Conroe ISD offers three self-funded medical plan options administered by BCBSTX for you to choose from: Blue Premier HMO, Blue Essentials HMO and Blue Choice PPO HDHP. With this arrangement, BCBSTX does not insure our employees, but rather processes and pays claims with money we provide from premiums, coinsurance, copays, deductibles, and the school district contributions. This means Conroe ISD and its participating employees, as a group, pay for the entire cost of all our medical and prescription drug expenses.
Blue Premier HMO
This traditional HMO plan offers affordable costs without compromising benefits, quality, or services. With Blue Premier HMO, you and any covered dependents will each select a Primary Care Physician (PCP) to partner with and help coordinate care. Referrals from your PCP are required before seeing a specialist, and you do not have access to providers outside of the Blue Premier HMO network. Kelsey-Seybold Clinic is not in-network.
Blue Essentials HMO
This plan provides access to a statewide network of contracting physicians and hospitals. With Blue Essentials HMO, you and any covered dependents will each select a primary care physician (PCP) to partner with and help coordinate care. Referrals from your PCP are required before seeing a specialist, and you do not have access to providers outside of the Blue Essentials HMO network. Kelsey-Seybold Clinic is in-network; go to www.kelsey-seybold.com/corporate-services/cisd for more information.
Blue Choice PPO HDHP
If you like having the flexibility to choose the doctors, hospitals, and other health care providers you use to get care, and you can afford to pay more at the time you receive care, a PPO may be the right plan for you and your family. It is also a health savings account (HSA) eligible plan! You are not required to select a PCP to coordinate your care, and you do not need a referral to see a specialist. Kelsey-Seybold Clinic is in-network; go to www.kelsey-seybold.com/corporate-services/cisd for more information.
Resources
Prescription Benefits
Prime Therapeutics (Effective September 1, 2023)
Specialty Pharmacy Information
What is Prior Authorization? Español
OptumRx (2022-2023)
Pharmacy Benefits Information and Forms
Premium Standard Formulary As of July 1, 2022
Provider Finder
How do I know which providers are in a plan’s network? To check if a doctor, hospital, or other provider is in a plan’s network, use Provider Finder®, the online BCBSTX directory. You can search by the plan name to see all the providers in the health plan’s network, or you can search for specific providers you want to use and see which health plans they accept.
To access Provider Finder:
- Go to www.bcbstx.com.
- Click Find Care.
- Under Providers in Your Network, click Find a Doctor or Hospital.
- Under Guest Search, click Search as a Guest.
- Select a plan:
- Blue Premier HMO – select Blue PremierSM [HMH]
- Blue Essentials HMO – select Blue EssentialsSM [HMO]
- Blue Choice PPO HDHP – select Blue Choice PPOSM [BCA]
Note: Provider network affiliations are subject to change at any time and are not based on a Conroe ISD plan year. Once enrolled, log in to your Blue Access for MembersSM (BAM) account at www.bcbstx.com and select Provider Finder, or download the BCBSTX app for the most up-to-date information.
Kelsey-Seybold Clinic is in-network for Blue Essentials HMO and Blue Choice PPO HDHP. Go to www.kelsey-seybold.com/corporate-services/cisd for more information.
Virtual Visits
Virtual Visits with MDLIVE allow you a convenient, cost-effective alternative to talk with a doctor by phone or video 24/7. They are free for Blue Choice PPO HDHP, Blue Essentials HMO, and Blue Premier HMO plan members. You can meet with the next available professional or make an appointment.
Consider Virtual Visits for more than 80 health conditions including allergies, cold and flu, fever, headaches, nausea, sinus infections, and more. Choose other care for testing and treating COVID-19, anything that requires a hands-on exam, anything that needs a lab test or x-ray, cancer or other complicated conditions, international visits, and sprains, broken bones, or other injuries requiring bandaging. Virtual Visits providers can prescribe medication, if needed (costs are based on your pharmacy benefit and are not covered as part of the visit).
You have multiple options for starting with Virtual Visits:
- Go to bcbstx.com and log in to your member account. From the member dashboard, select Find Care > Virtual Care. Click the button to Schedule a Virtual Visit and sign up on MDLIVE’s website.
- Call MDLIVE at 1-888-680-8646
- Go to MDLIVE.com/bcbstx
- Text BCBSTX to 635-483
- Download the MDLIVE app
Mental Health/ Behavioral Health Benefits
Virtual Visits powered by MDLive – FREE for all HMO and PPO plan members
Schedule sessions with licensed behavioral health therapists by phone, online video, or mobile app. Get virtual care for depression, eating disorders, ADHD, substance use disorders, trauma, PTSD, and more.
You have multiple options for starting with Virtual Visits:
- Go to http://www.bcbstx.com/ and log in to your member account. From the member dashboard, select Find Care > Virtual Care. Click the button to Schedule a Virtual Visit and sign up on MDLive’s website.
- Call MDLive at 1-888-680-8646
- Go to MDLIVE.com/bcbstx
- Text BCBSTX to 635-483
- Download the app at https://www.mdlive.com/mobile-app/
Behavioral health care with an in-network doctor/specialist, such as counseling, psychiatry, psychology – PCP copay for HMO plan members and deductible/coinsurance for PPO plan members
Contact an in-network doctor/specialist to schedule an appointment – no PCP referral required. Take the following steps to find an in-network provider:
- BCBSTX website:
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- Go to bcbstx.com and log in to your member account
- From the member dashboard, select Find Care > Medical
- Select Find a Doctor or Hospital
- Ensure the city, state or zip field is the area you wish to search, change if needed
- Under Common Searches, select Behavioral Health then choose the desired specialty
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- BCBSTX App:
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- Log in to the app
- Tap Find Care In-Network
- Select Launch Provider Finder
- Ensure the city, state or zip field is the area you wish to search, change if needed
- Under Common Searches, select Behavioral Health then choose the desired specialty
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You can refine your search to providers that are accepting new patients, offer telehealth, and/or have verified contact information, all within a mileage radius of your choice. Additional filters are also available.
Need help finding mental health care? Contact Headway at headway.co/m/bcbstx to locate providers who are in-network with BCBSTX, generally are available within five days, and accept virtual and in-person appointments. Headway offers personalized matching support and instant booking.
Learn to Live Digital Mental Health programs – FREE for all HMO and PPO plan members
Learn to Live offers Digital Mental Health programs for stress, anxiety and worry, depression, insomnia, social anxiety, substance use, panic, and resiliency.
Benefits:
- Immediate 24/7 access to self-paced programs
- Ability to start, stop, and save your progress
- No cost for BCBSTX members (ages 13+)*
- Coaching available (phone, email, and text)
- Programming available in English and Spanish
- Confidential participation – no personal information ever shared with employer
Watch this video to learn more about the online Learn to Live programs.
Get started by taking a confidential assessment – log in at bcbstx.com, click Wellness, then choose Digital Mental Health. In the BCBSTX App, tap Digital Mental Health.
* BCBSTX members 13 to 17 years must be registered by the parent enrolled in the plan. Once you’ve logged in to Learn to Live using the steps above, go the Resources tab. Then find the Register a Minor link to send your teen a registration email.
Away From Home Care Program
Summaries of Benefits and Coverage
Coverage Period: 9/1/2024-8/31/2025
Blue Choice PPO HDHP SBC 2024-2025 (Español)
Blue Essentials HMO SBC 2024-2025 (Español)
Blue Premier HMO SBC 2024-2025 (Español)
Coverage Period: 9/1/2023-8/31/2024
Blue Choice PPO HDHP SBC 2023-2024 (Español)
Machine-Readable Files/Transparency in Coverage Rule
On behalf of Conroe ISD, Blue Cross and Blue Shield of Texas (BCBSTX) creates, maintains, and publishes the machine-readable files (MRFs) required by the Transparency in Coverage Rule. The files are posted on the BCBSTX website.
Group Health Benefits
Blue Cross and Blue Shield of Texas Customer Service
Blue Premier HMO (Group #341643)
1-877-299-2377
Blue Essentials HMO (Group #341644)
1-877-299-2377
Blue Choice PPO HDHP (Group #341642)
1-800-521-2227
Personalized Member Website www.bcbstx.com
Pharmacy
Prime Therapeutics www.myprime.com
Express Scripts Pharmacy (Mail Order)
1-833-715-0942 www.express-scripts.com/rx
Accredo (Specialty Pharmacy)
1-833-721-1619 www.accredo.com
24/7 Nurseline
1-800-581-0393
Behavioral/Mental Health
1-800-528-7264
Ovia Maternity Support Program
1-888-421-7781
Virtual Visits with MDLIVE
1-888-680-8646
www.MDLIVE.com/bcbstx