Información pertinente para la aprobación de un plan de acceso
La red del plan de beneficios de proveedores preferentes (Preferred Provider Benefits Plan, PPBP, por su nombre y siglas en inglés) o del plan de beneficios de proveedores exclusivos (Exclusive Provider Benefit Plan, EPBP, por su nombre y siglas en inglés) de una aseguradora debe contar con suficientes proveedores autorizados en número, tamaño y distribución geográfica para satisfacer las necesidades de salud y de atención médica de los afiliados.
Cuando la red de proveedores contratados no puede satisfacer todas las necesidades de salud y atención médica de los afiliados, la aseguradora debe presentar un plan de acceso.
Un plan de acceso documenta cómo una aseguradora garantizará la atención médica necesaria, pero no disponible a través de los proveedores contratados, el plan está disponible para los afiliados y describe qué medidas tomará la aseguradora para aumentar sus proveedores contratados con el fin de mejorar la adecuación de su red.
Cuando se recurre a proveedores fuera de la red debido al uso de un plan de acceso por parte de la aseguradora, los gastos de su bolsillo se aplican a los gastos máximos del bolsillo del afiliado, y los proveedores reciben la tarifa habitual y acostumbrada o acordada.
Para obtener información detallada sobre el plan de acceso de cada aseguradora, visite el sitio web de ésta.
Planes aprobados de acceso a la red PPBP
Aseguradora: 4 Ever Life Insurance Company
Red:
Aseguradora: Aetna Life Insurance Company
Redes:
- 2023 Aetna Managed Pharmacy Network
- 2023 Aetna National Pharmacy Network
- 2023 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (Austin)
- 2023 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (Dallas)
- 2023 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (Houston)
- 2023 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (San Antonio)
- 2023 (TX) Aetna Whole Health - Baptist Health System & HealthTexas Medical Group - OA Managed Choice/Choice POS II
- 2023 (TX) Aetna Whole Health - Memorial Hermann Accountable Care Network - Managed Choice
- 2023 (TX) Aetna Whole Health - Rio Grande Valley - Open Access Managed Choice/Choice POS II
- 2023 (TX) Aetna Whole Health - Seton Health Alliance - Choice POS II/Open Access Managed Choice
- 2023 (TX) AWH - The Hospitals of Providence Health Alliance - OA Managed Choice/Choice POS II
- 2023 (TX) AWH - Texas Health - OA Choice PPO
- 2023 (TX) AWH - Texas Health - OA Managed Choice/Choice POS II
- 2023 Managed Choice POS
- 2023 Open Choice PPO
Aseguradora: American Family Life Assurance Company of Columbus
Red:
Aseguradora: American National Insurance Company
Red:
Aseguradora: American National Life Insurance Company of Texas
Red:
Aseguradora: Ameritas Life Insurance Corporation
Redes:
Aseguradora: Baylor Scott & White Insurance Company
Redes:
- 2023 BSW Solutions PPO
- 2023 BSW Preferred PPO Network
- 2023 BSW Premier PPO
- 2023 BSW Plus PPO
- 2023 BSW Extended PPO Network
- 2023 PPO Network
Aseguradora: Blue Cross and Blue Shield of Texas, A division of Health Care Service Corporation
Red:
Aseguradora: Cigna Health and Life Insurance Company
Redes:
- 2023 Cigna LocalPlus (Austin)
- 2023 Cigna LocalPlus (Dallas)
- 2023 Cigna LocalPlus (Houston)
- 2023 Cigna Open Access Plus
- 2023 Cigna PPO
Aseguradora: Colonial Life & Accident Insurance Company
Red:
Aseguradora: Combined Insurance Company of America
Redes:
- 2023 EyeMed Access Network
- 2022 EyeMed Advantage Network
- 2023 EyeMed Insight Network
- 2023 EyeMed Select Network
Aseguradora: Companion Life Insurance Company
Red:
Aseguradora: CompBenefits Insurance Company
Red:
Aseguradora: Curative Insurance Company
Red:
Aseguradora: Delta Dental Insurance Company
Red:
Aseguradora: Equitable Financial Life Insurance Company
Red:
Aseguradora: Equitable Financial Life Insurance Company of America
Red:
Aseguradora: Evry Health Insurance Company of Texas
Red:
Aseguradora: Fidelity Security Life Insurance Company
Redes:
- 2023 Avesis Network TX Adequacy
- 2023 FSL EyeMed - Access Network
- 2023 EyeMed Advantage Network
- 2023 EyeMed Insight Network
- 2023 EyeMed Select Network
- 2023 FSL -National Vision Administrator (NVA Network)
Aseguradora: Freedom Life Insurance Company of America
Redes:
Aseguradora: Gerber Life Insurance Company
Red:
Aseguradora: Golden Rule Insurance Company
Redes:
Aseguradora: HM Life Insurance Company
Red:
Aseguradora: Humana Dental Insurance Company
Red:
Aseguradora: Humana Insurance Company
Redes:
Aseguradora: Integon National Insurance Company
Red:
Aseguradora: Kansas City Life Insurance Company
Red:
Aseguradora: Memorial Hermann Health Insurance Company
Red:
Aseguradora: Metropolitan Life Insurance Company
Redes:
Aseguradora: Moda Health Plan, Inc.
Redes:
Aseguradora: Nationwide Life Insurance Company
Red:
Aseguradora: Nippon Life Insurance Company of America
Redes:
Aseguradora: Pacific Life & Annuity Company
Red:
Aseguradora: Pacific Life Insurance Company
Red:
Aseguradora: Principal Life Insurance Company
Red:
Aseguradora: Reliance Standard Life Insurance Company
Redes:
Aseguradora: Renaissance Life & Health Insurance Company of America
Redes:
Aseguradora: Standard Insurance Company
Redes:
Aseguradora: Standard Life and Accident Insurance Company
Red:
Aseguradora: Starmount Life Insurance Company
Redes:
Aseguradora: Sun Life Assurance Company of Canada
Red:
Aseguradora: Texas Health + Aetna Health Insurance Company
Redes:
Aseguradora: Thrivent Financial for Lutherans
Red:
Aseguradora: Trustmark Insurance Company
Red:
Aseguradora: United Concordia Insurance Company
Red:
Aseguradora: UnitedHealthcare Insurance Company
Redes:
Aseguradora: Vision Service Plan Insurance Company
Red:
Aseguradora: Wellfleet Insurance Company
Redes:
Planes aprobados de acceso a la red EPBP
Aseguradora: Aetna Life Insurance Company
Redes:
- 2023 Aetna National EPO Network
- 2023 Aetna Managed Pharmacy EPO Network
- 2023 (TX) Aetna Whole Health - Baptist Health System & HealthTexas Medical Group - OA Elect Choice/OA Aetna Select
- 2023 (TX) Aetna Whole Health - Memorial Hermann Accountable Care Network - Elect Choice/Aetna Select
- 2023 (TX) Aetna Whole Health - Rio Grande Valley - Open Access Elect Choice/Open Access Aetna Select
- 2023 (TX) Aetna Whole Health - Seton Health Alliance - Elect Choice/Aetna Select
- 2023 (TX) AWH - The Hospitals of Providence Health Alliance - OA Elect Choice/OA Aetna Select
- 2023 Elect Choice EPO (Open Access)
Aseguradora: Aetna Health and Life Insurance Company
Redes:
Aseguradora: Baylor Scott & White Insurance Company
Red:
Aseguradora: Celtic Insurance Company
Red:
Aseguradora: Cigna Health and Life Insurance Company
Redes:
- 2023 Cigna LocalPlus IN (Austin)
- 2023 Cigna LocalPlus IN (Dallas)
- 2023 Cigna LocalPlus IN (Houston)
- 2023 Cigna Open Access Plus In-Network
Aseguradora: Community First Group Hospital Service Corporation
Red:
Aseguradora: Community First Insurance Plans
Red:
Aseguradora: Curative Insurance Company
Red:
Aseguradora: Evry Health Insurance Company of Texas
Redes:
Aseguradora: Golden Rule Insurance Company
Red:
Aseguradora: InnovationsHR, Inc
Red:
Aseguradora: Moda Health Plan, Inc
Red:
Aseguradora: Oscar Insurance Company
Redes:
Aseguradora: Texas Health + Aetna Health Insurance Company
Redes:
Aseguradora: UnitedHealthcare Insurance Company
Redes: