BCBSTX - Select Choice Plan
PPO Select Choice Overview
PPO Select Choice offers choice and flexibility for individual and family health care coverage. It is not a pre-packaged, one-size-fits-all health insurance plan, but rather health coverage that gives you a selection of benefits to fit your health care coverage needs now and the flexibility to fit your needs in the future. PPO Select Choice plan highlights include:
Key Select Choice® plan features include:
- Access to the BlueChoice network, one of the largest PPO networks in Texas
- $25 office visit copayment (excludes same day lab and x-rays
- Preventive care benefits for adults and children
- 80% coinsurance
- 3 tier prescription drug copay formulary ($10 / $30 / $45) after $200 prescription deductible
- Optional dental coverage
- 24-Hour Worldwide Care
- Unlimited lifetime maximum
PPO Select Choice Series III is a slightly watered-down version of the Select Blue Advantage plan that provides a high level of benefits at a more cost effective premium by changing a few of the enhanced benefits in the Select Blue Advantage plan. These benefit changes include:
- Adding a $200 prescription drug deductible
- $25 office visit initial office visit only covers consultation (excludes same day lab and x-ray benefit)
- No emergency room copay (subject to deductible and coinsurance)
- 80% coinsurance (instead of 85%)
Select Choice® 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 Choice 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.
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 Choice® 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 ($200 Rx Deductible)
- 80% 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.
- 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 Choice® 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
More Plan Details
It's important to know the critical features of the health plan you are considering. Each plan's Outline of Coverage provides brief descriptions of the basic provisions of our Select Choice plans, as well as details on policy renewability, benefit exclusions and coverage limitations.
For the Select Choice 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 after satisfying a $200 prescription 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 Choice Pays|
Per person per calendar year
Up to a 30-day supply.
|Preferred Drugs||$30 co-payment||100%|
|Non-Preferred Drugs||$45 co-payment||100%|
Up to a 90-day supply of maintenance drugs is available through home delivery.
|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 .
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
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.