Welcome to Lone Star Medical Associates

 ✅ Traditional Part B

Traditional Texas Medicaid:

 ✅ Texas Medicaid

Molina Healthcare:

 ✅ CHIP / CHIP Perinate

 ✅ CHIP RSA

 ✅ STAR

 ✅ STAR+PLUS

Superior HealthPlan:

 ✅ CHIP / CHIP Perinate

 ✅ STAR

 ✅ STAR+PLUS

 ✅ STAR Health

UnitedHealthcare:

 ✅ STAR+PLUS

Wellpoint (formerly Amerigroup):

 ✅ Wellpoint Star Medicaid Plan

 ✅ CHIP / CHIP Perinate

 ✅ STAR

PARKLAND

 ✅ PARKLAND HEALTHFIRST (Texas Medicaid Star)

 ✅ Open Choice PPO

 ✅ USAccess®

 ✅ Open Choice® PPO ( Health Fund)

 ✅ Signature Administrators (PPO)

 ✅ Voluntary Plans

 ✅ Affordable Health Choices limited benefits insurance plan (SRC only)

 ✅ Premier Care Network

 ✅ PPO

 ✅ HealthFund CDHP

 ✅ Standard PPO Plan

 ✅ Managed Choice Plan (PPO)

 ✅ PCP Referral Plan (TX only)

 ✅ HMO

 ✅ Open Access Select ( Health Fund)

 ✅ Health Network Only (Open Access)

 ✅ Open Access (HMO)

 ✅ Select (Open Access)

 ✅ HMO Basic

 ✅ HMO Deductible

 ✅ HealthFund HMO

 ✅ Health Network Only

 ✅ Health Network Option

 ✅ Open Access Select HMO (Performance)

 ✅ (TX) Medical Neighborhood - Choice POS II

 ✅ (TX) El Paso - Option One Managed Choice POS

 ✅ Choice® POS (Open Access)

 ✅ Choice® POS II (Open Access)

 ✅ Health Network Option (Open Access)

 ✅ Managed Choice (Open Access)

 ✅ Managed Choice POS

 ✅ QPOS

 ✅ HealthFund® Health Network Only (Open Access)

 ✅ HealthFund® Health Network Option (Open Access)

 ✅ Open Access Managed Choice POS ( Health Fund)

 ✅ Choice POS II ( HealthFund)

 ✅ Choice POS ( HealthFund)

 ✅ ActiveCare 1-HD

 ✅ ActiveCare 2

 ✅ ActiveCare Select

 ✅ AFA Choice POS II 2500 HSA 100/80 CY

 ✅ Premier Care Network Plus - Choice POSII

 ✅ Premier Care Network (APCN) - Choice POSII

 ✅ Savings Plus Open Access Managed Choice POS

 ✅ Open Access POS II (Performance Network)

 ✅ Choice POS II

 ✅ Elect Choice EPO

 ✅ Open Access Elect Choice EPO ( Health Fund)

 ✅ Elect Choice EPO (Open Access)

 ✅ (TX) El Paso - Option One EPO

 ✅ (TX) EPO and Open Access Select Texas Health

 ✅ (TX) Whole Health - Baylor - Bryan College Station

 ✅ (TX) Whole Health - Baylor - Central Texas

 ✅ (TX) Whole Health - Baylor - Hill Country

Texas Health Aetna

 ✅ HMO

 ✅ Open Access HMO

 ✅ Open Access HMO Option

 ✅ Point-of-Service (POS)

 ✅ Open Access POS II

 ✅ PPO

 ✅ Open Access Managed Plus

NOTICE- OUT OF NETWORK PLANS

Aetna Medicaid & Medicare Plans

 ❌ Aetna Better Health STAR Medicaid Plan

 ❌ Aetna Medicaid

 ❌ Aetna Medicare Advantage HMO (No longer in network after 1/1/2025)

 ❌ Aetna Medicare Advantage PPO (No longer in network after 1/1/2025)

Aetna ACA Marketplace (Exchange) Plans

 ❌ Aetna ACA Marketplace HMO

 ❌ Aetna ACA Marketplace EPO

 ❌ Aetna CVS Bronze Value HMO

 ❌ Aetna CVS Silver HMO

 ❌ Aetna CVS Gold HMO

Aetna EPO / Narrow Network Plans

 ❌ Aetna Elect Choice EPO

 ❌ Aetna Select EPO

 ❌ Aetna Indemnity (MedPremier without NAP)

 ❌ Aetna SmartCare HMO

 ❌ Aetna plans affiliated with Imagine Health (including employer-sponsored plans)

Aetna Whole Health Plans (Without Texas Health Logos)

 These ACO-based plans are only accepted if the card specifically shows a Texas Health logo. The following are not accepted:

 ❌ Aetna Whole Health – Baylor Scott & White Quality Alliance (BQA)

 ❌ Aetna Whole Health – Memorial Hermann Accountable Care Network

 ❌ Aetna Whole Health – Seton Health Alliance

 ❌ Aetna Whole Health – Baptist Health System

Other Aetna Plans

 ❌ Aetna Gold HMO Plan

 ❌ Aetna ACO (Accountable Care Organization)

 ❌ Aetna Workers' Compensation PPO

BLUE CROSS BLUE SHIELD OF TEXAS

 ✅ Blue Choice Silver PPO

 ✅ PPO Select Saver Series III

 ✅ Blue Choice Bronze PPO

 ✅ Blue Cross Blue Shield Solution, a MultiState Plan

 ✅ Blue Cross Blue Shield Premier, a MultiState Plan

 ✅ Blue Cross Blue Shield Basic, a MultiState Plan

 ✅ Blue Choice Platinum PPO

 ✅ Blue Choice Gold PPO

 ✅ EPO

 ✅ Blue Advantage HMO

 ✅ HMO Blue Texas

 ✅ HealthSelectSM of Texas

 ✅ HealthSelectSM Out-of-State

 ✅ Consumer Choice PPO

 ✅ TRS-ActiveCare: ActiveCare 2

 ✅ BlueCard PPO

 ✅ Blue Choice PPO Plan

 ✅ UT Select PPO

 ✅ BlueCard Traditional (Indemnity)

 ✅ HealthSelectSM Secondary

 ✅ TRS-ActiveCare Primary

 ✅ TRS-ActiveCare Primary+

 ✅ TRS-ActiveCare: ActiveCare HD HSA

 ✅ Blue Cross Medicare Advantage (HMO)

 ✅ Blue Cross Medicare Advantage (HMO-POS)

 ✅ Blue Cross Medicare Advantage (PPO)

 ✅ Blue Cross Medicare Advantage Value (HMO)

 ✅ Blue Cross Medicare Advantage Select (HMO)

 ✅ Blue Cross Medicare Advantage Basic (HMO)

 ✅ Blue Cross Medicare Advantage Choice Plus (PPO)

 ✅ Blue Cross Medicare Advantage Choice Premier (PPO)

 ✅ Medicare Supplement

 ✅ BlueOptions

 ✅ BlueCard PPO

 ✅ BlueCard PPO Basic

 ✅ Federal Employee Program - Standard Option

 ✅ Federal Employee Program - Basic Option

 ✅ BlueCard Traditional (Indemnity)

 ✅ Medicare Advantage PPO

ANTHEM BLUE CROSS BLUE SHIELD

 ✅ National PPO (BlueCard PPO)

 ✅ Anthem BlueCard PPO 100

 ✅ PPO/EPO

 ✅ Federal Employee Program

 ✅ Anthem Medicare Preferred

 ✅ Blue Medicare Advantage PPO

 ✅ Anthem Medicare Preferred (PPO) (California)

 ✅ Anthem Medicare Preferred (PPO) (Colorado)

 ✅ Anthem Medicare Preferred Standard (PPO) (Connecticut)

 ✅ Anthem Medicare Preferred (PPO) (Indiana)

 ✅ Blue Medicare Access Value (RPPO)

 ✅ Anthem Medicare Preferred (PPO) (Kentucky)

 ✅ Anthem Medicare Preferred (PPO) (Maine)

 ✅ Anthem Medicare Preferred (PPO) (Missouri)

 ✅ Anthem Medicare Preferred (PPO) (Nevada)

 ✅ Anthem Medicare Preferred (PPO) (Ohio)

 ✅ Anthem Medicare Preferred (PPO) (Wisconsin)

 ✅ Anthem Medicare Preferred (New Hampshire)

 ✅ Anthem MediBlue Preferred (PPO) (Connecticut)

OUT OF STATE PLANS ACCEPTED

 ✅ Horizon Blue Cross Blue Shield of New Jersey

 ✅ Federal Employee Plan - Standard Option

 ✅ Federal Employee Plan - Basic Option

 ✅ Blue Cross Blue Shield Federal Employee Program

 ✅ Standard Option

 ✅ Basic Option

 ✅ Empire Blue Cross Blue Shield (Health)

 ✅ Empire MediBlue(SM) Freedom I (PPO)

 ✅ Independence Blue Cross

 ✅ Personal Choice 65 PPO

 ✅ Highmark Blue Cross Blue Shield

 ✅ Freedom Blue PPO (Medicare)

 ✅ Highmark Blue Shield

 ✅ Freedom Blue PPO (Medicare)

 ✅ Capital Blue Cross

 ✅ SeniorBlue PPO

 ✅ Blue Cross Blue Shield of Georgia

 ✅ Medicare Preferred (PPO)

 ✅ Florida Blue: Blue Cross Blue Shield of Florida

 ✅ BlueMedicare PPO / BlueMedicare Group PPO

 ✅ BlueMedicare Regional PPO

 ✅ Blue Cross Blue Shield of Michigan

 ✅ Medicare Plus Blue (PPO)

 ✅ Blue Cross Blue Shield of South Carolina

 ✅ Medicare Advantage

 ✅ National Medicare Advantage PPO

 ✅ Blue Cross Blue Shield of North Carolina

 ✅ Medicare Advantage PPO

 ✅ Blue Cross Blue Shield of Tennessee

 ✅ Blue Advantage PPO

 ✅ Anthem Blue Cross

 ✅ Anthem Medicare Preferred Standard (PPO)

 ✅ Blue Cross Blue Shield of Alabama

 ✅ Preferred Provider Organization (PPO)

 ✅ Blue Cross of Northeastern Pennsylvania

 ✅ Medicare Advantage PPO

 ✅ Excellus Blue Cross Blue Shield

 ✅ Medicare PPO

 ✅ Regence Blue Cross Blue Shield

 ✅ Regence MedAdvantage (PPO)

 ✅ Highmark Blue Cross Blue Shield of Western New York

 ✅ Forever Blue Medicare PPO (All Plans)

 ✅ Blue Shield of Northeastern New York

 ✅ Forever Blue Medicare PPO (All Plans)

 ✅ Arkansas Blue Cross Blue Shield

 ✅ Medi-Pak Advantage (PPO)

 ✅ Triple-S Salud: Blue Cross Blue Shield of Puerto Rico

 ✅ Medicare Advantage (PPO)

 ✅ Blue Cross of Idaho

 ✅ Medicare Advantage - Secure Blue PPO

NOTICE- OUT OF NETWORK PLANS

Commercial PPOs/EPOs:

❌ Blue Edge PPO

❌ BlueOptions

❌ ParPlan

❌ SelecTEMP PPO

❌ Blue High Performance Network (HPN)

❌ Blue Premier (all products)

❌ Dallas ACO Select

❌ UT Connect (ACO)

❌ Blue Premier Access HMO

❌ Consumer Choice PPO (must verify individually)

Commercial HMOs/ACAs:

❌ Blue Option Network

❌ Primary Choice

❌ BlueChoice® Individual

❌ Blue Advantage Plus HMO

❌ Blue Advantage Security HMO 200

❌ Consumer Choice HMO

❌ Blue Premier HMO

TRS ActiveCare Plans:

❌ TRS ActiveCare Primary (must verify network)

❌ TRS ActiveCare Primary+ (must verify network)

❌ TRS ActiveCare ActiveCare HD HSA (must verify network)

Other:

❌ Generic EPOs (must verify individually - not automatic in-network)

 ✅ Open Access Plus

 ✅ Choice Fund PPO

 ✅ Open Access Value (all deductible levels)

 ✅ Open Access Value Plan

 ✅ PPO

 ✅ HMO Open Access

 ✅ Medicare Expand

 ✅ Premier Medicare (HMO-POS)

 ✅ Preferred Savings Medicare (HMO)

 ✅ Primary Medicare (HMO)

 ✅ True Choice Plus Medicare (PPO)

 ✅ Alliance Medicare (HMO)

 ✅ Fundamental Medicare (HMO)

 ✅ Preferred Plus Medicare (HMO)

 ✅ True Choice Medicare (PPO)

 ✅ Preferred Medicare (HMO)

 ✅ True Choice Core Medicare

 ✅ True Choice Savings Medicare (PPO)

 ✅ True Choice Courage Medicare (PPO)

 ✅ True Choice Access Medicare (PPO)

 ✅ Open Access Plus/CareLink

 ✅ Choice Fund Open Access Plus with CareLink

 ✅ Open Access (all deductible levels)

 ✅ Open Access Plan

 ✅ EPO

 ✅ Choice Fund Open Access Plus

 ✅ Open Access Plus In-Network

 ✅ Health Savings

 ✅ Health Savings (all deductible levels)

 ✅ Health Savings

 ✅ POS Open Access

 ✅ HealthCare of Texas- Open Access POS

CIGNA HEALTHSPRING

 ✅ HMO

 ✅ Preferred (HMO)

 ✅ Advantage (HMO)

 ✅ PPO

 ✅ Advantage (PPO)

 ✅ Preferred (PPO)

 ✅ Medicare Advantage

 ✅ Medicare Advantage

GWH-Cigna (formerly Great West Healthcare)

 ✅ POS

 ✅ PPO

 ✅ ONE +

 ✅ Open Access

NOTICE- OUT OF NETWORK PLANS 

 ❌ Cigna Local Plus ASO Plan

 ❌ Cigna Choice Local Plus Plan

 ❌ Cigna Connect HMO Plan

 ❌ Cigna EPO Connect

 ❌ Cigna POS Plan

 ❌ Cigna + Oscar ACA Plans (EPO)

 ❌ Cigna ACA Marketplace Plans (Cigna Connect, any Marketplace HMO/EPO)

 ❌ Cigna TX Focus Network

 ❌ Cigna Standard HMO Plans (Austin, Dallas, El Paso, Houston, Lufkin, North Texas, San Antonio)

 ❌ Cigna North Texas Provider Select Plan

 ❌ Cigna Care Designation Network (CCD/CCN)

 ❌ Cigna Workers' Compensation Plans

 ❌ Cigna Indemnity Plans

 ❌ Cigna True Choice Savings Medicare PPO Plan

 ❌ Cigna PDP (Prescription Drug Plans): Secure Rx, Secure-Essential Rx, Secure-Extra Rx

 ❌ Cigna I-SNP and C-SNP Plans (Achieve Medicare, Traditions Medicare)

 ❌ Cigna Medicare Supplement / Medigap Plans (Plan A, F, G, N, High Deductible Plan F)

 ❌ Cigna Medicare Surround

 ❌ Cigna Out-of-State Cigna Plans (Arizona, California, Colorado, Maryland, Florida, Connecticut, etc.)

 ✅ Options PPO

 ✅ Core

 ✅ Heritage Plus

 ✅ Options Non-Differential PPO

 ✅ Additional Network Benefit Plan/W500 Directory

 ✅ Compass Rose Health Plan FEHP FFS (PPO)

 ✅ Passport Connect Choice Plus

 ✅ Passport Connect Options PPO

 ✅ PPO (Choice Plus)

 ✅ Select Plus PPO

 ✅ Choice Advanced

 ✅ Navigate Plus PPO

 ✅ Select HMO

 ✅ Select Plus HMO

 ✅ Choice HMO/Choice Plus HMO

 ✅ OCI HMO

 ✅ Navigate

 ✅ Navigate/Navigate Balanced

 ✅ Navigate Plus

 ✅ Heritage Choice Standard

 ✅ Choice Plus Advanced (HMO)

 ✅ Choice Plus Plan with HSA

 ✅ Doctors Plan Plus (HMO)

 ✅ Doctors Plan HMO / Doctors Plan Plus HMO

 ✅ Choice Plus HMO Premier

 ✅ MedicareComplete Focus (HMO)

 ✅ AARP Medicare Advantage Plus (HMO-POS)

 ✅ Medicare Advantage Assure (PPO)

 ✅ AARP Medicare Advantage Choice Plan 1 (PPO)

 ✅ AARP MedicareComplete Plan 3 (HMO)

 ✅ MedicareComplete Choice Plan 1 (Regional PPO)

 ✅ MedicareComplete Choice Plan 3 (Regional PPO)

 ✅ MedicareComplete Choice Plan 4 (Regional PPO)

 ✅ AARP MedicareComplete (HMO)

 ✅ Medicare Select

 ✅ AARP Medicare Advantage Essential (HMO)

 ✅ AARP Medicare Advantage Plan 3 (HMO)

 ✅ AARP Medicare Advantage Walgreens (HMO)

 ✅ Medicare Advantage Choice (Regional PPO)

 ✅ MedicareComplete Essential (HMO)

 ✅ AARP MedicareComplete Focus (HMO)

 ✅ AARP MedicareComplete Focus Essential (HMO)

 ✅ Evercare Plan

 ✅ Medicare Advantage PPO

 ✅ AARP MedicareComplete SecureHorizons Plan2 (HMO)

 ✅ AARP MedicareComplete SecureHorizons Plan3 (HMO)

 ✅ AARP MedicareComplete SecureHorizons Plan1 (HMO)

 ✅ MedicareComplete Choice Essential (Regional PPO)

 ✅ MedicareComplete Choice

 ✅ AARP MedicareComplete Plan 1 (HMO)

 ✅ MedicareDirect Essential (PFFS)

 ✅ AARP MedicareComplete Essential (HMO)

 ✅ AARP MedicareComplete SecureHorizons Essential (HMO)

 ✅ AARP MedicareComplete Plan 2 (HMO)

 ✅ MedicareComplete Choice (Regional PPO)

 ✅ AARP Personal Health Insurance Plan

 ✅ AARP MedicareComplete Plus (HMO-POS)

 ✅ AARP MedicareComplete Choice (PPO)

 ✅ AARP Medicare Advantage PPO

 ✅ AARP Medicare Advantage POS

 ✅ AARP Medicare Advantage HMO

 ✅ AARP MedicareComplete Mosaic (HMO)

 ✅ Group Medicare Advantage (HMO)

 ✅ Group Medicare Advantage (PPO)

 ✅ Medicare Advantage Assure (HMO)

 ✅ AARP Medicare Advantage SecureHorizons (HMO)

 ✅ AARP Medicare Advantage Walgreens (PPO)

 ✅ Assisted Living Plan 1 (PPO I-SNP)

 ✅ Assisted Living Plan 2 (PPO I-SNP)

 ✅ The Villages MedicareComplete 1 (HMO)

 ✅ The Villages MedicareComplete 2 (HMO-POS)

 ✅ TX: Chronic Complete (HMO SNP)

 ✅ Group Medicare Advantage

 ✅ AARP MedicareComplete SecureHorizons Focus (HMO)

 ✅ MedicareComplete Assure (PPO)

 ✅ AARP MedicareComplete Choice Essential (Regional PPO)

 ✅ AARP MedicareComplete Choice Plan 2 (Regional PPO)

 ✅ Assisted Living Plan (PPO SNP)

 ✅ Sync (PPO) - Medicare

 ✅ AARP MedicareComplete Access (HMO)

 ✅ AARP MedicareComplete Premier (HMO)

 ✅ AARP MedicareComplete SecureHorizons Value (HMO)

 ✅ Medicare Gold (Regional PPO C-SNP)

 ✅ Medicare Silver (Regional PPO C-SNP)

 ✅ AARP MedicareRx Preferred (PDP)

 ✅ AARP MedicareRx Saver Plus (PDP)

 ✅ AARP MedicareRx Walgreens (PDP)

 ✅ Medicare Advantage Essential (Regional PPO)

 ✅ Medicare Advantage Choice (Regional PPO)

 ✅ AARP Medicare Advantage Walgreens Plan 1 (HMO)

 ✅ AARP Medicare Advantage Walgreens Plan 2 (HMO)

 ✅ AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)

 ✅ AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)

 ✅ AARP Medicare Advantage (HMO-POS)

 ✅ Erickson Advantage Signature without Drugs (HMO-POS)

 ✅ AARP Medicare Advantage Plan 1 (HMO)

 ✅ TX: Erickson Advantage Signature without Drugs (HMO-POS)

 ✅ TX: Erickson Advantage Signature with Drugs (HMO-POS)

 ✅ TX: Erickson Advantage Freedom (HMO-POS)

 ✅ AARP MedicareComplete Plan 4 (HMO)

 ✅ AARP Medicare Advantage Patriot (HMO-POS)

 ✅ Medicare Advantage Ally (HMO-POS C-SNP)

 ✅ AARP Medicare Advantage Walgreens (HMO-POS)

 ✅ AARP Medicare Advantage Walgreens Plan 2 (PPO)

 ✅ AARP Medicare Advantage Walgreens Plan 1 (PPO)

 ✅ AARP Medicare Advantage Patriot (PPO)

 ✅ AARP Medicare Advantage Choice Plan 2 (PPO)

 ✅ TX: HealthSelectsm Medicare Rx (PDP)

 ✅ AARP Medicare Advantage Plan 2 (HMO)

 ✅ AARP Medicare Advantage Mosaic Choice (PPO)

 ✅ AARP Medicare Advantage Mosaic (HMO)

 ✅ AARP Medicare Advantage Essential (HMO-POS)

 ✅ AARP MedicareComplete SecureHorizons Premier (HMO)

 ✅ AARP Medicare Advantage Plan 1 (HMO-POS)

 ✅ AARP Medicare Advantage Value Care (HMO-POS)

 ✅ AARP Medicare Advantage Choice Premier (PPO)

 ✅ Care Improvement Plus Medicare Advantage (Regional PPO)

 ✅ Chronic Complete Assure (C-SNP)

 ✅ Choice Plus Network - UMR

 ✅ Select EPO

 ✅ Choice

 ✅ Passport Connect Choice

 ✅ Navigate EPO

 ✅ Heritage Select EPO

 ✅ EPO

 ✅ All Savers

 ✅ Select Plus POS

 ✅ Choice Plus

 ✅ Heritage Choice

 ✅ HealthSelect of Texas (POS)

 ✅ Core POS

UNITEDHEALTHONE

 ✅ UnitedHealthcare Choice Plus Network

 ✅ UnitedHealthcare Navigate Plus

 ✅ UnitedHealthcare Navigate

 ✅ UnitedHealthcare Choice

 ✅ UnitedHealth Allies

 ✅ My HPN HMO

NOTICE- OUT OF NETWORK PLANS

UNITEDHEALTHCARE ACA MARKETPLACE (EXCHANGE) PLANS – ALL OUT OF NETWORK

 ❌ UHC Gold Advantage HMO Plan

 ❌ UHC Gold Standard HMO Plan

 ❌ UHC Bronze Virtual First HMO Plan

 ❌ UHC Bronze Standard HMO Plan

 ❌ UHC Silver Advantage HMO Plan

 ❌ UHC Silver Virtual First HMO Plan

 ❌ UHC Select Silver HMO Plan

 ❌ UHC Value Silver HMO Plan

 ❌ UHC Bronze Classic HMO Plan

UHC CHARTER NETWORK PLANS – OUT OF NETWORK

 ❌ UnitedHealthcare Charter HMO Plan

 ❌ UHC Charter Balanced HMO

 ❌ UHC Charter Plus HMO

 ❌ AllSavers with Charter Network

UMR (WITH IMAGINE HEALTH LOGO) – OUT OF NETWORK

 ❌ UMR plans are typically employer-sponsored. Those with the Imagine Health logo are not accepted:

UMR – NCH Corporation with Imagine Health

UMR – Imagine Health Tiered Network Plan

 ✅ Open Access Plus EPO

 ✅ Open Access EPO

 ✅ HMO

 ✅ HMO, HMO CCO, HMO - POS

 ✅ HMO Select Plus

 ✅ Freedom HMO

 ✅ Choice HMO

 ✅ HMO

 ✅ HMO Staff

 ✅ Health Maintenance Organization (HMO)

 ✅ HMO Select

 ✅ ChoiceCare MD/ANC

 ✅ Premier Point of Service

 ✅ POS Total Health Access

 ✅ POS

 ✅ HMO/POS Total Health

 ✅ Preferred POS

 ✅ HCG Open Access

 ✅ Select Network HMO/POS

 ✅ Point of Service

 ✅ COT National POS - Open Access

 ✅ Preferred POS-OpenAccess

 ✅ Choice POS

 ✅ National POS - Open Access

 ✅ National POS - Open Access Plus

 ✅ Open Access

 ✅ Preferred Open Access

 ✅ PPO/T. H. OHPtions

 ✅ ChoiceCare PPO

 ✅ PPO

 ✅ Preferred PPO

 ✅ ChoiceCare Network PPO

 ✅ ChoiceCare+ Network PPO

 ✅ PPO

 ✅ EPO PPO Open Access

 ✅ Medicare PPO

 ✅ Gold Plus HMO/Employer HMO

 ✅ Medicare Advantage Network

 ✅ Gold Plus HMO-POS

 ✅ TeamCare Gold

 ✅ TRS-Care Medicare Advantage

 ✅ TX: Choice R4182-003 (Regional PPO)

 ✅ Total Care Advantage HMO (Medicare)

 ✅ Value Plus PPO (Medicare)

 ✅ Honor (PPO)

 ✅ Community HMO Diabetes and Heart

 ✅ Medicare PPO/Employer PPO Plus

 ✅ Gold Plus HMO (Medicare)

 ✅ ChoicePPO (Medicare PPO)

 ✅ Community HMO

 ✅ GoldPlusHMO-SNP-Diabetes/Heart

 ✅ Gold Plus HMO

 ✅ Community HMO

 ✅ Kidney Care (HMO SNP)

 ✅ Choice (PPO)

NOTICE- OUT OF NETWORK PLANS 

 ❌ Humana Gold Plus HMO (D-SNP)

 ❌ Humana Gold Choice PFFS (Private Fee-for-Service)

 ❌ Humana Regional PPO

 ❌ Humana Honor PPO

 ❌ Humana Institutional and Chronic Special Needs Plans (I-SNP/C-SNP)

 ❌ Humana patients assigned to WellMed PCPs

 ❌ Humana TRICARE / Military Plans (TRICARE East)

 ❌ Humana Prescription Drug Plans (PDP): Walmart Value Rx, Premier Rx, Basic Rx

 ❌ Humana National POS Open Access

 ❌ Humana HMOX (ACA Exchange Product)

 ❌ Humana Group Medicare Plans tied to external ACO networks

 ✅ Medicare Complete (HMO)

 ✅ MedicareComplete SecureHorizons

 ✅ Personal Health Insurance Plan

 ✅ MedicareComplete Plus (HMO-POS)

 ✅ MedicareComplete Choice (PPO)

 ✅ Medicare Advantage PPO

 ✅ Medicare Advantage POS

 ✅ Medicare Advantage HMO

 ✅ Horizon Blue Cross Blue Shield of New Jersey

 ✅ Federal Employee Plan - Standard Option

 ✅ Federal Employee Plan - Basic Option

 ✅ Blue Cross Blue Shield Federal Employee Program

 ✅ Standard Option

 ✅ Basic Option

 ✅ Empire Blue Cross Blue Shield (Health)

 ✅ Empire MediBlue(SM) Freedom I (PPO)

 ✅ Independence Blue Cross

 ✅ Personal Choice 65 PPO

 ✅ Highmark Blue Cross Blue Shield

 ✅ Freedom Blue PPO (Medicare)

 ✅ Highmark Blue Shield

 ✅ Freedom Blue PPO (Medicare)

 ✅ Capital Blue Cross

 ✅ SeniorBlue PPO

 ✅ Blue Cross Blue Shield of Georgia

 ✅ Medicare Preferred (PPO)

 ✅ Florida Blue: Blue Cross Blue Shield of Florida

 ✅ BlueMedicare PPO / BlueMedicare Group PPO

 ✅ BlueMedicare Regional PPO

 ✅ Blue Cross Blue Shield of Michigan

 ✅ Medicare Plus Blue (PPO)

 ✅ Blue Cross Blue Shield of South Carolina

 ✅ Medicare Advantage

 ✅ National Medicare Advantage PPO

 ✅ Blue Cross Blue Shield of North Carolina

 ✅ Medicare Advantage PPO

 ✅ Blue Cross Blue Shield of Tennessee

 ✅ Blue Advantage PPO

 ✅ Anthem Blue Cross

 ✅ Anthem Medicare Preferred Standard (PPO)

 ✅ Blue Cross Blue Shield of Alabama

 ✅ Preferred Provider Organization (PPO)

 ✅ Blue Cross of Northeastern Pennsylvania

 ✅ Medicare Advantage PPO

 ✅ Excellus Blue Cross Blue Shield

 ✅ Medicare PPO

 ✅ Regence Blue Cross Blue Shield

 ✅ Regence MedAdvantage (PPO)

 ✅ Highmark Blue Cross Blue Shield of Western New York

 ✅ Forever Blue Medicare PPO (All Plans)

 ✅ Blue Shield of Northeastern New York

 ✅ Forever Blue Medicare PPO (All Plans)

 ✅ Arkansas Blue Cross Blue Shield

 ✅ Medi-Pak Advantage (PPO)

 ✅ Triple-S Salud: Blue Cross Blue Shield of Puerto Rico

 ✅ Medicare Advantage (PPO)

 ✅ Blue Cross of Idaho

 ✅ Medicare Advantage - Secure Blue PPO

 ✅ Coventry National Network

 ✅ First Health

 ✅ CoventryOne National

 ✅ Employer Group PPO

 ✅ Coventry Preferred (PPO)

 ✅ Carelink from Coventry

 ✅ PPO ASO

 ✅ PPO

 ✅ HMO Select Network

 ✅ Individual HMO/Open Access

 ✅ Employer Group HMO/Open Access

 ✅ Open Access Plan (OAP)

 ✅ Group Health Plan (GHP) Medicare Advantage

 ✅ Advantra Freedom (Medicare)

 ✅ Vista - A Plan

 ✅ Advantra Medicare Advantage HMO

 ✅ Advantra Medicare Advantage PPO

 ✅ Advantra Medicare Advantage POS

 ✅ Advantra TotalCare (HMO)

 ✅ Advantra Total Care (PPO)

 ✅ Coventry Medicare Summit Plan (HMO)

 ✅ Florida: VISTA Medicare: Coventry Advantra Ideal (HMO) - Hillsborough

 ✅ VISTA (CHC Florida) Individual

 ✅ Florida: VISTA Medicare: Coventry Advantra Ideal (HMO) - Polk

 ✅ Mercy MedicareADVANTAGE

 ✅ Gold Advantage

 ✅ VISTA Medicare

 ✅ Coventry POS

 ✅ Employer Group Open Access POS

 ✅ Employer Group POS

 ✅ of Texas

 ✅ CoventryOne POS

NOTICE- OUT OF NETWORK PLANS

 ❌ Coventry HMO & Premier (Standard HMO, non-Open Access)

 ❌ CoventryOne HMO

 ❌ Coventry EPO

 ❌ Coventry Curative Plan

 ❌ Coventry Workers’ Compensation Plans

 ❌ Coventry PPO Rental Network Plans (PHCS, Multiplan, Beech Street, etc.)

 ❌ Coventry Out-of-State Plans (Oklahoma, Tennessee, Illinois, Nevada, Delaware, Georgia,  Iowa, Kansas, Louisiana, Missouri, Nebraska)

 ❌ Special Employer Plans (MoDot and MSHP PPO, Nebraska Medical Center)

 ❌ Indemnity Plans (Foreign Service Benefit Plan, MHBP, Rural Carrier Benefit Plan)

 ❌ Other Out-of-Area Plans (Altius Health Plan, Carpenters Benefit Plans, FEHB, Preferred Health Systems, Southern Health Services, WellPath)

 ✅ Medicare Advantage

NOTICE- OUT OF NETWORK PLANS

 ❌ Superior Health Star Plus Medicaid Plan

 ❌ Community Health Choice Star Medicaid Plan

 ✅ Value Script (PDP)

 ✅ Medicare Rx Value Plus (PDP)

 ✅ TexanPlus Patriot Giveback (HMO)

 ✅ Patriot No Premium (HMO)

 ✅ No Premium (HMO-POS)

 ✅ Assist (HMO)

 ✅ Complement Assist (HMO)

 ✅ TexanPlus No Premium (HMO)

 ✅ Giveback (HMO)

 ✅ Specialty No Premium (HMO C-SNP)

 ✅ Premium Enhanced Open (PPO)

 ✅ No Premium (HMO)

 ✅ WellCare Rx (HMO)

 ✅ WellCare Plus (HMO)

 ✅ WellCare Prime (PPO)

 ✅ WellCare Value (HMO)

 ✅ Choice

 ✅ Texas Medicare

 ✅ WellCare Classic (PDP)

 ✅ WellCare Extra (PDP)

 ✅ WellCare Premier (PPO)

 ✅ TX: WellCare Value (HMO-POS)

 ✅ TX: WellCare TexanPlus Classic (HMO)

 ✅ Assist Open (PPO)

 ✅ Giveback Open (PPO)

 ✅ No Premium Open (PPO)

 ✅ WellCare TexanPlus No Premium (HMO-POS)

 ✅ TX: WellCare No Premium Rx Plus Open (PPO)

 ✅ TexanPlus Classic No Premium (HMO)

 ✅ WellCare Preferred (HMO-POS)

 ✅ No Premium Essentials (HMO)

 ✅ Community Assist (PPO)

 ✅ Patriot Giveback Open (PPO)

 ✅ Low Premium (HMO-POS)

 ✅ Patriot Giveback (HMO-POS)

 ✅ Advantage No Premium (PFFS)

 ✅ Premium Ultra Open (PPO)

NOTICE- OUT OF NETWORK PLANS

 ❌ Wellcare No Premium Open (HMO)

 ❌ Wellcare Giveback (HMO)

 ❌ Wellcare Assist (HMO D-SNP)

 ❌ Wellcare Dual Liberty (HMO D-SNP)

 ❌ Wellcare Dual Access (HMO D-SNP)

 ❌ Wellcare Patriot (PPO)

 ❌ Wellcare TexanPlus Plans

 ❌ Wellcare Regional PPO Plans

 ❌ Wellcare Premier Rx (PDP)

 ❌ Wellcare Value Script (PDP)

 ❌ Wellcare Rx Saver (PDP)

 ❌ Wellcare by Allwell Plans (All Medicare Advantage Plans)

 ❌ All Out-of-State Wellcare Plans (California, Florida, Georgia, Kentucky, Arizona, New York, etc.)

 ✅ Wellpoint Star Medicaid Plan

 ✅ WELLPOINT Dual Advantage HMO

 ✅ Texas Medicare

 ✅ TX: Amerivantage Select HMO

 ✅ Amerivantage Classic HMO

 ✅ Amerivantage Balance (HMO)

 ✅ Amerivantage Heart Care Plus (HMO C-SNP)

 ✅ Amerivantage Diabetes Care Plus (HMO C-SNP)

 ✅ Amerivantage Comfort Plus (HMO I-SNP)

 ✅ Amerivantage Classic Plus (HMO)

 ✅ Amerivantage Choice (PPO)

 ✅ Amerivantage Lung Care (HMO C-SNP)

 ✅ Amerivantage Heart Care (HMO C-SNP)

 ✅ Amerivantage ESRD Care Plus (HMO C-SNP)

 ✅ Amerivantage Diabetes Care (HMO C-SNP)

 ✅ Amerivantage Comfort (HMO I-SNP)

 ✅ TX: Amerivantage ESRD (HMO-POS C-SNP)

 ✅ Amerivantage ESRD Care (HMO-POS C-SNP)

 ✅ Blue Choice Health Plan

 ✅ BlueCard PPO Basic

 ✅ BlueCard PPO/EPO

 ✅ Open Access (AdvantagePlus, CarolinaADVANTAGE, MyChoice)

 ✅ BlueCard Traditional

 ✅ National Medicare Advantage PPO

NOTICE- OUT OF NETWORK PLANS

❌Wellpoint Medicare – IntegraNet Gulf Coast IPA Plans
❌Any Amerigroup or Wellpoint plan with “IntegraNet – Gulf Coast IPA” beneath the PCP name
❌Amerigroup Out-of-State Medicaid Plans
❌Wellpoint Out-of-State Medicare Advantage Plans
❌Amerigroup / Wellpoint Employer Group Medicare Advantage Plans (non-standard plans not credentialed through SWHR)

 ✅ Medicare Advantage PPO Plans

 ✅ Choice (PPO)

 ✅ Choice Plus (PPO)

 ✅ Choice Premium (PPO)

 ✅ Classic (HMO)

 ✅ Medicare Advantave HMO Plans

 ✅ Ambetter Essentials (Non-VALUE)

 ✅ Ambetter Balanced (Non-VALUE)

 ✅ Ambetter Secure (Non-VALUE)

 ✅ Ambetter Virtual Access (Non-VALUE)

 ✅ Ambetter Secure Care (standard tier)

NOTICE- OUT OF NETWORK PLANS

OUT OF NETWORK WITH ALL "VALUE" PLANS

❌ Ambetter Clear VALUE Silver HMO Plan

❌ Ambetter Standard Gold VALUE HMO Plan

❌ Ambetter Standard Silver VALUE HMO Plan

❌ Ambetter HMO Value Gold Plan

❌ Ambetter HMO Value Silver Plan

❌ Ambetter HMO Value Bronze Plan

❌  Ambetter Standard Gold HMO Plan

❌ Ambetter Standard Silver HMO Plan

❌  Ambetter Virtual Value Silver Plan

❌ Ambetter Virtual Value Gold Plan

❌  Ambetter Virtual Value Bronze Plan

❌  Ambetter Value Select Gold HMO

❌  Ambetter Value Select Silver HMO

❌ Ambetter Value Select Bronze HMO

❌ Ambetter Essentials VALUE Plan

❌  Ambetter Balanced VALUE Gold Plan

❌  Ambetter Balanced VALUE Silver Plan

❌  Ambetter Secure VALUE Silver Plan

❌ Ambetter Clear Secure Silver VALUE HMO
❌ Ambetter Clear Bronze VALUE Plan
❌ Ambetter Bronze Classic VALUE Plan
❌ Ambetter Virtual Access Value Plan
❌ Ambetter Balanced Bronze VALUE Plan

❌ Ambetter Gold VALUE – No Referral HMO
❌ Ambetter Value Bronze HMO – Limited Network
❌ Ambetter Marketplace VALUE Bronze Plan
❌ Ambetter Marketplace VALUE Silver Plan
❌ Ambetter Out-of-State Ambetter Marketplace Plans (non-TX or non-DFW region) 

 ✅ Payors Organization (HPO)

 ✅ Preferred Care

 ✅ GEPO

 ✅ Interplan Health Group (IHG) Network

 ✅ ACCEL

 ✅ High Performance Network

 ✅ Preferred Network (Formerly Emerald Health Network)

NOTICE OF OUT OF NETWORK PLANS

  ❌ HealthSmart Complete PPO
 ❌ HealthSmart GEPO
 ❌ HealthSmart EPO
 ❌ HealthSmart HMO
 ❌ HealthSmart Student Health Plans
 ❌ HealthSmart Limited Benefit Plans
 ❌ HealthSmart SmartCare Plans
 ❌ HealthSmart Imagine Health Plans
 ❌ HealthSmart Access / Practitioner-Only Plans
 ❌ HealthSmart Beech Street–based PPO Plans
 ❌ HealthSmart Out-of-State Plans
 ❌ HealthSmart PPO plans with Physician-Only access
 ❌ Employer Group TPA Plans using HealthSmart without SWHR contracting 

 ✅ Molina STAR (Medicaid)

 ✅ Molina CHIP / CHIP Perinate

 ✅ Molina STAR+PLUS (Medicaid)

 ✅ Molina Medicare Advantage Complete Care (D-SNP)

NOTICE- OUT OF NETWORK PLANS

Out of network with ALL MOLINA COMMERCAL PLANS

  ❌ Molina Marketplace Bronze Plan
 ❌ Molina Marketplace Silver Plan
 ❌ Molina Marketplace Gold Plan
 ❌ Molina Marketplace Select Silver Plan
 ❌ Molina Marketplace Value Silver HMO Plan
 ❌ Molina Marketplace Standard Silver HMO Plan
 ❌ Molina Marketplace MyChoice Silver Plan
 ❌ Molina Marketplace Core Care Bronze Plan
 ❌ Molina Marketplace Standard Gold HMO Plan
 ❌ Molina Marketplace No Referral HMO Plan
 ❌ Molina Marketplace Virtual Access Plans
 ❌ Molina Marketplace Virtual Bronze HMO
 ❌ Molina Marketplace Enhanced Silver 94 Plan
 ❌ Molina Marketplace Enhanced Silver 87 Plan
 ❌ Molina Marketplace Enhanced Silver 73 Plan
 ❌ Molina Marketplace Minimum Coverage Plan
 ❌ Molina Marketplace Community Plus Silver
 ❌ Molina Marketplace Bronze Classic
 ❌ Molina EPO Marketplace Plans
 ❌ Molina Care Select HMO Plan
 ❌ Molina Multi-State Plan
 ❌ Molina Marketplace Out-of-State Plans
 ❌ Molina Medicaid Plans issued outside Texas (STAR, CHIP, STAR+PLUS)
 ❌ Molina Medicare Advantage PPO Plans
 ❌ Molina Medicare Advantage HMO Plans not labeled Complete Care D-SNP
 ❌ Molina Medicare Advantage Out-of-State Plans
 ❌ Molina Medicare Employer Group Plans
 ❌ Molina TRS Medicare Advantage Plans
 ❌ Molina Dual Eligible Regional PPO Plans
 ❌ Molina Value HMO Plans in non-DFW regions
 ❌ Molina Texas HMO Marketplace Plans issued outside DFW 

MULTIPLAN PHCS

 ✅ Multiplan

 ✅ PHCS

 ✅ HealthEOS PPO

 ✅ HealthEOS Plus+

Consolidated Health Plans

 ✅ MultiPlan

 ✅ PHCS

 ✅ First Health Network

Memorial Hermann

 ✅ MultiPlan

 ✅ PHCS

POMCO

 ✅ PHCS/Multiplan

Tufts Health Plan

 ✅ PPO/PHCS Network

 American Republic Insurance Company

 ✅ PHCS PPO

 ✅ First Health

Moda Health

 ✅ PHCS

US Health Group

 ✅ Private Healthcare Systems (PHCS) (PPO)

NOTICE- OUT OF NETWORK PLANS

  ❌ PHCS Healthy Directions
 ❌ PHCS Savility Network
 ❌ Multiplan PPO
 ❌ Multiplan ValueOptions
 ❌ Beech Street PPO
 ❌ Multiplan Limited Benefit Plans
 ❌ Multiplan Discount Network Plans
 ❌ PHCS Practitioner & Ancillary Only Network
 ❌ Multiplan Practitioner-Only Networks
 ❌ Multiplan Behavioral Health Plans
 ❌ Student Health Plans using Multiplan or PHCS
 ❌ Travel Health Plans (IMG, Seven Corners) using Multiplan
 ❌ HealthShare Plans using Multiplan (e.g., Christian Healthcare Ministries, Liberty HealthShare)
 ❌ Short-Term Medical Plans using PHCS/Multiplan
 ❌ Group & Pension Administrator (GPA) PHCS “Physician-Only” Plans
 ❌ Multiplan EPO or Custom Employer PPO Plans
 ❌ Any Multiplan or PHCS card without “PHCS Primary PPO” 

 USA MANAGED CARE ORGANIZATION

 ✅ USA Health & Wellness Network (Medical)

 QUICKTRIP

 ✅ Employee Benefit Plan

 FIRST HEALTH (COVENTRY HEALTH CARE)

 ✅ First Health Network PPO

 Caterpillar

 ✅ UHC PPO Network Plan

 ✅ UHC Choice Plan

 Health Net

 ✅ National PPO - First Health

 UNITED HEALTH CARE

UNITEDHEALTHCARE ACA MARKETPLACE (EXCHANGE) PLANS – ALL OUT OF NETWORK

 ❌ UHC Gold Advantage HMO Plan

 ❌ UHC Gold Standard HMO Plan

 ❌ UHC Bronze Virtual First HMO Plan

 ❌ UHC Bronze Standard HMO Plan

 ❌ UHC Silver Advantage HMO Plan

 ❌ UHC Silver Virtual First HMO Plan

 ❌ UHC Select Silver HMO Plan

 ❌ UHC Value Silver HMO Plan

 ❌ UHC Bronze Classic HMO Plan

UHC CHARTER NETWORK PLANS – OUT OF NETWORK

 ❌ UnitedHealthcare Charter HMO Plan

 ❌ UHC Charter Balanced HMO

 ❌ UHC Charter Plus HMO

 ❌ AllSavers with Charter Network

 UMR (WITH IMAGINE HEALTH LOGO) – OUT OF NETWORK

 ❌ UMR plans are typically employer-sponsored. Those with the Imagine Health logo are not accepted:

 UMR – NCH Corporation with Imagine Health

 UMR – Imagine Health Tiered Network Plan

 CIGNA

 ❌ Cigna Local Plus ASO Plan

 ❌ Cigna Choice Local Plus Plan

 ❌ Cigna Connect HMO Plan

 ❌ Cigna EPO Connect

 ❌ Cigna POS Plan

 ❌ Cigna + Oscar ACA Plans (EPO)

 ❌ Cigna ACA Marketplace Plans (Cigna Connect, any Marketplace HMO/EPO)

 ❌ Cigna TX Focus Network

 ❌ Cigna Standard HMO Plans (Austin, Dallas, El Paso, Houston, Lufkin, North Texas,  San Antonio)

 ❌ Cigna North Texas Provider Select Plan

 ❌ Cigna Care Designation Network (CCD/CCN)

 ❌ Cigna Workers' Compensation Plans

 ❌ Cigna Indemnity Plans

 ❌ Cigna True Choice Savings Medicare PPO Plan

 ❌ Cigna PDP (Prescription Drug Plans): Secure Rx, Secure-Essential Rx, Secure-Extra Rx

 ❌ Cigna I-SNP and C-SNP Plans (Achieve Medicare, Traditions Medicare)

 ❌ Cigna Medicare Supplement / Medigap Plans (Plan A, F, G, N, High Deductible Plan F)

 ❌ Cigna Medicare Surround

 ❌ Cigna Out-of-State Cigna Plans (Arizona, California, Colorado, Maryland, Florida, Connecticut, etc.)

 AETNA

Aetna Medicaid & Medicare Plans

 ❌ Aetna Better Health STAR Medicaid Plan

 ❌ Aetna Medicaid

 ❌ Aetna Medicare Advantage HMO (No longer in network after 1/1/2025)

 ❌ Aetna Medicare Advantage PPO (No longer in network after 1/1/2025)

Aetna ACA Marketplace (Exchange) Plans

 ❌ Aetna ACA Marketplace HMO

 ❌ Aetna ACA Marketplace EPO

 ❌ Aetna CVS Bronze Value HMO

 ❌ Aetna CVS Silver HMO

 ❌ Aetna CVS Gold HMO

Aetna EPO / Narrow Network Plans

 ❌ Aetna Elect Choice EPO

 ❌ Aetna Select EPO

 ❌ Aetna Indemnity (MedPremier without NAP)

 ❌ Aetna SmartCare HMO

 ❌ Aetna plans affiliated with Imagine Health (including employer-sponsored plans)

Aetna Whole Health Plans (Without Texas Health Logos)

These ACO-based plans are only accepted if the card specifically shows a Texas Health logo. The following are not accepted:

 ❌ Aetna Whole Health – Baylor Scott & White Quality Alliance (BQA)

 ❌ Aetna Whole Health – Memorial Hermann Accountable Care Network

 ❌ Aetna Whole Health – Seton Health Alliance

 ❌ Aetna Whole Health – Baptist Health System

Other Aetna Plans

 ❌ Aetna Gold HMO Plan

 ❌ Aetna ACO (Accountable Care Organization)

 ❌ Aetna Workers' Compensation PPO

 BYLOR, SCOTT AND WHITE

Out of Network with All BSW

 ❌ BSW Prime Silver HMO Plan

 MOLINA

Out of network with ALL MOLINA COMMERCAL PLANS

  ❌ Molina Marketplace Bronze Plan
 ❌ Molina Marketplace Silver Plan
 ❌ Molina Marketplace Gold Plan
 ❌ Molina Marketplace Select Silver Plan
 ❌ Molina Marketplace Value Silver HMO Plan
 ❌ Molina Marketplace Standard Silver HMO Plan
 ❌ Molina Marketplace MyChoice Silver Plan
 ❌ Molina Marketplace Core Care Bronze Plan
 ❌ Molina Marketplace Standard Gold HMO Plan
 ❌ Molina Marketplace No Referral HMO Plan
 ❌ Molina Marketplace Virtual Access Plans
 ❌ Molina Marketplace Virtual Bronze HMO
 ❌ Molina Marketplace Enhanced Silver 94 Plan
 ❌ Molina Marketplace Enhanced Silver 87 Plan
 ❌ Molina Marketplace Enhanced Silver 73 Plan
 ❌ Molina Marketplace Minimum Coverage Plan
 ❌ Molina Marketplace Community Plus Silver
 ❌ Molina Marketplace Bronze Classic
 ❌ Molina EPO Marketplace Plans
 ❌ Molina Care Select HMO Plan
 ❌ Molina Multi-State Plan
 ❌ Molina Marketplace Out-of-State Plans
 ❌ Molina Medicaid Plans issued outside Texas (STAR, CHIP, STAR+PLUS)
 ❌ Molina Medicare Advantage PPO Plans
 ❌ Molina Medicare Advantage HMO Plans not labeled Complete Care D-SNP
 ❌ Molina Medicare Advantage Out-of-State Plans
 ❌ Molina Medicare Employer Group Plans
 ❌ Molina TRS Medicare Advantage Plans
 ❌ Molina Dual Eligible Regional PPO Plans
 ❌ Molina Value HMO Plans in non-DFW regions
 ❌ Molina Texas HMO Marketplace Plans issued outside DFW 

 AMBETTER

  ❌ Ambetter Clear VALUE Silver HMO Plan
 ❌ Ambetter Standard Gold VALUE HMO Plan
 ❌ Ambetter Standard Silver VALUE HMO Plan
 ❌ Ambetter HMO Value Gold Plan
 ❌ Ambetter HMO Value Silver Plan
 ❌ Ambetter HMO Value Bronze Plan
 ❌ Ambetter Standard Gold HMO Plan
 ❌ Ambetter Standard Silver HMO Plan
 ❌ Ambetter Virtual Value Silver Plan
 ❌ Ambetter Virtual Value Gold Plan
 ❌ Ambetter Virtual Value Bronze Plan
 ❌ Ambetter Value Select Gold HMO
 ❌ Ambetter Value Select Silver HMO
 ❌ Ambetter Value Select Bronze HMO
 ❌ Ambetter Essentials VALUE Plan
 ❌ Ambetter Balanced VALUE Gold Plan
 ❌ Ambetter Balanced VALUE Silver Plan
 ❌ Ambetter Secure VALUE Silver Plan
 ❌ Ambetter Clear Secure Silver VALUE HMO
 ❌ Ambetter Clear Bronze VALUE Plan
 ❌ Ambetter Bronze Classic VALUE Plan
 ❌ Ambetter Virtual Access Value Plan
 ❌ Ambetter Balanced Bronze VALUE Plan
 ❌ Ambetter Gold VALUE – No Referral HMO
 ❌ Ambetter Value Bronze HMO – Limited Network
 ❌ Ambetter Marketplace VALUE Bronze Plan
 ❌ Ambetter Marketplace VALUE Silver Plan
 ❌ Ambetter Out-of-State Ambetter Marketplace Plans (non-TX or non-DFW region) 

AMERIGROUP/WELLPOINT

 ❌ Wellpoint Medicare – IntegraNet Gulf Coast IPA Plans
❌ Any Amerigroup or Wellpoint plan with “IntegraNet – Gulf Coast IPA” beneath the PCP name
❌ Amerigroup Out-of-State Medicaid Plans
❌ Wellpoint Out-of-State Medicare Advantage Plans
❌ Amerigroup / Wellpoint Employer Group Medicare Advantage Plans (non-standard plans not credentialed through SWHR)

WELLCARE

 ❌ Wellcare No Premium Open (HMO)

 ❌ Wellcare Giveback (HMO)

 ❌ Wellcare Assist (HMO D-SNP)

 ❌ Wellcare Dual Liberty (HMO D-SNP)

 ❌ Wellcare Dual Access (HMO D-SNP)

 ❌ Wellcare Patriot (PPO)

 ❌ Wellcare TexanPlus Plans

 ❌ Wellcare Regional PPO Plans

 ❌ Wellcare Premier Rx (PDP)

 ❌ Wellcare Value Script (PDP)

 ❌ Wellcare Rx Saver (PDP)

 ❌ Wellcare by Allwell Plans (All Medicare Advantage Plans)

 ❌ All Out-of-State Wellcare Plans (California, Florida, Georgia, Kentucky, Arizona, New York, etc.)

SUPERIOR

 ❌ Superior Health Star Plus Medicaid Plan

 ❌ Community Health Choice Star Medicaid Plan

 BLUE CROSS BLUE SHIELD

Commercial PPOs/EPOs:

❌ Blue Edge PPO

❌ BlueOptions

❌ ParPlan

❌ SelecTEMP PPO

❌ Blue High Performance Network (HPN)

❌ Blue Premier (all products)

❌ Dallas ACO Select

❌ UT Connect (ACO)

❌ Blue Premier Access HMO

❌ Consumer Choice PPO (must verify individually)

Commercial HMOs/ACAs:

❌ Blue Option Network

❌ Primary Choice

❌ BlueChoice® Individual

❌ Blue Advantage Plus HMO

❌ Blue Advantage Security HMO 200

❌ Consumer Choice HMO

❌ Blue Premier HMO

TRS ActiveCare Plans:

❌ TRS ActiveCare Primary (must verify network)

❌ TRS ActiveCare Primary+ (must verify network)

❌ TRS ActiveCare ActiveCare HD HSA (must verify network)

Other:

❌ Generic EPOs (must verify individually - not automatic in-network)

COVENTRY

 ❌ Coventry HMO & Premier (Standard HMO, non-Open Access)

 ❌ CoventryOne HMO

 ❌ Coventry EPO

 ❌ Coventry Curative Plan

 ❌ Coventry Workers’ Compensation Plans

 ❌ Coventry PPO Rental Network Plans (PHCS, Multiplan, Beech Street, etc.)

 ❌ Coventry Out-of-State Plans (Oklahoma, Tennessee, Illinois, Nevada, Delaware, Georgia, Iowa, Kansas, Louisiana, Missouri, Nebraska)

 ❌ Special Employer Plans (MoDot and MSHP PPO, Nebraska Medical Center)

 ❌ Indemnity Plans (Foreign Service Benefit Plan, MHBP, Rural Carrier Benefit Plan)

Other Out-of-Area Plans (Altius Health Plan, Carpenters Benefit Plans, FEHB, Preferred Health Systems, Southern Health Services, WellPath)

 MULTIPLANS:

  ❌ PHCS Healthy Directions
 ❌ PHCS Savility Network
 ❌ Multiplan PPO
 ❌ Multiplan ValueOptions
 ❌ Beech Street PPO
 ❌ Multiplan Limited Benefit Plans
 ❌ Multiplan Discount Network Plans
 ❌ PHCS Practitioner & Ancillary Only Network
 ❌ Multiplan Practitioner-Only Networks
 ❌ Multiplan Behavioral Health Plans
 ❌ Student Health Plans using Multiplan or PHCS
 ❌ Travel Health Plans (IMG, Seven Corners) using Multiplan
 ❌ HealthShare Plans using Multiplan (e.g., Christian Healthcare Ministries, Liberty HealthShare)
 ❌ Short-Term Medical Plans using PHCS/Multiplan
 ❌ Group & Pension Administrator (GPA) PHCS “Physician-Only” Plans
 ❌ Multiplan EPO or Custom Employer PPO Plans
 ❌ Any Multiplan or PHCS card without “PHCS Primary PPO” 

 HEALTHSMART

  ❌ HealthSmart Complete PPO
 ❌ HealthSmart GEPO
 ❌ HealthSmart EPO
 ❌ HealthSmart HMO
 ❌ HealthSmart Student Health Plans
 ❌ HealthSmart Limited Benefit Plans
 ❌ HealthSmart SmartCare Plans
 ❌ HealthSmart Imagine Health Plans
 ❌ HealthSmart Access / Practitioner-Only Plans
 ❌ HealthSmart Beech Street–based PPO Plans
 ❌ HealthSmart Out-of-State Plans
 ❌ HealthSmart PPO plans with Physician-Only access
 ❌ Employer Group TPA Plans using HealthSmart without SWHR contracting 

OTHER

 ❌ Curative EPO Plan

 ❌ PHCS MEC Plus Advantage EPO Plan

 ❌ Community Health Choice Star Medicaid Plan

 ❌ STAR PLUS LTC - NON DUAL ELIGIBLE OTHER COMMUNITY

 ❌ OSCAR Silver Classic Standard EPO Plan

 ❌ TRICARE Prime - Retired Sponsors And Family Members Plan