Blue Access for Producers

Consumer Choice Plans


Blue Cross and Blue Shield of Texas offers Preferred Provider Health Insurance Plan (PPO) and Health Maintenance Organization (HMO) Small Group Employer Consumer Choice insurance plans as mandated by the Texas Insurance Code. The Consumer Choice Options are:

Consumer Choice PPO Plan — Plan L100
If members choose a Consumer Choice PPO Plan through Blue Cross and Blue Shield of Texas, they may access the BlueChoice network, one of the largest provider networks in the state. Members should seek care from BlueChoice network providers to receive the higher level of benefits. Or, they may choose to seek care from a non-network provider or a ParPlan provider and receive a reduced level of benefits.

The Consumer Choice PPO Plan has a $1000 individual / $3000 family combined deductible, usually no office visit copayment, 80 percent / 60 percent coinsurance, $150 ER copayment, $3000 individual / $9000 family coinsurance stop-loss, $1,000,000 lifetime maximum per participant and a $20/$35/$50 prescription drug program.

The Consumer Choice PPO Plan does not include, in whole or in part, coverage for the following health care benefits as mandated by state law:

  • Treatment of Chemical Dependency

  • Prescription Contraceptive Drugs and Devices and Related Drugs (Oral Contraceptives not excluded)

  • In-Vitro Fertilization

  • Serious Mental Illness (non-public entities only)

  • Speech and Hearing

  • Home Health Care


Consumer Choice HMO Plan — Plan 99
If members choose a Consumer Choice HMO Plan through HMO Blue Texas, they must access the HMO Blue Texas network of providers for services to be covered. If members receive care from a network provider other than their Primary Care Physician (PCP) and are not referred to that network provider by their PCP or if they receive services from a non-network provider, those services are not covered.

The Consumer Choice HMO Plan has a $25 physician office visit copayment, $500 copayment per day / $2500 per admission maximum inpatient hospital care, $150 ER copayment, $5,000 individual / $10,000 family out-of-pocket and no lifetime maximum. Members can add a $20/$35/$50 prescription drug coverage program at additional cost.

The Consumer Choice HMO Plan does not include, in whole or in part, coverage for the following health care benefits:

  • Treatment of Chemical Dependency

  • Prescription Contraceptive Drugs and Devices and Related Drugs (Oral Contraceptives not excluded)

  • In-Vitro Fertilization

  • Serious Mental Illness (non-public entities only)

  • Speech and Hearing

  • Rehabilitation Services (other than for acquired brain injury)