List of all medications that are covered at 100% on all formularies. Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap).See your doctor and refer to the CDC’s posted schedule of immunizations for more information. Doses, recommended ages and recommended populations vary. The following are the recommended vaccines for men that are covered with no out of pocket cost. More information: Preventive care includes 4 treatments provided by a physician and 30 nutritional counseling visits by a licensed dietician or nutritionist.Frequency: May vary based on your health so ask your doctor.Description: If your body mass index (BMI) is 30 or higher, your doctor should refer you to or offer you intensive, multi-component behavioral interventions.
Barium enema is a covered service but not at 100% so you may have out of pocket costs. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this ACA Copay Waiver Criteria if you meet these criteria, they can submit this information on this fax form. Certain bowel preparation medications for a screening colonoscopy are covered at 100% when prescribed by a doctor. Provider consultation prior to the colonoscopy procedure is covered at 100%. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. Your doctor may order a colonoscopy more frequently than every 10 years. To register your account, you’'ll need your subscriber ID number, which is listed on your BCBSTX ID. If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs. Blue Access for Members (BAM) You can now use Blue Access for Members SM (BAM SM), the Blue Cross and Blue Shield of Texas’ (BCBSTX) member site, by clicking on Log In in the top right corner of the TRS-ActiveCare website’s homepage. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. If you have a positive fecal blood test (gFOBT or FIT or Cologuard), or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. Frequency: Using fecal blood testing (gFOBT or FIT) annually, Cologuard every 3 years, sigmoidoscopy or CT/virtual colonography every 5 years, or colonoscopy every 10 years. * Effective no later than April 1, 2022, colorectal cancer screening and associated services are covered at 100% for eligible members aged 45 and older. Description: Screening for colon/colorectal cancer in adults age 45–75. Non-Discrimination Policy and Accessibility Services. Get a Quote for Individual and Family PlansĪncillary and Specialty Benefits for Employees. Health Plans for Individuals and Families. Please contact your BCBSTX account representative if you have any other questions. stand-alone dental or vision, Medicare and retiree-only plans). This data is not necessary for plans that are not required to submit RxDC reporting to CMS (i.e. Groups should refer to their own legal or regulatory counsel for any additional information on this requirement. Since this data is required by CMS, any employer groups not included in the BCBSTX submission will need to submit their own average monthly premium data directly to CMS by June 1, 2023. If this data is not submitted to BCBSTX by April 27, BCBSTX will not be able to include it in our RxDC submission to CMS. 
The form and instructions are available by logging into BAE and clicking on Prescription Drug Data Collection under the Regulatory Data Collection section. Groups who have not submitted their data received reminder emails last week notifying them that the deadline for inclusion in BCBSTX’s RxDC submission was extended to April 27.
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This submission can be completed in Blue Access for Employers SM (BAE SM) by the employer group or a broker (Primary Producer of Record or Delegated Producer with Maintenance Use).Įmployer group contacts for active groups received instructions via email in March on how to submit this data to BCBSTX. To complete this reporting requirement for our group customers, the account’s benefits administrator must provide us with some information.Īction required: These groups must submit both their average monthly premiums paid by members and by the employer for the 2022 reference year to BCBSTX by April 27. Action Required: Average Monthly Premium Data is Due April 27īlue Cross and Blue Shield of Texas (BCBSTX) is assisting our fully insured, Blue Balance Funded SM and Minimum Premium group customers with the Prescription Drug Data Collection (RxDC) Reporting to the Centers for Medicare & Medicaid Services (CMS) for the 2022 reference year.
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