Blue Advantage Plus - Texas Health Agents

Blue Advantage Plus Plans

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Blue Advantage Plus HMO

Network Type: HMO with Out-of-Network Options
Coverage Area: Statewide across Texas
Provider Access: Members have access to the same network as Blue Advantage HMO but can also choose out-of-network providers at a higher out-of-pocket cost.
Primary Care Physician (PCP): Selection of a PCP is required for in-network services; referrals are needed for specialists.
Out-of-Network Coverage: Available at a higher cost-sharing rate, providing more flexibility.

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 Plus Bronze 201 (off exchange) – $4,500 individual deductible and 40% coinsurance
Blue Advantage Plus Bronze 303 – $5,500 individual deductible and 50% coinsurance
Blue Advantage Plus Bronze 305 – $6,100 individual deductible and 50% coinsurance
Blue Advantage Plus 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 Plus Bronze 201	$9,200 / $18,400	40% / 40%	20% / 25% / 30% / 35% / 45% / 50%
Blue Advantage Plus Bronze 303	$9,200 / $18,400	$80 / 50%	$5 / $15 / $140 / 35% / 45% / 50%
Blue Advantage Plus Bronze 305	$9,200 / $18,400	40% / 50%	20% / 25% / 30% / 35% / 45% / 50%
Blue Advantage Plus 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 202 – $1,500 individual deductible and 50% coinsurance
Blue Advantage Plus Silver 306 – $1,500 individual deductible and 50% coinsurance
Blue Advantage Plus Silver 605 – $0 individual deductible and 50% 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 Plus Silver 202	$9,200 / $18,400	$25 / 50%	$5 / $15 / 30% / 35% / 45% / 50%
Blue Advantage Plus Silver 306	$9,200 / $18,400	$0 / 50%	$0 / $5 / $75 / 35% / 45% / 50%
Blue Advantage Plus Silver 605	$8,400 / $16,800	$115 / $125	$40 / $45 / 20% / 45% / 50% / 60%
Blue Advantage Plus 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 Plus Bronze 203 – $850 individual deductible and 30% coinsurance
Blue Advantage Plus Bronze 803 – $2,200 individual deductible and 30% coinsurance
Blue Advantage Plus 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 Plus Gold 203	$9,200 / $	$20 / $45	$0 / $10 / $50 / 35% / 45% / 50%
Blue Advantage Plus Gold 303	$9,200 / $	$0 / $20	$0 / $10 / $50 / 35% / 45% / 50%
Blue Advantage Plus Gold Standard	$7,800 / $	$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.