MyBlue Health

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MyBlue Health

If you’re looking for a health plan that’s easy to understand, easy to use and easy on your wallet, an HMO may be just what you need. With MyBlue Health, you can schedule an appointment with your primary care providers and expect:

Network Type: HMO
Affordable costs for scheduled in-person or telehealth primary care appointments with select primary care providers¹
Benefit coordination with your primary care provider if you need to see a specialist
Routine check-ups and annual exams
Coverage Area: Available in specific counties, including Bexar, Dallas, Harris, Travis, and Williamson.
Provider Access: Features a more focused network of providers, including select PCPs and hospitals.
Primary Care Physician (PCP): Selection of a PCP is required, with $0 copay for scheduled visits to select PCPs.
Out-of-Network Coverage: Not covered, except for emergencies.
Additional Features: Offers lower monthly premiums and access to virtual visits.

Benefits of MyBlue Health

With a MyBlue Health plan, you’ll have low-cost scheduled in-person and telehealth PCP appointments at select PCPs. The MyBlue Health plan may also give you access to:

Certain X-rays, ultrasounds and ECGs
Testing for allergies
Chronic disease management programs
Health education programs and wellness services
Mental and behavioral health office visits
With 3 levels of coverage available, the MyBlue Health plan offers you a more affordable monthly payment with the same great support you’ve come to expect from BCBSTX.

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:

MyBlue Health Bronze 402 – $7,400 individual deductible and 50% coinsurance
MyBlue Health Bronze Standard – $7,500 individual deductible and 50% coinsurance

Plan Name	Max Out-of-Pocket (Ind/Fam)	PCP Office / Virtual Visit	Prescription Drugs (Preferred)
MyBlue Health Bronze 402	$9,200 / $18,400	$0 / $105* / 50%	$10 / $20 / 30% / 35% / 45% / 50%
MyBlue Health Bronze Standard	$9,200 / $18,400	$50 / $100	$25 / $50 / $100 / $500

*$0 copay applies only for appointments if you choose a Select Primary Care Physician

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:

MyBlue Health Silver 405 – $1,800 individual deductible and 40% coinsurance
MyBlue Health Silver 901 OFF – $1,500 individual deductible and 50% coinsurance
MyBlue Health Silver Standard – $5,000 individual deductible and 40% coinsurance

Plan Name	Max Out-of-Pocket (Ind/Fam)	PCP Office / Specialist	Prescription Drugs (Preferred)
MyBlue Health Silver 405	$9,200 / $18,400	$0 / $30* / 40%	$5 / $15 / 30% / 35% / 45% / 50%
MyBlue Health Silver 901 OFF	$9,200 / $18,400	$0 / $15* / 50%	$0 / $5 / $75 / 35% / 45% / 50%
MyBlue Health Silver Standard	$8,000 / $16,000	$40 / $80	$20 / $40 / $80 / $350

*$0 copay applies only for appointments if you choose a Select Primary Care Physician

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

MyBlue Health Gold 403 – $$500 individual deductible and 30% coinsurance
MyBlue Health Gold Standard – $1,500 individual deductible and 25% coinsurance

Plan Name	Max Out-of-Pocket (Ind/Fam)	PCP Office / Specialist	Prescription Drugs (Preferred)
MyBlue Health Gold 403	$8,500 / $18,400	$0 / $20* / 30%	$5 / $15 / 30% / 35% / 45% / 50%
MyBlue Health Gold Standard	$7,800 / $15,600	$30 / $60	$15 / $30 / $60 / $250

*$0 copay applies only for appointments if you choose a Select Primary Care Physician

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.