Our Series V Products include:
- PPO Select® Blue Advantage Series V (policy form # PPO-SELBLUE-ADV-5-1),
- PPO Select® Choice Series V (policy form # PPO-SELCHOICE-5-1) and
- PPO Select® Saver Series V (policy form # PPO-SELSAVER-5-1).
- Inpatient hospitalization services
- Medical and surgical expenses
- Preventive care, such as routine physicals, immunizations, diagnostic tests and more
- Three-tier prescription drug program
- 24-Hour Worldwide Care
- 100% coverage in or out of network for childhood immunizations up to age 8.
- Access to one of the largest provider networks in Texas, BlueChoice®
A Series V health insurance plan may be right for you if you are an individual or family who:
- Seeks coverage comparable to that of an employer
- Seeks the flexibility to meet your individual needs, family situation and budget, not a “pre-packaged, one-size-fits-all” health insurance plan
- Wants a choice of deductibles and coinsurance maximum levels to help control premium costs
- Regularly visits a doctor
- Needs coverage for prescription medication
Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Texas family.
- Individual deductibles for individuals ranging from $250 to $10,000*
- Individual maximum out-of-pocket is $3,000*
- Family deductibles ranging from $750 to $30,000*
- Family maximum out-of-pocket costs ranging from $6,000-$9,000*
- Office visits—copayments ranging from $25 up to 75 percent of allowable amount after deductible
- Coinsurance—you pay 15–25 percent and the health insurance plan pays 75–85 percent*
- To see what your monthly payments would be, get a quick quote.
* Represents estimated cost range for in-network coverage only. Out-of-network coverage costs can be significantly higher. Your greatest coverage and savings are realized when you use the services of participating providers within the network.
- Series V Products pays 75–85 percent and you pay 15–25 percent of covered expenses, after you meet your deductible
- Doctor's office visits covered 75–100 percent after $25 copayment or deductible, depending on the health insurance plan you choose
- Easy claims processing—no forms to file in most cases
- BlueCard® PPO benefits
More Health Insurance Plan Details
It's important to know the features of the health insurance plan you are considering. Our Outline of Coverage documents give you brief descriptions of the basic details of our Series V Products, as well as details on renewability, exclusions and limitations.
You can customize any Series V health insurance plan with the following option:
Optional Dental Coverage
Optional Dental 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
- Learn more about optional dental coverage
- Prescription drug coverage is included with Series V Products.
- Copayments for prescription drugs vary based on the health insurance plan options you choose.
- If you take medications for birth control, high blood pressure, cholesterol or other long-term needs, you can also receive up to a 90-day supply at retail. In some cases, you'll pay less for the same amount of medication than at a retail pharmacy.
- View the individual health insurance plan Preferred Drug List
to see if your prescriptions are included. - Prescription Drug Utilization/Benefit Management Programs for policies with effective dates on or after 3/1/2012. See Compare Plans Chart for more information.
Are you looking for the kind of health insurance plan that gives you more control? If so, BlueEdgeSM Individual HSA may be right for you. This health savings account (HSA) health insurance plan enables you to decide how, when and where your health care dollars are spent. A high deductible affords you low monthly premiums, plus you gain tax advantages.*
BlueEdgeSM Individual HSA Coverage Overview
This health insurance product provides cost-sharing health coverage for inpatient settings with the freedom to choose your hospitals. Other key coverage and health insurance plan features include:- Medical services and surgical expenses
- Accident and emergency care
- 100% Preventive Care for adults and children
- 100% coverage in or out of network for childhood immunizations up to age 6
- Three-tier prescription drug program
- Want affordable premiums and need a wide range of benefits
- Don’t expect to have a lot of medical expenses
- Have money saved just in case you have to pay unexpected out-of-pocket health care expenses
- Are looking for more control over your health care choices
* A Health Savings Accounts (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 advisor regarding the tax consequences of specific health insurance plans or products.
BlueEdgeSM Individual HSA provides different levels of out-of-pocket expense limits, deductibles and coinsurance to allow you to select the plan that best meets your budget. With BlueEdgeSM Individual HSA, here’s what you can expect:
View the plan's Outline of Coverage, which provides brief descriptions of the basic provisions of BlueEdgeSM Individual HSA, including costs and out-of-pocket expenses.
- PPO benefits begin after you meet the deductible
- Coinsurance level determined by health insurance plan selection
- Individual deductibles ranging from $1,200 to $5,000*
- Individual maximum out-of-pocket expenses ranging from $3,000 to $5,000*
- Family deductibles ranging from $2,400 to $10,000*
- Family maximum out-of-pocket expenses ranging from $6,000-$10,000*
- Copayments ranging from 75–100 percent of allowable amount after calendar year deductible for office visits (doctor consultation only) and emergency care
- Coinsurance — you pay 0–25 percent of allowable amount and the health insurance plan pays 75–100 percent of allowable amount*
- To see what your monthly payments would be, get a quick quote.
View the plan's Outline of Coverage, which provides brief descriptions of the basic provisions of BlueEdgeSM Individual HSA, including costs and out-of-pocket expenses.
* These cost ranges represent in-network coverage only. Out-of-network coverage costs can be significantly higher. Your greatest coverage and savings are realized when you use the services of participating providers within the network.
- BlueEdgeSM Individual HSA pays 75–100 percent of allowable amount and you pay 0–25 percent of allowable amount for covered expenses after you meet your deductible (in-network).
- In-network doctor's office visits for routine physicals, immunizations and diagnostic tests are covered at 75–100 percent of the allowable amount, subject to deductible.
- Easy claims processing—no forms to file in most cases
- Emergency room visits are covered at 75–100 percent of allowable amount after calendar year deductible and coinsurance.
- The tax-favored advantages that come with a Health Savings Account*
- Access to online decision tools to help increase your knowledge of health issues and track your health care expenses
More Health Insurance Plan Details
It’s important to know the features of the health plan you are considering. Our Outline of Coverage document gives you brief descriptions of the basic details of our BlueEdgeSM Individual HSA health insurance plan, as well as details on renewability, exclusions and limitations.
* Health Savings Accounts (HSAs) have 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 advisor regarding the tax consequences of specific health insurance plans or products.
You can customize any Series V health insurance plan with the following option:Optional Dental 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
- Learn more about optional dental coverage
- Prescription drug coverage is included with this plan.
- Copayments for prescription drugs vary based on plan options you choose.
- If you take medications for birth control, high blood pressure, cholesterol or other long-term needs, you can also receive up to a 90-day supply at retail. In some cases, you'll pay less for the same amount of medication than at a retail pharmacy.
- View the Complete Prescription Drug List to see if your prescriptions are included in the plan.
- Prescription Drug Utilization/Benefit Management Programs for policies with effective dates on or after 3/1/2012. See Compare Plans Chart for more information.
Open enrollment is now closed for this product. The next open enrollment period is scheduled for May 1 through June 30 (5/1/2013 – 6/30/2013).
Our children's health insurance plan, Blue Pathway, provides coverage for individuals ages 1 through 18 and includes:
- Benefits for preventive care services
- Diagnostic testing
- Hospital services
- Emergency care
- Prescription drug coverage
- Physical, occupational and speech therapist therapy services
Blue Pathway provides guaranteed acceptance for applicants who are at least one year old and under 19 years of age.
View the features, options and costs of the Blue Pathway plan
to find out if it's right for you.2012 open enrollment period is closed for this product.
Annual Open Enrollment Period
- The annual Open Enrollment period runs from May 1 through June 30 (5/1 – 6/30).
- Use this time to enroll in Blue Pathway for the first time or to switch plans.
Health insurance costs include monthly premium payments, individual/family deductibles, out-of-pocket expenses, copayments and coinsurance. For Blue Pathway plans, here’s what you can expect:
For more information on costs, including out-of-pocket costs, see the Outline of Coverage document under What's Included with Blue Pathway below.
- Individual in-network deductible of $2,500/$5,000 for out-of-network
- Family in-network deductible of $7,500/$15,000 for out-of-network
- Coinsurance levels of 75% in-network/60% out-of-network
- Benefits for preventive care services covered of 100% in-network/60% out-of-network
For more information on costs, including out-of-pocket costs, see the Outline of Coverage document under What's Included with Blue Pathway below.
At Blue Cross and Blue Shield of Texas (BCBSTX), we understand your concerns about coverage continuity. BCBSTX will never terminate or refuse to renew your Policy because of the condition of your health. However, to protect you and the rights of all policy holders, there are situations when a policy may be terminated or a renewal refused:
For more information on renewability, see the Blue Pathway Outline of Coverage.
- Failure to pay premiums
- The Blue Pathway plan is discontinued (90 days notice given with an option to convert to any plan we offer)
- Discovery of fraud or an intentional misrepresentation of facts (30 days prior written notice given)
- Failure to continue residing, living or working in an area where we are authorized to do business
For more information on renewability, see the Blue Pathway Outline of Coverage
.
It’s important to know the features of the health insurance plan you are considering. Our Outline of Coverage documents give you brief descriptions of the basic details of our Blue Pathway product, as well as details on renewability, exclusions and limitations.
Blue Pathway Outline of Coverage
Blue Pathway Outline of Coverage
The Individual Dental plan is available as an optional benefit with your individual Blue Cross and Blue Shield of Texas insurance plan. There is an additional premium associated with this plan.
Learn more about the Dental Indemnity USA plan.
Learn more about the Dental Indemnity USA plan.
- Generic Drugs (Tier 1*) - $15 copayment in-network
- Preferred Brand Drugs (Tier 2*) – 75% coinsurance level in-network
- Your benefit plan includes a mail service program that offers you the convenience of having covered maintenance medications delivered directly to you.
- Your out-of-pocket cost for prescription drugs usually is less when you choose generic or formulary
Policy form #PPO-STM-3
Short-term Health Insurance Overview
SelecTEMP® PPO provides temporary health coverage for you, your spouse and your children. It offers various benefit periods and deductibles to give you the control to tailor coverage, premium rates and out-of-pocket expenses according to your own needs.SelecTEMP PPO Coverage Overview
Key features include:- Inpatient and outpatient medical, surgical and hospital services
- Diagnostic services
- Emergency care
- Office visits
- Childhood immunizations up to the child’s eighth birthday
- Prescription drug coverage
- Experiencing a gap in employer coverage or can’t afford COBRA
- Waiting for employer coverage to begin
- A recent graduate and still seeking employment
- Age 64 and about to retire, but not yet eligible for Medicare
Who is eligible for SelecTEMP PPO?
- Texas residents at least 60 days of age and under 65 years of age
- Non-expectant parents
- Unmarried dependent children at least 60 days of age and under 25 years of age
- U.S. citizens or non-U.S. citizens living in the United States for at least two years (a copy of your Alien Registration Receipt Card must be submitted with your application)
Health insurance costs include monthly payments, individual deductibles, drug coverage deductibles, out-of-pocket expenses, copayments, and coinsurance. For SelecTEMP PPO plans, here’s what you can expect:
For more information on costs, including out-of-pocket expenses, view this SelecTEMP PPO Outline of Coverage document.
- Individual deductibles for individuals ranging from $500 to $2,500*
- Family deductibles ranging from $1,500 to $7,500*
- Copayment of $100 for emergency room facility visit - waived if admitted to Hospital immediately following the visit. (This copayment amount applies to the facility visit only. The facility and physician services and supplies are subject to the deductible and coinsurance amount.)
- Coinsurance—you pay 20 percent of allowable amount after deductible with a maximum of $1,000, family coverage coinsurance maximum is $3,000*
- To see what your monthly payments would be, get a quick quote
For more information on costs, including out-of-pocket expenses, view this SelecTEMP PPO Outline of Coverage
document.
* These cost ranges represent in-network coverage only. Out-of-network coverage costs can be significantly higher. This plan uses the BlueChoice® network, which enables you to save on premiums and the cost of covered services when you use a participating hospital, doctor or specialist.
- Freedom to choose doctors and hospitals (out-of-pocket expenses will be less when using the services of doctors and hospitals in the BlueChoice Network)
- 24 hour worldwide coverage
- Choice of deductible amount, payment type and length of benefit period (one to six months)
- Prescription Drug Program (Generic, Preferred and Non-preferred drugs)
- Mail Order Prescription Drug Program (90-day supply of covered prescription drug for two copay amounts)
More Health Insurance Plan Details
It’s important to know the features of the health insurance plan you are considering. Our Outline of Coverage documents give you brief descriptions of the basic details of SelecTEMP PPO, as well as details on renewability, exclusions and limitations. View the SelecTEMP PPO Outline of Coverage.- Prescription drugs and medicines (not used in a hospital) are covered up to a maximum benefit of $750 per participant per benefit period.
- There is a separate $200 prescription program deductible that must be satisfied before benefits are available.
- Once the deductible has been met, a copayment will apply, the amount based on whether your prescription is filled at a participating pharmacy or through the Prescription Drug Mail Service and the type of drug dispensed (generic, preferred or non-preferred).
- You have the option to order your prescription drugs through the mail with our 90-Day Supply Program.
- SelecTEMP PPO is a short term health insurance plan for individuals and families who need temporary coverage.
- If you need temporary coverage for an additional period of time, you may apply for a second contract term.
- If accepted, any pre-existing condition incurred during the first contract will not be covered with the new contract.
- If you need a long-term health insurance solution, please consider our other individual and family coverage options.
document.
Every insurance plan has limitations. These limits are there to keep health care costs down for everyone. A pre-existing condition is just one example of a limitation. For example, a pre-existing condition will be excluded from your participation in a health insurance plan. This means your health care expenses related to a pre-existing condition will not be covered.
It’s important to know the limitations of your health insurance plan. For a full list of exclusions and limitations, see our SelecTEMP PPO Outline of Coverage document.
View the Complete Prescription Drug List to see if your prescriptions are included.
Some highlights of Dental Indemnity USA coverage:
See the Dental Indemnity USA Outline of Coverage for more details on benefits and policies.
www.nationwide.com/joshlewis
www.austinhealthbrokers.com
www.bcbstx.com
It’s important to know the limitations of your health insurance plan. For a full list of exclusions and limitations, see our SelecTEMP PPO Outline of Coverage
document.View the Complete Prescription Drug List
to see if your prescriptions are included.Dental Indemnity USA Plan
The Individual Dental plan is available as an optional benefit with your individual Blue Cross and Blue Shield of Texas insurance plan. There is an additional premium associated with this plan.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.
See the Dental Indemnity USA Outline of Coverage
for more details on benefits and policies.- You must enroll in a BCBSTX health plan in order to enroll in the dental plan (excluding SelecTemp PPO). You have up to 31 days from the effective date of your policy to enroll.
- All members on that health plan must be enrolled in Dental Indemnity USA.
- Once your dental plan is dropped for any reason, you cannot re-enroll unless you reapply for a new health insurance plan.
| Zip Codes 754-759, 764-769, 776-785, 788, 790-798 | |
|---|---|
| Member | $29.00 |
| Member + Spouse | $58.00 |
| Member + Child(ren) | $60.20 |
| Family | $100.80 |
| Zip Codes 733, 750-753, 760-763, 770, 772-775, 786-787, 789,799, 885 | |
| Member | $34.70 |
| Member + Spouse | $69.40 |
| Member + Child(ren) | $70.90 |
| Family | $119.50 |
www.nationwide.com/joshlewis
www.austinhealthbrokers.com
www.bcbstx.com
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