You can review your covered services at any time through your Summary of Benefits & Coverage (SBC) and your plan documents on the Employee Self-Service (ESS) Portal.

Where to check coverage:

• ESS Portal: https://mybenefits.county.org
• BCBSTX Member Portal / Mobile App (benefits, claims, digital ID card)
• BCBSTX Customer Service: 855-357-5228

Medical Coverage:

• BCBSTX Customer Service: 855-357-5228
• BCBSTX App or bcbstx.com

Pharmacy Coverage:

• Navitus Customer Care: 866-333-2757
• Navitus App or navitus.com

General Benefits Information:
ESS Portal: https://mybenefits.county.org  

Your cost depends on network status, deductible, and service type.

Tools to estimate costs:

• BCBSTX Cost Estimator (BCBSTX App or bcbstx.com)
• Navitus prescription pricing tool (Navitus App or navitus.com)

Key 2026 plan amounts:

• Deductible: $1,500 individual / $3,000 family
• Out-of-Pocket Max: $5,500 individual / $11,000 family

Use the BCBSTX provider search tool online or in the mobile app. You can search by doctor, specialty, city, ZIP, or facility. You may also call BCBSTX Customer Service: 855-357-5228.

Navitus manages Victoria County’s prescription benefits.

Search for participating pharmacies using the Navitus Member Portal or app. Major retail chains and many local pharmacies participate. You may also call Navitus Customer Care: 866-333-2757.

Use the Navitus price comparison tool to check pricing across pharmacies.

Ways to save:

• Choose generics
• Compare local pharmacies

You can check if your prescription is covered by reviewing the formulary (drug list) for your plan.

What is the formulary?
• Whether the drug is generic or brand name
• What tier it falls under (cost level)
• If there are any coverage requirements or limits (like prior authorization or step therapy)

How to check the formulary:
• Log into the ESS Portal → access the Navitus Member Portal
• Use the Navitus app or website
• Call Navitus Customer Care: 866-333-2757
• Downloadable PDF available on county.org

You can also use the Navitus portal to:
• Compare drug prices
• Find lower-cost alternatives
• Locate in-network pharmacies

Some medications have additional requirements to ensure they are safe, effective, and cost-efficient:
Prior Authorization (PA)
• Your provider must get approval before the drug is covered
• This confirms the medication is medically necessary and appropriate
Step Therapy (ST)
• You may need to try a lower-cost or proven alternative first
• If that option does not work, your provider can request approval for the original medication
Quantity Limits (QL)
• There is a limit on how much medication you can receive within a certain time period
• These limits follow FDA guidelines for safety

Certain medications—called specialty drugs—are used to treat complex or chronic conditions and require additional support. These medications must be filled through the plan’s specialty pharmacy, Lumicera Health Services.
Key things to know:
• Specialty medications are typically high-cost or require special handling, monitoring, or administration
• These prescriptions are usually limited to a 30-day supply
• Lumicera works closely with your provider to coordinate your medication and care
What support does Lumicera provide?
• Personalized guidance on how to take your medication
• Refill reminders and ongoing support
• Coordination with your doctor for treatment management
How to get started or get help:
• Lumicera will typically reach out to you directly once a specialty medication is prescribed
• You can also contact them for assistance with medication questions, refills, or delivery coordination
Specialty Pharmacy Contact Information:
• Lumicera Health Services
• Phone: 855-847-3553

Your doctor can verify your eligibility using your BCBSTX ID card (particularly your UID number). Providers typically confirm coverage through their BCBSTX provider portal or by calling customer service.

Some services require prior authorization to confirm medical necessity.
Key points:
• In-network providers usually request authorization for you.
• Always confirm the request was submitted and approved.
• Without prior authorization, coverage may be reduced or denied.

Telehealth lets you speak with a licensed doctor by video or phone for non-emergency medical needs such as allergies, sinus infections, nausea, asthma, cold/flu symptoms, and more. Telehealth is provided through MDLIVE.

• 24 hours a day, 7 days a week
• Visit MDLIVE.com or call 888-676-4204
• Victoria County employees have a $0 copay.

Victoria County created a dedicated benefit to support employees using Citizens Convenient Care Walk-In Clinics. Covered members can utilize these clinics for a $40 co pay per primary care provider office visits. The co pay does NOT apply to Citizens Specialty Offices and some other services received during office visit/consultation may be excluded. If you believe you were billed incorrectly, contact: BCBSTX Customer Service: 855-357-5228

Use the ESS Portal at: mybenefits.county.org
From there you can access:
• Medical and pharmacy benefits
• Benefit booklets and resource guides
• BCBSTX, Navitus, and Healthy County links