UT CONNECT ACO Medical Plan (for the Dallas / Fort Worth Area)
The UT CONNECT Accountable Care Organization (ACO), is available for Employees and certain Retirees living in the designated Dallas / Fort Worth (DFW) service area. This plan is an option that can be elected instead of UT SELECT during Initial or Annual Enrollment. By enrolling in the UT CONNECT ACO, participants will have access to excellent care managed through a designated primary care provider and will receive all of their medical services from a top quality network of Southwestern Health Resources providers and facilities.
Please review the details of the UT CONNECT plan below as well as a complete list of frequently asked questions.
To learn more about some exciting enhancements coming for the 2019-2020 plan year, please visit the plan website maintained by Blue Cross Blue Shield of Texas (BCBSTX) and review the new brochure and video with details about the plan and CONNECT, a new enhanced customer service option to help make navigating healthcare simpler. Virtual doctor visits via MDLIVE will also be offered beginning September 1, 2019, available 24/7/365 with a $0 copayment.
The UT CONNECT ACO focuses on achieving better health outcomes through closely managed medical care, and benefits are offered only for care obtained through a specific network of providers and facilities in the DFW area. Eligibility for the plan is limited to benefits-eligible Employees and non-Medicare eligible Retirees who live within the DFW service area. Retirees living in the area who are Medicare-eligible or who cover Medicare-eligible family members are not eligible to enroll in the UT CONNECT ACO, but continue to be eligible for the UT SELECT Medical plan.
IMPORTANT NOTE: New enrollees wishing to enroll in the UT CONNECT ACO plan must make an election during Annual Enrollment or following a qualifying change in status (allowed only in certain situations). If you are currently enrolled in the UT CONNECT ACO plan, you will continue in that plan unless you actively change to the UT SELECT Medical plan.
Quality Provider Network
By enrolling in the UT CONNECT ACO (administered by Blue Cross Blue Shield of Texas), you can be assured that you and your dependents will have access to carefully managed health care through a dedicated network of outstanding Southwestern Health Resources (SWHR) providers and facilities. To ensure a broad selection of providers in the Dallas area, UT CONNECT participants will have access to certain carefully-selected community doctors in addition to SWHR providers. If you currently receive services from a SWHR affiliated physician, they will be in the UT CONNECT provider network. If you don’t currently see a SWHR physician, but want to enroll in UT CONNECT, you can locate a network primary care provider online or by contacting BCBSTX’s dedicated UT CONNECT Customer Service team at (888) 372-3398. Beginning September 1, 2019, you can also contact CONNECT for assistance with locating a network primary care provider.
IMPORTANT NOTE: When enrolling in the UT CONNECT ACO plan, participants must designate a primary care provider (PCP) from the list of SWHR and affiliated community physicians. All care is coordinated through the PCP so participants must have one on file to receive benefits.
Out-of-Pocket Premium Savings
Just as with the UT SELECT Medical plan, full-time Employee-only and Retiree-only coverage is available at no cost to the primary subscriber. Out-of-pocket premium rates for full-time employee and retiree Subscriber/Spouse, Subscriber/Children, and Subscriber/Family levels of coverage are approximately 10% lower than those for the UT SELECT Medical plan. Check the complete UT Benefits premium rate chart to see the savings you can enjoy based on your level of coverage.
Enhanced Plan Design
When visiting UT CONNECT ACO network providers, benefits under the UT CONNECT plan are similar to those on the UT SELECT Medical plan. However, there are a few important differences between the two plans outlined below, and you can go online to take a deeper look at the UT CONNECT plan at www.bcbstx.com/utconnect.
|Benefits Highlights||UT CONNECT ACO (new)||UT SELECT PPO (current)|
|Administered by Blue Cross Blue Shield of Texas||Yes||Yes|
|Copay for Annual Primary Care Physician (PCP) Office Visit*||$0||$30 (unless for preventive care)|
|Copay for PCP Office Visits (After the First Visit)||$15 (unless for preventive care)||$30 (unless for preventive care)|
|Copay for Specialist Office Visit||$25||$35|
|Copay for First 5 Days of Inpatient Care for UT Southwestern, Texas Health, Children’s Health and Cook Children’s Hospital Locations||$0||$100 per day
|Copay for Outpatient Facility (Plus Coinsurance)||$50||$100|
|Annual Deductible - Individual / Family||$250 / $750||$350 / $1,050|
|Coinsurance||80% plan / 20% member||80% plan / 20% member|
|Coinsurance Maximum - Individual / Family||$2,150 / $6,450||$2,150 / $6,450|
|Annual Out-of-Pocket Maximum for the 2018-2019 plan year - Individual / Family (includes medical and prescription drug deductibles, copayments and coinsurance)||$7,350 / $14,700||$7,350 / $14,700|
|Out-of-Network and Out-of-Area Benefits||Urgent Care and Emergency Care Only||Yes|
*$0 PCP Copay for Preventive Care for UT CONNECT and UT SELECT
IMPORTANT NOTE: Due to the managed care model of the UT CONNECT ACO plan, there are no benefits for out-of-network or out-of-area services except for urgent care and medical emergencies.
The UT CONNECT ACO plan uses the prescription drug plan (administered by Express Scripts) that matches the UT SELECT prescription benefit. The UT CONNECT ACO plan includes Basic Life Insurance for employees and retirees, plus Accidental Death and Dismemberment Insurance for employees.
For more information about the UT CONNECT ACO plan or further assistance, please call BCBSTX’s dedicated UT CONNECT customer service team at (888) 372-3398, or read the UT CONNECT ACO Medical plan frequently asked questions. Beginning September 1, 2019, you can also contact CONNECT, your enhanced customer service option to help make navigating healthcare simpler.