Blue Cross and Blue Shield of Texas PPO Select Choice Plan I to VIII Plan Information
Coverage Level 80%
Physician/Hospital Network BlueChoice or BlueCard Preferred Provider Organization
Lifetime Benefit $5 Million
Individual Out-of-Pocket Expense Deductible plus $3,000
Office Visit Co-pay $25
Family Out-of-Pocket Expense Deductible plus $6,000
Outpatient Physician Medical Services Deductible and Coinsurance
Outpatient Physician Surgical Services Deductible and Coinsurance
Preventative Care 100% after you pay $25 doctor office visit copay; $300 max per year
Childhood Immunizations 100% to 8 years of age
Inpatient Physician Medical/Surgical Services Deductible and Coinsurance
Outpatient Hospital Services Deductible and Coinsurance
Outpatient Hospital Diagnostic Testing Deductible and Coinsurance
Inpatient Hospital Services and Diagnostic Testing Deductible and Coinsurance
Outpatient Prescription Drugs $200 deductible and $10 copay/generic; $30 copay/preferred; $45 copay/non-preferred; $3,000 calendar year max
Other Blue Cross and Blue Shield of Texas health insurance plans:
