Blue Cross and Blue Shield of Texas ÂⷠBlue Advantage Gold Hmoã¢â€žâ 206 Reviews

BlueCross BlueShield of Texas

AureateWellness Plans 2022

All Blue Advantage Gold HMO Plans offer the aforementioned gear up of essential health benefits, quality and amount of care every bit the Blueish Advantage Silver and Gold HMO Plans. The Blue Advantage Gilt HMO Plans are the most expensive plans, but too have the near comprehensive benefits. Gilt Plans have a college monthly premium and frequently lower out-of-pocket costs than Silver and Bronze plans. Blue Advantage Aureate HMO Plans may be right for y'all if you lot are an private or family who:

• Are willing to take a primary intendance physician (PCP) coordinate your intendance
• Prefers fixed doctor visit copayments
• Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
• Requires regular prescription medication
• Exercise NOT have an HSA (Gold plans are not HSA compatible)

At that place are deductibles for this programme, and this is an HMO programme. You must select a Blue Reward HMO Primary Care Physician (PCP) when enrolling in this plan.

While Gilt plans offer the highest level of coverage, there are no PPO options available in Texas, and then members that have doctors outside the network should opt for the Blue Advantage Plus Aureate 101 which will have some out-of-network benefits; but make certain to talk to your medico and BCBSTX to confirm the availability of these benefits.

Recommended Plan

The Best Gold Program

This HSA Eligible plan has a lower deductible and OOP max, significant you can save for the expenses you do incur and still have a higher level of protection in the event of unexpected wellness costs. The Blue Reward Plus plans also offer some out of network benefits even though this is still technically an HMO, so if your doctor isn't in any individual plan network for 2022, this is likely your best option. Click here to meet a chart comparison of the plans below.

Programme Proper noun	Blue Advantage Gold HMO 206	Bluish Reward Gold HMO 207
Summary of Benefits	Benefit Summary	Benefit Summary
Deductible a specified amount of money that the insured must pay before an insurance company will pay a claim.	$750	$0
Out-of-Pocket Maximum An out-of-pocket maximum is the most yous'll have to pay during a policy menstruum (usually a year) for wellness care services (includes deductible)	$8,700	$8,700
Principal Care Office Visit	$30 copay	$25 copay
Specialist Office Visit	twoscore%	$l copay
Mental Illness Treatment and Substance Abuse Rehab Office Visit	xl%	$25 copay
Emergency Room	$950 per occurrence copay, then twoscore%	$750 copay
Urgent Care	$45	$fifty copay
Inpatient Infirmary Service	$850 per occurrence deductible, so 40%	$1,500 per mean solar day copay
Outpatient Surgery	Freestanding Facility: $600/visit plus 20% coinsurance Infirmary: $600/visit plus twoscore% coinsurance	Freestanding Facility: $250/visit Hospital: $500/visit
Outpatient 10-Rays and Diagnostic Imaging	Freestanding Facility: 20% coinsurance Hospital: twoscore% coinsurance	Freestanding Facility: $10/exam Hospital: $20/examination
Outpatient Imaging (CT/PET Scans/MRIs)	Freestanding Facility: xx% coinsurance Hospital: 40% coinsurance	Freestanding Facility: $125/test Hospital: $250/test
Network	Blueish Advantage HMO
HSA Eligible	No	No
Outpatient Prescription Drugs – Preferred Pharmacy	$0/$ten/$50/35%/45%/fifty%	$0/$10/$50/$100/forty%/50%
Outpatient Prescription Drugs – Non-Preferred Pharmacy	$x/$20/$threescore/35%/45%/50%	$10/$xx/$70/$120/40%/fifty%

Prescription Drug Utilization Benefit Management Programs

Specialty Chemist's shop Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Chemist's provider. Member Pay the Departure: When choosing a make name drug over an available generic equivalent, y'all pay your usual share plus the difference in price. Prior Authorization/Step Therapy Requirements: Earlier receiving coverage for some medications, your doctor will demand to receive authority from BCBSTX and y'all may offset need to endeavor more clinically appropriate or cost-effective drugs. Mail service-Order Plan: Y'all may receive up to a 90-twenty-four hours supply for prescription drugs through the post-gild program or at select retail pharmacies depending on your prescription drug benefit.

*Percentages represent amount of coinsurance

**Not available on the health substitution market place (non subsidy eligible)

Plan Name	Bluish Reward Plus Gold 203	MyBlue Wellness Golden 403	Blue Advantage Aureate HMO 603
Summary of Benefits	View Full Details	View Total Details	View Full Details
Deductible a specified amount of money that the insured must pay before an insurance company will pay a claim.	$850	$1,100	$ane,500
Out-of-Pocket Maximum An out-of-pocket maximum is the most you'll have to pay during a policy period (normally a twelvemonth) for wellness intendance services (includes deductible)	$8,700	$8,700	$five,000
Primary Care Office Visit	$twenty copay	$0 / $20	$45
Specialist Office Visit	$45	thirty%	40%
Mental Illness Handling and Substance Abuse Rehab Office Visit	$20	20%	twoscore%
Emergency Room	$950 per occurrence deductible, and so 30%	$950 per occurrence deductible, then 30%	$950 per occurrence deductible, then 40%
Urgent Intendance	$45	$45 copay	$60 copay
Inpatient Hospital Service	$850 per occurrence deductible, and then xxx%	$850 per occurrence deductible, then 30%	$850 per occurrence deductible, so 40%
Outpatient Surgery	Freestanding Facility:20% coinsurance Hospital: thirty% coinsurance	Freestanding Facility: $300/visit plus 20% coinsurance Hospital: $300/visit plus 30% coinsurance	Freestanding Facility: $600/visit plus twenty% coinsurance Hospital: $600/visit plus twoscore% coinsurance
Outpatient 10-Rays and Diagnostic Imaging	Freestanding Facility: twenty% coinsurance Hospital: 30% coinsurance	Freestanding Facility (including bloodwork performed by a Select PCP): 20% coinsurance Hospital (including bloodwork):30% coinsurance In Office: Certain 10-Rays, Ultrasounds, and ECGs ordered by Select PCP): No Accuse; deductible does not apply	Freestanding Facility: 20% coinsurance Hospital: twoscore% coinsurance
Outpatient Imaging (CT/PET Scans/MRIs)	Freestanding Facility: twenty% coinsurance Hospital: 30% coinsurance	Freestanding Facility:twenty% coinsurance Hospital:thirty% coinsurance	Freestanding Facility:20% coinsurance Hospital:40% coinsurance
Network	Blue Reward HMO	MyBlue Health	Blue Advantage HMO
HSA Eligible	No	No	No
Outpatient Prescription Drugs – Preferred Pharmacy	$0/$10/$50/35%/45%/l%	$5/$xv/30%/35%/45%/50%	$0/$x/$50/35%/45%/50%
Outpatient Prescription Drugs – Non-Preferred Pharmacy	$10/$20/$60/40%/45%/50%	$x/$25/35%/40%/45%/fifty%	$10/$xx/$60/twoscore%/45%/50%

Prescription Drug Utilization Do good Management Programs

Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Chemist's provider. Member Pay the Deviation: When choosing a brand proper name drug over an available generic equivalent, you pay your usual share plus the difference in toll. Prior Say-so/Step Therapy Requirements: Before receiving coverage for some medications, your medico will need to receive authorization from BCBSTX and you may first demand to try more clinically advisable or cost-effective drugs. Mail-Guild Program: You may receive up to a 90-twenty-four hour period supply for prescription drugs through the mail service-society program or at select retail pharmacies depending on your prescription drug do good.

BCBSTX Dental Plans

• Dental Plans Brochure & Application

With the BCBSTX dental program, y'all'll go dental coverage on 24-hour interval one with no deductible deductible required for check-ups, cleanings and other preventive services. Most of import, costs are typically reduced when you receive care from any of our participating network dentists. However, you too have the option to see whatever dentist not in the network, but your out-of-pocket costs may exist college. Some highlights of Dental Indemnity Us coverage:

• Coverage can be used to provide dental benefits to an individual, spouse, children or any combination of dependents.
• A $50 deductible, based on fee schedule allowances, applies for dental procedures or services received by a covered private during each benefit year.
• Maximum deductible corporeality of $150 for family coverage.
• Deductibles do non apply to oral exams, cleanings, fluoride treatments, sealants and X-rays.
• $ane,000 orthodontia do good for children nether 19 years onetime

For more information on coverage and benefits, view the Dental Outline of Coverage  You must enroll in a BCBSTX health plan in guild to enroll in the dental plan (yous have up to 31 days from the effective date of your policy to enroll). Shop for a plan now.

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Source: https://texashealthagents.com/blue-cross-blue-shield-gold-plans-2022/

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