- 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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PPO Select® Saver Series III
Policy Form Number: PPO-SELSAVER-3
Prescription Drugs
|
Options |
Separate Deductibles |
Prescription Drug Card Program | |||
| Individual (per calendar year) |
Copayment Amounts | Calendar Year Maximum Benefits | |||
| Generic | Preferred | Non Preferred | |||
| Plan I |
$200
|
$10
|
$40
|
$55
|
$3,000
|
| Plan II |
$200
|
$10
|
$40
|
$55
|
$3,000
|
| Plan IIII | |||||
| Plan IV |
$200
|
$10
|
$40
|
$55
|
$3,000
|
| Plan V | |||||
| Plan VI |
$200
|
$10
|
$40
|
$55
|
$3,000
|
| Plan VII | |||||
- General Benefits
- Preventive Care
- Child-Only Coverage
- Prescription Drug Program
- View Outline of Coverage
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.
