- 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 Blue Advantage Series III
Policy Form Number: PPO-SELBLUE-ADV-3
Prescription Drugs
|
Options |
Prescription Drug Card Program |
|||
|
Copayment Amounts |
Calendar Year Maximum Benefits |
|||
|
Generic |
Preferred |
Non Preferred |
||
|
Plan I |
$10 |
$30 |
$45 |
$3,000 |
|
Plan II |
||||
|
Plan III |
$10 |
$30 |
$45 |
$3,000 |
|
Plan IV |
||||
|
Plan V |
$10 |
$30 |
$45 |
$3,000 |
|
Plan VI |
||||
|
Plan VII |
$10 |
$30 |
$45 |
$3,000 |
|
Plan VIII |
||||
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.
