Medical and Voluntary products: Dental,
Life, and Short Term & Long Term Disabilities
• Individual Insurance
• Small, Medium and Large groups Insurance
• Medicare Supplement Insurance
• Short Term (Temporary) Insurance
Blue Cross - Blue Shield
PPO Select Choice Provides:
| |
Affordable, cost effective health coverage. |
| |
Freedom to choose doctors and hospitals. |
| |
Choice of deductibles |
| |
Choice of out of pocket security provisions |
| |
Three-tier prescription drug program |
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Individual, spouse and child coverage's. |
|
Prescription Drug Card Program
|
Options
|
Separate
Deductibles |
Prescription Drug Card Program |
Individual
(per year) |
Copayment Amounts |
Max Benefits
(per year) |
| Gener |
Preferd |
Nonpref |
Plan I
Plan II |
$100 |
$15 |
$25 |
$40 |
$1,500 |
Plan III
Plan IV |
$200 |
$15 |
$25 |
$40 |
$1,500 |
Plan V
Plan VI |
$300 |
$15 |
$25 |
$40 |
$1,500 |
|
| Value |
|
| Feature for feature, PPO Select Choice offers
comprehensive major medical insurance for individuals and their families. |
$5,000,000 lifetime maximum benefit.
Inpatient hospital benefits and professional care (Preventative care)
Outpatient professional care (including office visits, X-rays, lab and
diagnostic services
24-hour, worldwide emergency care
Well-child care (routine physical exams and developmental assessment through
age 7)
Immunization benefits (thought age 7)
Human organ and tissue transplant benefits ($300,000 lifetime maximum) |
Home health care, hospice and skilled nursing facility benefits (subject
to limitations)
Age banded rates for child only coverage
Access to one of the largest provider networks in the state, Blue Choice
Security of one of the most widely recognized insurance cards - Blue Cross
and Blue Shield of Texas
Three tier pricing prescription drug plan
BlueCard program
Optional Dental
|
|
Options at a Glance
|
|
Options
|
Calendar Year Deductibles
|
Copayment
Amounts
|
Calendar Year out of Pocket
Maximum / Security Provisions
|
Coinsurance**
|
Individual
InNetwork
|
Individual
OutNetwork
|
Family
InNetwork
|
Family
OutNetwork
|
Office Visit*
|
Emergency
Care
|
Individual
InNetwork
|
Individual
OutNetwork
|
Family
InNetwork
|
Family
OutNetwork
|
InNetwork
|
OutNetwork
|
Plan
Pays
|
You
Pay
|
Plan
Pays
|
You
Pay
|
| Plan I |
$250 |
$500 |
$750 |
$1500 |
$25 |
80% |
$3000 |
$5000 |
$6000 |
$10000 |
80% |
20% |
75% |
25% |
| Plan II |
$500 |
$1000 |
$1500 |
$3000 |
| Plan III |
$1000 |
$2000 |
$3000 |
$6000 |
| Plan IV |
$1500 |
$3000 |
$4500 |
$9000 |
| Plan V |
$2500 |
$5000 |
$7500 |
$15000 |
| Plan VI |
$5000 |
$10000 |
$15000 |
$30000 |
* Physician consultation only. All other
Medical-sugical expense (lab & x-ray) will be subject to deductible
& coinsurance amounts. 80% subject to the deductible
** Percentages apply to covered expenses after calander-year
deductibles are met. Lifetime maximum is $2 million per person. |
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