Medical

HOW ARE THE PLANS ALIKE?

Both plans:

• Cover the same services, such as doctor’s office visits, hospitalization, emergency room care and prescription drugs.
• Pay 100% for in-network preventive care, such as routine physicals, well-woman exams, well-child exams, blood pressure checks, cholesterol tests and cancer screenings.
• Give you access to the same network of providers.
• Come with the Difference Card, a debit card funded by TEAM that helps you save money on your medical and pharmacy expenses.

Use The Difference Card

The Difference Card, also known as a medical expense reimbursement plan, or MERP, is a Mastercard funded by TEAM that helps pay for out-of-pocket medical and pharmacy costs.

• After you enroll in the BCBSTX Base Plan or Buy-Up Plan, you will automatically be enrolled in the Difference Card.
• Your Difference Card will be mailed to your home.

Medical Plans at a Glance

Both the BCBSTX Base and Buy-Up Plans have the same in-network providers. All covered services are subject to medical necessity as determined by the plan. All out-of-network services are subject to reasonable and customary (R&C) limitations.

Find a provider or facility near you by visiting bcbstx.com or calling 800-521-2227.

^*Out-of-network benefits are not shown under this summary. Please review the Summary of Benefits and Coverage for details.

1. Expenses that count toward meeting your out-of-pocket maximum include medical plan coinsurance and copays, prescription drug coinsurance and copays, and amounts you pay toward the deductible. Amounts above the reasonable and customary charge for out-of-network care do not count toward your out-of-pocket maximum.
2. Care Coordination must be notified within two days. Coverage for true emergencies only.
3. Inpatient Hospital: Pre-certification required.

Kaiser HMO at a Glance (California only)

If you live in California, you have another medical option available: the Kaiser HMO Plan.

With this plan, you must use in-network doctors to receive benefits — there is no out-of-network coverage except for urgent care and emergencies. You pay set copays for services, and there’s no deductible to meet. To find a provider, visit kp.org or call 800-464-4000.

1. Plan pays 100% for preventive care based on Kaiser’s preventive care guidelines.
2. Expenses that count toward meeting your out-of-pocket maximum include medical plan copays, prescription drug copays and coinsurance.

BCBSTX Base and Buy-Up Plans Paycheck Costs

Here are the premiums for the BCBSTX with Difference Card Base and Buy-Up Plans.

Kaiser HMO Paycheck Costs (California Only)

Here are your premium costs for the Kaiser HMO.