Southwestern Benefit Designers
Southwestern Benefit Designers

BCBS TX — MyBlue Health HMO: Using PCPs vs Select PCPs

24.10.22 01:18 PM By Forrest Huggins

MyBlue Health HMO: Overview

  • In January 2020, Standard Products launched the Texas high performance network in the Dallas and Harris Markets to establish a competitive product aimed to deliver value and offer a competitiaaaave offering for subsidized market providing access to high quality care at an affordable price.

  • While the MyBlue Health network is mirrored after the Blue Advantage HMO product, Blue Advantage HMO and Blue Advantage Plus are different products that do not have relation/combination with MyBlue Health.

  • A consumer not located in the zip codes where MyBlue Health is available, will not have the ability to enroll in the product.
  • A key feature of the MyBlue Health HMO is the Sanitas Medical Group collaboration model.

MyBlue Health HMO: Sanitas Benefits

  • All BCBSTX members (all lines of business) can utilize Sanitas Medical Group professionals and Sanitas Medical Centers but only MyBlue Health HMO members who selected a Sanitas PCP have a $0 PCP cost share when at a scheduled PCP visit with their Sanitas PCP

  • MyBlue Health HMO members don't have to use Sanitas PCPs; if they don't, they're encouraged to stay in network on their MyBlue Health HMO plan and would pay applicable cost shares

  • The Sanitas $0 PCP benefit is only for members who:

1. live in Dallas or Harris county

2. select a MyBlue Health HMO policy in the Retail ACA QHP market (on & off exchange)

3. choose a PCP from the Sanitas Medical Group

  • General plan benefits apply to services excluded from or not listed as included at $0
  • General plan benefits apply to all services provided outside of Sanitas Medical Group, even if referred from a Santas PCP

Select PCP Practice Groups

Bexar County:

CentroMed


Dallas County:

Sanitas Medical Centers


Harris County:

Sanitas Medical Centers


Travis County:

CommUnityCare

Lone Star Circle of Care


Williamson County:

CommUnityCare

Lone Star Circle of Care

Select PCP Practice Groups for Expansion Counties

Cameron County:

Su Clinica Familiar

Harlingen Physician Network

BHS Physicians Network (dba Baptist Medical Network)


Collin/Denton/Tarrant County:

VMO Primary Providers N TX PLLC


El Paso County:

Centro De Salud Familiar La Fe Inc

Project Vida Health Center


Hidalgo County:

South Texas Health System Clinics


*other independent community physicians may be eligible to serve as a Select PCP