- Individual and Family
Health Insurance - Individual and Family Health Insurance Plans
- PPO Select Blue Advantage Series III
- PPO Select® Choice Series III
- PPO Select® Saver Series III
- BlueEdgeSM Individual HSA
- PPO Select Value® CareSM
- PPO Select BasicSM
- SelecTEMP® PPO
- Foundation Hospital Care
- Texas Blue Alliance
- Dental Indemnity USA
- Health Savings Account (HSA)
- Short-Term Health Insurance
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Foundation Hospital Care PPO
Policy Form Number: PPO-IN HOSPITAL
General Benefits
| In-Network Benefits | Out-Of-Network Benefits |
| Foundation Hospital Care pays 80% of the allowable amount and you pay 20% of covered expenses after you meet your calendar year deductible. | Foundation Hospital Care pays 60% of the allowable amount and you pay 40% of covered expenses after you meet your calendar year deductible. |
| Emergency Room visit is subject to a $200 copayment amount and calendar year deductible, then pays 80% of the allowable amount and you pay 20%. | Emergency Room visit is subject to a $200 copayment amount and calendar year deductible, then pays 80% of the allowable amount and you pay 20%. |
Individual & Family Plans Only
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BlueCard PPO
Through the BlueCard PPO Program, BCBS Plans work together to help ensure that you receive affordable health care.
