https://connect.bcbstx.com/understanding-benefits/en-USTelligent Community 12https://connect.bcbstx.com/understanding-benefits/b/weblog/posts/in-network-health-careWed, 08 Jul 2026 14:01:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:46182eaf-b461-4426-841b-05ee98290bcbBCBSTX Connect TeamWhen you shop, you probably keep an eye on costs. You want to buy the things you need at a fair price. What about when you’re shopping for health care? Using providers in your health plan’s network can help you save money. A network includes hospitals, clinics, doctors, pharmacies and others who take part in your health plan. These network providers agree to work with your health plan. That helps keep your costs down. Providers who do not have a contract in place with your health plan are out-of-network . In-Network, Out-of-Network — What’s the Difference? By staying in your network, you can take advantage of discounted rates and avoid surprise charges. That’s because in-network health care providers and your health plan have agreed to a set price for each treatment or procedure in advance. A provider who is not in your plan's network can charge higher prices for the same care. You may also have to pay a higher copay or deductible for out-of-network care. In some cases, you may even have to pay the full cost. Before you go anywhere for care, make sure the provider or facility is in your health plan network. You’ll receive the same quality health care you should expect from any provider at the most affordable cost to you. Try these tips: Once you find a provider, check to see if they are in-network for your specific health plan. Simply asking if they take Blue Cross and Blue Shield insurance is not enough. Give them the information on your member ID card — including the full name of your plan — to make sure. If your primary care provider gives you a referral to another doctor, ask for one who is in your plan’s network. Then make sure that the new doctor is in your network. If you need surgery or other health services, check to make sure each facility where you will get care is in your network. It’s a good idea to see if each provider for the service or procedure is also in your network. But if you get care from an out-of-network provider while you’re at an in-network facility, you may be protected from unexpected costs, called balance billing or surprise billing. To find providers in your health plan’s network, log in to your account and select Find Care. Don’t Forget Pharmacies When you use a pharmacy that is in your network, you’ll save money. With some prescription drug plans, there can be another consideration. Along with in-network and out-of-network pharmacies, there may be a preferred pharmacy network in your plan benefits. If so, you’ll save the most money when you fill your prescriptions at preferred pharmacies. To find an in-network pharmacy, log in to your account and look under Pharmacy. On the Pharmacy page, search for retail or home delivery pharmacies. If you’ve been using a pharmacy that isn’t in-network, it’s easy to switch. You can take your prescription bottle/bag to the new in-network pharmacy. Or you can call the new pharmacy and ask them to contact your current pharmacy. You can also ask your health care provider to contact your new pharmacy. Make sure to ask your provider to send any new prescriptions to your network pharmacy. You may need to take your BCBSTX member ID card with you if it’s your first visit to the pharmacy or if you’ve changed health insurance plans. Plan in Advance Remember, whether it’s a doctor, clinic, hospital, therapist or other provider, you may pay less for care when you visit an in-network provider. That’s why it’s good to learn about your choices before you need care. It will help you be better prepared to take care of your health.Benefits and CoverageUsing Health InsuranceHealth Insurance NetworkHealth Care Costsin-networkhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/hipaa-what-more-do-you-need-to-knowWed, 08 Jul 2026 13:14:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:798d4b9b-cf20-4e32-8004-9216a640b2a1BCBSTX Connect TeamWhen you go to a doctor, dentist or eye doctor, you are asked to sign that you’ve seen their privacy statement. What does that mean? Thanks to the Health Insurance Portability and Accountability Act ( HIPAA ), you are reminded at each visit that your health information will be private and used only for making sure you get the care you need. Privacy Before HIPAA Before HIPAA, a University of Illinois study found, more than one-third of Fortune 500 companies looked at health records or health information as part of their employment decisions. Imagine worrying that a potential employer could refuse to hire you or your current employer could fire you if they found out that: You’re a recovering addict You may need to take extra time to handle your cancer treatment You have HIV, Hepatitis C, or some other health issue You receive care for mental health issues Before HIPAA, this happened. It happened to FBI agents. It happened to truck drivers. It may have happened to you or someone you know. Since HIPAA was signed into law in 1996, employers have not been allowed to see your health information. Privacy with HIPAA Have you: Been told to stand well back from the pharmacy counter? Signed a privacy form when you see a new doctor or go to a hospital? Found it impossible to get health information about a family member? Though these steps may sometimes frustrate you, they are needed to protect your health information and that of others. Things to Consider with HIPAA Your adult child . Do you have a child going off to college? If your child is 18 or over, you may not be able to receive their health information as you had in the past. If you want to know about the health care services your child receives, you’ll need to fill out an authorization form — with your child’s written permission. Helping loved ones with HIPAA . You notice an elderly family member having odd spells or memory issues. You want to know about their care and if there is anything you should be doing to help them. You’ll need an authorization or a power of attorney for health care from your family member before you can help. Completing one of these documents ahead of time can reduce the stress when an issue happens. Your spouse has a serious illness . Cancer, ALS, renal failure. These and other health problems can get critical fast. Make sure you can make decisions that will honor their wishes. Maybe they want to donate their body to science or to be an organ donor. Maybe they want a Do Not Resuscitate order on file. Be sure to complete the necessary forms so you can make or enforce those decisions if your spouse isn’t able to. Privacy laws like HIPAA have made a difference in making sure your health problems are kept private. Make sure you know how they work and what you may need to do if you want others close to you to know more.HIPAAStandard AuthorizationPHIUnderstanding Insurancehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/virtual-visits-annual-examsWed, 08 Jul 2026 09:13:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:6987b8f3-f247-4d6e-856c-1a899752aa64BCBSTX Connect TeamDoes your health plan offer telemedicine visits with doctors in your plan’s network? Now's a good time to check. It may be just what you need to stay on top of your health. During the pandemic, more health care facilities turned to telemedicine visits to help keep patients and staff safe. And telemedicine visits remain a good option for things like: New health concerns Annual exams Routine check-ins on health issues When There’s a Problem Having stomach issues? A headache that won’t go away? A rash that concerns you? These are the types of issues you may see your primary care doctor about. To do so, you usually have to schedule a visit and go to the office. But a hands-on exam may not be necessary. Instead, the doctor may simply offer helpful medical advice, prescribe a medicine or send you for a test. This is the type of visit that can often be handled just as well with a telemedicine visit. If your plan includes behavioral health care, a telemedicine visit is also a good opportunity to talk to your doctor about depression, anxiety or other mental health issues. Annual Exams Some primary care doctors, pediatricians and women’s health providers may also choose to do annual exams using telemedicine visits. These visits play a big role in catching small health problems before they become big ones. Doctors are finding that much of what they do in your yearly checkup can be done virtually: Review your health and family history Update a list of your current medicines Talk about your lifestyle Discuss tobacco and alcohol use, diet and sleep habits Other exams and tests can be scheduled separately. Blood tests, vision and hearing exams and imaging like mammograms are good examples. Your doctor can also send prescriptions directly to your pharmacy. As always, an annual exam is covered at no cost to you if you see a provider in your health plan’s network. Condition Check-ins Chronic health conditions like diabetes, asthma, heart disease and cancer need your attention every day. It’s vital that you keep your appointments, follow doctor’s instructions and let your care provider know if you have concerns. An added benefit of telemedicine visits is that you don’t have to arrange travel or time off from work or school. How Telemedicine Doctor Visits Work Depending on your health plan’s benefits, a telemedicine visit with a doctor in your plan’s network may be covered. Signing up for a telemedicine visit is easy: Make sure you have internet access and a smartphone, tablet or computer with a built-in or attached camera. Call your doctor’s office to ask about telemedicine visits and schedule an appointment. Be sure to ask if the provider is in your health plan’s network. You may need to handle paperwork and any payment before the call, either online or by email. When it’s time for your appointment, follow the instructions from the doctor’s office on how to connect with your doctor. Virtual Visits, powered by MDLIVE ® Telemedicine visits are covered under many Blue Cross and Blue Shield of Texas health care plans. Some BCBSTX health plans also include access to Virtual Visits*, powered by MDLIVE ® . This service gives you access to board-certified doctors and licensed behavioral health therapists for many non-emergency health situations. Log in to your online account to see if you have the Virtual Visits benefit. Go to My Health then Find Care. If you see Virtual Care, click there to see your telemedicine options. If you have Virtual Visits, you will see instructions for how to register and schedule an appointment. *MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Texas. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without permission. Virtual Visits may be limited by plan. For providers licensed in New Mexico and the District of Columbia, Urgent Care service is limited to interactive online video; Behavioral Health service requires video for the initial visit but may use video or audio for follow-up visits, based on the provider’s clinical judgment. Behavioral Health is not available on all plans.Benefits and CoverageVirtual VisitsAnnual ExamTelemedicinehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/fitness-program-waived-enrollmentMon, 06 Jul 2026 08:15:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:748a0159-2a63-4b3e-82d1-fe180b5fc7edBCBSTX Connect TeamWell onTarget, the Fitness Program and Blue Points SM are not available to all members. Check your online account information or ask your benefits administrator to see if you have these benefits. If you’re looking to stay in shape, or get back in shape, now is a good time to join the fitness program. The $19 enrollment fee will be waived for eligible new members who sign up now through Aug. 31, 2026.* Join today and get access to a nationwide network of participating facilities so you can work out whether traveling, at home or at work. You can also choose digital options like online fitness videos and live classes. Enjoy All the Fitness Program Benefits The Fitness Program offers flexible plan options ranging from $19 to $239 a month. You can select a plan option that best suits your lifestyle. You’ll have access to all locations available in the plan you choose, as well as locations in any of the lower-priced plan options. Digital fitness options are also included in all plans at no cost. The Digital Only plan is $10 per month. Choose from thousands of digital fitness videos and live classes. More Fitness Program Features Real-time check-in and activity reporting information is provided through the Well onTarget Fitness Program mobile app and Well onTarget portal. Get Complementary and Alternative Medicine (CAM) discounts through Choices by Whole Health Living.** Save money through a nationwide network of 40,000 health and well-being providers such as acupuncturists, massage therapists and personal trainers. To take advantage of these discounts, register at wholehealthliving.com . Go online to find fitness locations and track visits. Get the Well onTarget Fitness Program Mobile App You can use the Well onTarget Fitness Program app to: Have real-time check-in and activity reporting Explore nearby locations in the Fitness Program network Get easy access to your Fitness Program membership card Download the Well onTarget Fitness Program app free of charge from the Apple and Android app stores. Search for “Well onTarget Fitness Program.” Be sure to register in the Fitness Program portal before you start using the app. After you’ve registered, you can log in to the Well onTarget Fitness Program app using your Fitness Program portal username and password. Join Now To get the waived fee, use coupon code AUG26FP when you enroll. To enroll, log in to your Blue Cross and Blue Shield of Texas member account , go to the My Health drop-down menu and select Wellness . Then scroll down to Fitness Program . You can decide on the plan that best meets your needs and select the fitness location that is best for you. Remember to enter the coupon code AUG26FP during enrollment before Aug . 31 to get the waived fee. You can also enroll by calling 888-762-BLUE (2583) Monday through Friday, between 7 a.m. and 7 p.m. CT (6 a.m. and 6 p.m. MT). *After Aug . 31, 2026, regular enrollment fees will apply to all new memberships. This offer can’t be combined with any other promotional offers. ** Choices by WholeHealth Living benefits are not offered in Oklahoma and Montana. The waived enrollment promotion is only available to members with the Fitness Program, which is included in the Well onTarget ® program. Individuals must be 18 years old to purchase a membership. Dependents 16 to 17 years old can join but must be accompanied to the location by a parent/guardian who is also a Fitness Program member. Check your preferred location to see their membership age policy. Underage dependents can log in and join through the primary member’s account as an “additional member.” Member agrees to comply with all applicable federal, state and local laws, including making all disclosures and paying all taxes with respect to their receipt of any reward. The Fitness Program is provided by Tivity Health TM , an independent contractor that administers the Prime Network of fitness locations. The Prime Network is made up of independently owned and operated fitness locations. No endorsements, representations or warranties are made regarding third-party vendors and the products and services offered by them.Benefits and CoverageExerciseWell onTargetFitness Programhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/trouble-premium-paymentMon, 29 Jun 2026 16:50:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:0d040f44-2e3c-4d27-870e-de69d4bbcb65BCBSTX Connect TeamWe encourage members to make payments by electronic funds transfer and to set up monthly premium payments using Auto Bill Pay electronic funds transfers. When you’re first getting started, using electronic funds transfer helps us process your enrollment quickly. And throughout the plan year, auto payments help make sure your payments are on time without you having to worry about it. Using auto bill pay lowers your risk of losing coverage due to nonpayment of monthly premiums. Our member payment portal experience is designed for quick and easy use. But what can you do if you’re having trouble getting your payments set up? Here are a few common issues and tips that may help you fix them. If your payment set-up is not going through: Recheck for errors. Typos often happen with both number and letter entries. And autocorrect may sneak in an incorrect spelling before you copy and paste. Try a different payment method. Using a different credit card or bank account may help. Banking institutions can have system outages that keep your payment method from going through. And sometimes other electronic bills come through sooner or later than expected, keeping your payment set up from going through. If your payment is not appearing on your bank statement: Check the auto bill pay specifics: Double check the date of your first auto draft or the next date of the auto draft. Look to see where your payment is in the process during the end of the month draft (see status indicator). Remember that it can take up to 24 hours for the bank to show the draft in your account. If you’ve checked for these common issues and are still having trouble, call the number on your member ID card. A customer service representative will be happy to help you complete the process.https://connect.bcbstx.com/understanding-benefits/b/weblog/posts/preventive-or-medicalTue, 09 Jun 2026 00:10:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:85eaadfa-d45a-4b98-a551-39276627435cBCBSTX Connect TeamMany people may not know that there are two types of care you can receive when you go to the doctor — preventive care and medical care. The type of care is different, and your costs may be different, too. Medical Care vs. Preventive Care Think about how people use health care based on their needs. A person with a chronic disease may need to see a doctor or specialist often. Others may have occasional injuries or infections. Treatment of disease and injury is considered medical care. So What Is Preventive Care? Proper diet, exercise and healthy lifestyle can all help avoid certain health problems. Preventive care does the same thing. Preventive screenings can help catch problems early, before you notice symptoms. Yearly preventive exams and screenings may include: A physical exam Screenings for things like blood pressure and cholesterol levels Vaccines you need to prevent illness Mammogram screening Colon cancer screening Cervical cancer screening Diabetes screening Sometimes Preventive Care and Medical Care Cross Paths There are both “screening” and “diagnostic” versions of many tests , such as mammograms and colonoscopies. A screening version is considered preventive care. Preventive screenings are usually ordered at certain ages and at regular intervals when there is no reason to suspect a problem. If a person has symptoms or anything looks unusual on a screening test, then they may need a diagnostic test, which is considered medical care. Diagnostic tests take a closer look to see if disease is present. The technology for screening and diagnostic (medical) tests may be similar. But where and when you take them and who reads the results are different. The out-of-pocket costs may also be different. It’s a good idea to find out what your out-of-pocket costs will be before you schedule your appointment. Check with your doctor’s office to see which kind of test you’ll be getting. And check your benefits or call the customer service number on your member ID card to get the details about your coverage and costs for the test. Why Fix What Isn’t Broken? Even if you feel healthy, once a year you should get a preventive checkup from your doctor. Preventive care may help you avoid some health problems, or find health problems early, when your chances for treatment and cure are better. A preventive checkup is worth your time and effort because: It can catch disease early and may lead to better health outcomes and lower costs. Six in 10 American adults have a chronic disease. Four in 10 have four or more chronic diseases. These diseases are a leading cause of death and disability in the U.S. These conditions are preventable or treatable in many cases. Preventive screenings can find very early signs of a condition, when simple changes in diet and daily habits may reduce the risk or even reverse it. Our qualified* health plans cover most preventive health care services with no out-of-pocket costs when you go to your primary care provider or medical group (for some HMOs) or a doctor or medical center in your plan’s network (non-HMO plans). You pay no copay or coinsurance even if you haven’t met your deductible. You can find complete details of the preventive services your plan covers in your benefit book. To make sure a provider or facility is in your plan’s network, log in to your account online or through the BCBSTX App and go to Find Care. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Chronic Disease , Centers for Disease Control and Prevention; Fast Facts: Health and Economic Costs of Chronic Diseases , CDC, 2025; About Chronic Diseases , CDC, 2026Preventive CareBenefits and CoverageMedical Carehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/blue365-time-to-saveMon, 08 Jun 2026 16:49:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:fb22ccec-21f4-440d-b8e4-53c14504ddd9BCBSTX Connect TeamIf you’re looking for some great discounts on health-related products and services, check out the Blue365 ® program. It’s just one more advantage of being a Blue Cross and Blue Shield of Texas member. You and your covered family members can save with top retailers on products and services that may not be covered by insurance. There are no claims to file and no referrals or prior authorizations needed. Find Deals You Like You can find deals in six main categories: Apparel and Footwear Fitness Hearing and Vision Home and Family Nutrition Personal Care Some examples of discounted products and services you may find include: Outdoor clothing, athletic shoes and fitness products Gyms, classes and wearable devices Glasses and contacts Dental services, vitamins and supplements, and wearables Weight loss programs and meal delivery services Mindfulness classes and products and services that support mental wellness and reducing stress Start Saving To start saving, log in to the Blue365 site . If you don’t already have an account, it’s easy to create one . Be sure to have your BCBSTX member ID card handy when setting up your account. When you log in, you’ll see all the deals available to you. When you find a discount you like, click on details . You may get a coupon code that you can apply directly to your purchase on the vendor’s site. Or you may be sent to the vendor’s site, and the discount will have already been applied for you. Deals change often, so if you see one you like, don’t wait to take advantage of it. Blue365 is a discount program only for Blue Cross and Blue Shield of Texas members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. You should check your benefit booklet or call the Customer Service number on your member ID card for specific benefit facts. Use of Blue365 does not change monthly payments, nor do costs of the services or products count toward any maximums and/or plan deductibles. Discounts are only given through vendors that take part in this program. BCBSTX does not guarantee or make any claims or recommendations about the program’s services or products. You should consult your doctor before using these services and products. BCBSTX reserves the right to stop or change this program at any time without notice. Hearing services are provided by Start Hearing, Great Hearing Benefits, HearUSA and TruHearing ® . Vision services are provided by ContactsDirect ® , Croakies, Davis Vision SM , EyeMed Vision Care, Glasses.com, Jonathan Paul Fitovers, and LasikPlus ® . The relationship between these vendors and Blue Cross and Blue Shield of Texas is that of independent contractors.Benefits and CoverageBlue365DiscountsSave Moneyhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/travelers-checklist-protect-your-health-while-you-travelThu, 21 May 2026 14:07:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:ffb22feb-d580-4dc5-8473-673b2d8faf28BCBSTX Connect TeamVacation sounds good right about now. And whatever kind of vacation you like, there’s one thing that makes it go better – planning. Planning helps your road trip skip the bumps in the road. Planning helps you avoid turbulence, even once your plane has landed. A good first step as you plan your trip is to make sure you have health care that travels with you. Whether you’re taking a road trip or catching a plane, you don’t want sickness or injury to be part of your trip. Before you start to pack, take steps to be prepared. Double check that you have health insurance for where you're going, so you can get the help you need if something does happen. Do Your Research Don’t travel without access to your health plan information. Make sure you set up your online account account before you pack your bags. You can access coverage information, look for providers in your network and more in your account. If you're traveling domestically, you can make a list of the in-network doctors and/or hospitals near where you will be staying. This will save you time and worry if you or one of your family members gets sick. And if you or a family member has a serious, chronic health issue, be sure to talk to your doctor before your trip. There may be additional issues to consider. To find doctors and hospitals in your network, log in to your account online or through the BCBSTX App and go to Find Care . Bring Your Member ID Card Make sure you pack your member ID card. Bring along a photocopy in case you lose it. You will have to show your member ID card at the doctor's office, clinic or hospital if you need health care services. Many providers will allow you to show them a digital copy of your member ID card. You can access your digital ID card by logging into your member account or with the BCBSTX App. Pack Your Medicines and Copies of Your Prescriptions If you are taking prescription drugs, pack enough to last you the whole trip and extra in case of delays. The U.S. Department of State recommends that you leave your drugs in their original, labeled container. Pack them in your carry-on bag if you are flying. Be sure to bring copies of your prescriptions. Going Abroad? See if Your Coverage Travels with You Check your benefits to see what coverage you have when you are away from home. You may want to consider getting additional coverage if you're traveling outside of the U.S. Learn more about international coverage options. Need Shots? Talk to your doctor at least six weeks before your trip to allow time for any recommended or required vaccinations. Discuss your specific travel destinations and what shots you’ll need. Many take time to be effective. Some must be given in a series. While you’re there, make sure all your routine shots are up to date. The Centers for Disease Control and Prevention has a list of recommended shots for children and adults. Know Where You’re Traveling To stay safe, do your research and heed local warnings. Before you leave, stay informed about travel conditions abroad by checking the CDC's Travel Health notices. You’ll find up-to-date news and travel warnings about current health issues linked to specific destinations. These issues may spring from disease outbreaks, special events, natural disasters or other conditions that may affect travelers’ health and safety. Heading Home As you plan your trip, make sure you know what will be required to come back to the States. There are things you may have to do before you can get on a plane or leave the airport, from having your temperature taken to taking a test for a virus or disease. And travel from some countries back to the U.S. may be banned because of contagious disease outbreaks, including measles, malaria and yellow fever. Sources: Vaccines & Immunizations , Centers for Disease Control and Prevention; Medicine and Health: Your Health Abroad , U.S. Department of State, 2025PrescriptionsHealth Insurance NetworkImmunizationsUnderstanding InsuranceTravelingID cardhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/good-fit-doctorMon, 04 May 2026 18:57:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:b26f5af0-19ee-4dcc-a719-c308420aeaa4BCBSTX Connect TeamSometimes you know it’s time for a change. But what if that change involves finding a new primary care doctor? Maybe you’ve moved, and it’s a long drive to your current doctor. Perhaps you’ve had changes in your health or lifestyle. Or you just think it would be better to find someone new. No matter what the reason, you’re ready to act. Some change is hard, but this one doesn’t have to be. Here’s where to start. Take the First Step Your first step is to log in to your member account. You’ll find your coverage details, access resources and tools, and more. You can also learn more about your benefits and access member services. Once you have logged in to your account, go to Find Care to search for network providers in your area. You can search for a doctor by location, medical specialty and more. Remember, if you visit a doctor who is not in your network, you may have to pay more for your care. Sometimes, you may have to pay the full cost. If your health plan is an HMO, there may be special steps for changing doctors. Check your benefits book or call the customer service number on your member ID card if you have questions. Don’t Wait Don’t wait until you're sick to find a personal doctor. That might be an internal medicine doctor or one in family practice. For a woman, it might be an OB-GYN. Or you can select a pediatrician for your child. Remember to visit your primary care doctor for routine care. You may save money by seeing your regular doctor for the flu, minor aches and sprains, and other health issues instead of going to an urgent care clinic or emergency room (ER). There are times when using a walk-in retail health clinic or urgent care center is a good choice. Make sure you only use the ER when there’s an emergency. Start Building Once you’ve picked your new doctor, help your doctor give you the best care by always being open and honest. Asking questions also improves the quality of care you receive. Ask about recommended tests and treatments. Ask questions any time you don’t understand something. One way to build a relationship with your doctor is to schedule a yearly exam. That’s the time to talk to your doctor about your health, risk factors and family medical history to find out what health screenings you need each year. Getting the right preventive health services, screenings and treatments improves your chances of living a longer, healthier life. Build a Relationship with Your Doctor. Your Body Will Thank You There are benefits to regularly seeing the same doctor. The more your doctor knows about you, the better your care will be. Open communication is easier with someone you know. How to Choose When you’re ready to select a doctor, first narrow your choices. Then research the doctors you’re thinking about online or call doctors’ offices to get more information. Be sure to choose a provider who is in your network . Here are some questions the American Academy of Family Physicians suggests you ask: Are they in-network for your health plan? Do they take new patients? What are office hours? Do they have on-call hours? How long does it take to get an appointment with the doctor? What hospital does the doctor use? How many doctors are in the practice? Do they do lab tests in the office? When you find a doctor you want to check out, make an appointment and prepare for the visit. The doctor will need to know your health history and the medicines you take. And tell the doctor about upcoming events that could affect your health, such as travel. After your first appointment, think about your visit. Were you comfortable with the doctor and the office staff? Did they answer your questions? If you feel good about the visit, you may have found your new doctor. Sources: Are You Up to Date on Your Preventive Care? , Centers for Disease Control and Prevention, 2025; Patient Rights , American Medical Association; Choosing a Family Doctor , Familydoctor.org, 2025; Talking With Your Doctor or Health Care Provider , National Institutes of Health, 2025Benefits and CoverageDoctor Patient RelationshipBlue Access for MembersFind a Doctorhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/wheres-my-coverage-health-screenings-for-menMon, 04 May 2026 10:26:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:62f616ff-51bf-4dac-a628-3d3428edd1cdBCBSTX Connect TeamYou’re a healthy guy. You eat right and exercise. You’ve never even had a cavity. So you may think it’s no big deal to skip an annual wellness check. But not so fast. Preventive screenings are important for your health. Screenings help find hidden health problems early, before you have symptoms and when they are easier to treat. If you have insurance, your health plan covers a number of preventive screenings* at no cost. That means you won’t have to pay anything when you go for your exam. The type of screening tests you may need depend on your age and other risk factors. Use this guide to learn about the screening tests that are important for men to have for a long and healthy life. A Guide to Top Risks and How to Prevent Them Cancer Every year, more than 325,000 men lose their lives to cancer. The five most common cancers for men are skin, prostate, lung, bladder and colorectal. The facts drive home why regular screenings are so important. Talk to your doctor about which ones are best for you and how often you need them. After skin cancer, prostate cancer is the most common cancer in American men. It mostly turns up late in life and has a wide range of treatments. For men aged 55 to 69 years, the decision to get regular screenings for prostate cancer should be an individual one, according to the U.S. Preventive Services Task Force. You should discuss your risks with your doctor and decide on the best plan of action for you. Colorectal cancer is the second leading cause of cancer deaths in the U.S. of both men and women. A screening can find precancerous growths called polyps so they can be removed before turning into cancer. If cancer is found, early treatment is effective in preventing death. Do you smoke? Talk to your doctor about your lung health, and about ways to quit. Lung cancer is the No. 1 cause of cancer death in both men and women in the U.S. Counseling for quitting smoking may be covered by your plan. Aids to help you quit, like nicotine patches, may be covered, too. Check your benefits. If you’re over the age of 45, it’s time to get serious about cancer screenings. If some types of cancer run in your family, talk with your doctor about being screened earlier. Based on your results, your doctor will let you know when you should be screened again. High Blood Pressure A blood pressure check by a health professional is easy and painless — and important. High blood pressure (also called hypertension) is the single biggest risk factor for heart disease, stroke, kidney disease and other health problems. High blood pressure usually doesn’t have warning signs or symptoms. Checking your blood pressure is the only way to find out if you have it. Have yours checked regularly. If your blood pressure is high, or you have certain risk factors, your doctor may suggest more frequent checks. Talk with your doctor about ways to keep yours in check. High Cholesterol A simple blood test will let you know if your cholesterol levels are within a healthy range. If yours is high, you have a higher risk for heart disease and heart attack. As with high blood pressure, high cholesterol often doesn’t have symptoms. Men over 35 should get their cholesterol tested regularly. If you are at risk for heart disease, a doctor may advise you to start earlier. Family genetics, your own medical history of heart issues, and the amount of stress in your life are some of the risk factors. Type 2 Diabetes If you have high blood pressure or a family history of Type 2 diabetes , be proactive and get tested for the disease. Without proper management, Type 2 diabetes can lead to other serious health issues. In fact, people who don’t know they have Type 2 diabetes have a much higher risk for stroke and heart disease. Depression Your mental health is just as important as your physical health. If you feel sad and hopeless for more than two weeks, talk with your doctor about a screening for depression . Depression often gets worse if left untreated. Get Started This isn’t a complete list of all the preventive tests often covered by health plans at no charge to you. A good place to learn more about which screenings are right for you is a visit with your primary care provider. Schedule a yearly exam and talk about screenings and a preventive care plan tailored to your health needs. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Cancer Facts & Figures 2026 , American Cancer Society, 2026; Key Statistics for Prostate Cancer , American Cancer Society, 2026; Prostate Cancer: Screening , U.S. Preventive Services Task Force, 2018; High Blood Pressure , American Heart Association; About Cholesterol , Centers for Disease Control and Prevention, 2024; Type 2 Diabetes , CDC, 2024; Can Colorectal Cancer Be Prevented? , American Cancer Society, 2025; Measuring Your Blood Pressure , CDC, 2024; Lung Cancer Statistics , CDC, 2025; Lung Cancer Basics , American Lung Association, 2026Preventive CareBenefits and CoverageMental HealthHealthy LivingCancerMen’s Healthhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/estimate-costs-and-find-doctors-hospitals-with-provider-finderMon, 04 May 2026 08:00:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:63a7884c-2912-4e2a-9537-56b16df9d57dBCBSTX Connect TeamMany of us compare prices before we buy a product or service. It’s one of the best ways to be an informed consumer. But we might not think about comparing prices when it comes to our health care benefits. And that’s a missed opportunity because it could save quite a bit of money. If we want the most value for our health care dollars, a little research can make a big difference. It’s no surprise that costs can vary greatly depending on where you go for care. For example, the cost of an MRI might vary between $613 and $6,304 – depending on the provider. Knee replacements can range from $23,445 to $47,389. And higher cost doesn’t always mean better quality. By doing some research before you get care, you may be able to lower your out-of-pocket costs. Cost sample amounts compiled from allowable in-network cost data for providers within a 50-mile radius of Dallas, Texas. Costs are examples and may not apply to every member’s situation. Be a Smart Health Care Consumer We offer tools to help you make your health care choices. You can: Find a doctor or hospital in your health plan's network. Compare costs* for different providers. Estimate the cost for procedures, treatments and tests. View patient feedback and add your review for a provider. Review providers’ certifications and recognitions. To use these tools, log into your account and go to Find Care . Don't have an account yet? Get set up with a few easy steps. Once you're registered, you can log in to your account. Or you can use the BCBSTX App. The app is available in English and Spanish for iPhone and Android users. Download the BCBSTX App today. *Cost estimates are not available for all plans. Before you schedule a diagnostic imaging procedure, your plan may require that you call a Benefits Value Advisor or Health Advocate. If your plan does require that you contact a BVA or HA, your out-of-pocket costs may be higher if you do not call. Please see your plan documents for details. Cost estimates are just an estimate. In addition to your usual deductibles, copays and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed, what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations and exclusions of your plan.How Health Insurance WorksBlue Access for MembersProvider FinderHealth Care CostsInsurance BasicsFind a DoctorUnderstanding Insurancehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/work-together-with-doctorFri, 10 Apr 2026 18:52:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:0a5b0fda-5206-4408-a0bd-3b33f85bb9e3BCBSTX Connect TeamWhen you need medical care, do you have a doctor you can call? If not, find a doctor you can call your own. Don’t wait until you’re sick to become a patient. If you have an HMO* or POS** plan, you’ll need to find a primary care provider, or PCP, to be your “personal” doctor. A PCP most often focuses on general internal medicine, family medicine or obstetrics/gynecology (OB/GYN). Older adults can choose a geriatric doctor. Children can have a pediatrician. The Power of Teaming Up with Your Doctor Here are five ways having a PCP can benefit your health and well-being. Someone to quarterback your care : Having your own personal doctor means you’ll have someone in your corner making sure you get the care you need. They’ll know your health history, any health conditions you have and what medicines you take. More focus on staying healthy: Your doctor will provide your routine medical care such as annual exams and treatment for colds and the flu. They will also make sure you get vaccinations and screenings and talk with you about how your lifestyle might impact your health. That way you can focus on staying healthy, instead of seeking help only when you are already sick or hurt. A trusted guide to your follow-up care: Your doctor can guide you to the best place to go when you need more care. If you need to be seen by a specialist, they can coordinate the care, especially if you need to be seen by more than one. This keeps your care on track and can help you avoid unneeded visits. Detect and treat illness earlier: Early diagnosis and treatment can keep many common health problems from getting worse. Having your doctor manage your care means problems can be caught early before they become serious or lead to other major illnesses. For example, catching high blood pressure early and getting it under control could prevent you from having a stroke later. Manage your conditions and care better: If you have a chronic health issue such as asthma, diabetes or a heart problem, your doctor can make sure you have access to specialized care to help keep your condition from getting worse. Personal Care. Simplified. To make the most of your relationship with your PCP and get the most out of your health plan, follow this advice: Schedule that first visit now: If you’re choosing a new doctor as your PCP, schedule your first visit as soon as possible. The sooner you create a relationship with your doctor, the sooner you’ll have someone in your corner overseeing your care. And going to your new patient appointment right away will help avoid delays in getting an appointment when you’re sick or need a referral. To each, their own PCP: Each person on your plan can pick their own PCP. Your PCP’s name and contact information will be listed on your member ID card. If you decide later your PCP isn’t right for you, you can choose a different one. See your PCP first: It’s best to call or go to your PCP first when you need care unless it’s an emergency. Your PCP will be able to make informed choices and direct you where you need to go for further treatment. That may mean going in to see your PCP or a specialist, going to an urgent care center, or heading to an emergency room. If you need to be seen by a specialist such as a cardiologist, make sure to start with your PCP. It’s important to get your care from providers in your network. This will help ensure you have fewer out-of-pocket expenses. Depending on your type of plan, if you get care from a provider who is not in your plan’s network, you may have to pay the full cost of your care. To make sure a provider or facility is in your plan’s network, log in to your account and go to Find Care . You can search for the provider and location that is right for you. Depending on your plan, you may also be able to estimate the out-of-pocket costs for your tests or treatments. *HMO is the commonly recognized term that refers to a Health Maintenance Organization. **POS is the commonly recognized term for a Point-of-Service plan.Primary Care ProviderBenefits and CoverageDoctor Patient RelationshipFind a Doctorhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/breast-pumpsThu, 09 Apr 2026 18:22:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:ba728b4f-1ab7-45f4-92cb-73a10e78e952BCBSTX Connect TeamNourishing your newborn baby is one of the most important things you’ll do as a parent. Breastfeeding is a popular option for many parents — and for good reasons. Breast milk provides ideal nutrition that supports a baby’s growth and development. The Center for Disease Control and Prevention (CDC) reports it lowers an infant’s risk for ear infections, asthma, Type 1 diabetes, obesity and sudden infant death syndrome (SIDS). Anytime, Anywhere Convenience Along with important health benefits, breastfeeding does away with the need to mix formula or prepare bottles. It makes on-the-go feeding easy. Also, when traveling it can give comfort to babies when their normal routine has been disrupted. Breast pumps play a vital role in this flexibility. Pumping and storing breast milk allows both parents and others to share in feeding duties and increases your supply of breast milk. When you need to be away from your baby, there is a supply of milk ready to go. Blue Cross and Blue Shield of Texas covers a variety of breast pumps for members whose health care plan includes this benefit. If you have a Flexible Spending Account, you can use your FSA dollars toward any out-of-pocket costs for a breast pump. Which Breast Pump Is Right for You? Every pump is designed with a shield that covers the breast and a container that collects milk. There are some basic variations, though. Before choosing, you’ll want to do a little research to learn about your options. Manual breast pumps don’t require batteries or electricity. Instead, the pump is worked by hand so it can be used anywhere. A manual pump is best for parents who don’t need to pump a lot of milk at one time. Electric pumps have a motor that uses electricity or batteries. They come in single- and double-pump models. Single-pump models collect milk from one breast at a time. Double-pump models can collect milk from both breasts at the same time. Many parents who attend school or work away from home choose double pumps because they work faster and are more convenient. Hospital (or Medical)-grade breast pumps have a more powerful motor for better suction. They are typically used in a hospital setting. The purchase cost of these pumps isn’t usually covered by a health plan. However, they can be rented by the month for home use. Hospital-grade breast pumps are usually only recommended for: Moms who have trouble establishing their milk supply Parents with premature babies, babies with health issues that may impact feeding, or those infants in the NICU Parents of multiple babies Things to Keep in Mind You may not know how often you’ll need to pump until your baby arrives. Your third trimester is a good time to consider ordering your breast pump to ensure you have it before the delivery of your baby. If you’re not sure what kind of pump is best for you, talk with a trained breastfeeding counselor. The U.S. Department of Health and Human Services’ Office on Women’s Health also offers helpful information about breastfeeding , including Your Guide to Breastfeeding , which you can download to refer to when you have questions. We’re Here to Support Parents BCBSTX benefits help support families as they prepare for their new baby . We offer breastfeeding support, counseling and supplies through our maternity benefits. You’ll find a lot is covered by your health insurance plan when you use an in-network provider — even manual and electric breast pumps . Let Us Help You Find a Breast Pump To get started on getting a breast pump, call the number on your member ID card or send a secure message through your member account online . Our Customer Advocates can tell you: If your plan covers a breast pump. If it does, ask if both electric and hospital-grade models are covered. Some plans cover both an electric pump and the rental of a hospital-grade pump up to a certain dollar amount. Other plans may only cover one type of pump. Be sure to ask if there will be an out-of-pocket cost and what that cost may be. Full coverage may only apply to certain models of breast pumps. If your health plan requires a prescription for a breast pump. Which in-network providers or durable medical equipment (DME) suppliers in your network and state offer breast pumps and how to contact them. Depending on your health plan, your benefits may include Women and Family Health. The program offers access to a nurse case manager who can help you find breast pumps and connect you with other breast-feeding resources. Sources: Breastfeeding Benefits Both Baby and Mom , Centers for Disease Control and Prevention, 2025; How to Use a Breast Pump , WebMD, 2025; What to Know When Buying or Using a Breast Pump , U.S. Food and Drug Administration, 2023; Breastfeeding , American Academy of Pediatrics, 2024Benefits and CoverageWomen’s HealthPregnancyInfant Carehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/how-to-save-moneyThu, 02 Apr 2026 19:08:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:00ffb0bd-619c-42c9-b449-e45c9693bf01BCBSTX Connect TeamNo one likes to pay for health care. But we need health care to help us stay healthy, manage health conditions and get care when we need it most. Health insurance protects us from the financial burden of unexpected medical costs. There are a few ways to help lower your out-of-pocket costs. Read on to learn how you can save on doctor visits, prescription medications, fitness equipment and more. Stay Healthy with Preventive Care The best way to save money on health care costs is to stay on top of your health with preventive care. We can’t always avoid illness, but we can do our part to protect our health with annual exams, health screenings and staying up to date on immunizations. It all begins with scheduling an annual visit with your primary care provider . At the visit, you will talk with your doctor about your health history and any changes you may be noticing. You can also find out what screenings are right for you and if you’re due for any vaccines. Visit an In-Network Provider to Save Money Your health plan gives you access to many kinds of health care providers like doctors, therapists, clinics, pharmacies and hospitals. Before you go for care, make sure a provider is in your health plan network. Those who are contracted to provide care for you and other family members in your health plan are called network providers . They may also be called in-network providers or participating providers . Providers who do not have a contract with your health plan are out of your network . To find providers in your network, log in to your account online or through the BCBSTX App and go to Find Care . Then follow these tips to help keep your costs down. Save on Prescription Medicine There are a few easy ways to save on your prescription medicines: By filling your Rx at an in-network pharmacy for your health insurance plan, by checking your plan’s drug list, and by discussing your options with your provider or pharmacist. Preferred Pharmacy Savings If a preferred pharmacy network is part of your benefits, you’ll save the most money when you fill your prescriptions at one. When you use a preferred pharmacy, you pay the lowest out-of-pocket cost on covered prescription drugs. Some medicines have copays as low as $0 at preferred pharmacies. If you need a 90-day supply, you can get it at preferred pharmacies or by home delivery. Learn how to find an in-network pharmacy. Prescription Drug List A drug list is a list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. See if your drug is covered . Some prescription drug plans may require you to pay more if you fill a prescription for a brand name drug when a generic equivalent is available. Members are encouraged to use drugs that are safe, work well and are cost effective. Learn more about pharmacy and prescription plan coverage here. Ask your provider or pharmacist if there are any lower-cost alternatives for your prescription. A generic or lower-tier brand drug may be right for you. Treatment decisions are always between you and your provider. Get Member Perks Blue365 ®* Any member of a participating Blue Cross and Blue Shield plan is eligible for Blue365, a free health and wellness discount program offered to members. You and your covered family members can save with top retailers on products and services that may not be covered by insurance. There are no claims to file and no referrals or prior authorizations needed. Discounts fall into six categories: Apparel and footwear, fitness, hearing and vision, home and family, nutrition, and personal care. Learn how to create an account and save with Blue365. *Blue365 is a discount program only for Blue Cross and Blue Shield of Texas members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. You should check your benefit booklet or call the Customer Service number on your member ID card for specific benefit facts. Use of Blue365 does not change monthly payments, nor do costs of the services or products count toward any maximums and/or plan deductibles. Discounts are only given through vendors that take part in this program. BCBSTX does not guarantee or make any claims or recommendations about the program’s services or products. You should consult your doctor before using these services and products. BCBSTX reserves the right to stop or change this program at any time without notice. Hearing services are provided by Start Hearing, Beltone TM , HearUSA and TruHearing ® . Vision services are provided by ContactsDirect ® , Croakies, Davis Vision SM , EyeMed Vision Care, Glasses.com, Jonathan Paul Fitovers, and LasikPlus ® . The relationship between these vendors and Blue Cross and Blue Shield of Texas is that of independent contractors.PrescriptionsMember RewardsBenefits and CoverageBlue365Save MoneyProvider FinderHealth Care Costshttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/an-explanation-of-your-explanation-of-benefits-eobThu, 02 Apr 2026 12:16:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:b0be7c27-496a-4c4e-a318-ed0fe701464aBCBSTX Connect TeamYou’ve been to the doctor and paid your copay. How are you going to know when your claim is filed and finalized? Simple — you'll get your Explanation of Benefits (EOB). Your EOB will break down the services you received, the cost of the services and what you might have to pay. Your EOB is not a bill. What Is an EOB? An EOB is a notice you get when a health care benefits claim is processed by your health plan. The EOB shows the expenses submitted by the provider and how the claim was processed. If you get paper EOBs, an EOB will be mailed to you after a claim has been finalized. If you are signed up for paperless statements , you'll get an email when your EOB is ready to view in your online account . Below is a sample EOB that explains all of the sections. Keep in mind that every plan is different. The charges on your EOB are according to your plan's coverage and the services you received. Basics of Your EOB Page One A. Your member ID and group numbers B. How to access your claims online C. Helpful contacts and glossary Basics of Your EOB Page Two Top: D. Patient information E. Provider information F. Policy information Details: G. Amount billed by the provider H . Discounts and reductions in compliance with your plan I. Amount covered is the amount billed (G) minus the discounts and reductions (H) J. Health plan responsibility is the portion your health plan pays to the provider K. Deductible amount L. Copay amount M . Coinsurance amount N. Amount not covered O. The amount you’re responsible for. This column provides details about the amount you may owe shown in the claim summary (O 2 ) O 2 . Claim summary J 2 . Total covered benefits approved is the amount that was paid to the provider P. Numbered notes provide additional details Q. Health care plan maximums Always Check Your EOBs Your EOB is an important record of claims for services paid from your benefits. You need to carefully check your EOB . You want to be sure that the services you received match the services you were billed for. If something looks wrong, call us at the number on your member ID card. Or call your provider's office to ask about it. Keep your EOBs in case questions come up later about your claim or your bill. If you’ve registered for BAM, we store your EOBs there for 18 months. You can get more information in your online account . And check out these Health Care Coverage 1-on-1 videos to learn more about EOBs and other coverage information and insurance terms.How Health Insurance WorksBenefits and CoverageMember ClaimsExplanation of BenefitsHealth Care CostsInsurance BasicsUnderstanding Insurancehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/8-things-deductiblesThu, 02 Apr 2026 09:32:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:691a7e95-7ca2-48b0-9bc5-cebf7396b1f5BCBSTX Connect TeamHealth plans can seem complicated. It helps to know what questions to ask and where to find the information you need. Take deductibles, for example. They’re important to your pocketbook, but do you know how they work? To get you started, here are answers to some common questions we get from our members. Q: What is a deductible? A: A deductible is the amount you pay for certain health care services each year before your health plan starts to pay. For example, if you have a $1,500 deductible, you pay the first $1,500 of the covered services you need. Depending on your plan, you may also need to meet this in-network deductible before you pay for covered prescription drugs. This means you will pay the prescription’s full cost upfront until the deductible is met. Then you will pay your copay or coinsurance amount until you meet your yearly out-of-pocket maximum. But some plans do not have a deductible. And some types of medicines may be available at a lower cost (or at no cost), even if the deductible has not been met first. Q: What happens after I meet the deductible? A: Once you’ve met your deductible, you usually pay only a copay and/or coinsurance for covered services. Coinsurance is when your plan pays a large percentage of the cost of care and you pay the rest. For example, if your coinsurance is 80/20, you’ll only pay 20 percent of the allowed amount when utilizing an in-network provider. Your health plan pays the remaining 80 percent of the allowed amount. Q: You said a deductible is the amount you pay each year. Does the deductible reset each year? A: Yes. Since your deductible resets each plan year, it’s a good idea to keep an eye on the figures. If you’ve met your deductible for the year or are close to meeting it, you may want to squeeze in some other tests or procedures before your plan year ends to lower your out-of-pocket costs. Q: Is a health insurance deductible different from other types of deductibles? A: Unlike auto, renters or homeowner insurance where you don’t get services until you pay your deductible, many health plans cover the cost of some benefits before you meet the deductible. For example, your plan may cover the cost of annual physicals and many preventive health screenings before the deductible is met. Q: My plan information says I have a family deductible, too. What does that mean? A: If your plan covers your family, there will probably be a deductible for each person and a separate family deductible. As soon as the family deductible is met, your plan starts paying at the coinsurance amount for everyone’s care. That’s the case even if some family members haven’t met their individual deductible. Here’s a good example of how this works: Your family gets in a car accident. You all need to get checked at the hospital for injuries. If each person had to meet an individual deductible, you would pay all the deductible amounts before your coinsurance started paying. With a family deductible, once you met that one family deductible amount, no other individual deductibles are needed. After the family deductible is met, you’ll only pay your copay and/or coinsurance amount for services for each family member. Some plans, like a high-deductible health plan with a health spending account (HSA), may only have a family deductible. Check your benefit details if you aren’t sure. Q: Do all health care services apply to my deductible until it’s met? A: Not always. Some plans fully cover preventive services, which means you don’t pay anything at the time you get them. Because you don’t have an out-of-pocket charge, those services won’t count toward meeting your deductible. If you receive care that isn’t covered by your health plan, it often won’t count toward your deductible. This might include such things as cosmetic procedures or seeing a provider who isn’t in your health plan’s network. Q: What are the pros and cons of a high or low deductible? A: In most cases, the higher a plan’s deductible, the lower the monthly premium. If you’re willing to pay more when you need care, you can choose a higher deductible to reduce the amount you pay each month. The lower a plan’s deductible, the higher the premium. You’ll pay more each month, but your plan will start sharing the costs sooner because you’ll reach your deductible faster. Some people who don’t often need medical care would rather have a smaller premium and pay more up front for care as they go. But it can mean taking a chance that you might end up paying a big medical bill if you have an unexpected illness or injury. Other people like knowing that when they need their insurance, they won’t have to come up with a large sum of money before their plan starts helping with the cost. They’d rather have a higher premium, but a lower deductible. It makes costs more predictable. Q: If I pay so much out of pocket before my insurance kicks in, why should I have coverage? A: Health coverage can lower your costs even when you must pay out of pocket to meet your deductible. Insurance companies negotiate their rates with providers, and you’ll pay that discounted rate when you use those in-network providers. Without that discount, people often pay twice as much — or more — for care. For details about your deductible, log in to your online account. To see your deductible amount, go to Coverage and Benefits in the Coverage section. You can see how much of your deductible you’ve met to date in the Spending section. To find more information about insurance terms, check out our online glossary . Your Health Plan Offers Many Benefits at No Extra Cost Your health plan covers many preventive services, including vaccines for children and adults and yearly wellness exams, at no cost when you get services from a provider in your health plan’s network.* And screenings like mammograms, Pap tests and others are also covered at no cost. Learn more about the preventive services covered under your plan. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Source: Are You Up to Date on Your Preventive Care? , Centers for Disease Control and Prevention, 2025DeductiblesBenefits and CoverageHealth Care Costshttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/claims-everything-you-need-to-knowMon, 23 Mar 2026 09:00:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:16268d7d-49fb-4157-8546-75979fc2913dBCBSTX Connect TeamWe’ve all done it. Shown or uploaded our member ID card when filling out insurance forms in the doctor’s office or through an online portal. Your doctor’s office needs these details so they can file a claim. A claim is a bill your doctor and other health care providers send to a health insurance company for payment after they have treated you. In most cases, your provider’s office will submit the claim so you don’t have to worry about it. Still, there are times when you may have to submit a claim yourself. For example, if you choose to get care from a provider not in your plan's network. How to Submit a Claim If you need to submit a claim: Go to our Form Finder tool. You’ll find the forms you need to manage your health insurance plan in one convenient place. Scroll the page to find the claim form you need. You can choose from: Dental Medical (Domestic) Medical (International) Prescription Drug (Prime Therapeutics) Click the Download icon to the right. Fill out the form fully. You’ll need this information to complete the form: Date of service/treatment Type of service Dollar amount charged by the health care provider Member ID number (from your ID card) Print the completed form and mail it — along with the original bill from the provider — to the address at the top of the claim form. Some Tips Make copies. The bill you send in with your claim will not be returned to you, so you’ll want to have a copy. Don’t wait too long. Be sure to file your claim soon after you receive care. This is even more important when you go to the doctor late in the year and need to make sure the claim is applied to the right plan year. Check the Status of Claims You can find the status of your claim by: Visiting the “Claims” section in your account online Calling the customer service number on your ID card Your Member Account Online Please note the claim will not show up in your account online until it is processed. There are five types of claims statuses that you may see: Fully Paid: The health care services you received were fully paid by your BCBS Plan. You do not need to pay any part of the bill. Partially Paid: The health care services you received were partially paid by your BCBS Plan. You may still need to pay part of the bill. Check Details of Services for details of what you may owe. Discounts Applied: Your BCBS plan has negotiated cost savings for you with your provider. You may still need to pay part of the bill. Check Details of Services for details of what you may owe. Not Paid: The health care services you received were not paid by your BCBS Plan. You may still need to pay all or part of the bill. Check Details of Services for details of what you may owe. No Action Needed: Though the health care services you received were not paid by your BCBS Plan, you do not need to pay any part of the bill. No further action is needed. Claims may go through future reviews, and their statuses may change. Explanation of Benefits (EOB) Statement Once we process your claim, you will receive an EOB , either by email notification directing you to your account online or mail. This document will break down: Amount billed - The amount billed by your provider for service(s) rendered. Discounts and reductions – Cost savings offered by your plan. Amount covered – The amount billed minus any discounts and reductions. Health plan responsibility – The amount your health plan pays to the provider. Deductible – Before your health plan starts to pay for medical care and prescription costs, you pay 100% of these costs until you reach a set dollar amount known as your deductible. Once you pay your deductible in full, you then cover only your copay and coinsurance costs. Copay amount – A set amount you pay every time you see a doctor or get a prescription filled. Your copay is listed on your member ID card. Coinsurance – Your share of costs you pay for care after you’ve met your deductible. It may be a percentage of the cost, or a set amount. Amount not covered – Costs not covered by your health plan. Your total costs – The amount you may still owe your provider. If your claim was not paid, you can file an appeal. The appeals information is included with your EOB.Medical ClaimsBlue Access for MembersExplanation of BenefitsInsurance BasicsUnderstanding Insurancehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/choose-coverageFri, 20 Mar 2026 11:00:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:907a50fe-b8a1-42ed-9e46-3a7588df20bcBCBSTX Connect TeamAs you get ready to buy health care coverage, here are a few things to think about before you decide on a plan that works for you and your family. Do You Qualify for Assistance or Special Enrollment? Whether you’re buying for the first time or renewing the coverage you have, check to see if you qualify for help paying your monthly premium or your share of the cost for services . The rules may change from time to time. You may need your tax records from the last year to show your income. If you are enrolling outside open enrollment, you will also need valid proof of the life event that qualifies you for special enrollment . Do You Have a Doctor You Like? If you already have providers you like and will still want to see, make sure they’re in the network for the plans you’re interested in. To check, log in to your online account and go to Find Care . What Affects How Much You Spend? Your costs for health care coverage include: Monthly premium: Generally, the higher the monthly premium, the more the plan pays for covered services. This may be important if you have a chronic condition, plan to have a child, or expect to have higher health care costs. Deductible: A deductible is the amount you pay out of pocket before the plan pays. Plans with higher deductibles may have a lower monthly premium. Remember, you must meet the plan’s deductible before the plan starts paying benefits. Cost sharing: These include out-of-pocket payments such as copays and coinsurance. What’s Coming Up? Or Might Be Coming? We can’t predict the future. Illnesses, injuries and other unexpected events can happen, but you can plan ahead. If you have a family history of a chronic condition or conditions, you may want to consider a plan with lower copays for doctor and specialist visits and tests. Some sports may raise your risk of getting hurt. You may want to look at plans with a lower deductible if an extended stretch of treatments may come up. Consider your mental health as well as your physical health. Therapist visits for stress or mental health conditions may require copays as well. What Medicines Do You Take? Prescription drug coverage and copays or coinsurance amounts vary between plans. All health plans we provide have a list of drugs the plan covers. The list includes payment level tiers. Drugs in a lower tier usually cost less. If any of your covered drugs moves to a higher tier with a higher out-of-pocket cost, ask your doctor if there are lower tier alternatives or generics available. Generics typically work like a brand drug at the same dose, strength and use. Generics are also approved by the Food and Drug Administration. Is a Health Savings Account Right for You?* Some plans work with an HSA, which is a special savings account you can use to cover a wide range of qualified health care expenses. An HSA can help you take charge of your health and how you spend your health care dollars. Not all plans are HSA compatible, so be sure to review your options. Please note: Some people with cost-sharing reductions under their benefit plan that reduce the deductible below the federal government’s minimum deductible may not be eligible to contribute to a Health Savings Account. Please consult your tax adviser for more information. One of our licensed sales agents or your independent, authorized Blue Cross and Blue Shield of Texas agent can help you understand your options. *Health Savings Accounts (HSAs) have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax adviser regarding tax consequences of specific health insurance plans or products. Source: Overview and Basics , U.S. Food and Drug Administration, 2025Benefits and CoverageGetting Health InsuranceBuy Health InsuranceOpen EnrollmentIndividual and Family Coveragehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/beware-of-health-insurance-sales-phone-scamThu, 19 Mar 2026 06:42:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:26b13df4-c204-451a-a109-f37c52e7899aBCBSTX Connect TeamSome Blue Cross and Blue Shield of Texas members have been targeted by phone scammers. There are two types of scam calls that members should be aware of. The first type of scam call is known as "spoofing." Spoofing happens when someone fakes the identity of another device or user to steal data from the victim. For example, members receive calls that show "Blue Cross and Blue Shield" on their caller ID even though BCBSTX is not making the calls. These scam callers ask for protected health information (PHI). They also claim they can lower member premiums or offer more coverage. The second type of scam call is made by people who falsely say they represent Blue Cross or Blue Cross and Blue Shield. They claim they're selling health insurance. We don’t know yet who is making these calls, but it's important for you to know BCBSTX does not make any automated prerecorded sales calls. With both of these phone scams: The calls are not from us. Callers ask for personal or financial information. Hang up right away if you get one of these calls. Don’t give out your personal or financial information. Don’t press any number if prompted to do so. Remember, unless you have a qualifying life event , you can't apply for health insurance until the next Open Enrollment period starting in November. Read more about health care fraud and ways to protect your personal and financial information. If you have any questions about calls that may come from us, please call the number on your member ID card.Health Insurance ScamsNotificationsPhone scamsInsurance BasicsUnderstanding InsuranceFraudhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/beware-the-costs-of-freestanding-ersFri, 13 Mar 2026 12:15:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:348ce552-5626-4334-8587-07c4a4fe3155BCBSTX Connect TeamWhen you or a family member gets sick or hurt, chances are good it will happen when your doctor's office is closed. In the heat of the moment, you may head to an after-hours care facility closest to you. Makes sense, right? In reality, where you go for care makes a difference. If you visit a free-standing emergency room, you may be in for a costly surprise. Be sure to carefully consider all your choices for non-emergency care. Unless it is life threatening, an urgent care center is a good place to start. These centers handle health issues that aren’t emergencies, but need immediate attention. Some examples include: A cut that needs stitches A sprained ankle The flu An ear infection Beware of Look a Likes Freestanding ERs found in strip malls and other smaller buildings often look like walk-in clinics and urgent care centers, but charge prices that are more in line with a hospital ER. There are several reasons your out-of-pocket costs are likely to be more at a freestanding ER. They may not contract with your insurance company. They may say they take your health plan but forget to mention that you may not get "in network" benefits because the facility is actually out of network. Where You Go Matters Protect your wallet. Get care in the right setting for the care you need. In a true health emergency, seek immediate help at the nearest emergency facility. When your care is simply urgent, think about all your choices. Consider calling your doctor first for help (even after hours and weekends). Depending on your doctor's service options, you may even be able to get care through telemedicine. Ask questions until you get the answers you need to handle your health concerns. To get help finding the nearest urgent care clinic, use the Blue Cross and Blue Shield of Texas smartphone app or call the number on your member ID card.Emergency CareBenefits and CoverageWhere You Go MattersIn the TX CommunityPublic HealthCompare Costs