BlueCross BlueShield of Texas
Silver Health Plans 2022
BCBSTX Silver plans offer a higher level of coverage than Bronze plans, and those who purchase on-exchange may also be eligible for cost-sharing reductions based on income, lowering deductibles and co-pays. Silver plans are ideal for people who have regular medications or utilize specialist or doctors visits more often than their included yearly check-up. Silver plans are a good “middle of the road” option for people who might need to utilize their healthcare options more but may not be able to afford higher premium payments.
Recommended Plan
The Best Silver Plan
This HSA Eligible plan has a lower deductible and OOP max, meaning you can save for the expenses you do incur and still have a higher level of protection in the event of unexpected health costs. The Blue Advantage Plus plans also offer some out of network benefits even though this is still technically an HMO, so if your doctor isn’t in any individual plan network for 2019, this is likely your best option.
| Plan Name |
MyBlue Health Silver 405 |
Blue Advantage Silver HMO 306 | Blue Advantage Plus Silver HMO 306 |
Blue Advantage Silver HMO 601 |
| Summary of Benefits | View Full Details | View Full Details | View Full Details | View Full Details |
| Deductible a specified amount of money that the insured must pay before an insurance company will pay a claim. | $3,550 | $2,000 | $2,000 | $3,000 |
| Out-of-Pocket Maximum An out-of-pocket maximum is the most you’ll have to pay during a policy period (usually a year) for health care services (includes deductible) | $8,700 | $8,700 | $8,700 | $8,700 |
| Primary Care Office Visit | $0 | $25 | $25 | $50 |
| Specialist Office Visit | 40% | 50% | 50% | $90 |
| Mental Illness Treatment and Substance Abuse Rehab Office Visit | 30% | 50% | 50% | $50/office visits |
| Emergency Room | $950 + 40% coinsurance | $950 + 50% coinsurance | $950 + 50% coinsurance | $650 + 50% coinsurance |
| Urgent Care | $50 (Deductible does not apply) | $50 | $50 (Deductible does not apply) | $60 |
| Inpatient Hospital Service | $850 per occurrence copay, then 40% | $850 per occurrence copay, then 50% | $850/visit plus 50% | $350/visit plus 30% |
| Outpatient Surgery | $600 per occurrence copay, then 30% | $600 per occurrence copay, then 40% | $600 per occurrence copay, then 40% | $300/visit plus 30% |
| Outpatient X-Rays and Diagnostic Imaging | Freestanding Facility: 30% coinsurance Hospital (including bloodwork):40% coinsurance In Office: Certain X-Rays, Ultrasounds, and ECGs ordered by Select PCP): No Charge; deductible does not apply |
Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
40% | 30% |
| Outpatient Imaging (CT/PET Scans/MRIs) | Freestanding Facility:30% coinsurance Hospital:40% coinsurance |
Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
50% | $250/test plus 30% coinsurance |
| Network | Blue Advantage HMO | |||
| HSA Eligible | No | No | No | No |
| Outpatient Prescription Drugs – Preferred Pharmacy | $5/$15/30%/35%/45%/50% | $5/$15/$75/35%/45%/50% | $5/$15/$75/40%/45%/50% | $0/$10/$50/$100/$150/$250 |
| Outpatient Prescription Drugs – Non-Preferred Pharmacy | $10/$25/$35%/40%/45%/50% | $15/$25/$85/40%/45%/50% | $15/$25/$85/40%/45%/50% | $10/$20/$70/$120/$150/$250 |
| Prescription Drug Utilization Benefit Management Programs | Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSTX and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit. | ||
| Plan Name | Blue Advantage Plus Silver HMO 202 | Blue Advantage Silver HMO 205 | Blue Advantage Plus Silver HMO 605 |
| Summary of Benefits | View Full Details | View Full Details | View Full Details |
| Deductible a specified amount of money that the insured must pay before an insurance company will pay a claim. | $1,250 | $2,050 | $0 |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you’ll have to pay during a policy period (usually a year) for health care services (includes deductible) | $8,700 | $8,700 | $8,700 |
| Primary Care Office Visit | $15 | $15 | $80 |
| Specialist Office Visit | 50% | 50% | $100 |
| Mental Illness Treatment and Substance Abuse Rehab Office Visit | 50% coinsurance for office visits; 30% coinsurance for other outpatient services | 50% coinsurance for office visits; 40% coinsurance for other outpatient services |
$80/office visits; 40% coinsurance for other outpatient services |
| Emergency Room | $950 + 50% coinsurance | $950 + 50% coinsurance | $950 + 50% coinsurance |
| Urgent Care | $15 (Deductible does not apply) | $15/visit | $60 (Deductible does not apply) |
| Inpatient Hospital Service | $850 per occurrence copay, then 50% | $850 per occurrence copay, then 50% | $850 per occurrence copay, then 50% |
| Outpatient Surgery | Freestanding Facility: $600/visit plus 30% coinsurance Hospital: $600/visit plus 50% coinsurance |
Freestanding Facility: $600/visit plus 40% coinsurance Hospital: $600/visit plus 50% coinsurance |
Freestanding Facility:40% coinsurance Hospital: 50% coinsurance |
| Outpatient X-Rays and Diagnostic Imaging | Freestanding Facility: 30% coinsurance Hospital: 50% coinsurance |
Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
Freestanding Facility: $50/test plus 40% coinsurance; X-Rays: 40% coinsurance Hospital: $50/test plus 50% coinsurance; X-Rays: 50% coinsurance |
| Outpatient Imaging (CT/PET Scans/MRIs) | Freestanding Facility: 30% coinsurance Hospital: 50% coinsurance |
Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
Freestanding Facility:40% coinsurance Hospital:50% coinsurance |
| Network | Blue Advantage HMO | ||
| HSA Eligible | No | No | No |
| Outpatient Prescription Drugs – Preferred Pharmacy | $5/$15/30%/40%/45%/50% | $5/$15/30%/35%/45%/50% | $30/$40/50%/50%/50%/50% |
| Outpatient Prescription Drugs – Non-Preferred Pharmacy | $10/$25/35%/40%/45%/50% | $15/$25/35%/40%/45%/50% | $40/$50/50%/50%/50%/50% |
| Prescription Drug Utilization Benefit Management Programs | Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSTX and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit. | ||
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Popular Hospital Network Guide
| Hospital | Included in Advantage HMO Network? |
|---|---|
| Doctors Hospital At Renaissance (Edinburg) | YES |
| University Health System (San Antonio) | NO |
| Medical City Hospital (Dallas) | YES |
| Memorial Hermann Hospital (Sugar Land) | YES |
| Mother Frances Hospital (Tyler) | NO |
| Scott & White Hospital (Round Rock) | NO |
| North Austin Medical Center (Austin) | YES |
| Seton Medical Center (Austin) | YES |
| Hill Country Memorial Hospital (Fredericksburg) | YES |
| Texas Health Harris Methodist (Fort Worth) | YES |
| UT Southwestern Medical Center (Dallas) | NO |
| Memorial Hermann Texas Medical Center (Houston) | YES |
| St. Lukes Episcopal Hospital (Houston) | YES |
| Baylor University Medical Center (Dallas) | YES |
| The Methodist Hospital (Houston) | YES |
BCBSTX Dental Plans
Dental Plans Brochure Application With the BCBSTX dental plan, you’ll get dental coverage on day one with no deductible deductible required for check-ups, cleanings and other preventive services. Most important, costs are typically reduced when you receive care from any of our participating network dentists. However, you also have the option to see any dentist not in the network, but your out-of-pocket costs may be higher. Some highlights of Dental Indemnity USA coverage:
- Coverage can be used to provide dental benefits to an individual, spouse, children or any combination of dependents.
- A $50 deductible, based on fee schedule allowances, applies for dental procedures or services received by a covered individual during each benefit year.
- Maximum deductible amount of $150 for family coverage.
- Deductibles do not apply to oral exams, cleanings, fluoride treatments, sealants and X-rays.
- $1,000 orthodontia benefit for children under 19 years old
For more information on coverage and benefits, view the Dental Outline of Coverage You must enroll in a BCBSTX health plan in order to enroll in the dental plan (you have up to 31 days from the effective date of your policy to enroll). Shop for a plan now.
Looking for 2022 coverage? Click Here.
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