Blue Cross and Blue Shield of Texas SelecTEMP PPO Plan I to V Plan Information
Coverage Level 80%
Physician/Hospital Network BlueChoice Solutions or BlueCard Preferred Provider Organization
Lifetime Benefit $2 Million
Individual Out-of-Pocket Expense Deductible plus $1,000
Office Visit Co-pay Deductible and Coinsurance
Family Out-of-Pocket Expense Deductible plus $3,000
Outpatient Physician Medical Services Deductible and Coinsurance
Outpatient Physician Surgical Services Deductible and Coinsurance
Preventative Care Not Covered
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; $40 copay/preferred; $55 copay/non-preferred; $750 calendar year max
Other Blue Cross and Blue Shield of Texas health insurance plans:
