered prescription drug from an in-network pharmacy. Talk to your doctor about what is right for you
Time savings: Maintenance medications are those drugs you take on a regular basis. You can have up to a 90-day supply of these medications delivered directly to you through the mail order program or at a retail preferred pharmacy participating in the Preferred Pharmacy Network.5
Online resources: You can search the drug list, find a pharmacy, see your claims, order home delivery, and get an estimate of your costs for a medication 24/7 by logging in to Blue Access for MembersSM (BAMSM) at bcbstx.com.

*Estimates as of 7/31/2022

**A “preferred” or “participating” pharmacy has a contract with BCBSTX’s pharmacy benefit manager (Prime Therapeutics) to provide pharmacy services at a negotiated rate. A pharmacy benefit
manager administers prescription drug benefits for a health plan. The terms “preferred” and “participating” should not be construed as a recommendation, referral or any other statement as
to the ability or quality of such pharmacy.