- Routine Medical Care (such as physical exams, mild fever and pains, chronic pain and, headaches, colds and flu).
- Specialty Care (such as orthopedic or heart disease).
- Hospital Care (such as inpatient care and surgery, or outpatient surgery)
Visit a doctor – without a referral Preferred Provider Organization (PPO), plans offers the freedom to visit any licensed provider. A member does not need to choose a primary care physician (PCP) or need a referral to see a specialist. Even emergency services and urgent care are covered at the in-network benefit level. Where to Find the Care You Need Here is a summary of your plan’s services and how to arrange for care.
For non-emergency care, call your HealthCare carrier for approval and someone will work with you to coordinate all your hospital care.
- Urgent Medical Care (such as fever, sprains or strains, eye or ear infections, or severe sore throat)
- Emergency Care (such as poisoning, chest pains, broken bones, uncontrolled bleeding, loss of consciousness or sudden paralysis)
How a PPO might work for you
You choose a physician and set up an appointment for a wellness exam. Your physician orders some lab tests and suggests you see a specialist about some problems you have with your stomach. You make an appointment with a specialist in the PPO network
Visit a doctor – without a referral
Our new Individual and Family Plans offer a simple-to-use, comprehensive health plan designed to provide you and your family with the comfort and peace of mind that comes with dependable health coverage.
View our Sales Brochure (PDF 1.5MB) for more information.
Individuals age 64 1/2 or younger on the assigned effective date
Children without an adult subscriber who are 3 months of age or older, up to age 19, regardless of student status
You must be a resident of the state of Texas
Dependent Eligibility Criteria
Your lawful spouse of the opposite sex
Your unmarried children, stepchildren, adopted children, up to 26 years of age, regardless of student status
Your unmarried grandchildren up to 26 years of age if they are Your dependents for Federal Income Tax purposes at the time of application
Your own or your spouse’s unmarried children with continuing mental retardation or physical disability, regardless of age, enrolled prior to age 26. Proof of disability and dependency is required.
Plan Type Overview
Open Access Plan (New!)- flexible in and out-of-network coverage under a national network. No PCP or referral required.
Health Savings Plan (New!) – high deductible plans allow you to use a tax-advantaged Health Savings Account (HSA) to help pay for your current medical expenses or save for future medical expenses. In and out-of-network coverage under a national network. No PCP or referral required.
Members enrolled in the new Open Access Plans or Health Savings Plans have access to the national Open Access Plus Network, contracted with over 500,000 participating quality health care professionals and facilities throughout the country.
For the most up-to-date health care professional listing, please visit the Provider Directory. Enter what kind of health care professional you’re looking for and click “continue search.”
How to Apply
You can apply for Health Insurance coverage, Individual/Family Plan in one of three ways: Online Get a Quote to compare plan features such as deductibles, copays, and premiums. Then Apply using the online application. You can also apply directly without getting a quote.
8:00 am – 8:00 pm Central Time
Contact your authorized Health Insurance Broker or Agent
Please call your insurance broker or call us at 713-781-6119.
No. PCP selection is encouraged, although you are not required to choose one.
Referrals are not required to visit a Specialist.
For emergencies, you’re covered out of the service area – even outside of the U.S. For all non-emergency/non-urgent care, you should receive care from within your designated provider network.
As a member, you have access to a large network of hospitals throughout the state. For the most up-to-date hospital listing, click on the “Provider Directory” on the page of your insurance company. Select “Hospital” under “Type of Provider” and type in your zip code. Choose your state for the “Network” drop down list. Enter what kind of hospital you’re looking for and click “search.”
For questions regarding enrollment eligibility or a bill that was received, please call the office at 713-781-6119