Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.
each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums – the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
medical plan comparison
| CORE HDHP | BUY UP HDHP | EPO | HCA-PPO | |||||
|---|---|---|---|---|---|---|---|---|
| IN-NETWORK | OUT-OF-NETWORK | IN-NETWORK | OUT-OF-NETWORK | IN-NETWORK | OUT-OF-NETWORK | IN-NETWORK | OUT-OF-NETWORK | |
| CALENDAR YEAR DEDUCTIBLE | ||||||||
| INDIVIDUAL | $8,300 | $16,600 | $4,200 | $11,100 | $5,500 | Not covered | $5,500 | $13,500 |
| FAMILY | $16,600 | $33,200 | $8,400 | $22,200 | $11,000 | Not covered | $11,000 | $27,000 |
| RX DEDUCTIBLE | Combined with Medical | Combined with Medical | $200 per person | Combined with Medical | ||||
| COINSURANCE (PLAN PAYS) | 100%* | 100%* | 80%* | 50%* | 80%* | Not covered | 80%* | 50%* |
| ANNUAL OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE) | ||||||||
| INDIVIDUAL | $8,300 | $16,600 | $6,000 | $22,000 | $8,150 | Not covered | $8,150 | $27,000 |
| FAMILY | $16,600 | $33,200 | $12,000 | $44,000 | $16,300 | Not covered | $16,300 | $54,000 |
| COPAYS/COINSURANCE | ||||||||
| PREVENTIVE CARE | 0% | 0%* | 0% | 50%* | 0% | Not covered | 0% | 50%* |
| PRIMARY CARE | 0%* | 0%* | 20%* | 50%* | $35 copay | Not covered | 20%* | 50%* |
| SPECIALIST SERVICES | 0%* | 0%* | 20%* | 50%* | $70 copay | Not covered | 20%* | 50%* |
| SIMPLE LAB/X-RAY | 0%* | 0%* | 20%* | 50%* | 20%* | Not covered | 20%* | 50%* |
| MENTAL HEALTH - INPATIENT | 0%* | 50%* | 20%* | 50%* | 0% | Not covered | 0% | 0% |
| MENTAL HEALTH - OUTPATIENT | 0%* | 50%* | 20%* | 50%* | 0% | Not covered | 0% | 0% |
| URGENT CARE | 0%* | 0%* | 20%* | 50%* | $75 copay | Not covered | 0% | 0% |
| EMERGENCY ROOM | 0%* | 0%* | 20%* | 50%* | $1,000 copay, then 20% | $1,000 copay, then 20% | 20%* | 20%* |
| RETAIL RX (UP TO 30-DAY SUPPLY) | ||||||||
| GENERIC | 0%* | 0%* | $10* | $10* | $20* | $20* | $20* | $20* |
| PREFERRED BRAND | 0%* | 0%* | $40* | $40* | $80* | $80* | $80* | $80* |
| NON-PREFERRED BRAND | 0%* | 0%* | $60* | $60* | $120* | $120* | $120* | $120* |
| SPECIALTY | 0%* | 0%* | 30% | Not covered | 30% | Not covered | 30%* | Not covered |
| MAIL-ORDER RX (UP TO 90-DAY SUPPLY) | ||||||||
| GENERIC | 0%* | 0%* | $20* | $20* | $40* | $40* | $40* | $40* |
| PREFERRED BRAND | 0%* | 0%* | $80* | $80* | $160* | $160* | $160* | $160* |
| NON-PREFERRED BRAND | 0%* | 0%* | $120* | $120* | $240* | $240* | $240* | $240* |
| SPECIALTY | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered |
*After deductible
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Medical plan Information
Medical contact information
BCBSTX HDHP Plan/BCBSTX Basic EPO Plan/BCBSTX HRA Plan
Carrier: Blue Cross Blue Shield of Texas
Policy Number: #272727
Phone: 800-521-2227
Website: www.bcbstx.com
pharmacy plan documents
pharmacy contact information
Carrier: CVS Caremark
Phone: 866-693-4621
Website: www.caremark.com
