Blue Cross Blue Shield of Texas

Blue Cross Blue Shield of Texas | Blue Advantage Plus Silver℠ 102 - Three $0 PCP Visits

  • Blue Advantage Plus Silver℠ 102 - Three $0 PCP Visits is an Obamacare health insurance plan offered by Blue Cross Blue Shield of Texas that is available for individuals and families.

  • This plan is a HMO, meaning you will have to stay within the insurance company’s network, and will need to see a primary care doctor first and get a referral in order to see a specialist. (Read more about HMOs.)

  • This plan is a Silver metal level plan, which generally has a mid-level monthly cost and deductible (and co-pay), and provides middle-of-the-road insurance coverage for people who occasionally use their health care benefits (doctors, prescription drugs, etc.).

  • Deductible amount of $3,250. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of $6,850, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.


Ways to Enroll or Learn More

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Plan Summary

Monthly Cost

Plan Name:
Blue Advantage Plus Silver℠ 102 - Three $0 PCP Visits

Plan ID:
33602TX0770049

Plan Type:
HMO

Deductible:
$3,250

Maximum Out-of-Pocket:
$6,850

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a moderate monthly cost is great for individuals and families who occasionally visit the doctor or use prescription drugs. The very high deductible on this plan means you will pay a significant amount of money of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. Plans with this type of provider network tend to have a narrower provider network.

HealthCare.com is a privately-held internet start-up for healthcare consumers. We’re not the government website.

Highlights


Emergency Room:
$600 Copay then 20% Coinsurance after deductible

Retail Drugs:
$50

Generic Drugs:
No Charge

Overview


Plan Type:
HMO

Metal Level:
Silver

Health Spending Account:
No

Primary Care Office Visit:
20% Coinsurance after deductible

Specialist Office Visit:
20% Coinsurance after deductible

Out of Network Coverage:
Yes

Out of Country Coverage:
Yes

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible
Well Baby Care
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible

Inpatient

Hospital Services
In Network:
$400 Copay per Stay then 20% Coinsurance after deductible

Out of Network:
$1,500 Copay per Stay then 50% Coinsurance after deductible
Physician Fee
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Skilled Nursing Facility
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Mental Health
In Network:
$400 Copay per Stay then 20% Coinsurance after deductible

Out of Network:
$1,500 Copay per Stay then 50% Coinsurance after deductible
Substance Abuse
In Network:
$400 Copay per Stay then 20% Coinsurance after deductible

Out of Network:
$1,500 Copay per Stay then 50% Coinsurance after deductible
Home Healthcare
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Outpatient

Surgery
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
X-ray and Diagnostics
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Labs
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Facility Fee
In Network:
$300 Copay then 20% Coinsurance after deductible

Out of Network:
$1,500 Copay then 50% Coinsurance after deductible
Mental Health
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible
Substance Abuse
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Labor and Delivery Inpatient Services
In Network:
$400 Copay then 20% Coinsurance after deductible

Out of Network:
$1,500 Copay then 50% Coinsurance after deductible

Dental

Accidental Care
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
Not Covered
Glasses (Child)
In Network:
No Charge

Out of Network:
Not Covered

Additional Coverage

Chiropractic Care
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Habilitation Services
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services (Speech)
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services (Occupational Therapy)
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Hospice Service
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Diabetes Care Management
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Durable Medical Equipment
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Hearing Aids
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Nutritional Consuleling
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Reconstructive Surgery
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Doctor Visits

Primary Care Visit
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Specialist Visit
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Other Practitioner Office Visit
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$600 Copay then 20% Coinsurance after deductible

Out of Network:
$600 Copay then 20% Coinsurance after deductible
Urgent Care Services
In Network:
$75

Out of Network:
50% Coinsurance after deductible
Ambulance/Transportation Services
In Network:
20% Coinsurance after deductible

Out of Network:
20% Coinsurance after deductible

Drugs

Generic Prescription
In Network:
No Charge

Out of Network:
$5
Retail Brand Drugs
In Network:
$50

Out of Network:
$60
Non Retail Brand Drugs
In Network:
$100

Out of Network:
$110
Specialty Drugs
In Network:
30% Coinsurance after deductible

Out of Network:
50%

Additional Plan Information

Summary Of Benefits:

Provider Information:

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

Blue Cross and Blue Shield of Texas Quotit is an Independent, Authorized Agent for Blue Cross and Blue Shield of Texas. Blue Cross and Blue Shield of Texas, A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of Texas within the defined enrollment period to be accepted.

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