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Blue
Cross Blue Shield Experts
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Blue
Cross and Blue Shield of Texas is the largest insurer
in the state of Texas, offering traditional plans that can
include co-payments for doctor visits and prescriptions, and
economical major medical plans which have a deductible that
must be met before coverage begins.
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Plans
at a Glance: Select
a plan name below to view its
brochure 
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Plans
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Lifetime
Maximum
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$5
Million per Member
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$5
Million per Member
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$5
Million per Member
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$5
Million per Member
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Dr.
Co-Pay
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$30
- $45,
varies by deductible
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$25
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Subject
to Deductible
and Co-insurance
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Subject
to Deductible
and Co-insurance
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Rx
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$2,500
per Calendar Year maximum for each Participant.
Co-payment is $20 for Generic Drug,
$35 for Preferred Brand Name Drug,
$50 for Non-Preferred Brand Name
Drug. |
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$2,500
per Calendar Year maximum for each Participant.
$300 deductible.
Co-payment is $15 for Generic Drug,
$25 for Preferred Brand Name Drug,
$40 for Non-Preferred Brand Name Drug. |
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$2,500
per Calendar Year maximum for each Participant.
$500 deductible.
Co-payment is $10 for Generic Drug,
$50 for Preferred Brand Name Drug,
$65 for Non-Preferred Brand Name
Drug. |
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$2,500
per Calendar Year maximum for each Participant.
Deductible varies based on plan deductible.
Co-payment is $10 for Generic Drug,
$50 for Preferred Brand Name Drug,
$65 for Non-Preferred Brand Name
Drug. |
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Wellness
Services
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100%
of Allowable Amount subject to Physician
office visit Co-payment.
$300 per Calendar Year maximum.
Childhood Immunization:
100% of Allowable Amount, through
age 7. |
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Benefits provided for routine physical examinations,
well-child care, hemoccult test, pap smears,
immunizations for Participants 8 years of
age and over, routine lab, x-ray, vision
and hearing examinations up to a $300
combined Calendar Year max for Network and
Out-of-Network Benefits.
Subject to $25 co-pay. |
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Immunizations
through age 7 paid at 100%,
Annual mammogram screening for females over
age 35, Test for detection of prostate cancer
(at age 40 with a family history or routinely
after age 50). |
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Immunizations
through age 7 paid at 100%,
Annual mammogram screening for females over
age 35, Test for detection of prostate cancer
(at age 40 with a family history or routinely
after age 50). |
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Deductibles
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$250,
$500, $1,000, $1,500,
$2,500, $5,000 per individual.
The
family deductible is three times the individual
deductible.
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$250,
$500, $1,000, $1,500,
$2,500, $5,000 per individual.
The
family deductible is three times the individual
deductible.
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$1,500,
$2,500, $3,500, $5,000
per individual.
The
family deductible is three times the individual
deductible.
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$500,
$1,000, $1,500, $2,500,
$5,000 per individual.
The
family deductible is three times the individual
deductible.
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Network
Co-insurance
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85%
after deductible
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80%
after deductible
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75%
after deductible
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75%
after deductible
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Non-Network
Co-insurance
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Deductible
doubles,
then 75% after deductible.
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Deductible
doubles,
then 75% after deductible.
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50%
after deductible.
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Deductible
doubles,
then 60% after deductible.
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Out-of-Pocket Maximum
(in addition to the deductible)
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$250
or $500 ded. = ind:$2,000,
fam:$4,000
$1000
or $1500 ded. = ind:$3,000,
fam:$6,000
$2,500
or $5,000 ded. = ind:$5,000,
fam:$10,000
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$3,000
individual, $6,000 family
(in network).
$5,000 individual, $10,000
family
(out of network). |
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$3,000
individual
$9,000
family
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$3,000
individual
$9,000
family
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All
other
Services
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85%
after deductible
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80%
after deductible
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75%
after deductible
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75%
after deductible
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Coverage
Synopsis:
Blue
Cross Blue Shield generally offers the best value
for full coverage. They cover doctor visits, prescription
drugs, vision, accident benefit, and of course, hospitalization.
The coverage and rates are excellent, and they have
what is probably the widest PPO network in the state of Colorado.
Complete details can be seen by opening the"Outline
of Coverage" brochure for
the plan you are interested in:
You can
also refer to the chart above for a coverage
overview.

Rates:
Rates
vary based upon zip code, age, and effective date. You
can get an instant
quote, or check out the rate
chart.

PPO
Network:
Blue Cross
of Texas gives you access to one of the largest networks in
Texas, with thousands of health care providers throughout
the state. The large list of doctors and hospitals can
be viewed at their online
directory.

Underwriting:
Blue Cross
has one of the easiest, most efficient underwriting teams
in the industry. The process is very fast if no medical
records are needed. While it is always a good idea to
apply at least three weeks prior to the time you need your
new coverage to take effect, some applications that are done
online are approved by BCBS within 24 hours. If medical
records are needed, you may have to reapply, and include medical
records.
The company
does have the right to accept or decline any individual or
family application. Certain conditions may be waivered
with a temporary rider (usually for one to two years), or
an indefinite rider. If you are currently being treated
for depression, anxiety, or high cholesterol, please let us
know before you apply so we can make sure there are no delays
in getting you covered.

Effective
dates:
The coverage
can go into effect in as quickly as 24 hours, though
the applicant risks being declined if claims are submitted
before the underwriting process is completed. You may
request an effective date any time the date after you sign
the application and 60 days later. Please note
that you will be billed starting on your requested effective
date, even if you have not yet been notified that you have
been approved. This is very good for someone who does
not have any present coverage and would like for their benefits
to begin right away. For those who are already covered,
it is suggested that you maintain your current coverage in
force until you have received notice from either Health
Insurance for America or
directly from Blue Cross that your coverage has been approved
and is in force.
Your earliest
possible effective date will be the day after Blue Cross has
received all the necessary documents and information needed
to process your application.

About
Blue Cross Blue Shield:
Since
1939, Blue Cross and Blue Shield of Texas has worked to help
keep Texans healthy. The company's stated mission since
its founding has been to provide financially sound health
care coverage to as many Texans as possible.
- Blue
Cross serves more than 3 million members in all 254
Texas counties.
- Blue
Cross maintains its state headquarters in Richardson, with
regional headquarters in Houston, Austin and Lubbock.
- Blue
Cross processes members' claims in Texas -- an average of
more than $22 million worth every day, five days
a week -- in their claims and customer service facilities
in Abilene, Houston, Marshall, Richardson, San Angelo, Waco
and Wichita Falls.
- Over
the past few years, Blue Cross has cut administrative costs
by 20 percent, saved more than $100 million and increased
claims processing productivity by 24 percent.
- Their
health care provider network is the largest in the state,
with more than 27,000 physicians and 400 hospitals
across Texas.
- They
have 15 medical doctors on staff combining more than
400 years of experience in medicine, an Office of
Physician Advocacy dedicated to addressing network physician
concerns and fostering robust communication with the physician
community.
- Blue
Cross provides physicians with its exclusive BlueLink online
referral and precertification system, which allows physicians
to obtain real-time access to network specialist referrals
and approval of inpatient and outpatient procedures, 24
hours a day, seven days a week.
A division
of Health Care Service Corporation (HCSC), Blue Cross and
Blue Shield of Texas is among the financially strongest health
insurers in the nation providing its members with a high level
of confidence and security. For detailed financial reports,
please visit the HCSC
web site.

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