Use these steps and make the most of your health care coverage.
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Helpful Information
Stay informed and use these tools for cost-effective options.
Take Us With You
Wherever you are, get the care that
works for you.
Know Your Health Plan
Here are some details to know about your health plan. Remember, when you visit a doctor outside of your plan’s network, you may pay more or all of your bill.
Health Maintenance Organization (HMO)
Primary Care Provider (PCP)
You’ll need to select a PCP for your care. This is the one doctor who arranges your care and refers you to specialists. Find an in-network doctor.
Prior Authorization
Some services may require prior authorization (pre-approval).1 Ask your doctor about this so you’re sure who handles this step. Get details on prior authorization.
Plan Network
It's best to visit health care providers in your plan’s network. If you don’t, you’ll pay for most of or the full cost of your care. Review cost examples.
Preventive Care Services
Some screenings, like your Annual Exam, are included with your health plan at no additional cost. Learn why it's important to schedule your annual exam.
Participating Provider Option (PPO)
Primary Care Provider (PCP)
You don’t need to select a primary care provider for your care, but it’s recommended. Your primary care provider can coordinate your care and refer you to specialists. Find an in-network doctor.
Prior Authorization
You don’t need referrals to meet with specialists, but you may need prior authorization (pre-approval).1 Always talk with your doctor about your care. Get details on prior authorization.
Plan Network
You can visit any health care provider in your plan’s network. But, if you get care from an out-of-network doctor, you may spend more. Review cost examples.
Preventive Care Services
Check your Plan Benefit Book for screenings and services you can get at no additional cost to you, like your Annual Exam. Learn why it's important to schedule your annual exam.
Point of Service (POS)
Primary Care Provider (PCP)
You may need a PCP for your care. This is the main doctor who arranges your care and refers you to specialists. Find an in-network doctor.
Prior Authorization
Some services may require prior authorization (pre-approval).1 Ask your doctor about this so you’re sure who handles this step. Get details on prior authorization.
Plan Network
You can go to the health care provider of your choice, but you may pay for most of or the full cost of your care if you go out of network. Review cost examples.
Preventive Care Services
Some screenings, like your Annual Exam, are included with your health plan at no additional cost. Learn why it's important to schedule your annual exam.
Visit With Your Doctor
- Be your own advocate
- Ask your doctor important questions
- Learn when you need prior authorization (pre-approval)
- Build a good relationship with your doctor
Focus on Care
- What is an emergency?
- Choose your care options
- Compare test, lab and imaging costs
- Take a health assessment
Keep Yourself Organized
Find the Right Care When You Need It
Your primary care provider (PCP) should be your first call when you don't feel well. But, based on your symptoms, you have options for where to get care.
Your Doctor
Your doctor can help when you need regular checkups or minor sickness.
Examples: Fever, colds and flu
24/7 Nurseline
The 24/7 Nurseline is a toll-free number to call for general health-related questions and advice on care options.2
Examples: Headaches, dizziness or what to do if your child is sick
Virtual Visits
Virtual visits connect you with a doctor for live, non-emergency medical or behavioral health help by phone, online video or mobile app.3
Examples: Allergies, depression or pink eye
Retail Clinic
If your doctor isn't available and you want to get walk-in, non-emergency care for common symptoms, you can visit a retail clinic.4
Examples: Minor injuries, pain or sore throat
Urgent Care
When you visit an urgent care, you can get quick medical attention when your life or health isn't at risk.
Examples: Cuts that need stitches, sprains or animal bites
Emergency Room (ER)
Emergency rooms should be visited for emergency care if your life or health is at risk.
Examples: Heart attack, heavy bleeding or broken bones
Get Annual Preventive Care
Know how to find problems early, set goals and track your progress.
Preventive Screenings
Keep your health information up-to-date each year with screens for:
- Diabetes
- Cholesterol
- Heart disease
- Body Mass Index (BMI)
Some screenings, like your annual exam, may be offered at no cost to you if you stay in-network.
Preventive Services
Other preventive services that may have no out-of-pocket costs are:
- Immunizations and vaccines
- Weight loss programs
- Anti-smoking programs
- Maternity and well-child visits
Remember, its important to talk with your doctor about your lifestyle and any life changes.
Seeking Emotional Care
Your behavioral health is just as important as your physical health. Know where to turn when you need care.
Finding Helpful Providers
There are many kinds of mental health experts you can get help from.
Review Covered Drugs
Check to see if your drug is on the 2025 Drug Lists. Review drug lists.
Understand how to use your prescription and pharmacy benefits as an individual and family plan holder. Learn more about Rx coverage.
Ways to Save
Generally, you’ll pay less if you go to an in-network pharmacy. Find an in-network pharmacy.
Visit a Preferred Pharmacy Network (PPN) for your lowest costs. Learn more about PPNs and how to find them.
Talk with your doctor or pharmacist and learn if you could save by using a generic drug option instead. Know the difference between generic versus brand name drugs.
More Pharmacy Tips
Learn more about prior authorization or step therapy programs.
Review your prescription plan materials. Check out other pharmacy benefit information.
1 Prior Authorization not required in certain circumstances, such as emergency or urgent situations.
2 The 24/7 Nurseline may not be available with all plans. Check your benefits booklet for details.
3 Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe. Behavioral Health service is limited to interactive audio/video (video only), along with the ability to prescribe in all states. Service availability depends on location at the time of consultation.
4 Visiting a Retail Clinic may not be covered with all plans. Check your benefits booklet for details.
5 The Well onTarget program is offered to you as a part of your employer-sponsored benefits. Participation in the Well onTarget program, including the completion of a Health Assessment, is voluntary and you are not required to participate. Visit Well onTarget for complete details and terms and conditions. Coaching programs are only available to individuals whose employers have purchased the program. Check with your administrator to see if the Coaching programs are available to you. Program rules are subject to change without prior notice. See the Program rules on the Well onTarget Member Wellness Portal for more information.
The Well onTarget member rewards redemption service is provided by an independent third party. Onlife Health is an independent company that provides wellness services for the Well onTarget program. Members can use their Blue Access for Members credentials to access wellontarget.com. Blue Cross and Blue Shield of Texas makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.