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Human Resources Office

Health Select FAQs

The Department of Human Resources has compiled the following list of frequently asked questions for HealthSelect. If your question has not been answered at this site, please contact us at (325) 942-2168.

Q. How can I find a network provider who is listed on HealthSelect?

A. You can find a Primary Care Provider (PCP) or Specialist by visiting the HealthSelect Web site.

Q. Once I designate my PCP, can I select another?

A. Yes, you may change your PCP by calling HealthSelect Customer Service at (800) 252-8039. Your PCP change is effective the date of your call. You will receive an updated identification (ID) card that contains your new PCP's name and phone number.

Q. Can I choose a PCP from another network area, or another network city?

A. Yes. You may select any network PCP. Be sure you notify HealthSelect of your selection by calling HealthSelect Customer Service at (800) 252-8039.

Q. As an in-area participant, is there a deductible to satisfy when I use network providers?

A. No, deductibles apply only when you receive non-network benefits.

Q. Do I and all of my covered dependents have to satisfy a calendar year deductible?

A. Once three of your family members have each individually satisfied their calendar year deductible under one subscriber ID number, the rest of your covered family members do not have to satisfy a deductible.

Q. I have not satisfied my calendar year deductible and am receiving care in December which continues into January of the next year. Do I have to satisfy another deductible?

A. Yes. Your deductible is calculated on a calendar year basis. Therefore, on January 1st, you would be required to meet your deductible for the new calendar year. There is no carryover of deductible or coinsurance amounts.

Q. Are all in-area network services available for a copayment?

A. No. While you pay a copayment for office visits to a network provider, other services are paid differently. For example, you are responsible for coinsurance for expenses for routine x-rays, immunizations, and lab tests, "except when performed and billed by the same provider during the office visit." When these services are performed and billed by your physician during an office visit, you pay only a copayment for the service and the visit.

Q. Can network copayments be used to satisfy the out-of-pocket coinsurance maximum?

A. No, copayments do not apply to your coinsurance maximum.

Q. What is coinsurance? Once I satisfy my network out-of-pocket coinsurance maximum, do I still have to make copayments?

A. Coinsurance means the percentage you pay for services such as allergy injections, hospital care, etc. Even after the coinsurance maximum is met, you must pay copayments.

Q. How do my deductible and coinsurance accumulate?

A. Your deductible and coinsurance are accumulated and calculated on a calendar year basis, January 1st through December 31st of the same year. Deductible and coinsurance amounts are applied to your claims based on the date your claims are received and processed by HealthSelect, not necessarily in chronological order.

Q. Do I and all of my covered dependents have to satisfy the calendar year coinsurance?

A. Yes. Each covered family member must individually satisfy their calendar year coinsurance. Once the covered family member satisfies the calendar year coinsurance, HealthSelect will generally pay 100% of covered services and supplies, except for prescription drug copayments, for which you would still be responsible.

Q. I'm sick and I call my PCP. The nurse says the doctor can't see me for two weeks. What do I do?

A. Request an appointment with your PCP's backup. Every PCP is required to have one or more backup PCPs. If you are not able to obtain the names and telephone numbers of the backup PCPs, call HealthSelect Customer Service at (800) 252-8039.

Q. My physician has recommended that I pursue a certain treatment for my diagnosis. How can I be sure HealthSelect will provide benefits for the treatment?

A. You and your physician can request a predetermination of benefits for your proposed treatment. Your physician will need to provide HealthSelect with your diagnosis and history, past treatments, and a description of the proposed treatment. Based on the information provided, HealthSelect will respond with a written determination on whether or not the proposed services are medically necessary and therefore eligible for benefits.

Q. My PCP sent me to another network physician for care, but when I received an EOB from BCBSTX, it stated that I had received non-network benefits. Why?

A. Your PCP may have forgotten to contact HealthSelect to set up the referral. If you ever receive a confusing EOB from HealthSelect, call HealthSelect Customer Service (800) 252-8039 to investigate and correct any problems with your claims.

Q. Do I need a referral for routine eye exams?

A. No. One routine eye exam per calendar year, per participant, is covered (non-network, subject to calendar year deductible). To receive these services at the network level of coverage, simply schedule an appointment with a network optometrist or ophthalmologist. (Contact lens exams, prescriptions or fittings of contact lenses, and the cost of the contact lenses or eyeglasses are not covered)

Q. What is my group number and subscriber number?

A. Our group number is 38000 and your subscriber number is "ZGB" + your social security number.

Q. How many ID cards are issued to HealthSelect participants?

A. One card is issued for individual coverage and if you cover any dependents, a separate card is issued for each covered dependent. To receive additional cards, call HealthSelect Customer Service. Your ID card will list your name and PCP, as well as your covered dependents' names and PCP selections.

Q. Whom should I contact when my address changes?

A. Contact the Department of Human Resources at (325) 942-2168 if you are an active employee, or contact ERS at (877) 275-4377 if you are a retiree.

Q. My EOB was sent to the wrong address. Why? And how can I prevent this?

A. HealthSelect mails EOBs and subscriber reimbursement checks to the address shown on the claim that was filed. If your provider filed your claim, you should verify they have your correct address.

Q. I live in-area, but my covered dependent does not live with me and is at school out-of-areA. However, my dependent comes home for the summer. Whom do I contact with my dependent's address changes?

A. Contact HealthSelect Customer Service at (800) 252-8039 with any dependent address changes. Please note: The county you list for that dependent determines the type of coverage the dependent will receive.

Q. When will a dependent's coverage end?

A. The coverage will end if the dependent is no longer an eligible dependent (for example, your spouse's coverage will end if you get divorced, and a child's coverage will end if he or she gets married (Our office should be notified within 30 days of marriage of child) or reaches age 25, unless eligible as a disabled dependent); or if premium payments for dependent's coverage are not made; or if a dependent is removed from the health coverage.

Q. I am a retiree under age 65, and my dependent spouse will turn age 65 before I do. Will my dependent spouse be required to purchase Medicare Part B?

A. It is recommended that your dependent spouse purchase Medicare Part B; otherwise you will be considered the primary pay or and HealthSelect will be secondary.

Q. How do I file a claim in-network?

Remember: If you use a network provider you do not have to file claims. If, however, you receive care from a non-network provider or you are filing a claim for diabetic supplies (other than insulin or syringes), you must follow these steps:

Step 1 Get a claim form from the Department of Human Resources if you are an employee, or call HealthSelect Customer Service at (800) 252-8039 if you are retired. You may also download a claim form from the ERS web site or link directly to the HealthSelect Web site.

Step 2 Fill out the claim form completely.

Step 3 Attach your original itemized bills that show the services performed and the date, the charges, and the name of the patient. If you incur medical costs outside the United States, please obtain an itemized bill that has been translated into English and U.S. currency, using the rate of exchange on the date of service.

Step 4 Mail the form and bills to:
Blue Cross and Blue Shield of Texas
P.O. Box 660044
Dallas, TX 75266-0044

Step 5 Payment, if appropriate, will be made to you along with an EOB.

Regardless of who files the claim, you will receive an EOB from HealthSelect.

Q. Am I covered when traveling out of the network areas, particularly out of state and out of the country?

A. Yes. HealthSelect provides coverage for medical services received outside of the state or country. Typically, however, you will have to pay for these services in full when rendered and then file a claim with HealthSelect for reimbursement.

Q. How do I file a claim when traveling out of the network areas, particularly out of state?

A. When you or a covered dependent receive medical services outside the state of Texas, your claims may be filed for you through the Blue Cross and Blue Shield Inter-Plan Teleprocessing System (ITS).

ITS is a program that enables participating Blue Cross and/or Blue Shield Plans throughout the United States to exchange membership, claims, and reimbursement information electronically.

This program also allows you and your covered dependents to receive the benefit of discounts which other Blue Cross and/or Blue Shield Plans have negotiated with the participating providers in that state. Remember, in order for you to benefit from these discounts, participating providers must file your claims for you, to the Blue Cross and/or Blue Shield Plan in the state where services were rendered.