What’s New for 2025

Beginning January 1, 2025, medical, behavioral health and substance use disorder services will be provided by Blue Cross and Blue Shield of Texas (BCBSTX), your new medical carrier. Dental services will be provided by Delta Dental and vision services will be available through MetLife’s Vision - Superior.

Please read the following information to understand what this change means for you.

Look for your ID Cards – Before year end, you will receive new medical, dental and vision ID cards in the mail with information on how to set up your accounts. They will be delivered to the address you have set up in the Your Total Rewards portal. You can also find digital ID cards on the carrier websites.

Check to see if your provider is in the network – If so, there’s nothing more you need to do.

Take next steps if your provider is not in the network – If your provider is not in the network, feel free to nominate your provider to join the network using the new carriers’ websites. You may also be eligible for Transition of Care (TOC) for medical, behavioral health, prescription drugs and dental services.

Transition of Care (TOC)

TOC allows you to continue care for certain “covered health services” with your current provider at the in-network benefit level for a period of time. When this period of time ends, you must transfer to an in-network provider to continue to receive coverage at the in-network benefit level.

Medical TOC

• Am I eligible for TOC? To be eligible for TOC, you must meet the following guidelines: Your current provider doesn’t participate in the network with BCBSTX but is currently an in-network provider with Aetna or Cigna
  • You/your covered dependent: Is undergoing a course of treatment for a serious and complex condition
  • Is scheduled for nonelective surgery, including receipt of postoperative care
  • Is pregnant and undergoing a course of treatment for the pregnancy
  • Is or was determined to be terminally ill and is receiving treatment for such illness
• How to apply for TOC benefits
  1. Call Members Services at 877-278-5214. They’ll check your provider’s network status and provide you with a Transition of Care Request form if applicable
  2. You and your provider will complete the Transition of Care (TOC) form (bcbstx.com/docs/forms/provider/tx/transitional-care-request-tx.pdf), then submit it
  3. If approved, BCBSTX will authorize ongoing services for up to 90 days at the in-network benefits level
  4. Both you and your provider will receive an authorization letter from BCBSTX
• What happens with approved prior authorizations? You don’t need to apply for TOC benefits if you’re receiving services from a hospital or facility that does require precertification/prior authorization. For example, approvals may be in place for inpatient admissions and residential treatment center admissions. In these cases, BCBSTX will contact your current medical carrier and determine the medical necessity of continued care. There’s nothing more you need to do.

Inpatient Care – If you are hospitalized or being treated on an intermediate care basis (i.e., residential, partial/day, intensive outpatient) when you move to BCBSTX, coverage will continue under your current program until you are discharged or transitioned to a less intensive level of care. BCBSTX will work with your current care representative.

Outpatient Care and Applied Behavior Analysis (ABA) – If you are receiving treatment for covered services from a provider that is not in the network when you move to BCBSTX, you may request transition of care for up to 90 days. If you are still in treatment with the out-of-network provider after 90 days, outpatient care will be covered at the non-network benefit level if you are enrolled in PPO A or PPO B (EPO is a network-only option).

Apply for TOC or ask any questions by calling Customer Service at 877-278-5214 on weekdays from 7 am-6 pm CT. After January 1, 2025, Customer Service is available 24/7/365, except on major holidays.

Dental TOC

Your dental carrier is changing to Delta Dental Insurance Company on January 1, 2025. This is your effective date of coverage. In general, procedures started before this date are the responsibility of your previous carrier, while procedures started on or after this date are handled by Delta Dental. Here’s how payment is determined:

• Root canals: If you started treatment before January 1, 2025, your previous carrier is responsible for any later treatment.
• Crowns: If the crown is placed on or after January 1, 2025, it is covered by Delta Dental.
• Orthodontics: Your previous carrier will pay for treatment before January 1, 2025, and Delta Dental will cover treatment starting after that date. Same as 2024, your dental plan pays 50% of covered charges with no deductible up to the orthodontic lifetime limit of $2,000 per person for orthodontic services. Delta Dental will pick up payments for your orthodontic treatment where your previous carrier left off. To continue coverage into 2025, let your orthodontist know you’re switching to Delta Dental Insurance Company. Your orthodontist will need to submit a claim form that includes the banding date, total case fee and length of treatment to the following address:

  Delta Dental Insurance Company
  P.O. Box 1809
  Alpharetta, GA 30023-1809

For any questions, contact Delta Dental at 833-459-1169 and a representative will be able to further assist you.

Prescription Drugs TOC (applicable to Cigna OAPIN members only)

Express Scripts will be assisting in the process by:

• Transferring any home delivery (mail order) prescriptions that have remaining refills available
• Sending member communications for any prior authorizations that have an expiration on or after 1/1/2025 as these may require a new authorization
• Sending member communications to members who may be utilizing a retail pharmacy that will no longer be in-network

For any questions, contact Express Scripts at 800-695-4116 and a representative will be able to further assist you.

• Plan names. The names of the options will change.
  
• Plan contributions. Good news! Contributions will increase slightly or stay the same depending on the plan option you choose and who you cover.
• Bariatric surgery. The EPO option will now cover this procedure, so all three plan options will provide coverage at the applicable cost share. The $25,000 lifetime maximum will no longer apply. To be covered, you must receive the services through one of the Blue Distinction Centers (BDC). Travel benefits will be provided, if applicable.
• Behavioral health intensive outpatient and partial hospitalization services. To ensure proper care management and monitoring, you will need prior authorization before receiving partial hospitalization and intensive outpatient services.
• Chiropractic care. Your coverage will no longer be capped at the $1,000 annual maximum. The 20-visit per year maximum will stay the same.
• Diabetic supplies. The plan will now cover these supplies under the medical benefit, at the applicable cost share (subject to deductible).
• Digital wellness coaching with personalized guidance and support. The plan will cover digital coaching, which includes personalized guidance and support through BCBSTX’s Well on Target (wellontarget.com).
• Foot orthotics and routine foot care. Coverage for these services will be expanded to include other conditions in addition to diabetes, such as circulatory disorders.
• Gene therapies. The plan will cover specific gene therapies approved by Express Scripts in facilities that are in-network with BCBSTX. These therapies are subject to a medical necessity review and prior authorization.
• Ground ambulance transportation. The 100-mile limit will no longer apply, so there is no distance limit.
• Hearing aids. The plan will cover repair, maintenance and battery replacement, along with one pair of physician-prescribed hearing aids every three years, with applicable cost share. You will no longer have your coverage capped at $2,500.
• Hearing exams. There will no longer be an age limit (currently covered up to age 7).
• Marriage therapy. The plan will cover this service when linked to a behavioral health diagnosis at the applicable cost share. Family therapy is already covered.
• Maternity and newborn inpatient care stays. The plan will cover a 48-hour stay for vaginal delivery and a 96-hour stay for a caesarean (C-section) delivery.
• Oral surgery. For the PPO options, the plan will cover surgery at in-network or non-network levels depending on the provider’s network status. EPO option covers at the in-network level only.
• Organ transplants. All medical plan options will cover travel benefits if the travel distance is more than 50 miles.
• Physical therapy (PT), occupational therapy (OT) and speech therapy (ST). Subject to medical review, the plan will cover up to 60 sessions for a combination of PT and OT and up to 30 sessions for ST, at applicable copay or coinsurance percentage, depending on site of care. Additional visits may be approved if they meet medical necessity.
• Second opinion services. You will have access to second opinion services through My Medical Ally.
• Specialty drugs. Specialty drugs will have a separate tiering structure. See medical spotlight.
• Telemedicine services. Virtual visits will be available through MD Live (24/7 general medicine and mental health).
• Travel immunizations. Along with the PPO options, the EPO will now cover 100% of travel-related immunizations.
• Vision therapy. The 12-visit per year maximum for vision therapy will no longer apply. For your plan to cover vision therapy, you still need a medical review to make sure the therapy is medically necessary.
• Voluntary non-network claims. If you are enrolled in PPO A or PPO B and you choose to use non-network facilities and professionals in a non-emergency situation, the plan will reimburse the cost for services up to 150% of the Medicare Fee Schedule (MFS) amount (which is the basis for how reimbursement is calculated).

Important Savings Reminder If you earn the Culture of Health (CoH) rate by fulfilling the requirements every year, you can reduce your monthly contributions for the next calendar year by: $30/month for participant only coverage $60/month for participant + spouse coverage $60/month for participant + child(ren) coverage $90/month for family coverage

Note! The Well onTarget health assessment/survey is separate and does not count toward the CoH Rate Program. Instead, it’s another tool to participate in digital coaching, and other resources to get and stay healthy! The Well onTarget (wellontarget.com) program gives you access to one-on-one coaching to help with accountability, motivation and education. You can set goals to manage stress, quit tobacco, eat better and much more. Choose a program, set a goal and get started with small steps in the right direction. For more information, visit Well onTarget.

Dental Plan

• Plan contributions. Your monthly contributions will remain the same.
• Fluoride treatments. The age limit for dependent children to receive up to two fluoride treatments per calendar year will increase from age 16 to age 18, aligned with the American Dental Association and Delta Dental standard coverage.

Vision Plan

• Plan contributions. Great news, monthly premiums will decrease!
• Blue light protection. There will be $0 copay when in-network.
• Elective and medically necessary contact lenses discount. There will be a discount of 20% for conventional and 10% for disposable contact lenses in addition to regular in-network and non-network coverage (check if your provider participates in Superior Vision Discounts).
• Eye exams. The plan will continue to cover one exam a year for all participants and up to two exams a year for dependent children up to age 18 and adults with diabetes (Type 1 or Type 2).
• Frames discount. In addition to the current $150 allowance for in-network frames, a 20% discount will also apply.
• Laser surgery. The discount will be 20% to 50% off the national average price of LASIK.
• Lens tint options. You will pay up to $15 for a solid plastic or up to $18 for a plastic gradient when in-network.
• Medically necessary contact lenses. There will be $0 copay (currently $35 copay) when in-network.
• Photochromic lenses. You will pay up to $80 when in-network.
• Polarized lenses. The plan will cover polarized lenses up to a $75 out-of-pocket maximum.
• Polycarbonate lenses. There will be $0 copay when in-network for either adults or children.
• Progressive lenses. You will receive an $80 allowance to use toward these lenses when obtained not in-network.
• Ultraviolet lens treatment. You will pay up to $12 when receiving in-network care.

For money you contribute to the account(s) in 2024

• Health Care FSA and Dependent Care FSA. For expenses you incur in 2024, you have until April 15, 2025 to submit your claim for reimbursement. If any information is missing, you will only have until April 30, 2025, to provide it. If you don’t meet that deadline, the claim will be denied.

For money you contribute to the account(s) in 2025

• Debit card. If you elect to contribute to a Health Care and/or Dependent Care FSA in 2025, MetLife will mail you a debit card during December 2024. You can use this one card to pay for eligible expenses directly from your account(s).
• Health Care FSA. The following changes apply if you contribute to this account in 2025:
  • Contribution limit. It will increase to $3,200 in 2025.
  • Carryover maximum (from 2024 to 2025). It will increase to $640. Because of the carrier change, any carryover amount from 2024 will be available for you to use starting May 2025.
  • When you submit expenses. You will be able to submit 2025 eligible expenses between January 1, 2025, and March 31, 2026. No late submissions will be allowed.
• Dependent Care FSA. The following changes apply if you contribute to this account in 2025:
  • When you incur expenses. New grace period! You will be able to incur eligible expenses between January 1, 2025, and March 15, 2026, and use money you contributed in 2025 to pay for those expenses.
  • When you submit expenses. You will be able to submit eligible expenses between January 1, 2025, and March 31, 2026, to be paid with the money you contributed in 2025. No late submissions will be allowed.