Information relevant to the approval of an access plan
An insurer’s preferred provider benefit plan (PPBP) or exclusive provider benefit plan (EPBP) network is required to have licensed providers in sufficient number, size, and geographic distribution to meet the medical and health care needs of enrollees.
When the network of contracted providers cannot meet all enrollees’ medical and health care needs, the insurer must file an access plan.
An access plan documents how an insurer will ensure health care that is necessary, but not available through contracted providers, will be available to enrollees and describes what steps the insurer will take to increase its contracted providers to improve its network adequacy.
When out-of-network providers are utilized due to a insurer’s use of an access plan, out-of-pocket expenses are applied to the enrollee’s out-of-pocket maximums, and providers are paid at the usual and customary or agreed upon rate.
For detailed information about each insurer's access plan, please visit the insurer's website.
Approved PPBP network access plans
Insurer: 4 Ever Life Insurance Company
Network:
Insurer: Aetna Life Insurance Company
Networks:
- 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
Insurer: American Family Life Assurance Company of Columbus
Network:
Insurer: American National Insurance Company
Network:
Insurer: American National Life Insurance Company of Texas
Network:
Insurer: Ameritas Life Insurance Corporation
Networks:
Insurer: Baylor Scott & White Insurance Company
Networks:
- 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
Insurer: Blue Cross and Blue Shield of Texas, A division of Health Care Service Corporation
Network:
Insurer: Cigna Health and Life Insurance Company
Networks:
- 2023 Cigna LocalPlus (Austin)
- 2023 Cigna LocalPlus (Dallas)
- 2023 Cigna LocalPlus (Houston)
- 2023 Cigna Open Access Plus
- 2023 Cigna PPO
Insurer: Colonial Life & Accident Insurance Company
Network:
Insurer: Combined Insurance Company of America
Networks:
- 2023 EyeMed Access Network
- 2022 EyeMed Advantage Network
- 2023 EyeMed Insight Network
- 2023 EyeMed Select Network
Insurer: Companion Life Insurance Company
Network:
Insurer: CompBenefits Insurance Company
Network:
Insurer: Curative Insurance Company
Network:
Insurer: Delta Dental Insurance Company
Network:
Insurer: Equitable Financial Life Insurance Company
Network:
Insurer: Equitable Financial Life Insurance Company of America
Network:
Insurer: Evry Health Insurance Company of Texas
Network:
Insurer: Fidelity Security Life Insurance Company
Networks:
- 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)
Insurer: Freedom Life Insurance Company of America
Networks:
Insurer: Gerber Life Insurance Company
Network:
Insurer: Golden Rule Insurance Company
Networks:
Insurer: HM Life Insurance Company
Network:
Insurer: Humana Dental Insurance Company
Network:
Insurer: Humana Insurance Company
Networks:
Insurer: Integon National Insurance Company
Network:
Insurer: Kansas City Life Insurance Company
Network:
Insurer: Memorial Hermann Health Insurance Company
Network:
Insurer: Metropolitan Life Insurance Company
Networks:
Insurer: Moda Health Plan, Inc.
Networks:
Insurer: Nationwide Life Insurance Company
Network:
Insurer: Nippon Life Insurance Company of America
Networks:
Insurer: Pacific Life & Annuity Company
Network:
Insurer: Pacific Life Insurance Company
Network:
Insurer: Principal Life Insurance Company
Network:
Insurer: Reliance Standard Life Insurance Company
Networks:
Insurer: Renaissance Life & Health Insurance Company of America
Networks:
Insurer: Standard Insurance Company
Networks:
Insurer: Standard Life and Accident Insurance Company
Network:
Insurer: Starmount Life Insurance Company
Networks:
Insurer: Sun Life Assurance Company of Canada
Network:
Insurer: Texas Health + Aetna Health Insurance Company
Networks:
Insurer: Thrivent Financial for Lutherans
Network:
Insurer: Trustmark Insurance Company
Network:
Insurer: United Concordia Insurance Company
Network:
Insurer: UnitedHealthcare Insurance Company
Networks:
Insurer: Vision Service Plan Insurance Company
Network:
Insurer: Wellfleet Insurance Company
Networks:
Approved EPBP network access plans
Insurer: Aetna Life Insurance Company
Networks:
- 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)
Insurer: Aetna Health and Life Insurance Company
Networks:
Insurer: Baylor Scott & White Insurance Company
Network:
Insurer: Celtic Insurance Company
Network:
Insurer: Cigna Health and Life Insurance Company
Networks:
- 2023 Cigna LocalPlus IN (Austin)
- 2023 Cigna LocalPlus IN (Dallas)
- 2023 Cigna LocalPlus IN (Houston)
- 2023 Cigna Open Access Plus In-Network
Insurer: Community First Group Hospital Service Corporation
Network:
Insurer: Community First Insurance Plans
Network:
Insurer: Curative Insurance Company
Network:
Insurer: Evry Health Insurance Company of Texas
Networks:
Insurer: Golden Rule Insurance Company
Network:
Insurer: InnovationsHR, Inc
Network:
Insurer: Moda Health Plan, Inc
Network:
Insurer: Oscar Insurance Company
Networks:
Insurer: Texas Health + Aetna Health Insurance Company
Networks:
Insurer: UnitedHealthcare Insurance Company
Networks: