For detailed information on UT SELECT, including summaries of in- and out-of-area benefits and plan limitations and exclusions, review the 2009-2010 Benefits Booklet (PDF, 2MB).
Learn more about UT SELECT coverage:
In-Network vs. Out-of-Network Providers
Blue Care Connection® (PDF, 1.8MB)
Prescription Drug Program administered by Medco Health Solutions Inc.
In-Network vs. Out-of-Network Providers
You have the freedom to choose your own doctor at the point of service. No primary care physician (PCP) or referrals required.
With in-network providers:
With out-of-network providers:
ParPlan Providers
Even if you visit a non-network doctor, you may still save money. Blue Cross and Blue Shield of Texas contracts with many out-of-network doctors and hospitals, called ParPlan providers. When using a ParPlan provider, you will receive the out-of-network level of benefits. However, Parplan providers accept the Blue Cross and Blue Shield of Texas allowed amount. In most cases ParPlan providers will file claims, too.
Coverage Outside of Texas
The BlueCard PPO program provides coverage to you and your dependants when living or traveling outside of Texas. The program features:
- Access to more than 625,000 physicians and 6,000 hospitals nationwide
- PPOs can be found in all 50 states, District of Columbia and Puerto Rico
- Receive network (highest) level of benefits
- Claims filed by providers
- No balance billing - BlueCard providers accept the Blue Cross and Blue Shield of Texas allowed amounts for covered services and cannot bill you for charges which exceed the allowed amount.
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; the number is also listed on your UT SELECT ID card. Read more about preauthorization in the 2009-2010 Benefits Booklet (PDF, 2MB).
Condition Management
UT SELECT provides voluntary condition management programs designed specifically for those who have been diagnosed with asthma, diabetes, congestive heart failure, coronary artery disease, metabolic syndrome (high blood pressure, high cholesterol), lower back pain or end stage renal disease. When you enroll in one of the programs, you'll receive helpful information about your condition, at no out-of-pocket cost to you.
Condition management programs work together with your health plan, doctor and you to help identify the best way to manage your condition more effectively. Enrolling in a program can help:
- Decrease the intensity and frequency of your symptoms
- Enhance your self-management skills
- Minimize missed days at work
- Enrich your quality of life
Claims and pharmacy data review, preauthorization prior to a hospitalization or a physician referral are some of the factors that help determine if a condition management program is right for you. Blue Cross and Blue Shield of Texas will notify your doctor by letter if it finds that you would benefit by enrolling in a program.
Each program addresses your specific needs, based on the severity of your condition, complications and risk factors. If the severity of your condition is mild, you will receive:
- Coverage for targeted preventive screenings
- Seasonal mailings with educational materials related to your condition
- Annual contact calls to encourage medication compliance
- Tools to help you better self-manage your condition
If the symptoms of your chronic condition are moderate to severe, your program will be tailored to provide you with:
- Personalized self-management planning
- Regularly scheduled monitoring by a registered nurse
- 24-hour-a-day telephone access to a specialty nurse
- An audio library of topics related to your condition, available by telephone around-the-clock
- Assistance in getting durable medical equipment covered under your health plan
Call 1-800-462-3275 to enroll or to find out more about how condition management programs can help you.
24/7 NurseLine
A staff of trained, experienced registered nurse counselors is available 24/7 to answer health care questions and provide information about a wide variety of health care issues and medical non-emergencies. To talk to a nurse, call this toll-free number: 1-888-315-9473.
Special Beginnings®'
We understand how important having a healthy baby is to you, so Blue Cross and Blue Shield of Texas offers the confidential Special Beginnings maternity program.
Special Beginnings is designed to help you better understand and manage your pregnancy. You will receive the support you need through every stage of pregnancy, including:
- Pregnancy risk factor identification and ongoing communication/monitoring
- Education material covering pregnancy and infant care topics
- Personal telephone contact with program staff from early pregnancy until six weeks after delivery
- Assistance in managing high-risk conditions such as gestational diabetes and preeclampsia
Whether this is your first baby or you have other children, Special Beginnings is a wonderful source of information and support during your pregnancy.
Call 888-421-7781, 8:00 a.m. - 6:30 p.m., CT, to enroll. The first step to having a healthy baby is getting prenatal care, so be sure to enroll in Special Beginnings as soon as you find out you are pregnant.
Expecting a baby? Enroll in Special Beginnings during your first trimester and receive a $50 Reward Card from Target when you complete the program after delivery.
Learn more about Special Beginnings.
English or Spanish
Special Beginnings is not a substitute for professional medical guidance. It is important to share any health concerns with your physician.
