Plan Highlights

Preferred Provider Health Insurance Plan (PPO) Select Value^® Care^SM Provides:

$5,000,000 lifetime maximum benefit per person
Inpatient hospital benefits and professional care
Outpatient professional care (including office visits, X-rays,
lab and diagnostic services) covered 50/50
24-hour worldwide emergency care
Well-child routine physical, vision and hearing – 50/50 coinsurance up to $300 preventive care maximum per person per calendar year
Immunization benefits (through age 7) at 100 percent of allowable amount, no deductible
Human Organ and tissue transplant benefits – 50/50
($300,000 lifetime maximum)
Office visits and emergency room visits – 50/50
Home health care, hospice and skilled nursing facility benefits (subject to limitations)
Preventive Care – Up to maximum of $300 per person per calendar year, 50/50 coinsurance
Physical Medicine Services – 50/50 coinsurance – up to
$1,000 per person per calendar year
Ground and Air Ambulance Services – up to $1,500 per person per calendar year (in-network and out-of-network combined)
Any day of the month effective date except the 29^th, 30^th
or 31^st
Age-banded, child-only coverage
Access to one of the largest provider networks in the state, BlueChoice®
Security of one of the most widely recognized insurance
cards – Blue Cross and Blue Shield of Texas
Three-tier prescription drug program
Mail-order prescription drug program
BlueCard Program
Prescription Drug Card