Participants Transitioning to HealthSelect of Texas
Effective Sept. 1, 2021, HMO plans will no longer be an enrollment option under the Texas GBP. All current subscribers and dependents enrolled in one of the HMO plans will be automatically enrolled in HealthSelect of Texas® administered by Blue Cross and Blue Shield of Texas, unless they elect otherwise during their summer enrollment period. For more information about this change, visit the ERS website.
Important Information About the HealthSelect of Texas Plan
Selecting a Primary Care Provider
Participants must select a network primary care provider (PCP) and notify Blue Cross and Blue Shield of Texas (BCBSTX) of their selection to get the highest level of benefits. If participants do not have a PCP on file with BCBSTX within 60 days of the Sept. 1, 2021 effective date, they will receive out-of-network benefits, even if they are seeing in-network providers.
Referrals and Prior Authorizations
Participants who are transitioning from an HMO plan will have a 90-day referral grace period and will receive in-network benefits if they see an in-network specialist without a referral during this timeframe. After Nov. 30, 2021, if there is not a referral on file with BCBSTX, the specialist visit will be covered at the out-of-network benefit level, even if the specialist is in-network.
Please refer to the ERS Tools page for more information about referrals and prior authorizations.
Transition of Care
Transition of Care with a provider that is not in-network under the participant’s new plan may be available in certain scenarios. If a participant is receiving on-going treatment from a provider who is not in the HealthSelect network and the provider determines switching doctors may be harmful to the participant’s health, the participant should submit a transition of care form. A medical Transition of Care form can be submitted to see if they qualify to temporarily continue treatment with the non-network medical provider. A mental health Transition of Care form should be submitted to see if they qualify to temporarily continue treatment with the non-network mental/behavioral health provider.
Conditions that may be eligible for transition of care benefits are:
- Pregnancy in the second or third trimester
- Long-term treatment of cancer, heart disease or organ transplants
- Terminal illness if life expectancy is less than six months
- Certain mental health conditions/treatments
In-patient Hospital Stays
If a participant is in the hospital during the transition, the HMO plan will remain responsible for all services received through Aug. 31, 2021. Effective Sept. 1, 2021, the HealthSelect plan is responsible for any covered health services.
This means services rendered through Aug. 31, 2021 should be submitted to the HMO plan and services rendered on or after Sept. 1, 2021 should be submitted to BCBSTX. If the full hospital stay is billed to BCBSTX, BCBSTX will deny the claim requesting itemization from the facility. Upon receipt of the itemization, the claim will be adjusted and split to apply benefits for the Sept. 1, 2021 to discharge portion.