OVERVIEW
Each health benefit EPBP or PPBP must include a delivery network that is adequate and
complies with Insurance Code ยง1301. All covered services that are offered by an EPBP or
PPBP must be sufficient in number and location to be readily available and accessible within
the service area to all enrollees.
When contracted providers are not available within the TDI mileage access and/or availability
standards outlined in Title 28 Texas Administrative Code Section 3.3704, Aetna Premier Care
Network provides for in-network benefit coverage and has procedures that the EPBP/PPBP
will use to assist enrollees in obtaining medically necessary services when no network
physician or provider is available, including procedures to coordinate care.
See detailed worksheets for access information by county and by specialty.
PREMCAREAUS20
#Proprietary
Medical
County
(whole or part)
Provider type Reason Network Providers Not Available Access Plan
Hays
Acute Care Hospitals
4. Are unable to reach an agreement with the EPBP/PPBP; See Attempted to
Contract List
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Falls
Rehabilitation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
McLennan
Rehabilitation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Limestone
Rehabilitation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Falls
Vision Centers 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Vision care services can also be provided by PCPs, Optometrists and Ophthalmologists
McLennan
Vision Centers 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Vision care services can also be provided by PCPs, Optometrists and Ophthalmologists
Limestone
Vision Centers 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Vision care services can also be provided by PCPs, Optometrists and Ophthalmologists
Bastrop Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Bell Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Burnet Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Caldwell Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Coryell Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
PREMCAREAUS20
#Proprietary
Medical
County
(whole or part)
Provider type Reason Network Providers Not Available Access Plan
Falls Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Fayette Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Hays Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Lampasas Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Lee Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Limestone Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
McLennan Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Travis Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Williamson Therapeutic Oncologic Radiation Facilities 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Therapeutic Oncologic Radiation services are also available on outpatient basis at Acute
Hospitals.
Bell
Obstetrics & Gynecology 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Falls
Plastic Surgery 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
McLennan
Plastic Surgery 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
PREMCAREAUS20
#Proprietary
Medical
County
(whole or part)
Provider type Reason Network Providers Not Available Access Plan
Limestone
Plastic Surgery 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
Falls
Vascular Surgery 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
General Surgeyr and Cardiovascular Thoracic Surgery may also perform certain vascular
surgery procedures.
McLennan
Vascular Surgery 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
General Surgeyr and Cardiovascular Thoracic Surgery may also perform certain vascular
surgery procedures.
Limestone
Vascular Surgery 1. Are not available to contract
Services rendered by non-participating providers, within TDI mileage requirements, will
be covered at the in-network benefit level as specified in the Texas Administrative Code.
General Surgeyr and Cardiovascular Thoracic Surgery may also perform certain vascular
surgery procedures.
PREMCAREAUS20
#Proprietary
Behavioral Health
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
PREMCAREAUS20
#Proprietary
Behavioral Health
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
Any non-participating provider within TDI mileage requirements will be paid at the in-
network benefit level as specified in the Texas Administrative Code.
PREMCAREAUS20
#Proprietary
Hospital Based Providers
Name of Hospital Address City County
Anesthesia
Emergency Medicine
Neonatologist
Pathologist
Radiologist
General Plan for Access Reason Network Providers are Not Available
AdventHealth Rollins Brook 608 North Key Avenue Lampasas LAMPASAS X X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Arise Austin Medical Center 3003 Bee Cave Road Austin TRAVIS X X X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Ascension Providence 6901 Medical Pkwy. Waco MCLENNAN X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Baylor Scott & White Medical Center -
Hillcrest
100 Hillcrest Medical
Blvd. Waco MCLENNAN
N/A
N/A
Baylor Scott & White Medical Center -
Marble Falls 810 West Hwy. 71 Marble Falls BURNET X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Baylor Scott & White Medical Center -
Pflugerville
2600 East Pflugerville
Pkwy. Pflugerville TRAVIS X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Baylor Scott & White Medical Center -
Round Rock 300 University Blvd. Round Rock WILLIAMSON
N/A N/A
Baylor Scott & White Medical Center -
Temple 2401 South 31st Street Temple BELL
N/A N/A
Baylor Scott & White Medical Center-
Taylor 305 Mallard Lane Taylor WILLIAMSON
N/A N/A
Cornerstone Specialty Hospital 4207 Burnet Road Austin TRAVIS X X X X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Dell Children's Medical Center of Central
Texas 4900 Mueller Blvd. Austin TRAVIS X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Falls Community Hospital and Clinic 322 Coleman Street Marlin FALLS X X X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Heart Hospital of Austin
3801 North Lamar
Blvd. Austin TRAVIS X X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Limestone Medical Center 701 McClintic Drive Groesbeck LIMESTONE X X X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
McClane Children's Hospital Scott &
White
1901 Southwest H.K.
Dodgen Loop Temple BELL X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
North Austin Medical Center - HCA
Affiliate
12221 North MoPac
Expressway Austin TRAVIS X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Northwest Hills Surgical Hospital
6818 Austin Center
Blvd. Austin TRAVIS X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
Round Rock Medical Center - HCA Affiliate
2400 Round Rock
Avenue Round Rock WILLIAMSON X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
St. David's Georgetown Hospital - HCA
Affiliate 2000 Scenic Drive Georgetown WILLIAMSON X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
St. David's Medical Center 919 East 32nd Street Austin TRAVIS X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
St. David's South Austin Medical Center
901 West Ben White
Blvd. Austin TRAVIS X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
St. Mark's Medical Center 1 St. Mark's Place La Grange FAYETTE X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
PREMCAREAUS20
#
Proprietary
Hospital Based Providers
Name of Hospital Address City County
Anesthesia
Emergency Medicine
Neonatologist
Pathologist
Radiologist
General Plan for Access Reason Network Providers are Not Available
The Hospital at Westlake Medical Center 5656 Bee Caves Road Austin TRAVIS X X
The hospital-based provider will be paid at the in-network benefit level as
specified in the Texas Administrative Code.
5. Currently actively attempting to contract: See Attempted to Contract List
PREMCAREAUS20
#
Proprietary