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:
- 2022 Aetna Managed Pharmacy Network
- 2022 Aetna National Pharmacy Network
- 2020 Aetna Premier Care Network
- 2022 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (Austin)
- 2022 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (Dallas)
- 2022 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (Houston)
- 2022 Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice (San Antonio)
- 2020 Aetna Value Performance Network
- 2022 (TX) Aetna Whole Health - Baptist Health System & HealthTexas Medical Group - Managed Choice
- 2020 Aetna Whole Health - Baylor Scott & White Quality Alliance Managed Choice
- 2022 (TX) Aetna Whole Health - Memorial Hermann Accountable Care Network - Managed Choice
- 2022 (TX) Aetna Whole Health - Rio Grande Valley - Open Access Managed Choice/Choice POS II
- 2022 (TX) Aetna Whole Health - Seton Health Alliance - Choice POS II/Open Access Managed Choice
- 2022 (TX) Aetna Whole Health - The Hospitals of Providence Health Alliance - OA Managed Choice/Choice POS II
- 2022 Managed Choice POS
- 2022 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:
- 2022 BSW Solutions PPO
- 2022 BSW Preferred PPO Network
- 2022 BSW Premier PPO
- 2022 BSW Plus PPO
- 2022 BSW Extended PPO Network
- 2022 PPO Network Group
Insurer: Blue Cross and Blue Shield of Texas, A division of Health Care Service Corporation, an Independent Licensee of the Blue Cross and Blue Shield Association
Network:
Insurer: Cigna Health and Life Insurance Company
Networks:
- 2022 Cigna LocalPlus (Dallas)
- 2022 Cigna LocalPlus (Houston)
- 2022 Cigna Open Access Plus
- 2022 Cigna PPO
Insurer: Colonial Life & Accident Insurance Company
Network:
Insurer: Combined Insurance Company of America
Networks:
- 2022 EyeMed Access Network
- 2022 EyeMed Advantage Network
- 2022 EyeMed Insight Network
- 2022 EyeMed Select Network
Insurer: Companion Life Insurance Company
Network:
Insurer: CompBenefits Insurance Company
Network:
Insurer: Connecticut General Life Insurance Company
Networks:
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: Fidelity Security Life Insurance Company
Networks:
- 2022 Avesis Network
- 2020 Envolve Network
- 2022 EyeMed - Access Network
- 2022 EyeMed - Advantage Network
- 2022 EyeMed - Insight Network
- 2022 EyeMed - Select Network
- 2022 National Vision Administrator (NVA) Network
Insurer: Freedom Life Insurance Company of America
Networks:
- 2022 ChoicePlus
- 2020 Cigna PPO
- 2021 EyeMed Insight
- 2022 PHCS
- 2021 Spectera EyeCare Networks
- 2022 Vision
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: Insurance Company of Scott and White
Networks:
- 2021 BSW Extended PPO Network
- 2021 BSW Plus PPO Network
- 2021 BSW Preferred PPO Network
- 2021 PPO Choice Network (Tier 1)
- 2021 PPO Choice Network (Tier 2)
- 2020 PPO Choice Preferred Network (Tier 1)
- 2020 PPO Choice Preferred Network (Tier 2)
- 2021 PPO Network Group
Insurer: Integon National Insurance Company
Networks:
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: National Foundation Life Insurance Company
Networks:
Insurer: National Health Insurance Company
Network:
Insurer: Nationwide Life Insurance Company
Network:
Insurer: Nippon Life Insurance Company of America
Networks:
Insurer: Principal Life Insurance Company
Network:
Insurer: Reliance Standard Life Insurance Company
Networks:
Insurer: Renaissance Life & Health Insurance Company of America
Networks:
Insurer: SafeHealth Life Insurance Company
Network:
Insurer: Seton Insurance Company
Network:
Insurer: SHA, LLC
Network:
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: Trustmark Insurance Company
Network:
Insurer: Union Security Insurance Company
Network:
Insurer: United Concordia Insurance Company
Network:
Insurer: UnitedHealthcare Insurance Company
Networks:
- 2022 ChoicePlus
- 2022 Core
- 2022 NexusACO OAP
- 2022 OptionsPPO
- 2021 Spectera EyeCare Networks
- 2022 Vision
Insurer: USAble Mutual Insurance Company
Network:
Insurer: Vision Service Plan Insurance Company
Network:
Insurer: Wellfleet Insurance Company
Networks:
Approved EPBP network access plans
Insurer: Aetna Life Insurance Company
Networks:
- 2022 Aetna National Pharmacy Network
- 2022 Aetna Managed Pharmacy Network
- 2022 (TX) Aetna Whole Health - Baptist Health System & HealthTexas Medical Group - Elect Choice
- 2020 Aetna Whole Health - Baylor Scott & White Quality Alliance Elect Choice
- 2022 (TX) Aetna Whole Health - Memorial Hermann Accountable Care Network - Elect Choice/Aetna Select
- 2022 (TX) Aetna Whole Health - Rio Grande Valley - Open Access Elect Choice/Open Access Aetna Select
- 2022 (TX) Aetna Whole Health - Seton Health Alliance - Elect Choice/Aetna Select
- 2022 (TX) Aetna Whole Health - The Hospitals of Providence Health Alliance - OA Elect Choice/OA Aetna Select
- 2022 Elect Choice EPO (Open Access)
Insurer: Baylor Scott & White Insurance Company
Network:
Insurer: Celtic Insurance Company
Network:
Insurer: Cigna Health and Life Insurance Company
Networks:
- 2022 Cigna LocalPlus IN (Dallas)
- 2022 Cigna LocalPlus IN (Houston)
- 2022 Cigna Open Access Plus In-Network
Insurer: Community First Group Hospital Service Corporation
Network:
Insurer: Curative Insurance Company
Network:
Insurer: Evry Health Insurance Company of Texas
Networks:
Insurer: Friday Health Insurance Company Inc
Networks:
Insurer: Golden Rule Insurance Company
Network:
Insurer: Insurance Company of Scott and White
Networks:
- 2020 BSW Preferred EPO Network
- BSW Preferred EPO Network - ORX Broad
- 2021 EPO Network Group
- MyPlan EPO Narrow Pharmacy Network
- EPO Network Group ORX Broad
- 2021 EPO Individual/Family
- EPO Network Individual/Family ORX Broad
Insurer: Moda Health Plan, Inc
Network:
Insurer: Oscar Insurance Company
Networks:
Insurer: Seton Insurance Company
Network:
Insurer: Texas Health + Aetna Health Insurance Company
Networks:
Insurer: Texas Health + Aetna Health Plan Inc.
Network:
Insurer: UnitedHealthcare Insurance Company
Networks: