Blue Advantage HMO

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Blue Advantage HMO

Network Type: Health Maintenance Organization (HMO)
Coverage Area: Statewide across Texas
Provider Access: Members must use in-network providers for coverage, except in emergencies.
Primary Care Physician (PCP): Selection of a PCP is required to coordinate care and provide referrals to specialists.
Out-of-Network Coverage: Generally not covered, except for emergencies.

Blue Advantage Plus Bronze

Bronze Plan Summaries:

Bronze plans may be for you if you have fewer medical needs, would rather have a low monthly payment, and don’t take prescription drugs regularly. Below is a quick summary of available Blue Advantage Plus bronze plans:

Blue Advantage Bronze 204 – $6,000 individual deductible and 50% coinsurance
Blue Advantage Bronze 301 – $9,200 individual deductible and 0% coinsurance
Blue Advantage Bronze 302 OFF – $7,500 individual deductible and 0% coinsurance
Blue Advantage Bronze Standard – $7,500 individual deductible and 50% coinsurance

Plan Name	Max Out-of-Pocket (Ind/Fam)	PCP Office / Virtual Visit	Prescription Drugs (Preferred)
Blue Advantage Bronze 204	$9,200 / $18,400	$45 / 50%	$5 / $15 / 30% / 35% / 45% / 50%
Blue Advantage Bronze 301	$9,200 / $18,400	0% / 0%	0%
Blue Advantage Bronze 302	$7,500 / $15,000	0% / 0%	0%
Blue Advantage Bronze Standard	$9,200 / $18,400	$50 / $100	$25 / $50 / $100 / $500

Blue Advantage Plus Silver

Silver Plan Summaries:

Silver plans may be for you if you want to pay less out-of-pocket for care, qualify for a premium tax credit (also known as a subsidy), have a spouse/children on your health plan, or have regular medical needs. Below is a quick summary of available Blue Advantage Plus Silver Plans:

Blue Advantage Plus Silver 205 – $1,500 individual deductible and 50% coinsurance
Blue Advantage Plus Silver 306 OFF – $1,500 individual deductible and 50% coinsurance
Blue Advantage Plus Silver 601 OFF – $2,500 individual deductible and 30% coinsurance
Blue Advantage Plus Silver 8 01 – $3,000 individual deductible and 40% coinsurance
Blue Advantage Plus Silver Standard – $5,000 individual deductible and 40% coinsurance

Plan Name	Max Out-of-Pocket (Ind/Fam)	PCP Office / Specialist	Prescription Drugs (Preferred)
Blue Advantage Silver 205	$9,200 / $18,400	$0 / 50%	$5 / $15 / 30% / 35% / 45% / 50%
Blue Advantage Silver 306	$9,200 / $18,400	$25 / 50%	$5 / $15 / $75 / 35% / 45% / 50%
Blue Advantage Silver 601	$9,200 / $18,400	$40 / $85	$0 / $10 / $50 / $100 / $150 / $250
Blue Advantage Silver 801	$9,200 / $18,400	$30 / $60	0% / 10% / 20% / 30 % / 40% / 50%
Blue Advantage Silver Standard	$8,000 / $16,000	$40 / $80	$20 / $40 / $80 / $350

Blue Advantage Plus Gold

Gold Plan Summaries:

Gold plans may be for you if you have more health care needs than most, have a spouse/children on your plan or want to grow your family soon, or prefer to pay more each month but have lower out-of-pocket expenses. Below is a quick summary of available Gold plans

Blue Advantage Gold 206 – $450 individual deductible and 35% coinsurance
Blue Advantage Gold 207 – $0 individual deductible and 0% coinsurance
Blue Advantage Gold 603 – $1,500 individual deductible and 35% coinsurance
Blue Advantage Bronze Standard – $1,500 individual deductible and 25% coinsurance

Plan Name	Max Out-of-Pocket (Ind/Fam)	PCP Office / Specialist	Prescription Drugs (Preferred)
Blue Advantage Gold 206	$9,200 / $18,400	$30 / 35%	$0 / $10 / $50 / 35% / 45% / 50%
Blue Advantage Gold 207	$9,200 / $18,400	$45 / $90	$5 / $20 / $50 / $100 / 40% / 50%
Blue Advantage Gold 603	$5,000 / $10,000	$30 / 35%	$0 / $10 / $50 / 35% / 45% / 50%
Blue Advantage Gold Standard	$7,800 / $15,600	$30 / $60	$15 / $30 / $60 / $250

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.