Compare deductibles, out-of-pocket maximums, copays, and Rx benefits across the standard plan variants in BCBSTX’s 2026 small group lineup. Pick a plan family below to see its tier-by-tier comparison.
Note: Data shown reflects the standard (non-HSA-qualified, non-in-vitro-mandate) variants for each plan. The 2026 updates published in BCBSTX’s renewal notice have been applied where applicable (marked
2026 UPDATED). HSA-qualified high-deductible plans, Texas in-vitro mandate variants, and plans not listed here are also available —
request a quote for the full BCBSTX portfolio.
Blue Advantage HMO — Standard Plan Variants
BCBSTX’s flagship HMO with one of the largest networks in Texas. Members select a Primary Care Physician who coordinates referrals to in-network specialists. Lower premiums vs. PPO in exchange for the PCP-coordinated model.
| Plan |
Deductible
Individual / Family |
Out-of-Pocket Max
Individual / Family |
Coinsurance |
PCP Visit |
Specialist |
ER
(per occ.) |
Rx Preferred
(6 tiers) |
Bronze
Blue Advantage Bronze HMO 833
Plan ID: B661ADT |
$8,650
$17,300 |
$8,650
$17,300 |
100% |
Ded and Coins |
Ded and Coins |
Ded and Coins |
100% |
Silver
Blue Advantage Silver HMO 127
Plan ID: S9J7ADT |
$3,100
$9,200 |
$9,200
$18,400 |
70% |
$50 |
$100 |
$750 copay |
$5/$10/$50/$100/$150/$250 |
Silver
Blue Advantage Silver HMO 402
Plan ID: S9N3ADT |
$4,100
$12,300 |
$8,200
$16,400 |
80% |
$0 |
$110 |
$500 |
90%/90%/80%/70%/60%/50% |
Silver
Blue Advantage Silver HMO 846 2026 UPDATED
Plan ID: S644ADT |
$8,400
$16,800 |
$8,400
$16,800 |
100% |
$55 |
$110 |
$500 |
$0/$10/$50/$100/$150/$250 |
Gold
Blue Advantage Gold HMO 814
Plan ID: G662ADT |
$1,050
$3,150 |
$6,300
$12,600 |
80% |
$55 |
$100 |
$600 |
$0/$10/$50/$100/$150/$250 |
Gold
Blue Advantage Gold HMO 801 2026 UPDATED
Plan ID: G660ADT |
$3,500
$10,500 |
$3,500
$10,500 |
100% |
$55 |
$100 |
$400 |
100% |
Platinum
Blue Advantage Platinum HMO 501
Plan ID: P9O5ADT |
$1,000
$3,000 |
$3,000
$6,000 |
80% |
$0 |
$40 |
Ded and Coins |
$0/$10/$50/$100/$150/$250 |
Platinum
Blue Advantage Platinum HMO 808
Plan ID: P611ADT |
$1,350
$4,050 |
$1,350
$4,050 |
100% |
$30 |
$55 |
$400 |
$0/$10/$35/$75/$150/$250 |
Network: Blue Advantage HMO (BAV). “Ded and Coins” = subject to deductible-and-coinsurance rather than a flat copay. Subject to BCBSTX 2026 contract terms; consult the SBC for the specific plan ID once posted.
Blue Choice PPO — Standard Plan Variants
Maximum flexibility with no referrals required and full BlueCard PPO network access nationwide. Higher premiums than the HMO but employees can see any provider in or out of network. Each row shows in-network amounts — the slash separator (e.g. $3,500 / $7,000) means in-network / out-of-network. PPO out-of-pocket maximums are typically Unlimited out-of-network.
| Plan |
Deductible
In / Out (Individual) |
Out-of-Pocket Max
In / Out (Individual) |
Coinsurance |
PCP |
Specialist |
ER
(per occ.) |
Rx Preferred |
Bronze
Blue Choice Bronze PPO 833
Plan ID: B662CHC |
$8,650 / $17,300 |
$8,650 / $17,300 |
100% / 100% |
Ded and Coins |
Ded and Coins |
Ded and Coins |
100% |
Silver
Blue Choice Silver PPO 827
Plan ID: S663CHC |
$3,100 / $6,200 |
$9,200 / Unlimited |
70% / 50% |
$50 |
$100 |
$750 copay |
$5/$10/$50/$100/$150/$250 |
Silver
Blue Choice Silver PPO 402
Plan ID: S9N3CHC |
$4,100 / $8,200 |
$8,200 / Unlimited |
80% / 50% |
$0 |
$110 |
$500 |
90%/90%/80%/70%/60%/50% |
Silver
Blue Choice Silver PPO 146 2026 UPDATED
Plan ID: S9L7CHC |
$8,400 / $16,800 |
$8,400 / Unlimited |
100% / 80% |
$55 |
$110 |
$500 |
$0/$10/$50/$100/$150/$250 |
Gold
Blue Choice Gold PPO 114
Plan ID: G9K8CHC |
$1,050 / $2,100 |
$6,300 / Unlimited |
80% / 60% |
$55 |
$100 |
$600 |
$0/$10/$50/$100/$150/$250 |
Gold
Blue Choice Gold PPO 801 2026 UPDATED
Plan ID: G650CHC |
$3,500 / $7,000 |
$3,500 / Unlimited |
100% / 80% |
$55 |
$100 |
$400 |
100% |
Platinum
Blue Choice Platinum PPO 501
Plan ID: P9O3CHC |
$1,000 / $2,000 |
$3,000 / Unlimited |
80% / 50% |
$0 |
$40 |
Ded and Coins |
$0/$10/$50/$100/$150/$250 |
Platinum
Blue Choice Platinum PPO 811
Plan ID: P621CHC |
$1,350 / $2,700 |
$1,350 / Unlimited |
100% / 80% |
$30 |
$55 |
$400 |
$0/$10/$35/$75/$150/$250 |
Network: Blue Choice PPO (BCA), with full BlueCard nationwide access. Each cell shows in-network / out-of-network where applicable. “Ded and Coins” = subject to deductible-and-coinsurance.
Blue Balance Funded — Level Funded Option
BCBSTX’s level-funded product for groups of 5–50 employees. Instead of a flat fully insured premium, your monthly payment is split into claims fund + stop-loss + administration. If actual claims come in below the funded amount, your group earns a year-end surplus refund. Healthier groups typically save 10–25% vs. fully insured rates.
How Blue Balance Funded Works
1. Fixed Monthly Payment
Predictable monthly cost split into claims fund, stop-loss insurance premium, and administrative fee.
2. Stop-Loss Protection
Individual and aggregate stop-loss caps your group’s exposure on high-cost claims. 60-month run-out extension — longest in the industry.
3. Year-End Refund
If actual claims come in lower than the funded amount, your group receives a surplus refund — potentially 10–25% savings.
Plan Designs Available
Blue Balance Funded plan designs mirror the fully-insured Blue Advantage HMO and Blue Choice PPO plan structures shown in the other tabs — same networks, same benefit grids, same Rx tiers. The funding model is what differs. Specific plan-design choices are quoted at the group level after underwriting.
Included Wellness Programs
- Maven Maternity — comprehensive maternity and family planning support
- Twin Health — whole-body metabolism program for Type 2 diabetes reversal
- Airrosti Flex — musculoskeletal pain management (avg. 3.2 visits to resolve)
- Gene Therapy Solutions — financial protection against $1M–$4M gene therapy claims
- 24/7 virtual care included
Quote required: Blue Balance Funded plan designs and pricing are quoted at the group level based on census, ZIPs, and prior claims history. Request a Blue Balance Funded quote — we’ll have a side-by-side proposal in your inbox within 48 hours.
Need Help Choosing the Right BCBSTX Plan?
We compare every BCBSTX 2026 small group plan against your group census and budget — plus run quotes from Cigna, Aetna, UnitedHealthcare, and our level-funded carriers for a true side-by-side.
Request a Free Quote
Or call us directly: (972) 666-0578
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