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#TRUVADA BLUE CROSS BLUE SHIELD COPAY TEXAS PLUS#

Silver plans are ideal for people who have regular medications or utilize specialist or doctors visits more often than their included yearly check-up. Coverage limitations may apply to certain medications.īCBSTX Silver plans offer a higher level of coverage than Bronze plans, and those who purchase on-exchange may also be eligible for cost-sharing reductions based on income, lowering deductibles and co-pays. These tiers are limited to a 30-day supply. Mail order is not available for Preferred and Non-Preferred Specialty tier drugs.

Six prescription drug payment level tiers: Preferred Generics / Non-Preferred Generics / Preferred Brand / Non-Preferred Brand / Preferred Specialty / Non-Preferred Specialty.

Prescription benefit coverage starts after annual medical deductible has been met, not counting copays.

You should seek advice based on your particular circumstances from an independent tax adviser regarding tax consequences of specific health insurance plans or products. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on for the purpose of avoiding tax penalties. Blue Cross and Blue Shield of Texas does not provide legal or tax advice and nothing herein should be construed as legal or tax advice.

As a reminder, a Health Savings Account (HSA) has tax and legal ramifications.

See your Summary of Benefits and Coverage for additional details.

Members may have lower out-of-pocket costs for some services provided by non-emergency freestanding outpatient facilities than the out-of-pocket costs for services provided in a hospital setting.

All percentages shown are of the allowable amount for covered services.Note that copays apply whether or not you have met the deductible. You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. The standard deductible and out-of-pocket maximum for this plan are shown.All benefits shown indicate member responsibility. This is a summary of benefit highlights only. Depending on your plan, benefits are either reduced or not available when non-participating providers are used.Mail-Order Program: You may receive a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSTX and you may first need to meet certain criteria or try more cost-effective drugs.

#TRUVADA BLUE CROSS BLUE SHIELD COPAY TEXAS PLUS#

Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Prescription Drug Utilization Benefit Management Programs 8 Outpatient Prescription Drugs – Non-Preferred Pharmacy 6,7 Outpatient Prescription Drugs – Preferred Pharmacy 6 7 Outpatient X-Rays and Diagnostic Imaging 4 Mental Illness Treatment and Substance Abuse Rehabilitation Office Visit Out-of-Pocket Maximum An out-of-pocket maximum is the most you’ll have to pay during a policy period (usually a year) for health care services (includes deductible) 2

Goldĭeductible a specified amount of money that the insured must pay before an insurance company will pay a claim.Ĭoinsurance What % you pay after your deductible has been met and before your out of pocket max You must select a Blue Advantage HMO Primary Care Physician (PCP) when enrolling in this plan.

There are deductibles for this plan, and this is an HMO plan.

Requires regular prescription medication.

Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs.

Are willing to have a primary care physician (PCP) coordinate your care.

Blue Advantage Gold HMO Plans may be right for you if you are an individual or family who: Gold Plans have a higher monthly premium and often lower out-of-pocket costs than Silver and Bronze plans. The Blue Advantage Gold HMO Plans are the most expensive plans, but also have the most comprehensive benefits. All Blue Advantage Gold HMO Plans offer the same set of essential health benefits, quality and amount of care as the Blue Advantage Silver and Gold HMO Plans.