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Family Health Insurance Plans Blue Cross

2018 Individual and Family Plans

Blue Cross and Blue Shield of Texas (BCBSTX) has been around for 80 years. We stand by our members as one of the most experienced health care coverage companies in the state.

View Plans and Pricing

See what Individual and Family Health Care Plans are available in your area.

Plan Networks

Different health care plans use certain groups of doctors, hospitals and other health care professionals. These are known as networks, and each network provides a full range of covered health care services.

Networks – and member costs – differ from plan to plan. Before you choose a plan, you may want to check if your doctor or hospital is in the network. If you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost.

Blue Advantage HMO SM

  • Choice of Doctors: With an HMO, you choose a primary care provider (PCP) who will be your main contact for all your health care needs. Whether you are making an appointment for an annual exam or need a referral, your PCP is the person to call.
  • Premium:

Plan Levels

We have three levels of health care plans available for 2018 – bronze, silver and gold. All of our plans follow the Affordable Care Act (ACA) rules and give you the same set of essential health benefits, quality and amount of care (but your out-of-pocket costs for the benefits may differ).

Bronze Plans

Lowest premium costs

Higher out-of-pocket costs when you receive care

  • We pay 60%
  • You pay 40%

Silver Plans

Higher premium costs than Bronze plans

Lower out-of-pocket costs than Bronze plans

  • We pay 70%
  • You pay 30%

Gold Plans

Higher premium costs than Silver plans

Lower out-of pocket costs than silver plans

  • We pay 80%
  • You pay 20%

The percentages shown reflect the average total cost for members, including all deductibles, copays and coinsurance. Your actual costs and ratios may vary based on your specific plan and usage.

Our plan brochure can help you get started or learn more about our plans.

Financial Assistance

When shopping for a new health care plan, you may qualify for help with the cost of buying coverage by:

  • Getting low or no-cost coverage through a government program
  • Lowering your monthly premium bill with a premium tax credit (PTC)
  • Qualifying for cost-sharing reductions (CSRs) which are discounts to lower your out-of-pocket costs, like deductibles, copayments, coinsurance and prescription costs

Shopping Assistance

Thank you for looking at coverage options from BCBSTX. We’re here to help you get the 2018 coverage – and information – you need.

Key Coverage Details

Selecting a health care plan with BCBSTX may include some of these key coverage details.

Every one of our health care plans cover these essential health benefit categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health disorder services
  • Substance use disorder services
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services

Many long-term illnesses can be prevented or managed when found early. With ACA, most health care plans must cover a range of preventive care services with no in-network, out-of-pocket costs. Services include certain screenings, immunizations, and other types of care, like:

  • Blood pressure, diabetes and cholesterol tests
  • Many cancer tests, such as mammograms and colonoscopies
  • Help to stop smoking, lose weight, fight depression and reduce alcohol abuse

Remember, you may have to pay more for your care if you visit a doctor outside of your network. You can find in-network doctors and hospitals using our online Provider Finder ® tool.

If you’re not having a medical emergency, you have several options for care. Some are available 24 hours a day, seven days a week, like:

  • 24/7 Nurseline – When calling the number on the back of your member ID card, registered nurses will ask about your condition and may recommend where to go for care (if needed).
  • Provider Finder ® – Our online Provider Finder ® tool Opens in new window lets you find in-network doctors and hospitals in your area.
  • Virtual Visits, Powered by MDLIVE – Interact with independently contracted MDLIVE board-certified doctors where – and when – you need it. Learn more about virtual visits.

Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe. Behavioral Health service is limited to interactive audio/video (video only), along with the ability to prescribe in all states. Service availability depends on location at the time of consultation.

Virtual Visits, Powered by MDLIVE may not be available on all plans. Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations, and exclusions. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services.

MDLIVE operates and administers the virtual visit program and is solely responsible for its operations and that of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission.

Blue Cross ® , Blue Shield ® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. ↵

With prescription drug coverage, you may get help with paying for your medicine. Based on your coverage, you may pay either a fixed dollar amount (copayment) or a percentage (coinsurance) of your prescription drug costs. Your prescription drug coverage includes:

  • A broad pharmacy network
  • Mail order services
  • Access to online tools for managing your prescription drugs
  • A drug list
  • Other pharmacy benefits

Note: Prescription drug coverage varies by plan.

2018 Individual and Family Plans

Blue Cross and Blue Shield of Illinois (BCBSIL) has been around for 80 years. We stand by our members as one of the most experienced health care coverage companies in the state.

View Plans and Pricing

See what Individual and Family Health Care Plans are available in your area.

Plan Networks

Different health care plans use certain groups of doctors, hospitals and other health care professionals. These are known as networks, and each network provides a full range of covered health care services.

Networks – and member costs – differ from plan to plan. Before you choose a plan, you may want to check if your doctor or hospital is in the network. If you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost.

BlueCare Direct SM

  • Choice of Doctors: A Primary Care Provider (PCP) will coordinate your health care
  • Premium:

Blue FocusCare SM

  • Choice of Doctors: A Primary Care Provider (PCP) will coordinate your health care
  • Premium:

Blue Precision HMO SM

  • Choice of Doctors: A Primary Care Provider (PCP) will coordinate your health care
  • Premium:

Blue Choice Preferred PPO SM

  • Choice of Doctors: A network of doctors and hospitals to choose from.
  • Premium: May have higher monthly premiums than HMO

Plan Levels

We have three levels of health care plans available for 2018 – bronze, silver and gold. All of our plans follow the Affordable Care Act (ACA) rules and give you the same set of essential health benefits, quality and amount of care (but your out-of-pocket costs for the benefits may differ).

Bronze Plans

Lowest premium costs

Higher out-of-pocket costs when you receive care

  • We pay 60%
  • You pay 40%

Silver Plans

Higher premium costs than Bronze plans

Lower out-of-pocket costs than Bronze plans

  • We pay 70%
  • You pay 30%

Gold Plans

Higher premium costs than Silver plans

Lower out-of pocket costs than silver plans

  • We pay 80%
  • You pay 20%

The percentages shown reflect the average total cost for members, including all deductibles, copays and coinsurance. Your actual costs and ratios may vary based on your specific plan and usage.

Our plan brochure can help you get started or learn more about our plans.

Financial Assistance

When shopping for a new health care plan, you may qualify for help with the cost of buying coverage by:

  • Getting low or no-cost coverage through a government program
  • Lowering your monthly premium bill with a premium tax credit (PTC)
  • Qualifying for cost-sharing reductions (CSRs) which are discounts to lower your out-of-pocket costs, like deductibles, copayments, coinsurance and prescription costs

Shopping Assistance

Thank you for looking at coverage options from BCBSIL. We’re here to help you get the 2018 coverage – and information – you need.

Key Coverage Details

Selecting a health care plan with BCBSIL may include some of these key coverage details.

Every one of our health care plans cover these essential health benefit categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health disorder services
  • Substance use disorder services
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services

Many long-term illnesses can be prevented or managed when found early. With ACA, most health care plans must cover a range of preventive care services with no in-network, out-of-pocket costs. Services include certain screenings, immunizations, and other types of care, like:

  • Blood pressure, diabetes and cholesterol tests
  • Many cancer tests, such as mammograms and colonoscopies
  • Help to stop smoking, lose weight, fight depression and reduce alcohol abuse

Remember, you may have to pay more for your care if you visit a doctor outside of your network. You can find in-network doctors and hospitals using our online Provider Finder ® tool.

If you’re not having a medical emergency, you have several options for care. Some are available 24 hours a day, seven days a week, like:

  • 24/7 Nurseline – When calling the number on the back of your member ID card, registered nurses will ask about your condition and may recommend where to go for care (if needed).
  • Provider Finder ® – Our online Provider Finder ® tool Opens in new window lets you find in-network doctors and hospitals in your area.
  • Virtual Visits, Powered by MDLIVE – Interact with independently contracted MDLIVE board-certified doctors where – and when – you need it. Learn more about virtual visits.

Not available with some plans. ↵

Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe. Behavioral Health service is limited to interactive audio/video (video only), along with the ability to prescribe in all states. Service availability depends on location at the time of consultation.

Virtual Visits, Powered by MDLIVE may not be available on all plans. Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations, and exclusions. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services.

MDLIVE operates and administers the virtual visit program and is solely responsible for its operations and that of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission.

Blue Cross ® , Blue Shield ® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. ↵

With prescription drug coverage, you may get help with paying for your medicine. Based on your coverage, you may pay either a fixed dollar amount (copayment) or a percentage (coinsurance) of your prescription drug costs. Your prescription drug coverage includes:

  • A broad pharmacy network
  • Mail order services
  • Access to online tools for managing your prescription drugs
  • A drug list
  • Other pharmacy benefits

Note: Prescription drug coverage varies by plan.

Health coverage that works for you

You might not have an employer benefits plan, but that doesn’t mean you don’t have a master plan. With a Blue Choice personal health plan, you can meet your health care needs today and protect yourself tomorrow. Request a quote today.

Which plan is right for you?

*after defined waiting period

This information provides an overview of Blue Choice plans offered by Manitoba Blue Cross. This is not a contract or a complete listing of benefits. For more information, call 204.788.6858 or download a full brochure here.

This information provides an overview of Blue Choice plans offered by Manitoba Blue Cross. This is not a contract or a complete listing of benefits. For more information, call 204.788.6858 or download a full brochure here.

Prescription drugs

  • 70% up to $300 per year
  • Includes a pay direct drug card
  • *A pay direct drug card eliminates the need to pay up front on prescriptions

    Practitioner I services

    • 70% up to $35 per visit
    • $300 per year combined total
    • Treatment/service by:

      *Foot care nurse maximum is $25 per visit. Registered clinical psychologist/master of social work maximum is $50 per visit

      Other health benefits

      • 70% for accidental dental up to $1,000 per accident

      Preventative dental

      • 70% up to $300 per year for standard checkups, cleanings, fillings, extractions, root canals or surgery
      • *Three-month waiting period in effect

        Plan covers 100% of the following:

        • Emergency ambulance within Manitoba
        • Medical transfer up to $500 lifetime
        • Treat no transport

        ACCIDENTAL DEATH

        • $10,000 in the event of accidental death of a participant
        • Access to Blue Advantage®, our national discount program, and My Good Health®, our online health resource

        This information provides an overview of Blue Choice plans offered by Manitoba Blue Cross. This is not a contract or a complete listing of benefits. For more information, call 204.788.6858 or download a full brochure here.

        Prescription drugs

        • 75% up to $2,500 per year
        • Includes a pay direct drug card
        • *A pay direct drug card eliminates the need to pay up front on prescriptions

          Practitioner I services

          • 75% up to $35 per visit
          • $450 per year combined total
          • Treatment/service by:

            *Foot care nurse maximum is $25 per visit. Registered clinical psychologist/master of social work maximum is $50 per visit

            Practitioner II services

            • 75% up to $35 per visit
            • $300 per year combined total
            • Treatment/service by:

              *Foot care nurse maximum is $25 per visit

              Hearing aids

              • Plan covers $500 per five years

              Medical equipment

              • 75% for breathing equipment (e.g. CPAP), crutches, splints, casts, hospital beds, special equipment, walkers, wheelchairs and wigs

              Other health benefits

              • 75% for accidental dental, artificial limbs/eyes, assisted care, braces, cervical collars, elastic stockings, compression garments, breast prostheses, surgical bras, cardiac rehabilitation, orthopedic shoes, orthotics and private duty nursing

              Preventative dental

              • 75% up to $500 first year
              • *Three-month waiting period in effect

                *One-year waiting period in effect

                Services include:

                Restorative dental

                • 50% up to $1,000 per year combined with preventative for extensive restorations ( e.g. crowns, inlays, bridges) and dentures
                • *One-year waiting period in effect

                  • $150 combined every two years towards an eye exam and the purchase or repair of frames and/or lenses, including contact lenses

                  AMBULANCE/HOSPITAL

                  Plan covers 100% of the following:

                  • Emergency ambulance within Canada
                  • Medical transfer up to $500 lifetime
                  • Treat no transport
                  • Emergency air ambulance up to $5,000 per trip ($10,000 per person, per year)

                  Plan covers 100% of the following:

                  • Semi-private room or $20 per day in-lieu (up to 30 days)
                  • Hostel accommodation when medical treatment/diagnostic testing is required in a hospital located outside a 60-kilometer radius of the participant’s home

                  Travel coverage

                  • Within Canada: Up to $5 million lifetime, no trip length maximum and access to travel assistance
                  • Outside Canada: 10% discount on the purchase of travel coverage

                  ACCIDENTAL DEATH

                  • $15,000 in the event of accidental death of a participant

                  ASSISTANCE PROGRAM

                  • Six counselling sessions per year through Manitoba Blue Cross’s Assistance Program.
                  • Access to Blue Advantage®, our national discount program, and My Good Health®, our online health resource

                  This information provides an overview of Blue Choice plans offered by Manitoba Blue Cross. This is not a contract or a complete listing of benefits. For more information, call 204.788.6858 or download a full brochure here.

                  Prescription drugs

                  • 80% up to $5,000 per year
                  • Includes a pay direct drug card
                  • *A pay direct drug card eliminates the need to pay up front on prescriptions

                    Practitioner I services

                    • 80% up to $35 per visit
                    • $600 per year combined total
                    • Treatment/service by:

                      *Foot care nurse maximum is $25 per visit. Registered clinical psychologist/master of social work maximum is $50 per visit

                      Practitioner II services

                      • 80% up to $35 per visit
                      • $450 per year combined total
                      • Treatment/service by:

                        *Foot care nurse maximum is $25 per visit

                        Hearing aids

                        • Plan covers $700 per five years

                        Medical equipment

                        • 80% for breathing equipment (e.g. CPAP), crutches, splints, casts, hospital beds, special equipment, walkers, wheelchairs or wigs

                        Other health benefits

                        • 80% for accidental dental, artificial limbs/eyes, assisted care, braces, cervical collars, elastic stockings, compression garments, breast prostheses, surgical bras, cardiac rehabilitation, day surgery assisted care, orthopedic shoes, orthotics and private duty nursing

                        Preventative dental

                        • 80% up to $600 first year
                        • *Three-month waiting period in effect

                          *One-year waiting period in effect

                          Services include:

                          Restorative dental

                          • 50% up to $1,200 per year combined with preventative dental for extensive restorations (e.g. crowns, inlays, bridges) and dentures
                          • *One-year waiting period in effect

                            Orthodontic

                            • 50% up to $1,000 lifetime
                            • *Two-year waiting period in effect

                              • $250 combined every two years towards an eye exam and the purchase or repair of frames and/or lenses, including contact lenses

                              AMBULANCE/HOSPITAL

                              Plan covers 100% of the following:

                              • Emergency ambulance within Canada
                              • Medical transfer up to $500 lifetime
                              • Treat no transport
                              • Emergency air ambulance up to $5,000 per trip ($10,000 per person, per year)

                              Plan covers 100% of the following:

                              • Semi-private room or $20 per day in-lieu (up to 60 days)
                              • Hostel accommodation when medical treatment/diagnostic testing is required in a hospital located outside a 60-kilometer radius of the participant’s home

                              Travel coverage

                              • Within Canada: Up to $5 million lifetime, no trip length maximum and access to travel assistance
                              • Outside Canada: 10% discount on the purchase of travel coverage

                              ACCIDENTAL DEATH

                              • $25,000 in the event of accidental death of a participant

                              ASSISTANCE PROGRAM

                              • Six counselling sessions per year through Manitoba Blue Cross’s Assistance Program.
                              • Access to Blue Advantage®, our national discount program, and My Good Health®, our online health resource

                              You can also purchase your plan in person or by phone at 204.788.6858

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