TSHBP is pleased to announce new program updates and benefit enhancements for the 2021-22 plan year.
Here are some things to get excited about:
NEW OUT-OF-NETWORK BENEFITS
We are pleased to announce that the TSHBP will be offering in and out-of-network benefits starting September 1, 2021, for the 2021- 22 plan year. This enhancement will provide greater availability for members to access physician and ancillary services.
High Deductible Plan
The plan’s employee-only in-network deductible remains at $3,000 and the out-of-network deductible is $3,500. The family deductible is $9,000 and $9,500 accordingly. The plan pays 100% of eligible charges after the deductible is met.
The plan’s employee-only in-network deductible remains at $3,500 and the out-of-network deductible is $4,000. The family deductible is $10,500 and $11,000 accordingly. Copayments by the member are paid until the member meets their deductible, then plan pays 100%.
TYPE 2 DIABETES PROGRAM AVAILABLE
The TSHBP is pleased to announce its diabetes support program. Virta is a medically supervised, research-backed treatment that can help reverse type 2 diabetes, meaning that patients can lower their blood sugar and A1c, all while reducing diabetes medications and losing weight. TSHBP fully covers the cost of Virta, valued at over $3,000, for all eligible members with type 2 diabetes.
With Virta’s personalized treatment plan, each patient gets medical supervision from a physician-led care team, a one-on-one health coach, diabetes testing supplies, educational tools like videos and recipes, and a private online support community. Be sure to download this flyer with more details on this new benefit offering!
BALANCE BILLING & SUPPORT
Just a reminder that in the event a member receives a balance bill for a covered service, the TSHBP can and will help. In the event any of our members receive a balance bill from a provider for a covered service, the Texas Schools Health Benefits Program is fully prepared and equipped to fight for our members and protect them from the negative consequences of a balance bill. You can find more information on our process in our article “What Do I Do About My Surprise Medical Bill?”
The TSHBP specialty drug exclusion will remain the same for the 2021-22 plan year. It is important to remember that the cost of specialty medications are covered for the following:
- Cost is under $670 per month for a 30-day supply, payable under the Prescription Drug Program and regular plan benefits apply; subject to plan deductible and copayment requirements, as
- If administered in a Facility/Physician’s office setting as a component of a treatment plan when billed by the facility as a claim
Specialty drugs with costs over $670 are not covered, but the TSHBP will cover the specialty drug expense for a member for up to 90 days if alternative funding is not available for the drugs. The TSHBP patient advocate program is designed to help members gain access to publicly available Patient Assistance Programs (PAP) and Co-Pay Assistance Programs (CAP) that may provide funding for significant portions of their drug expenses. TSHBP patient advocate to complete all documents, over 95% have received assistance for their specialty drug costs.
If you have any questions about these new plan updates, please reach out to us at (888) 803-0081 and we will be happy to assist you.