Blue cross blue shield texas urgent care

BCBSTX Gold Plans

All Blue Advantage Gold HMO Plans offer the same set of essential health benefits, quality and amount of care as the Blue Advantage Silver and Gold HMO Plans. The Blue Advantage Gold HMO Plans are the most expensive plans, but also have the most comprehensive benefits. Gold Plans have a higher monthly premium and often lower out-of-pocket costs than Silver and Bronze plans. Blue Advantage Gold HMO Plans may be right for you if you are an individual or family who:

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BCBSTX Gold Plans
Blue Cross Silver Plans
Blue Cross Bronze Plans
Multi-State Plans
Is Blue Cross Blue Shield of Texas the same as Blue Cross Blue Shield?
How do I contact Blue Cross Blue Shield of Texas?
Can I use BCBS of Texas out of state?
Does Blue Cross Blue Shield of Texas cover mental health?

Are willing to have a primary care physician (PCP) coordinate your care
Prefers fixed doctor visit copayments
Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
Requires regular prescription medication

There are deductibles for this plan, and this is an HMO plan. You must select a Blue Advantage HMO Primary Care Physician (PCP) when enrolling in this plan.

Gold	Blue Advantage Plus Gold	Blue Advantage Plus Gold HMO
	203	306
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.	$750	$0
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max	30%	0%
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)2	$7,900	$7,900
Primary Care Office Visit	$15	$20
Specialist Office Visit	$15	$50
Mental Illness Treatment and Substance Abuse Rehabilitation Office Visit	$15	$20
Emergency Room	$950 per occurrence deductible, then 30%	$750
Urgent Care	$50 (Deductible does not apply)	$50
Inpatient Hospital Services	$850 per occurrence deductible, then 50%	$850 per occurrence deductible, then 40%
Outpatient Surgery4	$600 per occurrence deductible, then 50%	$600 per occurrence deductible, then 40%
Outpatient X-Rays and Diagnostic Imaging4	50%	40%
Outpatient Imaging (CT/PET Scans/MRIs)4	50%	40%
Network	Blue Advantage HMO	Blue Advantage Plus HMO
HSA Eligible5	No	Yes
Outpatient Prescription Drugs – Preferred Pharmacy 6 7	$0/$10	$50/$70/$150
Outpatient Prescription Drugs – Non-Preferred Pharmacy 6,7	$10/$20/$30	$10/$20/$30

Prescription Drug Utilization Benefit Management Programs8

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 meet certain criteria or try more cost-effective drugs. Mail-Order Program: You may receive a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.

Depending on your plan, benefits are either reduced or not available when non-participating providers are used. This is a summary of benefit highlights only. All benefits shown indicate member responsibility.
The standard deductible and out-of-pocket maximum for this plan are shown. You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Note that copays apply whether or not you have met the deductible.
All percentages shown are of the allowable amount for covered services.
Members may have lower out-of-pocket costs for some services provided by non-emergency freestanding outpatient facilities than the out-of-pocket costs for services provided in a hospital setting. See your Summary of Benefits and Coverage for additional details.
As a reminder, a Health Savings Account (HSA) has tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax adviser regarding tax consequences of specific health insurance plans or products.
Prescription benefit coverage starts after annual medical deductible has been met, not counting copays.
Six prescription drug payment level tiers: Preferred Generics / Non-Preferred Generics / Preferred Brand / Non-Preferred Brand / Preferred Specialty / Non-Preferred Specialty.
Mail order is not available for Preferred and Non-Preferred Specialty tier drugs. These tiers are limited to a 30-day supply. Coverage limitations may apply to certain medications.

Blue Cross Silver Plans

BCBSTX Silver plans offer a higher level of coverage than Bronze plans, and those who purchase on-exchange may also be eligible for cost-sharing reductions based on income, lowering deductibles and co-pays. Silver plans are ideal for people who have regular medications or utilize specialist or doctors visits more often than their included yearly check-up. Silver plans are a good “middle of the road” option for people who might need to utilize their healthcare options more but may not be able to afford higher premium payments.

	Blue Advantage Silver HMO	Blue Advantage Silver HMO	Blue Advantage Silver HMO	Blue Advantage Plus Silver
Plan Number	202	306	107	102 – Three $0 PCP Visits
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. 2	$1,000	$2,000	$1,900	$3,250
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max	30%-50%	30%-50%	35%-40%	20%
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)2	$7,900	$7,900	$7,900	$6,850
Primary Care Office Visit	$10	25%	$25 First two visits, then 50%	First three visits $0, then 20%
Specialist Office Visit	50%	100% after deductible	50%	20%
Mental Illness Treatment and Substance Abuse Rehab Office Visit	50%	50%	$30	$0
Emergency Room	$950 per occurence copay, then 50%	$950 per occurence copay, then 50%	$850 + 50% coinsurance	$600 per occurence copay, then 20%
Urgent Care	$15	$50	$50	$20
Inpatient Hospital Services	$850 per occurence copay, then 50%	$850 per occurrence copay, then 50%	$850 per occurrence copay, then 50%	$400 per occurence copay, then 40%
Outpatient Surgery5	$300 per occurence copay, then 30%	$600 per occurrence copay, then 40%	$600 per occurrence copay, then 40%	$300 per occurence copay, then 40%
Outpatient X-Rays and Diagnostic Imaging5	50%	40%	40%	$2,750
Outpatient Imaging (CT/PET Scans/MRIs)5	30%	40%-50%	20%	40%
Network	Blue Advantage HMO	Blue Advantage HMO
HSA Eligible6	No	Yes	No	No
Outpatient Prescription Drugs – Preferred Pharmacy7 8	$5/$10/$15	$5/$10/$15	$15/$15/$50/$100/40%	$0/$10/$50/$100/30%
Outpatient Prescription Drugs – Non-Preferred Pharmacy7 8	$15/$25/$45	$15/$25/$45	$15/$15/$50/$100/40%	$5/$15/$60/$110/30%

Blue Cross Bronze Plans

BlueCross BlueShield of Texas Bronze plans are ideal for individuals looking for low-cost plans. Bronze plans have higher out of pocket costs, but two plans (the 106 and 104) also have HSA options for those looking for tax savings. These plans are ideal for those who do not have regular medications or visit the doctor outside of their yearly check-up (included as preventative care on all plans.)

Bronze	Blue Advantage Bronze HMO	Blue Advantage Plus Bronze
	204 – Two $40 PCP Visits	201
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.	$6,000	$3,150
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max	50%	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)2	$7,900	$6,550
Primary Care Office Visit	First 2 PCP visits $40, then 50%	40%
Specialist Office Visit	50%	40%
Mental Illness Treatment and Substance Abuse Rehabilitation Office Visit	50%	40%
Emergency Room	$950 per occurrence deductible, then 50%	$950 per occurrence deductible, then 40%
Urgent Care	$60 copay	40%
Inpatient Hospital Services	$850 per occurrence deductible, then 50%	$850 per occurrence deductible, then 40%
Outpatient Surgery4	50%	$600 per occurrence deductible, then 30%
Outpatient X-Rays and Diagnostic Imaging4	40%	30%
Outpatient Imaging (CT/PET Scans/MRIs)4	40%	30%
Network
HSA Eligible5	No	Yes
Outpatient Prescription Drugs – Preferred Pharmacy 6 7	$15/$25/$45	30%
Outpatient Prescription Drugs – Non-Preferred Pharmacy 6 7	$25/$35/$75	35%

Prescription Drug Utilization Benefit Management Programs8

Depending on your plan, benefits are either reduced or not available when non-participating providers are used. This is a summary of benefit highlights only. All benefits shown indicate member responsibility.
The standard deductible and out-of-pocket maximum for this plan are shown. You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Note that copays apply whether or not you have met the deductible.
All percentages shown are of the allowable amount for covered services.
Members may have lower out-of-pocket costs for some services provided by non-emergency freestanding outpatient facilities than the out-of-pocket costs for services provided in a hospital setting. See your Summary of Benefits and Coverage for additional details.
As a reminder, a Health Savings Account (HSA) has tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax adviser regarding tax consequences of specific health insurance plans or products.
Prescription benefit coverage starts after annual medical deductible has been met, not counting copays.
Six prescription drug payment level tiers: Preferred Generics / Non-Preferred Generics / Preferred Brand / Non-Preferred Brand / Preferred Specialty / Non-Preferred Specialty.
Mail order is not available for Preferred and Non-Preferred Specialty tier drugs. These tiers are limited to a 30-day supply. Coverage limitations may apply to certain medications.

Multi-State Plans

The Multi-State Plan (MSP) Program, established under the Affordable Care Act, directs the Federal Office of Personnel Management to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans. There are no major differences between multi-state plans and other plans, and it does NOT mean these plans provide out of state benefits, just that benefits meet minimum requirements from state to state. Always check the doctor’s networks for each individual plans, and remember that emergency care is covered within the continental US. BCBSTX appears to have discontinued Multi-State plans for 2018.

HSA Plans

Health Savings Accounts can reduce your out of pocket costs as well as your tax burden. BCBSTX offers one of 3 HSA plans in Texas for 2018. Learn more at our HSA Guide.

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

Is Blue Cross Blue Shield of Texas the same as Blue Cross Blue Shield?

BCBSTX is a Division of Health Care Service Corporation (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country's largest customer-owned health insurer and fourth largest health insurer overall.

How do I contact Blue Cross Blue Shield of Texas?

Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card.

Can I use BCBS of Texas out of state?

It does not matter if you are inside or outside our service area. You will be covered for emergency services in the U.S. even if the emergency services provider is not part of the Blue Cross and Blue Shield of Texas (BCBSTX) network.

Does Blue Cross Blue Shield of Texas cover mental health?

Blue Cross and Blue Shield of Texas (BCBSTX) offers mental health rehabilitation services and targeted case management to STAR members. If you are an adult who has a mental illness or if you have a child with emotional needs, this benefit can help you or your child to learn how to be your best.

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