Learn about your plan year 2022 medical benefits
09/01/2021
The 2022 health plan year began September 1, 2021 and runs through August 31, 2022. Here’s what you can expect:
Welcome HMO participants to HealthSelect of Texas®
The Texas Employees Group Benefits Program (GBP) is no longer offering enrollment in a health maintenance organization (HMO) plan.
If you were enrolled in an HMO and didn’t change your enrollment selection or waive GBP health coverage during Summer Enrollment, you were automatically enrolled in HealthSelect of Texas beginning September 1, 2021.
Important: To get the most out of your HealthSelect of Texas benefits, you should choose an in-network primary care provider (PCP). If you haven’t named a PCP during your first 60 days in the plan, out-of-network costs apply to most services – even if they’re from an in-network provider – until you name a PCP. This includes preventive care and care from in-network providers and facilities. Choose a PCP online now.
You can learn more about the transition to HealthSelect of Texas from HMOs here.
Change to Total In-Network Out-of-Pocket Maximum
Effective January 1, 2022, the total in-network annual out-of-pocket maximum will increase for all HealthSelect plans, including Consumer Directed HealthSelectSM. The out-of-pocket maximum will increase to $7,000 for employee-only coverage and $14,000 for family coverage. The out-of-pocket maximum includes expenses you pay toward medical and prescription drug copays, coinsurance and deductibles (primarily for those enrolled in Consumer Directed HealthSelect).
Remember: It pays to stay in-network! There is no out-of-pocket maximum for out-of-network care which means the care you get from out-of-network providers may cost you more – sometimes a lot more – throughout the year
$0 Copay on Mental Health Virtual Visits
As of July 1, 2021, mental health Virtual Visits through Doctor on Demand® and MDLIVE® are covered at 100% if you are enrolled in HealthSelect of Texas, HealthSelectSM Out-of-State or HealthSelectSM Secondary. This means you pay nothing for medical and mental health Virtual Visits.
If you are enrolled in Consumer Directed HealthSelect, you must meet your annual deductible before mental health Virtual Visits are covered. After you meet your deductible, you will pay 20% coinsurance.
Visit the Mental Health page for more information about HealthSelect mental health benefits. See the Virtual Visits page for information about Virtual Visits.
Medical Virtual Visits benefits remain the same. You have no cost if you are enrolled in HealthSelect of Texas, HealthSelect Out-of-State or HealthSelect Secondary. If you are enrolled in Consumer Directed HealthSelect, you must meet your annual deductible before medical Virtual Visits are covered. After you meet your deductible, you will pay 20% coinsurance.
Hemoglobin A1C Lab Test
Effective September 1, 2021, Consumer Directed HealthSelect and HealthSelect Secondary plan participants will no longer need to meet their annual deductible before in-network diagnostic A1C testing for diabetes is covered. Coinsurance will still apply. Because there is no in-network deductible for HealthSelect of Texas and HealthSelect Out-of-State, there is no change to these plans. In-network preventive A1C testing will still be covered at no cost to you.
To learn more about your HealthSelect medical benefits, check out the new 2022 Medical Benefits Guide on the Publications and Forms page. If you have any questions you can call a BCBSTX Personal Health Assistant toll-free at (800) 252-8039, Monday – Friday 7 a.m. – 7 p.m. and Saturday 7 a.m. – 3 p.m. CT.