Download CHOOSE WELL - Blue Cross and Blue Shield of Texas

UT S E L E CT2007-2008 E n r o l l m e n t G u i d e
CHOOSE WELL
Your choice to find the health care you need, when and where you need it
www.bcbstx.com/ut
Choosing your doctor. Seeing a specialist without a referral. Getting care in a
hospital because it’s close to home or because it’s known worldwide.
Deciding what’s best for you. It’s all possible with the UT SELECT
plan administered by Blue Cross and Blue Shield of Texas for the employees
and retirees of The University of Texas System.
When it comes to your health care, choice matters.
As a UT SELECT member, you’ll be able to choose doctors, hospitals and
other providers from one of the largest networks of contracting providers in
Texas, and one of the largest in the country. We’ll provide information to
help you make the right choices for you and your family. When you have a
question, you’ll have access to innovative online information or you can
speak with our Customer Service Advocates who make it their priority to get
you the answers you need, quickly and accurately.
And we’ll be here for you when you need us. Our roots run deep. For more
than 60 years, we’ve been helping our members with the health care
coverage and services they want and need. As a result, we’re one of the
most widely recognized, and most widely respected, health care
companies in the state. If you have a choice in health care coverage, be
choosy. Choose UT SELECT from Blue Cross and Blue Shield of Texas.
Customer Service
1-866-882-2034
8 a.m. to 5 p.m. (Central Time) Monday – Friday
If you have enrollment questions regarding UT SELECT benefits and/or
network physicians and facilities, Blue Cross and Blue Shield of Texas
Customer Service Advocates are available to help you:
• Understand what is covered under the UT SELECT health benefit plan
• Find a contracting network doctor or hospital
• Learn about care management programs
• Learn how to use the online tools
• Confirm your coverage with providers via conference call
• And much more!
UT SELECT plan participants can count on consistent, professional
assistance and quick resolution of issues – usually with a single
phone call.
Choose Well:
How to use this guide and
enroll for coverage
This guide summarizes the benefits and features
of UT SELECT for the upcoming plan year. The
Annual Enrollment period is July 1 through
July 31, 2007. Benefit selections will be effective
September 1, 2007 through August 31, 2008.
Remember to review and update your benefit
selections on UT System’s automated enrollment
system, UTTOUCH Online. Please refer to The
University of Texas System Group Insurance
Handbook for additional information on your
benefits options and for specific instructions
for using UTTOUCH Online. Note: UT System
no longer offers an HMO option. If you are
currently enrolled in HMO Blue Texas, you will be
automatically enrolled in UT SELECT at the same
level of coverage, effective September 1, 2007.
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Choice and Access
Choice of Doctors — Each Time You Need Health Care
When you choose UT SELECT, you can receive care from any licensed doctor
you want. No referrals are required. If you use a network doctor, you’ll pay
less out of pocket, you usually won’t have to file any claims and you’ll get the
highest level of benefits. If you use a doctor outside of the network, you’ll still
be covered, but your out-of-pocket costs will be higher.
Access to One of the Largest Networks in Texas —
and in the Country
By choosing UT SELECT, you have access to one of the largest networks
of contracting doctors and hospitals in Texas, with more than 45,000
physicians and specialists and over 400 hospitals. You also have access
to the BlueCard network, one of the largest networks in the country, with
more than 600,000 doctors and 6,000 hospitals contracting with Blue Cross
and Blue Shield Plans nationwide. Chances are, the doctors and hospitals
you want to use are in the network.
To find a physician or specialist near you, search online at www.bcbstx.com/ut
or contact UT SELECT Customer Service toll free at 1-866-882-2034.
Even if you visit an out-of-network doctor,
you may still save money
Blue Cross and Blue Shield of Texas contracts with many non-network
doctors and hospitals. ParPlan providers accept the Blue Cross and Blue
Shield of Texas allowable amounts for covered services and cannot bill
you more. In most cases ParPlan providers will file claims, too. Look for
participating doctors and hospitals for UT SELECT at www.bcbstx.com/ut
under ParPlan.
Traveling away from home?
Kids off to school out of state?
Through the BlueCard network, you and your covered family members can receive health care coverage at lower out-of-pocket
costs from contracting doctors and hospitals almost anywhere in the country and around the world. Just like at home, it’s easy
to find a provider when you’re away. To find a contracting network doctor or hospital in or outside the U.S., go to the BlueCard
Doctor and Hospital Finder under UT SELECT at www.bcbstx.com/ut. When you become a member, you’ll also be able to call
our dedicated BlueCard line at 1-800-810-BLUE (2583).
www.bcbstx.com/ut
Questions & Answers
Q. Will I be able to continue seeing my current doctor?
A. Since we have one of the largest networks of contracting doctors, it’s
likely your doctor is in the network. If not, you can always continue your
care for covered services and pay a higher out-of-pocket cost.
Q. What if I’m seeing an out-of-network doctor now?
A. If you’re pregnant or require ongoing care for a serious illness when you
enroll, you may be able to continue seeing an out-of-network doctor while
you transition your care to a network doctor.
Q. Will I have to file claim forms?
A. No, not as long as you use a doctor or hospital in the network.
Q. What if I’m outside of Texas and need to see a doctor?
A. To pay the lowest out-of-pocket costs for covered services, visit a doctor
or hospital in the BlueCard network. If you use an out-of-network doctor,
you’ll be covered but you may pay more.
Q. What will I do in case of an emergency?
A. Call 911 or seek help from any doctor or hospital immediately. You don’t
need to try to find a network physician. Your emergency visit will be covered
at network benefit levels whether you’re at home or away. However, be sure
to have someone notify your network physician within 48 hours or as soon
as possible.
Choose Well:
Increase Your Physical Activity
If you need to boost your physical activity, try
incorporating some of these calorie-burning ideas
into your day to help safeguard your health:
• Park further away at work or at the shopping mall
• Take the dog for a walk instead of letting him out
in the backyard
• Take the stairs rather than the elevator
• Get involved in your kids’ activities
• Strive for 30 minutes of physical activity, such as
raking leaves or brisk walking, five or more days
a week
It’s the little extras that count. By burning extra
calories every day, you’ll be doing something very
important for your health and your life.
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Network or Non-Network Care: The Choice is Yours
Non-Network
General Provisions
(Including ParPlan)
Any charges over the
Allowed Amount are the
patient’s responsibility
Network
If you need to . . .
You pay lower out-of-pocket costs
if you choose network care
You pay higher out-of-pocket costs
if you choose out-of-network care
Visit a doctor or specialist
Visit any network doctor or specialist
Visit any licensed doctor or specialist
Pay any office visit copay
Pay for the office visit
Pay any coinsurance and deductible
File a claim and get reimbursed for the
visit minus any coinsurance and deductible
Your doctor cannot charge more than the
allowable amounts for covered services
Receive emergency care
Your costs will be based on allowable amounts;
you may be required to pay any costs over the
allowable amounts
Call 911 or go to any hospital or doctor immediately;
you’ll receive network benefits for emergency care
Pay any copay (waived if admitted)
Pay any coinsurance and deductible
Call the preauthorization number within 48 hours
Be admitted to the hospital
Receive behavioral health or
chemical dependency services
File a claim
Your network doctor will preauthorize
your admission
You, a family member, your doctor or the
hospital must preauthorize your admission
Go to the network hospital
Go to any licensed hospital
Pay any copays, coinsurance and deductible
Pay any coinsurance and deductible
Call the behavioral health number on your ID card first to preauthorize all care
See a network doctor or health care professional,
or go to any network hospital or facility
See any licensed doctor or health care professional,
or go to any licensed hospital or facility
Pay any copays, coinsurance and deductible
Pay any coinsurance and deductible
Claims will be filed for you
You may need to file the claim yourself
Preauthorization. UT SELECT requires advance approval (preauthorization) by Blue Cross and Blue Shield of Texas for certain services. Preauthorization
establishes in advance (or within 48 hours following an emergency hospital admission) the medical necessity of certain care and services covered under
UT SELECT. The following types of services require preauthorization: all inpatient admissions, treatment of all serious mental illness, mental health care
and chemical dependency, extended care, such as in a skilled nursing facility, through home health care or through hospice; private-duty nursing, home
infusion therapy, motorized and customized wheelchairs and certain other durable medical equipment totaling $5,000 or more and transplants. The
number to call for preauthorization is 1-800-441-9188.
Choose Well: How to get the most value from your coverage
Use in-network doctors and hospitals • Take advantage of your benefits for preventive services which can help you avoid more
costly illness-related services later • Discuss cost-effective services and drugs with your providers • Use emergency care only for
emergencies • Review your medical bills to make sure they are correct
www.bcbstx.com/ut
Summary of Benefits (In Area*)
Network and non-network benefits apply to eligible employees, retirees and their covered dependents residing in
Texas or New Mexico. Payment for non-network (including ParPlan) services is limited to the allowed amount as
determined by Blue Cross and Blue Shield of Texas. ParPlan providers accept the allowed amount. Any charges
over the allowed amount are the patient’s responsibility and are in addition to deductible, coinsurance and out-ofpocket maximums.
In-Area*
Non-Network
General Provisions
Deductible (per plan year)
When using Network providers,
office visit and related services are
not subject to deductible
• Individual
• Family
Out-of-Pocket Maximum
(per plan year; includes deductible
and coinsurance; does not include
copayments, charges exceeding the
Allowed Amount or non-covered
services and supplies)
Benefits will be paid at 100% for the
remainder of the plan year once the
out-of-pocket maximum is met
• Individual
• Family
Network
(Including ParPlan)
Any charges over the
Allowed Amount are the
patient’s responsibility
$250
$750
$500
$1,500
$1,750
$5,250
$4,000
$12,000
$25 copayment
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
$30 copayment
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
$25 copayment FCP
$30 copayment Specialist
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Diagnostic Services (Office)
Family Care Physician (FCP)
• Family Practice
• Internal Medicine
• OB/GYN
• Pediatrics
Specialists
(other than Behavioral Health)
Chiropractic Care
(subject to 20 visit plan year
maximum per condition if traditional
physical therapy modalities billed)
Allergy Services (testing)
Allergy Serum/Injections
(if no office visit billed)
Family Planning Services
(birth control management)
Plan pays 100%
(no copayment required)
$25 copayment FCP
$30 copayment Specialist
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
* Out-of-Area member benefits apply to any eligible employees, retirees and their dependents whose residence is outside of Texas or
New Mexico. Covered services are subject to $250 deductible and paid at 75% of the allowed amount.
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customer service 1.866.882.2034
In-Area*
Non-Network
(Including ParPlan)
Any charges over the
Allowed Amount are the
patient’s responsibility
General Provisions
Network
Diagnostic Laboratory and
X-ray Services
Contrast material administered in
conjunction with radiology services is
subject to the applicable deductible
and coinsurance
Diagnostic Tests
Plan pays 100%
(no copayment required)
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
$25 copayment FCP
$30 copayment Specialist
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
$25 copayment FCP
$30 copayment Specialist
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Periodic Physical Exam
(one per plan year)
$25 copayment FCP
$30 copayment Specialist
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Well Woman Exam
(one per plan year)
Mammogram
(one per plan year)
Well Child Care
(under age 2)
Immunizations
(up to age 6, applies for injection only)
$25 copayment FCP
$30 copayment Specialist
Plan pays 100%
(no copayment required)
$25 copayment FCP
$30 copayment Specialist
Plan pays 100%
(no copayment required)
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Immunizations
(age 6 and older, applies for
injection only)
$25 copayment FCP
$30 copayment Specialist
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
$25 copayment FCP
$30 copayment Specialist
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Infertility Diagnostic Testing
Preventive Care
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Plan pays 100% of the
Allowed Amount
Obstetrical Care
Initial Office Visit
Delivery–Facility (preauthorization
required) When using a Network facility:
If the mother is a covered participant,
she will be responsible for inpatient
copayments of $100 per day, not to
exceed $500 per stay, in addition to any
applicable deductible and coinsurance.
A separate inpatient copayment will not
be charged for the newborn unless the
newborn’s hospitalization exceeds the
mother’s or unless the mother is not a
covered participant on the UT SELECT
plan. No more than $500 in copayments
will apply to any individual delivery
admission. Applicable deductible
and coinsurance will be charged for
the newborn.
Delivery–Physician
After $100 copayment per day
After deductible, plan pays 60%;
($500 maximum copayment per
you pay 40% of the Allowed Amount
admission), plan pays 80%; you pay
20% after deductible
After deductible and $25 or
$30 copayment, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
www.bcbstx.com/ut
In-Area*
Non-Network
General Provisions
Lab and Radiology
Contrast material administered in
conjunction with radiology services is
subject to the applicable deductible
and coinsurance
Voluntary Sterilization–Facility
(preauthorization required)
Voluntary Sterilization–Physician
Network
(Including ParPlan)
Any charges over the
Allowed Amount are the
patient’s responsibility
Plan pays 100%
(no copayment required)
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After $100 copayment, plan pays
80%; you pay 20% after deductible
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Inpatient Care (preauthorization required)
Facility
• Preadmission Testing
• Semi-private Room and Board
• Intensive Care Unit (ICU)
• Inpatient Hospital Care
• Surgery
Physician
After $100 copayment per day
($500 maximum copayment
per admission), plan pays 80%;
you pay 20% after deductible
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After $100 copayment, plan pays
80%; you pay 20% after deductible
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
Plan pays 100%
(no copayment required)
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Outpatient Care
Observation
(a patient treated in a hospital or
clinic instead of in an overnight room
or ward)
Surgery–Facility
Surgery–Physician
Lab and Radiology
Contrast material administered in
conjunction with radiology services is
subject to the applicable deductible
and coinsurance
Diagnostic Tests
Medical diagnostic tests such as, but
not limited to: immune globulins,
therapeutic or diagnostic infusions
(excludes chemotherapy), biofeedback,
dialysis, gastroenterology, cardiovascular,
non-invasive vascular diagnostic
studies, pulmonary and neurology
Emergency Care
Facility–Emergency Room
Physician
Ambulance
$100 copayment (waived if admitted)
Plan pays 100% (no copayment required)
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
* Out-of-Area member benefits apply to any eligible employees, retirees and their dependents whose residence is outside of Texas or
New Mexico. Covered services are subject to $250 deductible and paid at 75% of the allowed amount.
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customer service 1.866.882.2034
In-Area*
Non-Network
General Provisions
Network
(Including ParPlan)
Any charges over the
Allowed Amount are the
patient’s responsibility
Extended Care (preauthorization required)
Skilled Nursing
(subject to 180 day plan year maximum)
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Home Health Care
(subject to 120 day plan year maximum)
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Home Infusion Therapy
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Hospice Care
(subject to 90 visit plan year maximum)
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Physical Therapy
(subject to 20 visit plan year maximum
per condition if traditional physical
therapy modalities billed)
Occupational Therapy
(subject to 20 visit plan year maximum
per condition)
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Speech and Hearing Therapy
(subject to 60 visit plan year maximum
per condition)
Respiratory Therapy
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Therapy
Other
Medical Supply/Durable Medical
Equipment (preauthorization
required)/Prosthetic/Orthotics
Hearing Aids
($500 per ear; once every 4 years
Plan pays 80%; you pay 20% (no deductible)
Serious Mental Illness (preauthorization required)
The Serious Mental Illness Benefit is not part of, but is in addition to, the Mental Illness Benefit
Inpatient–Facility
After $100 copayment per day
($500 maximum copayment per
admission), plan pays 80%; you
pay 20% after deductible
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Inpatient–Physician
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 80%;
you pay 20%
$25 copayment
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Outpatient
Office Visit
www.bcbstx.com/ut
In-Area*
Non-Network
General Provisions
Network
(Including ParPlan)
Any charges over the
Allowed Amount are the
patient’s responsibility
Chemical Dependency (preauthorization required; 3 episodes for treatment per lifetime)
Inpatient–Facility
(subject to 30 day plan year maximum)
After $100 copayment per day
($500 maximum copayment per
admission), plan pays 80%; you
pay 20% after deductible
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Inpatient–Physician
(subject to 30 day plan year maximum)
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Outpatient
(subject to 20 visit plan year maximum
for outpatient and office combined)
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Office Setting
(subject to 20 visit plan year maximum
for outpatient and office combined)
$25 copayment
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
$25 copayment
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
Smoking Cessation
Outpatient/Office Setting
(subject to 20 visit plan year maximum)
Other Mental Illness (preauthorization required)
Inpatient–Facility
(subject to 30 day plan year maximum)
Inpatient–Physician
(subject to 30 day plan year maximum)
Outpatient
(subject to 20 visit plan year maximum
for outpatient and office combined)
Office Setting
(subject to 20 visit plan year maximum
for outpatient and office combined)
After $100 copayment per day
($500 maximum copayment
per admission), plan pays 80%;
you pay 20% after deductible
After deductible, plan pays 80%;
you pay 20%
After deductible, plan pays 80%;
you pay 20%
$25 copayment
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
After deductible, plan pays 60%;
you pay 40% of the Allowed Amount
* Out-of-Area member benefits apply to any eligible employees, retirees and their dependents whose residence is outside of Texas or
New Mexico. Covered services are subject to $250 deductible and paid at 75% of the allowed amount.
Choose Well: Small Steps Lead to Big Strides for Your Health
There’s no limit to the small steps you can take toward achieving a healthier lifestyle. Here are some basic ideas to help you get started:
• Eat at least five fruits and vegetables a day
• Strive to keep a positive attitude and manage your stress
• Buckle up anytime you are in a vehicle
• Use sunscreen to protect your skin from harmful rays
• Boost physical activity by parking further away at work or
when shopping
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Choose Well: Achieve a Healthier Life with the Help of Blue Care Connection
Sometimes managing your health
requires more than doctor visits, lab tests
and prescriptions.
Blue Care Connection from Blue Cross and Blue Shield of Texas is
an umbrella of programs that offers you guidance to achieve higher
levels of wellness. Through outreach, educational resources and
health advocacy, we help guide you through the often-complex health
care system so you can focus on what matters most — getting
healthy and staying well.
Blue Care Connection programs assist UT SELECT plan participants
living with current serious medical conditions, as well as those
considered “at risk.” If you, or a covered dependent, are considered
"at risk," the Blue Care Connection programs are uniquely designed
to detect health care needs early. Early detection allows Blue Cross
and Blue Shield of Texas to provide appropriate outreach and
meaningful intervention to help prevent future medical complications.
Blue Care Connection programs are available at no
additional cost and include:
24/7 Nurseline
Around the clock access through a toll-free number to experienced
registered nurses who understand and can help with your health
care concerns. Good health starts by asking the right questions at
the right time. And we all know that sometimes those questions
come up unexpectedly, like when the doctor’s office is closed.
Whatever the time, you can get the answers to your health care
questions with the 24/7 Nurseline from Blue Cross and Blue Shield
of Texas. To take advantage of this free service and to talk to a
24/7 nurse, call toll-free: 1-888-315-9473.
Special Beginnings®
A maternity program that offers on-going contact with obstetric
nurses who provide prenatal risk assessment education and can
coordinate care with your physician. Blue Cross and Blue Shield of
Texas is offering a $50 Reward Card from Target for women who
enroll in their first trimester and complete the Special Beginnings
program through six weeks after delivery. Call 1-800-462-3275 to
enroll or ask questions about the program.
Condition Management
Voluntary health improvement programs that can help members
with: cancer, congestive heart failure, coronary artery disease,
chronic obstructive pulmonary disease, asthma, diabetes,
metabolic syndrome (high cholesterol, high blood pressure and
obesity) and low back pain.
Care Management
Focuses on traditional elements of medical care management with
targeted outreach if you are an “at-risk” member.
Case Management
Assists if you are a higher-risk plan participant coping with a
complex or catastrophic condition.
Enroll Today
To enroll in any Blue Care Connection program, or ask questions
about the program, please call toll-free at 1-800-462-3275.
www.bcbstx.com/ut
New! Effective September 1, 2007—More
Blue Care Connection Programs
In addition to the Blue Care Connection programs already listed,
some new programs will be available to UT SELECT plan
participants for the 2007-2008 plan year, effective September 1.
Blue Care Advisors
Blue Care Advisors are a multi-disciplinary team composed of
RNs, Licensed Professional Counselors and Licensed Master
Social Workers. Blue Care Advisors reach out to at-risk plan
participants, providing early chronic disease prevention in hopes
of achieving overall improved health. Blue Care Advisors:
•
Simplify the coordination of your health care benefits
• Educate and empower you to make informed choices about your
health care
• Support wellness by aiding your understanding of
preventive care guidelines, personal risk assessments
and preventive screenings
• Support behavior modification and readiness to change by
providing techniques that promote a healthy lifestyle
• Champion your care when assistance is needed
• Provide lifestyle coaching through the Obesity/Weight
Management Program (as needed)
Personal Health Manager
With Personal Health Manager, the support and resources you
need to manage your health online will be just a click away. By
logging onto Blue Access® for Members through www.bcbstx.com/ut
and clicking on Personal Health Manager you can:
•
Earn Blue Points SM every time you use the health and wellness
features in the For Your Health section. Receive up to 1,000
points a week when you set up and track the progress of an
exercise or meal program, read and rate health and wellness
related articles, or e-mail your health-related questions to
licensed professionals
• Complete a health risk assessment to evaluate your
health status
• Request fitness and weight loss advice with Ask A Dietitian
•
Receive help on managing stress, workplace conflicts or other
issues with Ask A Life Coach
• Ask registered nurses health-related questions online with the
Ask A Nurse feature
• Receive targeted wellness information via e-mail to help
manage specific medical conditions, including alerts for
screening tests, and set up reminders for medical appointments
and medication refills
• Access wellness tracking tools, videos and interactive tutorials.
• Get information on exercise, nutrition and lifestyle issues in the
For Your Health section
Behavior Modification Obesity/Weight
Management Program
UT SELECT coverage will also feature new lifestyle management
programs, comprised of Licensed Master Social Workers and
Licensed Professional Counselors who promote wellness through a
holistic approach of behavioral coaching, clinical coaching,
education and condition management.
Regardless of your personal health status — every UT SELECT
plan participant can take advantage of important health and
wellness resources from Blue Cross and Blue Shield of Texas.
Call 1-800-462-3275 to enroll or find out more about how
Blue Care Connection programs can help you.
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Blue Extras
SM
Blue Extras arranges for UT SELECT plan participants
and covered dependents to have access to discounts on
a variety of alternative and complementary health care
services and products.
Savings on Hearing Aids
Blue Cross and Blue Shield of Texas has arranged for a discount
program through TruHearing** that offers digital hearing aids at a
reduced price. This program allows you to receive discounts of
30% to 60% off manufacturer suggested retail price for the latest
technology digital hearing instruments. The program also includes
a free hearing screening, hearing instrument fitting and related
services through the TruHearing network of participating providers.
As a UT SELECT plan participant, your children, parents and
grandparents can also access this discount hearing program.
To access the program, call the TruHearing toll-free phone
number, 1-877-882-2020, during the hours of 8 a.m. to 8 p.m.,
Monday through Friday to locate a provider, schedule an
appointment and obtain a referral to the provider. It’s that easy!
For additional information, you may also visit the program’s
Web site at www.TruHearing.com.
**The relationship between Blue Cross and Blue Shield of Texas and TruHearing is that of
independent contractors.
Jenny Craig Membership Discounts
discounted joining fee to Jenny Craig. To learn more and register
for the Jenny Craig discounts, log onto Blue Access for Members
through www.bcbstx.com/ut and click on the My Coverage
tab, then Your Discounts, then the Jenny Craig logo. Fill out the
registration form and click submit. Once you submit, your special
offer coupon will appear on the screen. Print the coupon and
bring it with your UT SELECT ID card to your free consultation. To
find the nearest Jenny Craig Centre, log onto www.jennycraig.com
or call (800) 597-Jenny (5366). Be sure to identify yourself as a
Blue Cross and Blue Shield of Texas member and UT SELECT
plan participant.
Curves Membership Discounts
A regular exercise program is vital to achieving and maintaining a
healthy weight. Curves is the first fitness and weight loss facility
to target women and provide them with affordable, one-stop
exercise and nutritional information. UT SELECT plan participants
and covered dependents can join Curves for a special $49* joining
fee. To take advantage of the discount, present your UT SELECT
ID card to any Curves location**. For more information, you can
log onto Blue Access for Members at www.bcbstx.com/ut, click
on the My Coverage tab, then click Your Discounts. You may also
visit www.curves.com or call (800) CURVES-30.
* Additional regular monthly fee applies. **Franchisee participation and discount may vary.
Good health requires more than good intentions – especially when
it comes to weight management and fitness! Blue Cross and
Blue Shield of Texas now offers you and covered dependents a
Your Health is a Personal Matter
And we have taken measures to keep it that way.
We understand that your health care information should be treated confidentially, so we have
procedures in place to help ensure that occurs.
Your doctors and other contracting providers must also comply with applicable laws, professional
standards and policies regarding the confidential treatment of medical information.
www.bcbstx.com/ut
Transitional Benefits
If you or a covered dependent are currently being treated for a chronic or
ongoing medical condition at the time of enrolling in UT SELECT and your
doctor is not in the PPO network, ongoing care with your current doctor may
be requested for up to three months. Some medical conditions that are
eligible for transitional benefits include:
• Pregnancy (if you are in your third trimester on September 1)
• Cancer
•
Allergy Treatments
Organ Transplant
• Heart Failure
• Physical Therapy
• Behavioral Health Care
• Diabetes
•
Transitional benefits are subject to approval. To request transitional benefits,
complete a Transitional Benefits form available from your campus Benefits
Office or online at www.bcbstx.com/ut. Instructions for submitting the
request to Blue Cross and Blue Shield of Texas are on the form. If the
transitional care request is approved, you or your covered dependent may
continue to see the non-network doctor and receive the network level of
benefits from the UT SELECT plan for up to three months. If the transitional
care request is denied, you may still continue to see your current doctor, but
benefits will be paid at the non-network level.
If your doctor is in the network, you do not have to complete a Transitional
Benefits form.
Choose Well:
What you can do to help keep
your costs down
• Work
with your doctor to understand treatment
options and costs to make sure you’re getting
the most for your health care dollars
• Visit your doctor instead of the emergency room
for non-emergency care
• Talk with your doctor about choosing generic
drugs when possible, which can help reduce
prescription costs
• Work with your doctor to learn ways to stay
healthy through exercising, eating a balanced
diet, reducing alcohol consumption and other
preventive measures
UT SELECT and Medicare
If you are enrolled in Medicare and your physician accepts Medicare Assignment of benefits:
• You do not have to see a network physician to get the highest level of benefits.
• UT SELECT will pay 100% of the covered services approved but not paid by Medicare.
• UT SELECT will cover your annual deductibles, copayments and coinsurance.
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customer service 1.866.882.2034
Point Click Go!
Now, getting information about your health care benefits is easier than ever
at www.bcbstx.com/ut. When you go online, you’ll have the health and
benefit information you need right at your finger tips.
Here you will find the most up-to-date hospital and provider information. You can view and download the online directories already
designated by regions in the state of Texas. Provider Finder also allows you to search, customize and print a list of providers tailored to
your specific needs. While customizing your search, you will also find other useful provider information, such as:
• Office hours
• Board certification
• Languages spoken
• Provider’s gender
• Hospital and facility affiliations
BlueCompare Provider Finder®
• Online mapping to the provider’s location
Choose Well:
Enhancement
Choosing a doctor can be difficult. That’s why we
built BlueCompare, a component of Provider Finder
on www.bcbstx.com/ut, which will allow UT SELECT
plan participants and non-plan participants to research
care practices and affordability for physicians and
professional providers in the BlueChoice PPO network.
To give a more complete view of how a chosen
physician compares to those in his or her peer
group, BlueCompare uses blue ribbons to designate
physicians’ performance according to evidencebased measures guidelines. Similarly, a scale that
indicates “more,” “average” or “less” provides an
overview of which doctors and professional providers
are more affordable when managing the care of
patients who have similar medical conditions and
access care within the same geographic area.
BlueCompare is not meant to tell you which doctor
you should select. This is a very personal choice, and
you should not decide based only on BlueCompare
information.
www.bcbstx.com/ut
•
Review list of important phone
numbers, mailing addresses
and other contact information
•
Learn more about UT SELECT
and access enrollment and
benefits information, including
frequently asked questions
and downloadable forms
• Locate
network providers
• Log
on to Blue Access
for Members
As a UT SELECT member, you have immediate, secure access to your
medical claims information. Blue Access for Members lets you:
• Check the status of your claims and your claims history
• Confirm who in your family is covered under your plan
• View and print an Explanation of Benefits (EOB) for a claim
• Select the option to stop receiving EOBs in the mail
• Sign up to receive claim status e-mail alerts
• Request e-mail notification of finalized claims
• Request a new or replacement ID card or print a temporary ID card.
To register for Blue Access for Members, you will need your group and
identification numbers from your UT SELECT ID card. You will be asked
to create a user ID and password for immediate and secure access to
your personal information.
Choose Well: Take a Health Risk Assessment
Learn about your health status and risks by completing a confidential Health Risk Assessment (HRA) available through Blue Access for
Members. By completing the HRA, you can receive recommendations for improving your health and share the information with your
physicians. The HRA focuses on four key areas—stress, sleep, fitness, and nutrition.
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customer service 1.866.882.2034
Choose Well: How to plan for good health and take care of yourself
Set health improvement goals for next week, next month, next year and reward yourself for meeting them. Research shows that at least
50 percent of health status is based on lifestyle choices.
• Quit smoking
• Be active—exercising can help you lose weight or maintain a healthy weight and lower or control blood pressure and cholesterol levels
• Maintain a healthy weight—if you are already at a healthy weight, maintain your weight; if you are overweight, lose weight
• Control your blood pressure—regular exercise, a healthful diet and reducing your intake of salt and alcohol can help control your
blood pressure
•
Control your blood cholesterol levels—regular exercise, a healthful diet and losing weight can help control your cholesterol levels.
Eat a healthful diet—a diet low in cholesterol, saturated fats, salt and other sodium and high in fiber from fruits, vegetables and
whole grains
• Reduce your stress levels—exercise, relaxation, breathing techniques and meditation are inexpensive and healthful ways to help
lower stress
• Control your blood sugar levels
•
Choose Well: Curbing unhealthy choices at the drive-through
Whether scrambling to grab breakfast on the way to work or picking up dinner before baseball practice or piano lessons, Americans are
spending more and more time eating meals on the go. Here’s how to make fast food menu choices that are quick and healthy:
• Keep portion sizes small, such as choosing a regular or children’s-size hamburger rather than burgers with two to
three beef patties
• Substitute fries or onion rings with healthy side dishes like a salad or fruit bowl
• Opt for grilled items and avoid fried or breaded foods that are high in fat and calories
• Ask for healthier, low-fat options for condiments that come
with entrees
• Save calories by ordering water, diet soda, unsweetened ice tea, sparkling
water or mineral water
If life has you eating on the run, take a little
time to slow down and make smart, healthy
choices when you’re in the fast food lane.
UT
Claims Address
Blue Cross and Blue Shield of Texas
P.O. Box 660044
Dallas, Texas 75266-0044
Customer Service
1-866-882-2034
8 a.m. to 5 p.m. (Central Time) Monday–Friday
Online Provider Directory and Website
www.bcbstx.com/ut
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and
Blue Shield Association, provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims.
47642.0407