Texas HSA Plans

There are 3 HSA eligible plans in Texas in 2021, available state-wide through Blue Cross Blue Shield of Texas and in the Austin & San Antonio area by Oscar Health Plans. Health Savings Accounts can reduce your out of pocket costs as well as your tax burden. Learn more at our HSA Guide.

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Blue Advantage Bronze HMO 201 & Oscar Saver Plans

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Blue Cross And Blue Shield Of Texas · Blue Advantage Plus Bronze℠ 201 Oscar · Saver Bronze Oscar · Saver Silver
Blue Cross And Blue Shield Of Texas · Blue Advantage Plus Bronze℠ 201 Oscar · Saver Bronze Oscar · Saver Silver
Bronze HMO| Plan ID: 33602TX0770108 Bronze EPO| Plan ID: 20069TX0340001 Silver EPO| Plan ID: 20069TX0350001
Deductible Deductible Deductible
$2,850 Individual $6,500 Individual $5,000 Individual
$6,550 Out-of-pocket maximum $6,500 Out-of-pocket maximum $5,000 Out-of-pocket maximum (
60% coinsurance after ded. 100% coinsurance after ded. 100% coinsurance after ded.
Copayments / Coinsurance Copayments / Coinsurance Copayments / Coinsurance
Emergency room care: $950 Copay with deductible/40% Coinsurance after deductible Emergency room care: No Charge After Deductible Emergency room care: No Charge After Deductible
Generic drugs: 20% Coinsurance after deductible Generic drugs: No Charge After Deductible Generic drugs: No Charge After Deductible
Primary doctor: 40% Coinsurance after deductible Primary doctor: No Charge After Deductible Primary doctor: No Charge After Deductible
Specialist doctor: 40% Coinsurance after deductible Specialist doctor: No Charge After Deductible Specialist doctor: No Charge After Deductible
DOCUMENTS DOCUMENTS DOCUMENTS
Summary of Benefits Summary of Benefits Summary of Benefits
Plan brochure Plan Brochure
Plan Brochure
Costs for medical care Costs for medical care Costs for medical care
Deductible Deductible Deductible
$2,850 Individual Total $6,500 Individual Total $5,000 Individual Total
Out-of-pocket maximum Out-of-pocket maximum Out-of-pocket maximum
$6,550 Individual Total $6,500 Individual Total $5,000 Individual Total
Primary care doctor visit Primary care doctor visit Primary care doctor visit
In Network Tier 1: 40% Coinsurance after deductible In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 2: Not Applicable Out-of-Network: Benefit Not Covered Out of Network: Benefit Not Covered
Out of Network: 50% Coinsurance after deductible
Specialist visit Specialist visit Specialist visit
In Network Tier 1: 40% Coinsurance after deductible In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 2: Not Applicable Out-of-Network: Benefit Not Covered Out of Network: Benefit Not Covered
Out of Network: 50% Coinsurance after deductible
X-rays and diagnostic imaging X-rays and diagnostic imaging X-rays and diagnostic imaging
Limits and exclusions apply: X-rays and diagnostic imaging In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: 30% Coinsurance after deductible Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: Not Applicable
Out of Network: 50% Coinsurance after deductible
Laboratory outpatient and professional services Laboratory outpatient and professional services Laboratory outpatient and professional services
Limits and exclusions apply: Laboratory outpatient and professional services In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: 30% Coinsurance after deductible Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: Not Applicable
Out of Network: 50% Coinsurance after deductible
Outpatient facility Outpatient facility Outpatient facility
Limits and exclusions apply: Outpatient facility In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: $600 Copay with deductible/30% Coinsurance after deductible Out-of-Network: Benefit Not Covered Out-of-Network: Benefit Not Covered
In Network Tier 2: Not Applicable
Out of Network: $1500 Copay with deductible/50% Coinsurance after deductible
Outpatient professional services Outpatient professional services Outpatient professional services
In Network Tier 1: $200 Copay with deductible/40% Coinsurance after deductible In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 2: Not Applicable Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
Out of Network: 50% Coinsurance after deductible
Hearing aids Hearing aids Hearing aids
Limits and exclusions apply: Hearing aids Limits and exclusions apply: Hearing aids Limits and exclusions apply: Hearing aids
In Network Tier 1: 40% Coinsurance after deductible In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 2: Not Applicable Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
Out of Network: 50% Coinsurance after deductible
Routine eye exam for adults Routine eye exam for adults Routine eye exam for adults
In Network: Benefit Not Covered In Network: Benefit Not Covered In Network: Benefit Not Covered
Routine eye exam for children Routine eye exam for children Routine eye exam for children
Limits and exclusions apply: Routine eye exam for children In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: No Charge Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: Not Applicable
Out of Network: Benefit Not Covered
Eyeglasses for children Eyeglasses for children Eyeglasses for children
Limits and exclusions apply: Eyeglasses for children In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: No Charge After Deductible Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: Not Applicable Eligible for Health Savings Account (HSA)YesPrescription drug coverage Eligible for Health Savings Account (HSA)YesPrescription drug coverage
Out of Network: Benefit Not Covered
Eligible for Health Savings Account (HSA)Yes                 Prescription drug coverage
Generic drugs Generic drugs Generic drugs
Limits and exclusions apply: Generic drugs In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: 20% Coinsurance after deductible Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: 25% Coinsurance after deductible
Out of Network: 50% Coinsurance after deductible
Preferred brand drugs Preferred brand drugs Preferred brand drugs
Limits and exclusions apply: Preferred brand drugs In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: 30% Coinsurance after deductible Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: 35% Coinsurance after deductible
Out of Network: 50% Coinsurance after deductible
Non-preferred brand drugs Non-preferred brand drugs Non-preferred brand drugs
Limits and exclusions apply: Non-preferred brand drugs In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: 35% Coinsurance after deductible Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: 40% Coinsurance after deductible
Out of Network: 50% Coinsurance after deductible
Specialty drugs Specialty drugs Specialty drugs
Limits and exclusions apply: Specialty drugs In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: 45% Coinsurance after deductible Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
In Network Tier 2: 45% Coinsurance after deductible
Out of Network: 45% Coinsurance after deductible
Emergency room care Emergency room care Emergency room care
Limits and exclusions apply: Emergency room care In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 1: $950 Copay with deductible/40% Coinsurance after deductible Out of Network: No Charge After Deductible Out of Network: No Charge After Deductible
In Network Tier 2: Not Applicable
Out-of-Network: $950 Copay with deductible/40% Coinsurance after deductible
Inpatient doctor and surgical services Inpatient doctor and surgical services Inpatient doctor and surgical services
In Network Tier 1: 40% Coinsurance after deductible In Network: No Charge After Deductible In Network: No Charge After Deductible
In Network Tier 2: Not Applicable Out of Network: Benefit Not Covered Out of Network: Benefit Not Covered
Out of Network: 50% Coinsurance after deductible
Inpatient hospital services (like a hospital stay) Inpatient hospital services (like a hospital stay) Inpatient hospital services (like a hospital stay)
Limits and exclusions apply: Inpatient hospital services (like a hospital stay) Limits and exclusions apply: Inpatient hospital services (like a hospital stay) Limits and exclusions apply: Inpatient hospital services (like a hospital stay)
In-network Tier 1: $850 Copay per Stay with deductible/40% Coinsurance after deductible
In Network Tier 2: Not Applicable
Out-of-Network: $1500 Copay per Stay with deductible/50% Coinsurance after deductible

 

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