Enrollment Guide Series/Medical Benefits - YouTube

BlueCross BlueShield of Texas is proud to administer the medical benefits for your UT

SELECT medical plan.

The UT SELECT Medical Plan is a self-funded, Preferred Provider Organization (or PPO) plan.

Participants have access to the UT SELECT Medical Plan when enrolling in the Basic Coverage

package.

The UT SELECT Medical Plan benefits are based on the subscriber’s U.S. Mail address.

In-area benefits apply for participants who live in Texas, New Mexico, or Washington,

D.C.

Slightly different benefits apply for the small number of Out-of-Area participants whose

primary residence is outside of those locations.

Details about out-of-area benefits are available in the Enrollment Guide and on the OEB website

at www.utsystem.edu/offices/employee-benefits.

Please immediately advise your HR Benefits Office of any address updates necessary.

Each time you or one of your covered dependents are in need of health care services, you would

select a provider that could be In-Network or Out-of-Network.

In - Network providers are contracted with BlueCross BlueShield of Texas at a discount,

as a result you receive the highest level of benefits at the lowest out of pocket costs

for care.

As a member of the UT SELECT Plan, you do not need to select a primary care physician

or obtain a referral to see a specialist for care.

Network providers cannot charge you more than the allowable amount for covered services

so there's no balance billing.

And no claim forms to file.

Network providers will file claims with BlueCross and BlueShield of Texas.

While there are many advantages to using a network doctor and hospital, UT SELECT also

provides benefits for covered services from other healthcare providers outside of the

PPO Network.

Benefit services received outside of the PPO Network will require you to pay a higher out

of pocket cost for care which may result in balance billing to the participant.

How do you locate a network doctor or hospital?

You have a number of options.

• You can call UT SELECT Customer Service at (866) 882-2034.

This number is located on the back of your UT SELECT BCBSTX ID card.

You may access the website at bcbstx.com/ut and click on "Find a doctor or hospital.”

If you’re traveling outside of Texas, you can call the BlueCard Access phone number

to locate a hospital or doctor 24-hours a day, seven days a week.

Or you can ask your doctor if he or she contracts with Blue Cross Blue Shield of TX prior to

your scheduled visit.

Now let’s look at the In-Network medical benefits, effective September 1, 2018.

The deductible is the set amount of applicable out-of-pocket expenses you must pay for covered

health care services before the UT SELECT plan pays benefits.

UT SELECT has a plan year deductible, which means that the 12-month deductible period

begins September 1 and ends August 31 of each year.

The plan year deductibles are $350 per individual and $1,050 per family.

Coinsurance refers to the medical expenses you and the plan share after the deductible

has been met.

For example, the coinsurance level when using network providers is “80/20.”

This means the plan pays 80 percent and you pay 20 percent of allowable costs.

The most you will pay in a year for coinsurance is $2,150 per person and $6,450 per family.

If you reach the annual medical coinsurance limit, the plan then pays 100 percent of any

eligible expenses for the remainder of the plan year.

The Annual Out-of-Pocket Maximum includes all member cost share for allowable medical

and prescription drug services covered under the plan, to include the deductibles, coinsurance,

and copays.

The maximum limit is $7,150 per individual and $14,300 per family.

A copayment is the set amount you pay for certain medical services and prescription

drugs at the time of service.

For UT SELECT, the copay depends on whether the doctor is a “family care physician”

or a specialist.

Family care providers includes family practitioners, internists, OB/GYNs and pediatricians.

All other physicians are specialists.

The copay is $30 for office visits to a family care physician and $35 for a specialist.

The copay for visits to an emergency room is $150 plus a 20% coinsurance per visit.

The ER copay will be waived if the patient is admitted to the hospital.

There is a $100 copay per procedure for non-emergency, outpatient MRIs and CAT Scans/CTs.

The copay will be waived if the member calls BlueCross and BlueShield Customer Service

to speak to a Benefits Value Advisor prior to receiving the service.

The phone number to call is (866-882-2034) and this number appears on the back of the

UT/SELECT BCBSTX ID card.

The Inpatient Hospital Care benefit requires a $100 copay per day, plus 20% coinsurance

after the deductible has been met.

There is a $500 maximum inpatient copay per member admission.

For all eligible Outpatient Surgical Care services, there is a $100 copay per-day, plus

20% coinsurance after the deductible has been met.

Your Therapy Benefits require a $35 copay per visit for all In-Network Physical, Occupational,

Chiropractic Care, Airrosti, Speech and Hearing Therapies.

Applied Behavior Analysis is covered as other therapy benefits based on medical necessity.

Preventive care services such as routine physicals, well-woman and well-child exams, immunizations,

routine mammograms, colonoscopies, and other cancer screenings, are paid by the plan at

100 percent when using network providers.

When billed by the network doctor as “preventive care” no copay or deductible will apply.

For more details please view the UT SELECT Medical Plan Guide on the OEB website at www.utsystem.edu/offices/employee-benefits.

Thank you for taking time to learn about the UT SELECT Medical Plan.