Blue Cross Blue Shield Blue Choice Silver PPO 003 (Texas)

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Company Blue Cross Blue Shield of Texas
Plan Year 2014
State Texas
Metal Tier Silver
Plan Type PPO
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Cost Sharing Benefits (In Network)

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,000
Deductible (Family) $12,700
Coinsurance $0
Out of Pocket Maximum (Individual) $6,000
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit $30
Specialist Visit $50
In Patient Hospital Services $250 Copay per Stay
Emergency Room Services $500

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $0
Laboratory Outpatient and Professional Services $0
X-ray and Diagnostic Imaging $0

Other

Mental / Behavioral Health $30 copay
Rehabilitative Speech Therapy $0
Rehabilitative Occupational & Physical Therapy $0
Outpatient Facility $200 copay
Outpatient Surgery $0

Prescription Drugs

Generic Rx No Charge
Preferred Brand Rx $50
Non Preferred Brand Rx $100
Specialty Drugs $150

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $5,000.00
Deductible (Family) $10,400.00
Out of Pocket Maximum (Individual) $5,000.00
Out of Pocket Maximum (Family) $10,400.00
Primary Care Physician $30
Specialists $50
Emergency Room $500
Inpatient Facility $250 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $50
Non Preferred Brand Rx $100
Specialty Drugs $150

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,500.00
Deductible (Family) $4,500.00
Out of Pocket Maximum (Individual) $1,500.00
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician $30
Specialists $50
Emergency Room $500
Inpatient Facility $250 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $50
Non Preferred Brand Rx $100
Specialty Drugs $150

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $500.00
Deductible (Family) $1,500.0
Out of Pocket Maximum (Individual) $500.00
Out of Pocket Maximum (Family) $1,500.00
Services In Network Out of Network
Primary Care Physician $30
Specialists $50
Emergency Room $500
Inpatient Facility $250 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $50
Non Preferred Brand Rx $100
Specialty Drugs $150

Other Plans

Other plans that are available in the state.

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