Select Value Care Plan
PPO Select Value Care Overview
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PPO Select Value Care plan is a cost-sharing plan that provides a wide range of benefits at a reduced co-insurance level. The plan provides 50% benefit coverage on which BCBSTX will share in 50% of your health care costs with no deductible to meet. The coinsurance is shared 50%/50% until you reach your out-of-pocket maximum amount of $10,000 in-network. PPO Select Value Care is a is a great plan for individuals and families seeking a low-cost plan, but needing coverage for health services most likely to involve catostrophic expenses.
PPO Select Value Care plan features include:
- Access to the BlueChoice network, one of the largest PPO networks in Texas
- No deductible to meet
- Preventive care benefit for adults and children (Pays 50%)
- 3 tier prescription drug copay formulary ($10 / $30 / $45) (after $200 Rx deductible)
- Choice of $10,000, $20,000, or $30,000 out-of pocket maximum for individuals
- Choice of $20,000, $40,000, or $60,000 out-of pocket maximum for families
- 50% coinsurance
- The option for a child-only individual health insurance plan with affordable rates based on age
- Optional dental coverage
- $5,000,000 lifetime maximum
PPO Select Value® CareSM may be right for you if you are an individual or family who:
- Seeks comprehensive coverage at an affordable price
- Wants no deductible to meet
- Wants no copays
- Occasionally visits a doctor
Select Value Care 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 Value Care 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 Value Care® plans:
- Prescription drug copays - $10 generic, $40 preferred, $55 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 $9,000 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 PPO Select® Choice
- 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® Saver 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 Value Care 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 Value Care Pays |
| Prescription Deductible Per person per calendar year |
$200 | |
| 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.