Consumer Directed HealthSelectSM High-Deductible Health Plan
For more information on the HDHP and how the deductible works, please see questions 13-28 below.
For more information on the HSA, please see the HSA Frequently Asked Questions.
For some retirees, the state’s premium contribution for any of the health plans is based on years of service.
Whether you spend less and save money with Consumer Directed HealthSelect depends on a number of things – including your and your family’s health, and your financial situation. Members who cover eligible dependents will pay lower monthly premiums in Consumer Directed HealthSelect. And the state will contribute to eligible members’ health savings accounts (HSAs) to help pay for any health expenses they might have. But Consumer Directed HealthSelect has a much higher annual deductible than the other plans, which means you could pay much more out of pocket. The deductible is the amount you or your family would have to pay out of pocket before the plan starts to pay for any covered expenses, except for in-network preventive services. (In-network preventive services, such as annual check-ups and vaccinations, are covered at 100%, even if you haven’t met the deductible yet.) So, even if you spend less on dependent premiums and get state contributions into an HSA, you could end up spending thousands of dollars out of pocket on health services and/or prescriptions before the plan begins to pay.
Blue Cross and Blue Shield of Texas, the third-party administrator of Consumer Directed HealthSelect and HealthSelect of Texas, has an interactive plan decision tool to help you decide which plan might be right for you.
This new health plan option is available to all State of Texas employees and retirees who are eligible for health insurance coverage and who are not enrolled in Medicare. But it’s important to know that, according to U.S. Internal Revenue Service (IRS) rules, not everyone is eligible to participate in a health savings account (HSA). Because the main benefits of Consumer Directed HealthSelect are the ability to lower taxable income and get state contributions through an HSA, you should make sure you’re allowed to participate in an HSA by talking with a financial or tax advisor.
In general, you cannot participate in an HSA if:
- You are covered by a non-HDHP, such as a spouse’s plan, that provides any benefits covered by your HDHP with Consumer Directed HealthSelect. Exceptions include coverage like vision or dental.
- You are enrolled in any part of Medicare (Part A, B, C and/or D).
- You are claimed as a dependent on someone else’s tax return.
- You receive benefits under TRICARE or TRICARE for Life.
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You have a health care flexible spending account (like a TexFlex health care account) in the same plan year. For information about enrolling in Consumer Directed HealthSelect if you have funds remaining in a TexFlex health care flexible spending account, please see question 26 in the HSA Frequently Asked Questions.
Because out-of-pocket costs in Consumer Directed HealthSelect could be much higher than in HealthSelect of Texas or the HMOs, you should learn all you can about the plan and think carefully before changing to Consumer Directed HealthSelect. If you cannot afford thousands of dollars in upfront out-of-pocket costs before the plan starts paying for any covered health services and prescriptions (except in-network preventive care), you probably should not enroll in Consumer Directed HealthSelect.
Blue Cross and Blue Shield of Texas, the third-party administrator of Consumer Directed HealthSelect and HealthSelect of Texas, has an interactive plan decision tool to help you decide which plan might be right for you.
You do not need to submit evidence of insurability (EOI, also called proof of good health) to change health plans.
Changing from a high-deductible health plan like Consumer Directed HealthSelect to a non-HDHP plan, or vice versa, during the plan year could have an impact on your taxable income, depending on how much money is deposited in your health savings account before or after you change plans. In general, the maximum you can contribute to an HSA during the plan year is based on how long you participate in an HDHP. For more information, please see the in-depth HSA Frequently Asked Questions.
There are other things to consider, such as the ability to participate in a health care flexible spending account. You should carefully review IRS regulations, or talk to a financial or tax advisor to make sure you understand how changing from an HDHP to a non-HDHP (or vice versa) during the plan year can affect your HSA and taxable income.
More information about how the plan works is available on the Consumer Directed HealthSelect website.
More information about the provider network is available on the HealthSelect provider page. The HealthSelect network includes more than 50,000 doctors and other providers in Texas, and more nationwide.
Blue Cross and Blue Shield of Texas, the third-party administrator of Consumer Directed HealthSelect and HealthSelect of Texas, has an interactive plan decision tool to help you decide which plan might be right for you.
More information about HSAs is available in the HSA Frequently Asked Questions.
For 2021 and 2022, the annual in-network deductible is $2,100 for individual coverage or $4,200 for family coverage. For 2021 and 2022, the annual out-of-network deductible is $4,200 for individual coverage or $8,400 for family coverage. The deductible resets on January 1 each year.
NOTE: If you are enrolled in family coverage, the entire family deductible amount must be met before benefits are paid for any individual participant (except in-network preventive benefits). Each participant's eligible costs count toward the family deductible.
Consumer Directed HealthSelect has the same large national provider network as HealthSelect of Texas. The HealthSelect network includes tens of thousands of providers in Texas. To see if a doctor is in the HealthSelect network, visit BCBSTX’s provider finder.
- The cost of out-of-network services probably will be higher than the cost of in-network services, because you will not be able to take advantage of the plan’s negotiated network rates. Remember, you’ll be paying the full cost of non-preventive services—the plan will not pay anything—until you or your family reach the deductible.
- After you or your family reach the deductible, the plan will pay only 60% for out-of-network services—instead of 80% for in-network services.
- Your deductible will be twice as high for out-of-network services. For the current in-network and out-of-network deductible amounts, see question 15 above.
Like in all ERS health plans, in-network preventive services such as annual check-ups, screenings and vaccines are covered at 100% in Consumer Directed HealthSelect, even if the deductible hasn’t been met.
If you or your family go out of network for preventive services, you or your family will have to meet the out-of-network deductible before the plan begins to pay anything. After meeting the out-of-network deductible, you will pay 40% of the full cost of out-of-network preventive services. For the current in-network and out-of-network deductible amounts, see question 15 above.
In other ERS health plans, you have to pay a $50 per person prescription deductible before the plan starts to pay anything for prescription drugs. After you meet the deductible, you have a prescription copay of $10, $30 or $75, depending on the drug. That $50 per-person deductible is much lower than the deductible in Consumer Directed HealthSelect, which includes both prescriptions and medical care.
Under Consumer Directed HealthSelect, you have to pay the full cost of any prescription drugs until you or your family meet the annual deductible. The full cost of a drug could be much higher than the copays in other ERS health plans. Some drugs could cost hundreds of dollars before the deductible is met. Once you do meet the deductible, you’ll pay 20% of the full cost of the drug at in-network pharmacies or 40% at out-of-network pharmacies. For the current in-network and out-of-network deductible amounts, see question 15 above.
NOTE: If you are enrolled in family coverage, the entire family deductible amount must be met before benefits are paid for any individual participant (except in-network preventive benefits). Each participant's eligible costs count toward the family deductible.
You can check estimated costs for medical services by logging in to your Blue Access for Members account through the HealthSelect website. On the site, you can even compare costs between providers. You can also contact Blue Cross and Blue Shield of Texas at (800) 252-8039 (TTY: 711).
For prescription drugs, OptumRx has an online tool to check the coverage and estimated cost of prescription drugs before you meet Consumer Directed HealthSelect’s high deductible. To use the tool:
- Visit HealthSelectRx.com.
- Click on the Drug Pricing Tool tab at the top of the page.
- From the Select your plan drop down menu, choose Consumer Directed HealthSelect Prescription Drug Program.
- Provide the requested information.
- Click Search
To find out coverage and cost under HealthSelect of Texas, choose HealthSelect of Texas Prescription Drug Program from the drop down at step 3.
Like HealthSelect of Texas, Consumer Directed HealthSelect has an annual out-of-pocket maximum that protects participants from catastrophic health costs. The annual out-of-pocket maximum is the most a member or family will have to pay for in-network, eligible health and prescription drug expenses each year, not including the monthly dependent premium payment. If the member or family meets the out-of-pocket maximum, the plan will pay 100% of eligible, in-network health costs for the rest of the calendar year. Remember that the out-of-pocket maximum, like the deductible, is based on a calendar year and will reset every January 1.
For ERS’ non-Medicare Advantage plans, the annual out-of-pocket maximums are:
- 2021—$6,750 for individual coverage or $13,500 for family coverage
- 2022—$7,000 for individual coverage or $14,000 for family coverage.
NOTE: If you are enrolled in family coverage, the entire family out-of-pocket maximum amount must be met before the plan begins paying 100%. Each participant's eligible out-of-pocket costs count toward the family out-of-pocket maximum.
If you get care from a provider who is not in the HealthSelect network, that provider may bill you for the portion of the charges that HealthSelect doesn’t cover, after you’ve paid any required copay, coinsurance and deductible. This is known as “balance billing.” It’s one way you may pay more if you see a provider who is not in the HealthSelect network.
You may be eligible to challenge a balance bill by requesting mandatory mediation between the provider and HealthSelect from the Texas Department of Insurance (TDI). To be eligible for mandatory mediation from TDI, the balance bill must be either:
- from an out-of-network hospital-based physician at an in-network hospital in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for medical services or supplies provided after September 1, 2015,
- from an out-of-network hospital-based health care professional (in addition to physicians) at an in-network hospital in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for health care services, medical services or supplies provided after December 31, 2017, or
- from an out-of-network emergency care provider or facility in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for health care services, medical services or supplies provided after December 31, 2017.
Learn about how you can avoid balance billing from out-of-network providers at in-network facilities.