PPO? Point-of-service? HDHP? What does it all mean?

December 06, 2017

When signing up for health insurance, a lot of us are familiar with the most common types of plans, such as preferred provider organizations (PPOs). Some of us may also be familiar with high-deductible health plans (HDHPs).

But HealthSelect of Texas® is a point-of-service plan, which many new employees have never encountered before. Yet it is the type of plan chosen by most Texas Employees Group Benefits Program (GBP) members.

The HealthSelect of Texas plan is a statewide point-of-service plan. A point-of-service plan provides both in-network and out-of-network benefits, but requires that you choose a primary care provider (PCP) and get referrals to see specialists.  Your PCP should be your primary point of service for getting the care you need. Your PCP is responsible for helping direct you to the appropriate specialists for treatment and obtaining referrals for you to see those specialists. HealthSelect of Texas participants pay less out of pocket if they choose an in-network PCP and get referrals from that PCP if they need to see a specialist, such as a dermatologist or cardiologist. Using a PCP to help decide the most appropriate care helps keep plan costs in check while ensuring members get the care they need.

The Consumer Directed HealthSelectSM  plan is a high-deductible health plan (HDHP) with a health savings account (HSA) and PPO network. This plan is available to people not enrolled in Medicare. The PPO network means that participants have both in-network and out-of-network benefits, but don’t have to designate a PCP or get referrals to see specialists. However, there is a high deductible that must be met each calendar year before the plan will begin to pay for any covered health services (other than preventive care) and prescription drugs. To help offset the cost of the high deductible, the State of Texas contributes funds to a HSA, which can be used to pay for qualified medical expenses.

The HealthSelect Out-of-State plan is a PPO that provides coverage outside Texas. This plan is available only to active employees, retirees not enrolled in Medicare and their eligible dependents living or working outside Texas. As a PPO, this plan offers both in-network and out-of-network benefits, but does not require a PCP or referrals to see specialists.

At-a-Glance Comparison of Health Plan Types

  PCP designation required? Referrals to specialists required? Out-of-network benefits available?
HealthSelect of Texas 
(In Area) Plan
 
(Point-of-service plan)
Yes Yes, for most specialists Yes
Consumer Directed HealthSelect
(HDHP PPO with an HSA)
No No Yes
HealthSelect of Texas Out of State
(PPO)
No No Yes