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Blue Essentials Access – Plan Highlights Effective September 1, 2017, Blue Cross and Blue Shield of Texas willoffer Blue Essentials Access. HMO coverage was previously provideby Allegian Health Plan. Available for employees living, working or residing in Cameron,Hidalgo, Starr and Willacy Counties. The Blue Essentials Access plan was developed for members lookingfor cost saving alternatives, offering a choice of providers with noreferral. Eligible members have access to a statewide Blue Essentials Network.1
Blue Essentials Access – Benefit HighlightsMedical2017-2018Deductible 500 per individual 1,000 per familyOut-of-Pocket Maximum 4,500 per individual 9,000 per familyOffice VisitPrimary Care – 25Specialist – 60Inpatient / Outpatient Copayment20% – after deductible(member share)2
Blue Essentials Access – Benefit HighlightsPharmacy2017-2018Deductible 100 per individualRx Yearly MaximumUnlimitedCopaymentsTier 1 – 10Tier 2 – 40Tier 3 – 65Tier 4 – 20%FormularyClosedPharmacy Network excludes CVS3
Blue Essentials AccessChanges effective September 1, 2017 Visit, day and dollar limits removed for home health, skilled nursingfacilities, accidental dental care, prosthetics, orthotics, spinalmanipulation and durable medical equipment ; Hearing aids are now covered - one per ear every 36 months; No maximum for specialty drugs, the 20% coinsurance will apply tothe overall 4500 out-of-pocket maximum; Pharmacy network excludes CVS4
Monthly Premium Rates for 2017-2018Premium rates effective September 1, 2017Coverage CategoryEmployee OnlyEmployee and SpouseEmployee and Child(ren)Family2017-2018 460.50 1,113.72 720.86 1,181.285
Blue Essentials Access – Service Area Available to employees living,working or residing in thefollowing counties:––––CameronHidalgoStarrWillacy Provider Network– Statewide Access Provider Finder– A complete list of networkproviders is available at:www.bcbstx.com/trshmo6
Why Blue Essentials Access Works Employees can use a select network of providers statewide Employees traveling outside of Texas who need urgent care haveaccess to the BlueCard program. Employees have access to health and wellness programs A dedicated Customer Service line for TRS-ActiveCare members7
Blue Essentials Access - Contact usPersonalized Service Call customer service for:––––––Claim questions/statusNetwork provider informationMedical and Rx coverage questionsID card requestsTransition of care informationHelp with online toolshttp://www.bcbstx.com/trshmoCustomer Service1-888-378-16338
by Allegian Health Plan. Available for employees living, working or residing in Cameron, Hidalgo, Starr and Willacy Counties. The Blue Essentials Access plan was developed for members looking for cost saving alternatives, offering a choice of providers with no referral. Eligible me
