February 2014 > UT SELECT Health Plan Summary

Be a Wise Healthcare Consumer

UT SELECT Health Plan Summary Information

The UT SELECT Health plan is the primary insurance plan in the UT Benefits program. Benefits for medical and prescription services are available to all benefits-eligible employees, retirees, and their dependents. Currently, the medical benefits are administered by Blue Cross and Blue Shield of Texas (BCBSTX). The prescription drug benefits are being administered by Express Scripts, Incorporated (ESI).

Unlike many insurance plans, the UT SELECT Health plan is a self-funded plan. This means that the claims are paid for solely by the premiums that are paid rather than being paid by an outside insurance company. Premium funds are provided by the state of Texas and your institution in the form of premium sharing paid on behalf of eligible employees, retirees, and dependents. The remaining premium funds come from the portion of premium costs that employees and retirees pay out-of-pocket, primarily when covering eligible family members.

The University of Texas has employees and retirees throughout the state of Texas (and beyond) who are affiliated with nine academic and six health institutions as well as with UT System Administration. This makes UT System one of the largest employers in the state.

Most eligible employees and retirees participate in the UT SELECT Health plan. At the end of the most recent plan year, which ended on August 31, 2013, the overall membership for the UT SELECT Health plan included around 185,000 participants with varying levels of coverage (as shown below).

UT SELECT Membership Demographics
for the 2012-2013 Plan Year
Category Total/Percentage
Enrollment  
Employees and Retirees 105,359
Dependents 78,771
Total Members 184,130
   
Coverage Level  
Employee Only 34.8%
Employee + Spouse 15.6%
Employee + Children 19.0%
Employee + Family 30.6%
   
Gender  
Female 56.0%
Male 44.0%


What it Takes to Service the UT SELECT Health Plan

Naturally, the administrative and financial resources required to provide medical and prescription benefits to this large group are significant. Both BCBSTX and ESI have dedicated teams of Customer Service representatives who are trained to understand the UT SELECT Health plan. These representatives receive calls and answer questions from UT SELECT participants and the healthcare providers who deliver the medical services to UT System participants. On average, these teams handled more than 1,000 calls per day during the most recent plan year (2012-2013).

UT SELECT Customer Service Calls
for the 2012-2013 Plan Year
Plan Administrator
and Call Type
Total Calls
Blue Cross Blue Shield of Texas  
Member Calls 84,317
Provider Calls 225,952
Total 310,269
   
Express Scripts  
Total 113,688

During the 2012-2013 plan year, the majority of UT SELECT plan participants used their medical and prescription benefits. Just over 88% of UT SELECT members had at least one medical claim, adding up to over 2.5 million total claims. Around 80% of UT SELECT members filled at least one prescription. On average, there were about 6,400 prescriptions dispensed each and every day of the 2012-2013 plan year under the UT SELECT Prescription plan (including mail and retail).

Utilization of the UT SELECT Health Plan (Medical and Prescription)
for the 2012-2013 Plan Year
Claim Type Total/Percentage
UT SELECT Medical (BCBSTX)  
Total Claim Payments ~$650,000,000
    Service Category  
      Inpatient* 26.1%
      Oupatient** 33.8%
        Professional*** 40.1%
   
UT SELECT Prescription (ESI)  
Total Prescription Payments ~$200,000,000
Total Prescriptions 2,344,038

The summary information above clearly shows the importance of the UT SELECT Health plan to all of the UT employees, retirees and family members it covers. As a self-funded plan, the performance of the plan can be directly affected by the way participants use the benefits. You can do your part to be a good steward by wisely using the programs and services available through the UT SELECT Health plan. Take good care of yourself and take advantage of benefits for various services that are designed to help employees, retirees and dependents stay healthy and live well, including 100% coverage for preventive health services and other available programs.

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*Inpatient services include but are not limited to: procedures and treatment obtained in an inpatient facility; surgical procedures completed in an inpatient facility; maternity; mental health/substance abuse services involving inpatient facility treatment.

**Outpatient services include but are not limited to: surgical procedures such as arthroscopy, cardiac catheterization, colonoscopy; radiology; Emergency Room; laboratory; dialysis; physical, occupational and speech therapy; and psychiatric services, including individual therapy.

***Professional services include but are not limited to: provider surgical fees; radiology; evaluation and management, including office visits; medical services and supplies, including chemotherapy drugs and durable medical equipment; anesthesia; and therapeutic procedures, including physical, occupational, and speech therapy evaluation, tests, and measurements.