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Harlingen CISD

HCISD 2027 Health Plan

New Employee Health Plan Options for 2027

 

 

Board Approves New Employee Health Plan Options for 2027

The Harlingen CISD Board of Trustees approved changes to the district’s employee health plan on September 16. Employees will be able to choose between an HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization) plan. Coverage begins January 1, 2027.

Key Information

  • HMO employee-only premium: $0
  • PPO premium: Monthly cost based on coverage level
  • MDLIVE: $0 copay under either plan
  • Virtual information meetings: September 28-October 2
  • Open Enrollment: October 5-November 6
  • New coverage begins: January 1, 2027

Compare the Two Plan Options

HCISD_2027_Health_Plan_Rates(1)

 

HCISD_2027_Health_Plan_Benefit_Comparison(1)

 

 

HMO (Health Maintenance Organization) Plan

  • Offers lower monthly rates
  • Requires members to select a primary care physician
  • May require referrals for specialist care
  • Does not provide out-of-network benefits except as allowed by the plan
  • Employee-only premium remains at $0

PPO (Preferred Provider Organization) Plan

  • Offers greater flexibility in choosing providers
  • Allows members to use out-of-network providers
  • Generally costs more when care is received outside the network
  • Requires a monthly premium based on the employee’s coverage level

What Is Changing?

Health Plan Choices

Employees will be able to choose between an HMO and a PPO plan.

Plan Costs

The employee-only premium for the HMO plan will remain at $0. Employees who select the PPO plan will pay a monthly premium based on their coverage level.

Plan Benefits

Deductibles, copays and out-of-pocket maximums will change. A detailed comparison will be provided before Open Enrollment.

Pharmacy Benefits

Pharmacy copays and the covered drug list will change, which may affect the cost of some medications. The Human Services team will be available to help employees understand these changes.

HMO Requirements

Employees enrolled in the HMO will need to select a primary care physician. Referrals may be required for specialist care, and out-of-network benefits will not be available except as allowed by the plan.

How the Plan Was Developed

District administrators and members of the Employee Benefits Committee met several times to review the plan’s financial condition and consider different benefit structures and costs.

Employee feedback played an important role in developing the final recommendation. Based on that feedback, the district:

  • Preserved the PPO as an additional option
  • Maintained the $0 employee-only premium for the HMO
  • Kept MDLIVE visits available at no cost

The approved changes are intended to help keep the district’s health plan financially sustainable while continuing to provide employees and their families with access to health care coverage.

Supporting Employee and Community Wellness

The health plan changes are one part of the district’s broader commitment to health and wellness through Living Longer by Design.

The district is working to connect current and future initiatives that support students, employees, families and the Harlingen community. This work may include:

  • Exploring employee wellness incentives
  • Expanding health and wellness opportunities
  • Reviewing school nutrition and cafeteria menus
  • Strengthening partnerships with community organizations
  • Identifying additional ways to encourage healthier lifestyles

Important Dates

Date What Employees Need to Know
Sept. 28-Oct. 2 Virtual Health Care Connections meetings through Microsoft Teams
Oct. 5-Nov. 6 Open Enrollment
Jan. 1, 2027 New health plan coverage begins

What Happens Next?

Before Open Enrollment, employees will receive a detailed comparison of the HMO and PPO plans, including:

  • Monthly premium rates
  • Deductibles and copays
  • Out-of-pocket maximums
  • Pharmacy benefit changes
  • Provider and referral requirements

Information will be available in English and Spanish.

Employees are encouraged to attend a virtual Health Care Connections meeting, carefully review the plan materials and understand the differences between the HMO and PPO plans before making their 2027 selection.

Stay Informed

This webpage will serve as the central location for information about the 2027 health plans. Employees should return regularly as additional resources, meeting information, plan documents and frequently asked questions are added.

Board Approves New Employee Health Plan Options for 2027

The Harlingen CISD Board of Trustees approved changes to the district’s employee health plan on Sept. 16. Employees will be able to choose between an HMO and a PPO plan. Coverage begins January 1, 2027.

HCISD will continue to pay 100% of the employee-only premium for the HMO plan. Employees who choose the PPO plan will pay a monthly premium based on their coverage level.

MDLIVE will remain available at a $0 copay for employees enrolled in either plan.

Here is a quick look at the two options:

  • An HMO health plan offers lower monthly rates, requires members to select a primary care physician and obtain referrals to see specialists, and does not provide out-of-network benefits except as allowed by the plan.
  • A PPO health plan offers higher monthly rates and more flexibility in choosing providers. Members may use out-of-network providers, but they will generally pay more when receiving care outside the plan’s network.

What is changing?

  • Health plan choices: Employees will have the option to choose an HMO or PPO plan.
  • Plan costs: The employee-only premium for the HMO plan will remain at $0. Employees who select the PPO plan will pay a monthly premium based on their coverage level.
  • Plan benefits: Deductibles, copays, and out-of-pocket maximums will change.
  • Pharmacy: Pharmacy copays and the covered drug list will change, which may affect the cost of some medications. The Human Services team will be available to help employees understand these changes.
  • HMO requirements: HMO members will need to select a primary care physician, and referrals may be required for specialist care. The HMO will not provide out-of-network benefits except as allowed by the plan.

District administrators and members of the Employee Benefits Committee met several times to review the plan’s financial condition and consider different benefit structures and costs.

Employee feedback played an important role in developing the final recommendation. Based on that feedback, the district preserved the PPO as an additional option, maintained the $0 employee-only premium for the HMO, and kept MDLIVE visits at no cost.

Board President Eladio Jaimez recognized the care that went into developing the recommendation.

“This decision followed a careful and thoughtful review by our Employee Benefits Committee, district administration, and Finance team,” Jaimez said. “We appreciate the employees who shared their perspectives throughout the process as we worked to develop a plan that supports our staff and remains sustainable for the district.”

The changes are intended to help keep the district’s health plan financially sustainable while continuing to provide employees and their families with access to health care coverage.

The work also represents one part of a broader district focus on health and wellness for students, employees, families, and the Harlingen community.

Superintendent Dr. Veronica Kortan said the district’s work will include a greater focus on creating healthier lifestyles and connecting current and future initiatives through the district’s Living Longer by Design work.

“This is the first step toward a very different way of how we are going to lean into our heart for people,” Dr. Kortan said. “We are on a mission to make sure that, collectively with our community partners inclusive of UTRGV and the Valley Baptist Legacy Foundation, we will do our part in creating healthier lifestyles for our students, our employees and our community.”

As that work continues, the Employee Benefits Committee and district administration will explore additional opportunities to support employee wellness, including possible health-related incentive programs and partnerships with community organizations.

The district is also looking at health and wellness more broadly through Living Longer by Design. The effort is intended to connect work supporting students, families, employees, and the community rather than treating each initiative separately. That work may include examining areas such as school nutrition and cafeteria menus, expanding wellness opportunities, strengthening community partnerships, and identifying additional ways to encourage healthier lifestyles.

Dr. Kortan said these efforts are part of a larger picture and should help employees and families understand how individual initiatives connect to the district’s overall commitment to health and wellness.

She also thanked the Employee Benefits Committee for representing employees and providing feedback throughout the process.

“I want to thank our Benefits Committee,” Dr. Kortan said. “I want to thank our chair, Dr. Muniz, because he’s spent quite a bit of time with us getting ready for today. Tonight, I want to thank our Board for leaning into that, making sure that we’re going to listen to our stakeholders and the voices of our stakeholders, and creating a comprehensive plan that we can propose today and have approved that’s going to meet the needs of our employees and the organization as a whole.”

Before Open Enrollment, employees will receive a detailed comparison of the HMO and PPO plans, including monthly rates and benefit changes. Information will be available in English and Spanish.

The district will also maintain a dedicated employee benefits webpage that will serve as a central location for information about the 2027 plans. Employees are encouraged to return to the webpage regularly as additional details, resources, meeting information, and plan materials are added.

Virtual Health Care Connections meetings will be held through Microsoft Teams from Sept. 28 through Oct. 2. These meetings will explain the changes and give employees an opportunity to ask questions.

Open Enrollment will run from Oct. 5 through Nov. 6. Employees are encouraged to carefully review the information, participate in the virtual meetings as needed, and understand the differences between the HMO and PPO plans before making their 2027 selection.

Additional information about the health plans, Living Longer by Design, employee wellness opportunities, and related district initiatives will be shared as the work continues.

 

Please note: Harley, our new AI Chat Bot will be happy to answer any questions you may have.

 

  1. What health plan options will be available for 2027?
  • Employees will be able to choose between an HMO, or Health Maintenance Organization, and a PPO, or Preferred Provider Organization. Coverage under the new plans begins January 1, 2027.

 

  1. Will HCISD still pay 100% of the employee-only premium?
  • Yes. HCISD will continue to pay 100% of the employee-only premium for the HMO plan. Employees who select the PPO plan will pay a monthly premium based on their coverage level.

 

  1. What is the difference between the HMO and PPO plans?
  • The HMO generally offers lower monthly costs and requires members to select a primary care physician. Referrals may be required for specialist care, and there are no out-of-network benefits except as allowed by the plan.
  • The PPO provides more flexibility in choosing providers and allows members to receive care outside the network, although out-of-network care will generally cost more.

 

  1. Will my deductible and copays change?
  • Yes. Deductibles, copays and out-of-pocket maximums will change for 2027. A detailed comparison of the current plan and the new HMO and PPO options will be available on this webpage before Open Enrollment.

 

  1. How do I know if my doctor is in the HMO or PPO network?
  • Employees should review the provider network information before selecting a plan. Provider search tools and additional instructions will be available on this webpage to help employees determine whether their current doctors participate in the plan they are considering.  For now, we will provide staff with a short list of in-network providers who accept the HMO plan.  This list may not be all inclusive.  A provider search link will be available before open enrollment.

 

  1. Will I need a referral to see a specialist under the HMO?
  • HMO members may be required to obtain a referral from their primary care physician before seeing certain specialists. Additional information about the referral process will be provided as plan details are finalized.

 

  1. Will my prescription drug coverage change?
  • Yes. Pharmacy copays will change; however, some covered medications may change for 2027.  Covered members whose medication may be disrupted will receive a letter from Blue Cross/Prime Therapeutics the week of October 15, 2026.  The drug list is the same coverage for both HMO and PPO plans.  Additional pharmacy resources will be posted on this webpage.

 

  1. Will MDLIVE still be available?
  • Yes. MDLIVE will continue to be available at a $0 copay for employees and their covered dependents enrolled in either the HMO or PPO plan.

 

  1. When is Open Enrollment?
  • Open Enrollment will run from October 5 through November 6. Employees are encouraged to review the plan information carefully before making their 2027 selection.

 

  1. Where can I get more information or ask questions?
  • This webpage will serve as the central source for 2027 employee health plan information. Additional resources and FAQs will be added as information becomes available and employee questions are received. Virtual Health Care Connections meetings will also be held through Microsoft Teams from September 28 through October 2, giving employees an opportunity to learn more and ask questions.  If you have an questions about your personal situation, please contact the Director for Employee Benefits, Rachel Cortez at 956-430-9553 or via email at raquel.cortez@hcisd.org? 


 

  1. Will the drug list and pharmacy copay and pharmacy deductible be the same for both HMO and PPO plans?
  • Yes, the approved 2027 drug list formulary, pharmacy copays and pharmacy deductible will be the same for both health plans.

 

  1. When will the 2027 drug list be available?

 

  1. What is the pharmacy appeals process, and will the appeal form be included in the disruption letter?   Are the pharmacy appeals filed electronically by the doctor?
  • Specific drug coverage consideration forms will not be included with the disruption letter. Providers may submit coverage consideration requests electronically, by phone at 1-800-289-1525, or by fax at 1-877-243-6930.

 

  1. When were the disruption letters mailed for those whose medications were not covered.
  • The disruption letters were mailed out on 10/12/2026.

 

 

  1. Will the labs I normally get now on the PPO plan be processed differently between an HMO and PPO plans?  In other words, will the same lab work cost more under an HMO than a PPO? Coverage will depend on the place of treatment.
  • In the office will follow the $35/$55 copay, outpatient will be covered at deductible/out of pocket maximum.

 

  1. I am switching to an HMO in January 2027, currently I am on a PPO, my child sees a specialist that was just approved under the PPO plan for 12 months.  Can my doctor begin the referral process now so my child can have a referral in place for January 1, 2027 when I am on the HMO plan?
  • The PCP under the HMO plan can’t request a referral until the plan is showing active on 1/1/27.

 

  1. If my current PCP cannot start the referral process today for January 2027 HMO coverage, when can my PCP start the referral process when I get on the HMO plan, so my child does not have disruption in treatment?
  • The HMO PCP can request the referral to specialist on 1/1/27.

 

 

 

  1. I have 3 specialty medications.  Will I have to pay the deductible 3 times?  I only cover myself on the health plan
  • The deductible is a cumulative amount that must be satisfied before the plan begins paying benefits according to the plan design. Members are responsible for their applicable cost share until the annual deductible has been met. Once the deductible is satisfied, the member is responsible only for the applicable copayment or coinsurance, up to the plan's annual out-of-pocket maximum.

 

  1. Will Xarelto be covered in the new drug list for 2027?
  • Xarelto is currently covered on the 2026 formulary as a preferred brand medication and is subject to quantity limits. Generic alternatives are also available. Xarelto is in the approved 2027 drug list.  Please review for quantity and dispensing limits.

 

 

  1. I am switching to the HMO plan in January 2027,   I cover my son who attending an out of state college, will he be able to select a doctor in his current state?  If not, what are my options to get him a PCP in his state on the HMO plan?
  • This would depend on if the state he is attending school accepts Guest Membership. Please call 855-346-2014 to verify if the state your dependent is going to school accepts Guest membership.

 

  1. I am switching to the HMO plan in January 2027, my daughter is attending college in Corpus Christi, Texas, will she need a PCP in Corpus Christi, or can she select a PCP in Harlingen where I live?
  • Please call 855-346-2014 to start an application and get a PCP assigned in Corpus Christi.

 

  1. How long will a referral to a specialist take to be approved or denied?
  • Referral from the PCP to an in-network SPC are generally approved/denied the same day requested.   Is this referral process done electronically by the doctor? Yes, all referral requests are done electronically.

 

  1. How will I be notified if the referral to a specialist is approved or denied?
  • Yes, both you and the provider will be notified. The provider will be notified via the referral portal, the member will be notified by mail.

 

  1. Can a nurse practitioner or physician’s assistant be my primary care doctor?
  • No, the PCP must be a Dr.

 

  1. If I am on the HMO plan in January 2027, I understand there are not any out of network benefits only in certain cases? Correct      Which are these cases and if it is an emergency (car accident, stomachache)?
  • Emergency services and all providers during the ER visit are covered. If you need to see a specialist after discharge a referral from you PCP would be required.

 

  1. I currently pay for family coverage, we are staying on the HMO plan I, the employee, see 3 specialists, can my PCP submit a referral to all 3 specialists in one PCP visit?
  • Yes.

 

  1. I’ve been seeing the same endocrinologist,  psychiatrist and hormone specialist   for 5 years under the current PPO plan.  If I switch to the HMO plan effective January 1, 2027 do I still need to get a referral to see my longstanding endocrinologist , psychiatrist, and hormone specialist?  
  • Yes, a referral would be required. You can call customer service to make sure the specialist you’re seeing are also contracted on the HMO blue plan.

 

  1. I see my endocrinologist every 3-6 months.  Would I need a referral every time I go?  A new one once a year? Or once I have a referral it is good forever?
  • Your PCP can request a referral for 1 year since you have 2 to 4 visits per year.

 

  1. In regard to the OBGYN.  Is a referral needed for the initial annual (preventative) visit, or would a new referral be needed every year?
  • No referral is needed to see a HMO Blue contracted Ob-Gyn. Women can self-refer to OB-GYN

 

 

  1. If I am on the HMO plan on January 2027 if I have an emergency, can I go to an urgent care or a night clinic?
  • I’ve attached a list of contracted HMO Urgent Care Centers.  You can view these on the find a provider link for the HMO essentials plan.

 

  1. I will be switching to the HMO plan in January 2027, currently my minor daughter, who I cover under the HCISD PPO plan, does not have visitation limits for Physical Therapy, Occupational Therapy and Speech. Does the HMO have limits for these services? Are the limits annually? Monthly?  How can I get unlimited visits for her?
  • There won’t be any physical therapy visit limitations under the HMO plan.

 

  1. Is an OB/GYN considered a specialist under this HMO plan, and would I need a referral from my primary care physician to see my OB/GYN for routine care? Also, would I need a referral for pregnancy-related visits or other OB/GYN services?
  • Women can self-refer to an Ob-Gyn no referral is required.

 

  1. How is routine and diagnostic blood work covered under this HMO plan? Do I have a copay, deductible, or coinsurance for lab work? Coverage will depend on the place of treatment for example outpatient in a hospital setting will have the deductible /out of pocket maximum applied to these services. Labs done in an office setting would be PCP/SPC copay. Routine labs covered at 100% of allowed. Also, are there specific in-network labs that I am required to use, and does blood work ordered by a specialist require prior authorization? The participating laboratories can be found in “find a doctor” previously provided.  You can type the word laboratories in the search box to see all participating laboratories based on the zip code and plan selected. If the ordering provider is a specialist and has a valid referral labs will be covered. 

 

  1. How is routine and diagnostic blood work covered under this HMO plan? Do I have a copay, deductible, or coinsurance for lab work? Also, are there specific in-network labs that I am required to use, and does blood work ordered by a specialist require prior authorization? 
  • Coverage will depend on the place of treatment for example outpatient in a hospital setting will have the deductible /out of pocket maximum applied to these services. Labs done in an office setting would be PCP/SPC copay. Routine labs covered at 100% of allowed.

 

  1. Can you give us a list of which doctor’s and facilities are not in the HMO network in our surrounding area (78550)?
  • The list of non-HMO Blue provider is too larger and can’t be downloaded. Please log into BCBSTX.com/provider and search for provider under that zip code. If there is a certain provider, you need please call the customer service number on the back of your ID card for assistance.  

 

  1. I see doctors in the VA (Veteran’s administration) here in Harlingen Texas.  They change doctor’s a lot at the VA.  How do I know if I can use the district’s HMO plan at the VA?  As per the Veteran’s administration in Harlingen, Texas, they do not accept the HMO plan. 
  • You will need to select an outside doctor (outside of the VA provider) as your primary doctor for the HMO essential plan. If want to continue to be treated at the VA and you have selected the HMO essentials plan, then you will be required to use VA fee structure for services.  The VA fee structure is based on the service connection percentage unique to all service members.  Please contact your VA benefits office to speak with benefit advisor for more information on the VA fee structure.  Their phone number is 956-291-9000.

 

  1. I cannot locate my PCP nor my specialist doctor in the HMO essentials link search- does this mean they do not accept HMO essentials?
  • If you’re unable to locate your Primary care and Specialist physicians under HMO Blue Essentials, the providers may not be contracted under out HMO Blue contract. You can call customer service and ask them to research the providers in question.

 

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Open Enrollment will run from October 5 through November 6. Employees are encouraged to carefully review the information, participate in the virtual meetings as needed, and understand the differences between the HMO and PPO plans before making their 2027 selection.

  • Is my doctor in the network?
  • Do I understand the difference between the HMO and PPO?
  • Am I comfortable selecting a primary care doctor  if I choose the HMO plan?
  • Do I understand how referrals work in the HMO plan?
  • Do I know what will my monthly premium be?
  • What are my deductible, copays and out-of-pocket maximum?

Virtual Health Care Connections meetings will be held through Microsoft Teams from September 28 through October 2. These meetings will explain the changes and give employees an opportunity to ask questions.

Afternoon Sessions
 September 28–October 2
 3:30–4:30 p.m. each day

Lunch Sessions
 September 30 and October 2
 11:30 a.m.–1:00 p.m.

These are general sessions. For specific questions regarding your personal plan contact:

Raquel Cortez
Director of Employee Benefits and Risk Management
raquel.cortez@hcisd.org
956-430-9553

Click here to join the session

 

 

Use this provider list  to help determine whether your current doctors, specialists, and other health care providers participate in the 2027 health plan networks.

Employees are encouraged to review this information carefully before making a plan selection during Open Enrollment. Provider participation may vary by plan, so please confirm that your preferred providers are included in the HMO or PPO network you are considering.

 

Find your Provider

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BCBS - Drug List 2027

  •  

    Board Approves New Employee Health Plan Options for 2027

    The Harlingen CISD Board of Trustees approved changes to the district’s employee health plan on September 16. Employees will be able to choose between an HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization) plan. Coverage begins January 1, 2027.

    Key Information

    • HMO employee-only premium: $0
    • PPO premium: Monthly cost based on coverage level
    • MDLIVE: $0 copay under either plan
    • Virtual information meetings: September 28-October 2
    • Open Enrollment: October 5-November 6
    • New coverage begins: January 1, 2027

    Compare the Two Plan Options

    HCISD_2027_Health_Plan_Rates(1)

     

    HCISD_2027_Health_Plan_Benefit_Comparison(1)

     

     

    HMO (Health Maintenance Organization) Plan

    • Offers lower monthly rates
    • Requires members to select a primary care physician
    • May require referrals for specialist care
    • Does not provide out-of-network benefits except as allowed by the plan
    • Employee-only premium remains at $0

    PPO (Preferred Provider Organization) Plan

    • Offers greater flexibility in choosing providers
    • Allows members to use out-of-network providers
    • Generally costs more when care is received outside the network
    • Requires a monthly premium based on the employee’s coverage level

    What Is Changing?

    Health Plan Choices

    Employees will be able to choose between an HMO and a PPO plan.

    Plan Costs

    The employee-only premium for the HMO plan will remain at $0. Employees who select the PPO plan will pay a monthly premium based on their coverage level.

    Plan Benefits

    Deductibles, copays and out-of-pocket maximums will change. A detailed comparison will be provided before Open Enrollment.

    Pharmacy Benefits

    Pharmacy copays and the covered drug list will change, which may affect the cost of some medications. The Human Services team will be available to help employees understand these changes.

    HMO Requirements

    Employees enrolled in the HMO will need to select a primary care physician. Referrals may be required for specialist care, and out-of-network benefits will not be available except as allowed by the plan.

    How the Plan Was Developed

    District administrators and members of the Employee Benefits Committee met several times to review the plan’s financial condition and consider different benefit structures and costs.

    Employee feedback played an important role in developing the final recommendation. Based on that feedback, the district:

    • Preserved the PPO as an additional option
    • Maintained the $0 employee-only premium for the HMO
    • Kept MDLIVE visits available at no cost

    The approved changes are intended to help keep the district’s health plan financially sustainable while continuing to provide employees and their families with access to health care coverage.

    Supporting Employee and Community Wellness

    The health plan changes are one part of the district’s broader commitment to health and wellness through Living Longer by Design.

    The district is working to connect current and future initiatives that support students, employees, families and the Harlingen community. This work may include:

    • Exploring employee wellness incentives
    • Expanding health and wellness opportunities
    • Reviewing school nutrition and cafeteria menus
    • Strengthening partnerships with community organizations
    • Identifying additional ways to encourage healthier lifestyles

    Important Dates

    Date What Employees Need to Know
    Sept. 28-Oct. 2 Virtual Health Care Connections meetings through Microsoft Teams
    Oct. 5-Nov. 6 Open Enrollment
    Jan. 1, 2027 New health plan coverage begins

    What Happens Next?

    Before Open Enrollment, employees will receive a detailed comparison of the HMO and PPO plans, including:

    • Monthly premium rates
    • Deductibles and copays
    • Out-of-pocket maximums
    • Pharmacy benefit changes
    • Provider and referral requirements

    Information will be available in English and Spanish.

    Employees are encouraged to attend a virtual Health Care Connections meeting, carefully review the plan materials and understand the differences between the HMO and PPO plans before making their 2027 selection.

    Stay Informed

    This webpage will serve as the central location for information about the 2027 health plans. Employees should return regularly as additional resources, meeting information, plan documents and frequently asked questions are added.

  • Board Approves New Employee Health Plan Options for 2027

    The Harlingen CISD Board of Trustees approved changes to the district’s employee health plan on Sept. 16. Employees will be able to choose between an HMO and a PPO plan. Coverage begins January 1, 2027.

    HCISD will continue to pay 100% of the employee-only premium for the HMO plan. Employees who choose the PPO plan will pay a monthly premium based on their coverage level.

    MDLIVE will remain available at a $0 copay for employees enrolled in either plan.

    Here is a quick look at the two options:

    • An HMO health plan offers lower monthly rates, requires members to select a primary care physician and obtain referrals to see specialists, and does not provide out-of-network benefits except as allowed by the plan.
    • A PPO health plan offers higher monthly rates and more flexibility in choosing providers. Members may use out-of-network providers, but they will generally pay more when receiving care outside the plan’s network.

    What is changing?

    • Health plan choices: Employees will have the option to choose an HMO or PPO plan.
    • Plan costs: The employee-only premium for the HMO plan will remain at $0. Employees who select the PPO plan will pay a monthly premium based on their coverage level.
    • Plan benefits: Deductibles, copays, and out-of-pocket maximums will change.
    • Pharmacy: Pharmacy copays and the covered drug list will change, which may affect the cost of some medications. The Human Services team will be available to help employees understand these changes.
    • HMO requirements: HMO members will need to select a primary care physician, and referrals may be required for specialist care. The HMO will not provide out-of-network benefits except as allowed by the plan.

    District administrators and members of the Employee Benefits Committee met several times to review the plan’s financial condition and consider different benefit structures and costs.

    Employee feedback played an important role in developing the final recommendation. Based on that feedback, the district preserved the PPO as an additional option, maintained the $0 employee-only premium for the HMO, and kept MDLIVE visits at no cost.

    Board President Eladio Jaimez recognized the care that went into developing the recommendation.

    “This decision followed a careful and thoughtful review by our Employee Benefits Committee, district administration, and Finance team,” Jaimez said. “We appreciate the employees who shared their perspectives throughout the process as we worked to develop a plan that supports our staff and remains sustainable for the district.”

    The changes are intended to help keep the district’s health plan financially sustainable while continuing to provide employees and their families with access to health care coverage.

    The work also represents one part of a broader district focus on health and wellness for students, employees, families, and the Harlingen community.

    Superintendent Dr. Veronica Kortan said the district’s work will include a greater focus on creating healthier lifestyles and connecting current and future initiatives through the district’s Living Longer by Design work.

    “This is the first step toward a very different way of how we are going to lean into our heart for people,” Dr. Kortan said. “We are on a mission to make sure that, collectively with our community partners inclusive of UTRGV and the Valley Baptist Legacy Foundation, we will do our part in creating healthier lifestyles for our students, our employees and our community.”

    As that work continues, the Employee Benefits Committee and district administration will explore additional opportunities to support employee wellness, including possible health-related incentive programs and partnerships with community organizations.

    The district is also looking at health and wellness more broadly through Living Longer by Design. The effort is intended to connect work supporting students, families, employees, and the community rather than treating each initiative separately. That work may include examining areas such as school nutrition and cafeteria menus, expanding wellness opportunities, strengthening community partnerships, and identifying additional ways to encourage healthier lifestyles.

    Dr. Kortan said these efforts are part of a larger picture and should help employees and families understand how individual initiatives connect to the district’s overall commitment to health and wellness.

    She also thanked the Employee Benefits Committee for representing employees and providing feedback throughout the process.

    “I want to thank our Benefits Committee,” Dr. Kortan said. “I want to thank our chair, Dr. Muniz, because he’s spent quite a bit of time with us getting ready for today. Tonight, I want to thank our Board for leaning into that, making sure that we’re going to listen to our stakeholders and the voices of our stakeholders, and creating a comprehensive plan that we can propose today and have approved that’s going to meet the needs of our employees and the organization as a whole.”

    Before Open Enrollment, employees will receive a detailed comparison of the HMO and PPO plans, including monthly rates and benefit changes. Information will be available in English and Spanish.

    The district will also maintain a dedicated employee benefits webpage that will serve as a central location for information about the 2027 plans. Employees are encouraged to return to the webpage regularly as additional details, resources, meeting information, and plan materials are added.

    Virtual Health Care Connections meetings will be held through Microsoft Teams from Sept. 28 through Oct. 2. These meetings will explain the changes and give employees an opportunity to ask questions.

    Open Enrollment will run from Oct. 5 through Nov. 6. Employees are encouraged to carefully review the information, participate in the virtual meetings as needed, and understand the differences between the HMO and PPO plans before making their 2027 selection.

    Additional information about the health plans, Living Longer by Design, employee wellness opportunities, and related district initiatives will be shared as the work continues.

     

  • Please note: Harley, our new AI Chat Bot will be happy to answer any questions you may have.

     

    1. What health plan options will be available for 2027?
    • Employees will be able to choose between an HMO, or Health Maintenance Organization, and a PPO, or Preferred Provider Organization. Coverage under the new plans begins January 1, 2027.

     

    1. Will HCISD still pay 100% of the employee-only premium?
    • Yes. HCISD will continue to pay 100% of the employee-only premium for the HMO plan. Employees who select the PPO plan will pay a monthly premium based on their coverage level.

     

    1. What is the difference between the HMO and PPO plans?
    • The HMO generally offers lower monthly costs and requires members to select a primary care physician. Referrals may be required for specialist care, and there are no out-of-network benefits except as allowed by the plan.
    • The PPO provides more flexibility in choosing providers and allows members to receive care outside the network, although out-of-network care will generally cost more.

     

    1. Will my deductible and copays change?
    • Yes. Deductibles, copays and out-of-pocket maximums will change for 2027. A detailed comparison of the current plan and the new HMO and PPO options will be available on this webpage before Open Enrollment.

     

    1. How do I know if my doctor is in the HMO or PPO network?
    • Employees should review the provider network information before selecting a plan. Provider search tools and additional instructions will be available on this webpage to help employees determine whether their current doctors participate in the plan they are considering.  For now, we will provide staff with a short list of in-network providers who accept the HMO plan.  This list may not be all inclusive.  A provider search link will be available before open enrollment.

     

    1. Will I need a referral to see a specialist under the HMO?
    • HMO members may be required to obtain a referral from their primary care physician before seeing certain specialists. Additional information about the referral process will be provided as plan details are finalized.

     

    1. Will my prescription drug coverage change?
    • Yes. Pharmacy copays will change; however, some covered medications may change for 2027.  Covered members whose medication may be disrupted will receive a letter from Blue Cross/Prime Therapeutics the week of October 15, 2026.  The drug list is the same coverage for both HMO and PPO plans.  Additional pharmacy resources will be posted on this webpage.

     

    1. Will MDLIVE still be available?
    • Yes. MDLIVE will continue to be available at a $0 copay for employees and their covered dependents enrolled in either the HMO or PPO plan.

     

    1. When is Open Enrollment?
    • Open Enrollment will run from October 5 through November 6. Employees are encouraged to review the plan information carefully before making their 2027 selection.

     

    1. Where can I get more information or ask questions?
    • This webpage will serve as the central source for 2027 employee health plan information. Additional resources and FAQs will be added as information becomes available and employee questions are received. Virtual Health Care Connections meetings will also be held through Microsoft Teams from September 28 through October 2, giving employees an opportunity to learn more and ask questions.  If you have an questions about your personal situation, please contact the Director for Employee Benefits, Rachel Cortez at 956-430-9553 or via email at raquel.cortez@hcisd.org? 


     

    1. Will the drug list and pharmacy copay and pharmacy deductible be the same for both HMO and PPO plans?
    • Yes, the approved 2027 drug list formulary, pharmacy copays and pharmacy deductible will be the same for both health plans.

     

    1. When will the 2027 drug list be available?

     

    1. What is the pharmacy appeals process, and will the appeal form be included in the disruption letter?   Are the pharmacy appeals filed electronically by the doctor?
    • Specific drug coverage consideration forms will not be included with the disruption letter. Providers may submit coverage consideration requests electronically, by phone at 1-800-289-1525, or by fax at 1-877-243-6930.

     

    1. When were the disruption letters mailed for those whose medications were not covered.
    • The disruption letters were mailed out on 10/12/2026.

     

     

    1. Will the labs I normally get now on the PPO plan be processed differently between an HMO and PPO plans?  In other words, will the same lab work cost more under an HMO than a PPO? Coverage will depend on the place of treatment.
    • In the office will follow the $35/$55 copay, outpatient will be covered at deductible/out of pocket maximum.

     

    1. I am switching to an HMO in January 2027, currently I am on a PPO, my child sees a specialist that was just approved under the PPO plan for 12 months.  Can my doctor begin the referral process now so my child can have a referral in place for January 1, 2027 when I am on the HMO plan?
    • The PCP under the HMO plan can’t request a referral until the plan is showing active on 1/1/27.

     

    1. If my current PCP cannot start the referral process today for January 2027 HMO coverage, when can my PCP start the referral process when I get on the HMO plan, so my child does not have disruption in treatment?
    • The HMO PCP can request the referral to specialist on 1/1/27.

     

     

     

    1. I have 3 specialty medications.  Will I have to pay the deductible 3 times?  I only cover myself on the health plan
    • The deductible is a cumulative amount that must be satisfied before the plan begins paying benefits according to the plan design. Members are responsible for their applicable cost share until the annual deductible has been met. Once the deductible is satisfied, the member is responsible only for the applicable copayment or coinsurance, up to the plan's annual out-of-pocket maximum.

     

    1. Will Xarelto be covered in the new drug list for 2027?
    • Xarelto is currently covered on the 2026 formulary as a preferred brand medication and is subject to quantity limits. Generic alternatives are also available. Xarelto is in the approved 2027 drug list.  Please review for quantity and dispensing limits.

     

     

    1. I am switching to the HMO plan in January 2027,   I cover my son who attending an out of state college, will he be able to select a doctor in his current state?  If not, what are my options to get him a PCP in his state on the HMO plan?
    • This would depend on if the state he is attending school accepts Guest Membership. Please call 855-346-2014 to verify if the state your dependent is going to school accepts Guest membership.

     

    1. I am switching to the HMO plan in January 2027, my daughter is attending college in Corpus Christi, Texas, will she need a PCP in Corpus Christi, or can she select a PCP in Harlingen where I live?
    • Please call 855-346-2014 to start an application and get a PCP assigned in Corpus Christi.

     

    1. How long will a referral to a specialist take to be approved or denied?
    • Referral from the PCP to an in-network SPC are generally approved/denied the same day requested.   Is this referral process done electronically by the doctor? Yes, all referral requests are done electronically.

     

    1. How will I be notified if the referral to a specialist is approved or denied?
    • Yes, both you and the provider will be notified. The provider will be notified via the referral portal, the member will be notified by mail.

     

    1. Can a nurse practitioner or physician’s assistant be my primary care doctor?
    • No, the PCP must be a Dr.

     

    1. If I am on the HMO plan in January 2027, I understand there are not any out of network benefits only in certain cases? Correct      Which are these cases and if it is an emergency (car accident, stomachache)?
    • Emergency services and all providers during the ER visit are covered. If you need to see a specialist after discharge a referral from you PCP would be required.

     

    1. I currently pay for family coverage, we are staying on the HMO plan I, the employee, see 3 specialists, can my PCP submit a referral to all 3 specialists in one PCP visit?
    • Yes.

     

    1. I’ve been seeing the same endocrinologist,  psychiatrist and hormone specialist   for 5 years under the current PPO plan.  If I switch to the HMO plan effective January 1, 2027 do I still need to get a referral to see my longstanding endocrinologist , psychiatrist, and hormone specialist?  
    • Yes, a referral would be required. You can call customer service to make sure the specialist you’re seeing are also contracted on the HMO blue plan.

     

    1. I see my endocrinologist every 3-6 months.  Would I need a referral every time I go?  A new one once a year? Or once I have a referral it is good forever?
    • Your PCP can request a referral for 1 year since you have 2 to 4 visits per year.

     

    1. In regard to the OBGYN.  Is a referral needed for the initial annual (preventative) visit, or would a new referral be needed every year?
    • No referral is needed to see a HMO Blue contracted Ob-Gyn. Women can self-refer to OB-GYN

     

     

    1. If I am on the HMO plan on January 2027 if I have an emergency, can I go to an urgent care or a night clinic?
    • I’ve attached a list of contracted HMO Urgent Care Centers.  You can view these on the find a provider link for the HMO essentials plan.

     

    1. I will be switching to the HMO plan in January 2027, currently my minor daughter, who I cover under the HCISD PPO plan, does not have visitation limits for Physical Therapy, Occupational Therapy and Speech. Does the HMO have limits for these services? Are the limits annually? Monthly?  How can I get unlimited visits for her?
    • There won’t be any physical therapy visit limitations under the HMO plan.

     

    1. Is an OB/GYN considered a specialist under this HMO plan, and would I need a referral from my primary care physician to see my OB/GYN for routine care? Also, would I need a referral for pregnancy-related visits or other OB/GYN services?
    • Women can self-refer to an Ob-Gyn no referral is required.

     

    1. How is routine and diagnostic blood work covered under this HMO plan? Do I have a copay, deductible, or coinsurance for lab work? Coverage will depend on the place of treatment for example outpatient in a hospital setting will have the deductible /out of pocket maximum applied to these services. Labs done in an office setting would be PCP/SPC copay. Routine labs covered at 100% of allowed. Also, are there specific in-network labs that I am required to use, and does blood work ordered by a specialist require prior authorization? The participating laboratories can be found in “find a doctor” previously provided.  You can type the word laboratories in the search box to see all participating laboratories based on the zip code and plan selected. If the ordering provider is a specialist and has a valid referral labs will be covered. 

     

    1. How is routine and diagnostic blood work covered under this HMO plan? Do I have a copay, deductible, or coinsurance for lab work? Also, are there specific in-network labs that I am required to use, and does blood work ordered by a specialist require prior authorization? 
    • Coverage will depend on the place of treatment for example outpatient in a hospital setting will have the deductible /out of pocket maximum applied to these services. Labs done in an office setting would be PCP/SPC copay. Routine labs covered at 100% of allowed.

     

    1. Can you give us a list of which doctor’s and facilities are not in the HMO network in our surrounding area (78550)?
    • The list of non-HMO Blue provider is too larger and can’t be downloaded. Please log into BCBSTX.com/provider and search for provider under that zip code. If there is a certain provider, you need please call the customer service number on the back of your ID card for assistance.  

     

    1. I see doctors in the VA (Veteran’s administration) here in Harlingen Texas.  They change doctor’s a lot at the VA.  How do I know if I can use the district’s HMO plan at the VA?  As per the Veteran’s administration in Harlingen, Texas, they do not accept the HMO plan. 
    • You will need to select an outside doctor (outside of the VA provider) as your primary doctor for the HMO essential plan. If want to continue to be treated at the VA and you have selected the HMO essentials plan, then you will be required to use VA fee structure for services.  The VA fee structure is based on the service connection percentage unique to all service members.  Please contact your VA benefits office to speak with benefit advisor for more information on the VA fee structure.  Their phone number is 956-291-9000.

     

    1. I cannot locate my PCP nor my specialist doctor in the HMO essentials link search- does this mean they do not accept HMO essentials?
    • If you’re unable to locate your Primary care and Specialist physicians under HMO Blue Essentials, the providers may not be contracted under out HMO Blue contract. You can call customer service and ask them to research the providers in question.

     

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  • Open Enrollment will run from October 5 through November 6. Employees are encouraged to carefully review the information, participate in the virtual meetings as needed, and understand the differences between the HMO and PPO plans before making their 2027 selection.

    • Is my doctor in the network?
    • Do I understand the difference between the HMO and PPO?
    • Am I comfortable selecting a primary care doctor  if I choose the HMO plan?
    • Do I understand how referrals work in the HMO plan?
    • Do I know what will my monthly premium be?
    • What are my deductible, copays and out-of-pocket maximum?

  • Virtual Health Care Connections meetings will be held through Microsoft Teams from September 28 through October 2. These meetings will explain the changes and give employees an opportunity to ask questions.

    Afternoon Sessions
     September 28–October 2
     3:30–4:30 p.m. each day

    Lunch Sessions
     September 30 and October 2
     11:30 a.m.–1:00 p.m.

    These are general sessions. For specific questions regarding your personal plan contact:

    Raquel Cortez
    Director of Employee Benefits and Risk Management
    raquel.cortez@hcisd.org
    956-430-9553

    Click here to join the session

     

     

  • Use this provider list  to help determine whether your current doctors, specialists, and other health care providers participate in the 2027 health plan networks.

    Employees are encouraged to review this information carefully before making a plan selection during Open Enrollment. Provider participation may vary by plan, so please confirm that your preferred providers are included in the HMO or PPO network you are considering.

     

    Find your Provider

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