How Are the Plans Alike?

All three 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-baby exams, blood pressure checks, cholesterol tests and cancer screenings.
  • Let you see any doctor but offer savings when you use Blue Cross Blue Shield in-network doctors.

How Are the Plans Different?

CDHP

  •  No copays with this plan. You pay the full cost of care (except for in-network preventive care) until you meet the deductible. After you meet the deductible, you and the plan share the cost of care.
  • Company-funded HSA to help you pay for care; you can add money of your own, too.
  • Lowest paycheck contributions of all three plans, but you’ll have to meet higher deductibles.
Consider the CDHP if you want lower paycheck contributions and the tax advantages of an HSA.

PPO Plans

  • Copays for some services such as doctor’s office visits; for other services such as hospitalization, you must meet the deductible and then you and the plan share costs (coinsurance).
  • Lower deductibles than the CDHP, so your paycheck contributions are higher.
  • No company-funded Health Savings Account (HSA).
Consider a PPO if you’re willing to have higher paycheck contributions in exchange for more predictable costs.

Find the Right Fit: Your Medical Plan Options

Trying to decide which plan to choose? Learn how the plans work and which may be the best choice for you.

How the Plans Work

Here’s a step-by-step look at how the plans work.

CDHP

Step 1: Set Up Your HSA

The company adds money to your account: $1,000 for employee-only or employee and spouse coverage or $2,000 for employee and children or family coverage. You can also contribute pre-tax money of your own, up to IRS limits.

Step 2: Pay Toward Your Deductible

You pay 100% of the cost for medical care and prescription drugs (except for in-network preventive care) until you meet your deductible. You can use your HSA to help you pay for care before you have to dip into your own pocket.

Step 3: Share Costs With the Plan

Once you meet your deductible, you’ll share costs with the plan — using money from your HSA or wallet — until you meet the out-of-pocket maximum.

Step 4: The Plan Pays the Rest

If you reach your out-of-pocket maximum, the plan will pay 100% of your eligible expenses for the rest of the plan year.

Basic & Enhanced PPO

Step 1: You Pay for Care

You pay copays for doctor’s office visits and prescription drugs. You don’t have to meet the deductible for these services.

Step 2: Share Costs With the Plan

For other services, such as hospitalization, you must meet your deductible before the plan shares costs.

Step 3: The Plan Pays the Rest

If you reach your out-of-pocket maximum, the plan will pay 100% of your eligible expenses for the rest of the plan year

Anytime, Anywhere Care, @Work or @Home

Talk to a doctor 24/7 from your computer, smartphone or tablet. MDLive doctors can answer your questions, make a diagnosis and even prescribe basic medications (subject to availability by state). You and your covered family members can use this benefit if you’re enrolled in a TEAM medical plan. For the CDHP, you’ll pay 20% after the deductible. For the PPO plans, you’ll pay your PCP copay. To use MDLive, visit members.mdlive.com/bcbstx or call 888-680-8646.

Medical Plans at a Glance

With all three plans, you can see any provider. But if you visit an in-network provider, you’ll get services at the lower negotiated rate. If you use an out-of-network provider, you’ll get a lower level of coverage and your costs will be higher. Find an in-network provider by visiting bcbstx.com or calling 800-521-2227. Here’s a look at what you’ll pay when you need care.

CDHP Basic PPO Enhanced PPO
In-Network Out-of-Network1 In-Network Out-of-Network1 In-Network Out-of-Network1
2019 Health Savings Account (HSA) Contributions from TEAM
Employee only or employee and spouse $1,000 No contribution No contribution
Employee and children or family $2,000 No contribution No contribution
Deductible (The amount you must pay benefits for some services. Amounts you pay towards the the deductible count toward your out-of-pocket maximum.)
Employee only $2,000 $5,000 $1,500 $2,000 $750 $900
Family $4,000 $10,000 $4,500 $6,000 $2,250 $2,700
What you pay
Preventive care2 $0 50% after deductible $0 60% after deductible $0 40% after deductible
Office visits 20% after deductible 50% after deductible $15 copay for Blue Distinction provider; $30 copay for primary care physician (PCP); $40 copay for specialist; $35 copay for urgent care 60% after deductible $15 copay for Blue Distinction provider; $25 copay for primary care physician (PCP); $35 copay for specialist; $35 copay for urgent care 40% after deductible
Virtual visits 20% after deductible N/A $30 copay N/A $25 copay N/A
Maternity care 20% after deductible 50% after deductible $30 PCP copay/$40 specialist copay, then 30% of remaining eligible expenses after deductible 60% after deductible $25 PCP copay/$35 specialist copay, then 20% of remaining eligible expenses after deductible 40% after deductible
Inpatient hospital3 20% after deductible 50% after deductible4 $250 copay per admission, then 30% after deductible $500 copay per admission, then 60% after deductible4 20% after deductible $500 copay per admission, then 40% after deductible4
Outpatient surgery 20% after deductible 50% after deductible 30% after deductible 60% after deductible 20% after deductible 40% after deductible
Emergency care5 20% after deductible 30% after deductible $250 copay (waived if admitted)
Out-of-pocket maximum6 (The maximum amount you will have to pay out of pocket for the plan year. If you reach this limit, the plan will pay 100% of your eligible expenses for the rest of the plan year.)
Employee only $3,500 $10,000 $6,000 $12,000 $3,500 $7,500
Family $7,000 $20,000 $12,000 $24,000 $10,500 $20,000
  1. If you use an out-of-network provider, you are responsible for any charges above the reasonable and customary limit.
  2. Plan pays 100% for in-network preventive care based on Blue Cross Blue Shield’s preventive care guidelines.
  3. Pre-certification required.
  4. You pay a $350 penalty if you fail to pre-certify your hospital stay.
  5. Care Coordination must be notified within 2 days. Coverage for true emergencies only.
  6. 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.

Paycheck Costs

Here are your premium costs for the medical plans.

CDHP Basic PPO Enhanced PPO
Bi-weekly Monthly Bi-weekly Monthly Bi-weekly Monthly
Employee only $20.65 $44.75 $30.75 $66.62 $57.15 $123.82
Employee and children $116.46 $252.33 $127.68 $276.64 $240.95 $522.05
Employee and spouse $133.02 $288.22 $156.67 $339.45 $295.02 $639.22
Family $179.28 $388.43 $214.65 $465.08 $403.19 $873.57

Tobacco Surcharge

If you use tobacco products (cigarettes, chew and/or electronic cigarettes), you’ll pay an additional $125 per month for your medical benefits. This surcharge will be waived if you’re participating in a smoking cessation program at the time you enroll. For more information on the smoking cessation program, contact Blue Cross Blue Shield at 866-412-8795.

Spousal Surcharge

To help keep our costs down, we’ve added a spousal surcharge. If your spouse has other coverage available through his or her employer and you enroll your spouse in a TEAM medical plan, you’ll pay a spousal surcharge of $150 per month.