BlueCross BlueShield of Texas
Bronze Health Plans
Recommended Plan
Blue Advantage Plus Bronze 104
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 pretection 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 2017, this is by far your best bet.
| Plan Name | Blue Advantage Bronze HMO 006 | Blue Advantage Bronze HMO 105 | Blue Advantage Plus Bronze 103 | Blue Advantage Plus Bronze 104 |
| Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $6,500 | $6,850 | $6,600 | $5,000 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | None (Member pays 0% after deductible) | 30% | 20% | 40% |
| 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) | $6,500 | $7,150 | $7,150 | $6,550 |
| Primary Care Office Visit | 0% after deductible | First 2 visits $40, then 30% | First visit $0, then 20% | 40% |
| Specialist Office Visit | 0% after deductible | 30% | 20% | 40% |
| Mental Illness Treatment and Substance Abuse Rehab Office Visit | 0% after deductible | $0 | $0 | 40% |
| Emergency Room | 0% after deductible | 30% | $950 per occurrence copay, then 20% | 40% |
| Urgent Care | 0% after deductible | $40 | 100% after deductible | $20 |
| Inpatient Hospital Service | 0% after deductible | 30% | $750 per occurrence copay, then 20% | 40% |
| Outpatient Surgery | 0% after deductible | 50% | $400 per occurrence copay, then 40% | 50% |
| Outpatient X-Rays and Diagnostic Imaging | 0% after deductible | 50% | $80 per occurrence copay, then 40% | 50% |
| Outpatient Imaging (CT/PET Scans/MRIs) | 0% after deductible | 50% | $600 per occurrence copay, then 40% | 50% |
| Network | Blue Advantage HMO | |||
| HSA Eligible | Yes | No | No | Yes |
| Outpatient Prescription Drugs – Preferred Pharmacy | 0% after deductible | 20%/20%/30%/40%/50% | $15/30%/40%/45%/50% | 30%/30%/40%/50%/50% |
| Outpatient Prescription Drugs – Non-Preferred Pharmacy | 0% after deductible | 25%/25%/40%/50%/50% | $20/35%/50%/50%/50% | 35%/35%/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.
BlueCross BlueShield Texas
Individual Plan Guides
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