Select Blue Advantage Plan
Select Blue Advantage Overview
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Select Blue Advantage provides the most extensive benefits of any individual health insurance plan offered by BlueCross BlueShield of Texas usually found in employer group health plans. Select Blue Advantage uses the BCBS PPO network, the one of the largest PPO network in Texas.
Key Select Blue Advantage® plan features include:
- Access to the BlueChoice network, one of the largest PPO networks in Texas
- $25 office visit copayment that includes same day lab and x-rays
- $100 emergency room copayment
- Preventive care benefits for adults and children
- 85% coinsurance
- 3 tier prescription drug copay formulary ($10 / $30 / $45) with no prescription deductible
- Optional dental coverage
- 24-Hour Worldwide Care
- $5,000,000 lifetime maximum
Select Blue Advantage® may be right for you if you are an individual or family who:
- Seeks coverage comparable to what is offered by employers
- Prefers fixed doctor visit copayments
- Regularly visits a doctor
- Requires regular prescription medication
- Wants the option of child-only coverage
Select Blue Advantage uses the BlueChoice® Network: The BlueChoice® network allows you to save on premiums and the cost of covered services when you use a contracting BlueChoice® hospital, doctor or specialist. You do not need to select a primary care physician or obtain a referral to see a specialist.
Compare the features, options and costs of the Series 3 Plans® plans to find the one that's right for you.
Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Texas family.
Select Blue Advantage Costs
Health insurance costs include monthly premium payments, individual/family deductibles, out-of-pocket expenses, copayments, and coinsurance. Here is what you can expect with Select Blue Advantage® plans:
- Individual in-network deductibles ranging from $250 to $10,000 – customize your plan by choosing a deductible amount that works best for your situation
- $25 office visit copayments
- Prescription drug copays - $10 generic, $30 preferred, $45 non-preferred (No Rx Deductible)
- 85% coinsurance of services provided in-network, after deductible and copayments are met
- Annual out-of-pocket maximum of $3,000 for individuals and $6,000 for families
By using a contracting BCBS PPO hospital, doctor or specialist you are able to save on premiums and the cost of covered services. You do not need to select a primary care physician or obtain a referral to see a specialist.
For more information on costs, get a quick quote or see the benefit summary.
What's Included with Select Blue Advantage®
- Coverage for major hospital, medical and surgical expenses incurred as a result of a covered accident or sickness
- Coverage for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care
- Although you can go to the hospital or doctor of your choice, your benefits under a Select Blue Advantage® plan will be higher, and your costs lower, when you use the services of participating PPO or BlueChoice® providers.
- As with all individual Blue Cross and Blue Shield of Texas plans, the freedom of not having to select a primary care doctor or obtain a referral to see a specialist
Prescription Drug Coverage
For the Select Blue Advantage plans, there is a prescription drug card benefit that includes a $10 copay for generic, $30 copay for preferred, and $45 copay for non-preferred drugs. This benefit is immediately available and not subject to a deductible.
If you take medications for birth control, high blood pressure, cholesterol, or other long-term needs, there is a Home Delivery prescritpion benefit where you can receive a 90 day supply in the mail for the cost of a 60 day supply at retail. You may also fill a 90-day supply at a retail pharmacy and in some cases, you may pay less than filling three 30 day supplies.
| Outpatient Prescription Drug Benefit | You Pay | Select Blue Advantage Pays |
| Retail Pharmacy Up to a 30-day supply. |
||
| Generic | $10 co-payment | 100% |
| Preferred Drugs | $30 co-payment | 100% |
| Non-Preferred Drugs | $45 co-payment | 100% |
| Home Delivery Up to a 90-day supply of maintenance drugs is available through home delivery. |
||
| Generic | $20 co-payment | 100% |
| Preferred Drugs | $60 co-payment | 100% |
| Non-Preferred Drugs | $90 co-payment | 100% |
| Calendar Year Maximum | There is a $3,000 calendar year maximum for each member whether or not benefits are received at a participating pharmacy, non-participating pharmacy, or through the mail service prescription drug program. | |
To see if your prescriptions are included, view the individual health insurance plan Preferred Drug List 
.
Plan Renewals
Your BCBSTX policy can ONLY be terminated for the following reasons:
- Failure to pay
- The 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)
- If you no longer reside, live or work in an area where we are authorized to do business
Optional Dental Plan
The Individual Dental Indemnity plan is available as an optional benefit with your individual Blue Cross Blue Shield of Texas Select health insurance plan. There is an additional premium.
Some of the highlights of Dental Indemnity USA coverage include:
- Covers oral exams, cleanings, fluoride treatments, sealants, x-rays, and other preventive procedures immediately with no waiting period
- A $50 individual and $150 family deductible, based on fee schedule allowances, applies for dental procedures or services received by a covered individual during each benefit year
- $1,000 benefit per person per year
- $1,000 orthodontia lifetime maximum benefit per person
- Up to 20 percent discount for orthodontic services at participating providers
- Covered individuals must be enrolled for 12 months before receiving dental benefits in these categories; major restorative, periodontics, removable prosthetics, fixed bridge and orthodontia.
See the complete dental outline of coverage for more details on covered benefits.