Policy Documents for Small Group Qualified Health Plans
Below is a list of actual Blue Cross and Blue Shield of Texas policy documents for Small Group Metallic Qualified Health Plans. These policies describe how the plans generally work and include eligible expenses, claim filing steps, appeals procedures, coverage limitations and exceptions, and more.
Help locating your policy
- Get your policy documents through your online account .
- Get your policy document through the BCBSTX app. Learn more about the BCBSTX app.
- Contact a customer service representative at 1-888-697-0683. to get help finding or accessing your policy documents.
- If you have coverage through an employer, you may want to contact the employer's benefit administrator to get the name of your plan.
- If you know you have a Small Group Qualified Health Plan, and you know its name, find it below and download the policy.
Small Group Metallic Qualified Health Plan policy documents for the 2027 plan year are not available yet. The links below go to placeholder files. The policy documents will be available in November. Please check back then.
Platinum Plans
Blue Choice Advantage Platinum PPO Plans
Off Exchange
- Blue Choice Platinum PPO 202
- Blue Choice Platinum PPO 202-in vitro
- Blue Choice Platinum PPO 301
- Blue Choice Platinum PPO 301-in vitro
- Blue Choice Platinum PPO 501
- Blue Choice Platinum PPO 501-in vitro
- Blue Choice Platinum PPO 810
- Blue Choice Platinum PPO 810-in vitro
- Blue Choice Platinum PPO 811
- Blue Choice Platinum PPO 811-in vitro
Blue Advantage Platinum HMO Plans
Off Exchange
- Blue Advantage Platinum HMO 202
- Blue Advantage Platinum HMO 202-in vitro
- Blue Advantage Platinum HMO 301
- Blue Advantage Platinum HMO 301-in vitro
- Blue Advantage Platinum HMO 501
- Blue Advantage Platinum HMO 501-in vitro
- Blue Advantage Platinum HMO 807
- Blue Advantage Platinum HMO 807-in vitro
- Blue Advantage Platinum HMO 808
- Blue Advantage Platinum HMO 808-in vitro
Gold Plans
Blue Choice Gold PPO Plans
Off Exchange
- Blue Choice Gold PPO 112
- Blue Choice Gold PPO 112-in vitro
- Blue Choice Gold PPO 114
- Blue Choice Gold PPO 114-in vitro
- Blue Choice Gold PPO 117
- Blue Choice Gold PPO 117-in vitro
- Blue Choice Gold PPO 203
- Blue Choice Gold PPO 203-in vitro
- Blue Choice Gold PPO 204
- Blue Choice Gold PPO 204-in vitro
- Blue Choice Gold PPO 801
- Blue Choice Gold PPO 801-in vitro
- Blue Choice Gold PPO 819
- Blue Choice Gold PPO 819-in vitro
- Blue Choice Gold PPO 820
- Blue Choice Gold PPO 820-in vitro
- Blue Choice Gold PPO 822
- Blue Choice Gold PPO 822-in vitro
- Blue Choice Gold PPO 823
- Blue Choice Gold PPO 823-in vitro
- Blue Choice Gold PPO 830
- Blue Choice Gold PPO 830-in vitro
Blue Advantage Gold HMO Plans
Off Exchange
- Blue Advantage Gold HMO 203
- Blue Advantage Gold HMO 203-in vitro
- Blue Advantage Gold HMO 204
- Blue Advantage Gold HMO 204-in vitro
- Blue Advantage Gold HMO 801
- Blue Advantage Gold HMO 801-in vitro
- Blue Advantage Gold HMO 812
- Blue Advantage Gold HMO 812-in vitro
- Blue Advantage Gold HMO 814
- Blue Advantage Gold HMO 814-in vitro
- Blue Advantage Gold HMO 816
- Blue Advantage Gold HMO 816-in vitro
- Blue Advantage Gold HMO 817
- Blue Advantage Gold HMO 817-in vitro
- Blue Advantage Gold HMO 822
- Blue Advantage Gold HMO 822-in vitro
- Blue Advantage Gold HMO 830
- Blue Advantage Gold HMO 830-in vitro
- Blue Advantage Gold HMO 919
- Blue Advantage Gold HMO 919-in vitro
- Blue Advantage Gold HMO 922
- Blue Advantage Gold HMO 922-in vitro
- Blue Advantage Gold HMO 923
- Blue Advantage Gold HMO 923-in vitro
Silver Plans
Blue Choice Silver PPO Plans
Off Exchange
- Blue Choice Silver PPO 101
- Blue Choice Silver PPO 101-in vitro
- Blue Choice Silver PPO 102
- Blue Choice Silver PPO 102-in vitro
- Blue Choice Silver PPO 118
- Blue Choice Silver PPO 118-in vitro
- Blue Choice Silver PPO 120
- Blue Choice Silver PPO 120-in vitro
- Blue Choice Silver PPO 135
- Blue Choice Silver PPO 135-in vitro
- Blue Choice Silver PPO 146
- Blue Choice Silver PPO 146-in vitro
- Blue Choice Silver PPO 201
- Blue Choice Silver PPO 201-in vitro
- Blue Choice Silver PPO 401
- Blue Choice Silver PPO 401-in vitro
- Blue Choice Silver PPO 402
- Blue Choice Silver PPO 402-in vitro
- Blue Choice Silver PPO 803
- Blue Choice Silver PPO 803-in vitro
- Blue Choice Silver PPO 824
- Blue Choice Silver PPO 824-in vitro
- Blue Choice Silver PPO 825
- Blue Choice Silver PPO 825-in vitro
- Blue Choice Silver PPO 827
- Blue Choice Silver PPO 827-in vitro
- Blue Choice Silver PPO 834
- Blue Choice Silver PPO 834-in vitro
- Blue Choice Silver PPO 844
- Blue Choice Silver PPO 844-in vitro
- Blue Choice Silver PPO 845
- Blue Choice Silver PPO 845-in vitro
Blue Advantage Silver HMO Plans
Off Exchange
- Blue Advantage Silver HMO 101
- Blue Advantage Silver HMO 101-in vitro
- Blue Advantage Silver HMO 102
- Blue Advantage Silver HMO 102-in vitro
- Blue Advantage Silver HMO 120
- Blue Advantage Silver HMO 120-in vitro
- Blue Advantage Silver HMO 127
- Blue Advantage Silver HMO 127-in vitro
- Blue Advantage Silver HMO 134
- Blue Advantage Silver HMO 134-in vitro
- Blue Advantage Silver HMO 201
- Blue Advantage Silver HMO 201-in vitro
- Blue Advantage Silver HMO 401
- Blue Advantage Silver HMO 401-in vitro
- Blue Advantage Silver HMO 402
- Blue Advantage Silver HMO 402-in vitro
- Blue Advantage Silver HMO 803
- Blue Advantage Silver HMO 803-in vitro
- Blue Advantage Silver HMO 804
- Blue Advantage Silver HMO 804-in vitro
- Blue Advantage Silver HMO 818
- Blue Advantage Silver HMO 818-in vitro
- Blue Advantage Silver HMO 820
- Blue Advantage Silver HMO 820-in vitro
- Blue Advantage Silver HMO 846
- Blue Advantage Silver HMO 846-in vitro
- Blue Advantage Silver HMO 925
- Blue Advantage Silver HMO 925-in vitro
- Blue Advantage Silver HMO 935
- Blue Advantage Silver HMO 935-in vitro
- Blue Advantage Silver HMO 945
- Blue Advantage Silver HMO 945-in vitro
Bronze Plans
Blue Choice Bronze PPO Plans
Off Exchange
- Blue Choice Bronze PPO 805
- Blue Choice Bronze PPO 805-in vitro
- Blue Choice Bronze PPO 806
- Blue Choice Bronze PPO 806-in vitro
- Blue Choice Bronze PPO 833
- Blue Choice Bronze PPO 833-in vitro
Blue Advantage Bronze HMO Plans
Off Exchange
- Blue Advantage Bronze HMO 806
- Blue Advantage Bronze HMO 806-in vitro
- Blue Advantage Bronze HMO 833
- Blue Advantage Bronze HMO 833-in vitro
- Blue Advantage Bronze HMO 905
- Blue Advantage Bronze HMO 905-in vitro
Platinum Plans
Blue PPO Platinum Plans
Off Exchange
Blue Choice Preferred PPO Platinum Plans
Off Exchange
- P5E2BCE Blue Choice Preferred Platinum PPO 119
- P5E1BCE Blue Choice Preferred Platinum PPO 136
- P5M1BCE Blue Choice Preferred Platinum PPO 501
Blue Precision Platinum Plans
Off Exchange
- P506PSN Blue Precision Platinum HMO 107
- P5E1PSN Blue Precision Platinum HMO 110
- P5J1PSN Blue Precision Platinum HMO 200
Blue Options Platinum Plans
Gold Plans
Blue PPO Gold Plans
Off Exchange
- G530PPO Blue PPO Gold 101
- G531PPO Blue PPO Gold 102
- G532PPO Blue PPO Gold 107
- G533PPO Blue PPO Gold 113
- G534PPO Blue PPO Gold 114
- G535PPO Blue PPO Gold 115
- G536PPO Blue PPO Gold 116
- G537PPO Blue PPO Gold 123
- G5M2PPO Blue PPO Gold 502
Blue Precision Gold HMO Plans
Off Exchange
- G532PSN Blue Precision Gold HMO 101
- G5J2PSN Blue Precision Gold HMO 201
- G5N1PSN Blue Precision Gold HMO 402
Blue Options Gold Plans
Off Exchange
- G506OPT Blue Options Gold PPO 101
- G507OPT Blue Options Gold PPO 102
- G508OPT Blue Options Gold PPO 106
- G5K1OPT Blue Options Gold PPO 200
- G5M3OPT Blue Options Gold PPO 503
BlueChoice Preferred Gold PPO Plans
Off Exchange
- G530BCE Blue Choice Preferred Gold PPO 101
- G531BCE Blue Choice Preferred Gold PPO 102
- G532BCE Blue Choice Preferred Gold PPO 107
- G533BCE Blue Choice Preferred Gold PPO 113
- G534BCE Blue Choice Preferred Gold PPO 114
- G535BCE Blue Choice Preferred Gold PPO 115
- G536BCE Blue Choice Preferred Gold PPO 116
- G537BCE Blue Choice Preferred Gold PPO 123
- G5M2BCE Blue Choice Preferred Gold PPO 502
Silver Plans
Blue PPO Silver Plans
Off Exchange
- S531PPO Blue PPO Silver 104
- S535PPO Blue PPO Silver 105
- S532PPO Blue PPO Silver 120
- S534PPO Blue PPO Silver 133
- S5J1PPO Blue PPO Silver 200
Blue Precision Silver HMO Plans
Off Exchange
BlueChoice Preferred Silver PPO Plans
Off Exchange
- S531BCE Blue Choice Preferred Silver PPO 104
- S535BCE Blue Choice Preferred Silver PPO 105
- S532BCE Blue Choice Preferred Silver PPO 120
- S534BCE Blue Choice Preferred Silver PPO 133
- S5J1BCE Blue Choice Preferred Silver PPO 200
Blue Options Silver PPO Plans
Off Exchange
- S506OPT Blue Options Silver PPO 104
- S507OPT Blue Options Silver PPO 107
- S5N1OPT Blue Options Silver PPO 404
Bronze Plans
Blue PPO Bronze Plans
Off Exchange
BlueChoice Preferred Bronze PPO Plans
Off Exchange
Platinum Plans
Blue PPO Platinum Plans
Off Exchange
Blue Choice Preferred PPO Platinum Plans
Off Exchange
- P5E2BCE Blue Choice Preferred Platinum PPO 119
- P5E1BCE Blue Choice Preferred Platinum PPO 136
- P5M1BCE Blue Choice Preferred Platinum PPO 501
Blue Precision Platinum Plans
Off Exchange
- P506PSN Blue Precision Platinum HMO 107
- P5E1PSN Blue Precision Platinum HMO 110
- P5J1PSN Blue Precision Platinum HMO 200
Blue Options Platinum Plans
Gold Plans
Blue PPO Gold Plans
Off Exchange
- G530PPO Blue PPO Gold 101
- G531PPO Blue PPO Gold 102
- G532PPO Blue PPO Gold 107
- G533PPO Blue PPO Gold 113
- G534PPO Blue PPO Gold 114
- G535PPO Blue PPO Gold 115
- G536PPO Blue PPO Gold 116
- G537PPO Blue PPO Gold 123
- P5M2PPO Blue PPO Gold 502
Blue Precision Gold HMO Plans
Off Exchange
- G532PSN Blue Precision Gold HMO 101
- G5J2PSN Blue Precision Gold HMO 201
- G5N1PSN Blue Precision Gold HMO 402
Blue Options Gold Plans
Off Exchange
- G506OPT Blue Options Gold PPO 101
- G507OPT Blue Options Gold PPO 102
- G508OPT Blue Options Gold PPO 106
- G5K1OPT Blue Options Gold PPO 200
- G5M3OPT Blue Options Gold PPO 503
BlueChoice Preferred Gold PPO Plans
Off Exchange
- G530BCE Blue Choice Preferred Gold PPO 101
- G531BCE Blue Choice Preferred Gold PPO 102
- G532BCE Blue Choice Preferred Gold PPO 107
- G533BCE Blue Choice Preferred Gold PPO 113
- G534BCE Blue Choice Preferred Gold PPO 114
- G535BCE Blue Choice Preferred Gold PPO 115
- Blue Choice Preferred Gold PPO 116
- Blue Choice Preferred Gold PPO 123
- Blue Choice Preferred Gold PPO 502
Silver Plans
Blue PPO Silver Plans
Off Exchange
- S531PPO Blue PPO Silver 104
- S535PPO Blue PPO Silver 105
- S532PPO Blue PPO Silver 120
- S534PPO Blue PPO Silver 133
- S5J1PPO Blue PPO Silver 200
Blue Precision Silver HMO Plans
Off Exchange
BlueChoice Preferred Silver PPO Plans
Off Exchange
- S531BCE Blue Choice Preferred Silver PPO 104
- S535BCE Blue Choice Preferred Silver PPO 105
- S532BCE Blue Choice Preferred Silver PPO 120
- S534BCE Blue Choice Preferred Silver PPO 133
- S5J1BCE Blue Choice Preferred Silver PPO 200
Blue Options Silver PPO Plans
Off Exchange
- S506OPT Blue Options Silver PPO 104
- S507OPT Blue Options Silver PPO 107
- S5N1OPT Blue Options Silver PPO 404
Bronze Plans
Blue PPO Bronze Plans
Off Exchange
BlueChoice Preferred Bronze PPO Plans
Off Exchange
Platinum Plans
Blue PPO Platinum Plans
Off Exchange
Blue Choice Preferred PPO Platinum Plans
Off Exchange
Blue Precision Platinum Plans
Off Exchange
- P506PSN Blue Precision Platinum HMO 107
- P5E1PSN Blue Precision Platinum HMO 110
- P5J1PSN Blue Precision Platinum HMO 200
Blue Options Platinum Plans
Gold Plans
Blue PPO Gold Plans
Off Exchange
- G530PPO Blue PPO Gold 101
- G531PPO Blue PPO Gold 102
- G532PPO Blue PPO Gold 107
- G533PPO Blue PPO Gold 113
- G534PPO Blue PPO Gold 114
- G535PPO Blue PPO Gold 115
- G536PPO Blue PPO Gold 116
- G537PPO Blue PPO Gold 123
Blue Precision Gold HMO Plans
Off Exchange
- G532PSN Blue Precision Gold HMO 101
- G5J2PSN Blue Precision Gold HMO 201
- G5N1PSN Blue Precision Gold HMO 402
Blue Options Gold Plans
Off Exchange
- G506OPT Blue Options Gold PPO 101
- G507OPT Blue Options Gold PPO 102
- G508OPT Blue Options Gold PPO 106
- G5K1OPT Blue Options Gold PPO 200
BlueChoice Preferred Gold PPO Plans
Off Exchange
- G530BCE Blue Choice Preferred Gold PPO 101
- G531BCE Blue Choice Preferred Gold PPO 102
- G532BCE Blue Choice Preferred Gold PPO 107
- G533BCE Blue Choice Preferred Gold PPO 113
- G535BCE Blue Choice Preferred Gold PPO 115
Silver Plans
Blue PPO Silver Plans
Off Exchange
- S531PPO Blue PPO Silver 104
- S535PPO Blue PPO Silver 105
- S532PPO Blue PPO Silver 120
- S534PPO Blue PPO Silver 133
- S5J1PPO Blue PPO Silver 200
Blue Precision Silver HMO Plans
Off Exchange
BlueChoice Preferred Silver PPO Plans
Off Exchange
- S531BCE Blue Choice Preferred Silver PPO 104
- S535BCE Blue Choice Preferred Silver PPO 105
- S532BCE Blue Choice Preferred Silver PPO 120
- S534BCE Blue Choice Preferred Silver PPO 133
- S5J1BCE Blue Choice Preferred Silver PPO 200
Blue Options Silver PPO Plans
Off Exchange
- S506OPT Blue Options Silver PPO 104
- S507OPT Blue Options Silver PPO 107
- S5N1OPT Blue Options Silver PPO 404
Bronze Plans
Blue PPO Bronze Plans
Off Exchange
BlueChoice Preferred Bronze PPO Plans
Off Exchange
Last Updated: Aug. 13, 2026