Policy Documents for Small Group Pre-Affordable Care Act Plans

Below is a list of Blue Cross and Blue Shield of Texas policy documents for Pre-Affordable Care Act policies in the small group market, also called grandfathered and transitional small group plans. These policies describe how the plans generally work and include eligible expenses, claim filing steps, appeals procedures, coverage limitations and exceptions, and more.

The following is true for those with pre-Affordable Care Act small group coverage: 

• You enrolled in a health plan through an employer,
• Your plan was effective before January 1, 2014,
• The employer has between 1 and 50 employees, and
• Your plan is not a "metallic" (platinum, gold, silver or bronze) health plan.

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 Pre-Affordable Care Act Plan, and you know its name, find it below and download the policy.

Blue Choice PPO

•   A1015 BlueChoice PPO
•   A201 BlueChoice PPO
•   B100 BlueChoice PPO
•   M301 BlueChoice PPO
•   M34 BlueChoice PPO
•   M4015 BlueChoice PPO
•   M409 BlueChoice PPO
•   M501 BlueChoice PPO
•   M524 BlueChoice PPO
•   M622 BlueChoice PPO
•   M625 BlueChoice PPO
•   M635 BlueChoice PPO
•   M639 BlueChoice PPO
•   M800 BlueChoice PPO
•   M802 BlueChoice PPO
•   M803 BlueChoice PPO
•   M804 BlueChoice PPO
•   M806 BlueChoice PPO
•   M807 BlueChoice PPO
•   M809 BlueChoice PPO
•   M810 BlueChoice PPO
•   M811 BlueChoice PPO
•   M812 BlueChoice PPO
•   M813 BlueChoice PPO
•   M814 BlueChoice PPO
•   M815 BlueChoice PPO
•   M816 BlueChoice PPO
•   M822 BlueChoice PPO
•   M823 BlueChoice PPO
•   M902 BlueChoice PPO
•   M903 BlueChoice PPO
•   M904 BlueChoice PPO
•   M907 BlueChoice PPO
•   M910 BlueChoice PPO
•   M911 BlueChoice PPO
•   M912 BlueChoice PPO
•   M914 BlueChoice PPO
•   M922 BlueChoice PPO
•   M923 BlueChoice PPO
•   M926 BlueChoice PPO
•   S01 BlueChoice PPO
•   S02 BlueChoice PPO
•   S03 BlueChoice PPO
•   S04 BlueChoice PPO
•   S05 BlueChoice PPO
•   S06 BlueChoice PPO
•   S07 BlueChoice PPO
•   S09 BlueChoice PPO
•   S10 BlueChoice PPO
•   S11 BlueChoice PPO
•   S14 BlueChoice PPO
•   S15 BlueChoice PPO
•   S16 BlueChoice PPO
•   S17 BlueChoice PPO
•   S18 BlueChoice PPO
•   S19 BlueChoice PPO
•   S23 BlueChoice PPO
•   S24 BlueChoice PPO
•   S25 BlueChoice PPO
•   S26 BlueChoice PPO
•   S30 BlueChoice PPO
•   S32 BlueChoice PPO
•   S33 BlueChoice PPO
•   S34 BlueChoice PPO
•   SB1 BlueChoice PPO
•   SB2 BlueChoice PPO
•   SB4 BlueChoice PPO
•   GFRS09 BlueChoice PPO
•   RS01 BlueChoice PPO
•   RS02 BlueChoice PPO
•   RS03 BlueChoice PPO
•   RS04 BlueChoice PPO
•   RS05 BlueChoice PPO
•   RS06 BlueChoice PPO
•   RS07 BlueChoice PPO
•   RS08 BlueChoice PPO
•   RS09 BlueChoice PPO
•   RS10 BlueChoice PPO
•   RS11 BlueChoice PPO
•   RS14 BlueChoice PPO
•   RS15 BlueChoice PPO
•   RS16 BlueChoice PPO
•   RA17 BlueChoice PPO
•   RS18 BlueChoice PPO
•   RS19 BlueChoice PPO
•   RS20 BlueChoice PPO
•   RS22 BlueChoice PPO
•   RS23 BlueChoice PPO
•   RS24 BlueChoice PPO
•   RS25 BlueChoice PPO
•   RS26 BlueChoice PPO
•   RS28 BlueChoice PPO
•   RS29 BlueChoice PPO
•   RS30 BlueChoice PPO
•   RS31 BlueChoice PPO
•   RS32 BlueChoice PPO
•   RS33 BlueChoice PPO
•   RS34 BlueChoice PPO
•   RS36 BlueChoice PPO
•   RS37 BlueChoice PPO
•   RS38 BlueChoice PPO
•   RS41 BlueChoice PPO
•   RS43 BlueChoice PPO
•   RS44 BlueChoice PPO
•   RS45 BlueChoice PPO
•   RSB1 BlueChoice PPO
•   RSB2 BlueChoice PPO
•   RSB3 BlueChoice PPO
•   RSB4 BlueChoice PPO
•   RSE1 BlueChoice PPO
•   RSF5 BlueChoice PPO
•   RSF6 BlueChoice PPO
•   RSF7 BlueChoice PPO
•   RSF8 BlueChoice PPO
•   RSS2 BlueChoice PPO

BlueEdge HSA

•   E250Y26 BlueEdge HSA
•   E251Y26 BlueEdge HSA
•   E350 BlueEdge HSA
•   E702Y26 BlueEdge HSA
•   E70326 BlueEdge HSA
•   EHSA13Y26 BlueEdge HSA
•   H100Y26 BlueEdge HSA
•   H15026 BlueEdge HSA
•   H251 BlueEdge HSA
•   H350 BlueEdge HSA
•   H702 BlueEdge HSA
•   H704 BlueEdge HSA
•   RSH1Y26 BlueEdge HSA
•   RSH226 BlueEdge HSA
•   RSH3 BlueEdge HSA
•   RSH426 BlueEdge HSA
•   RSH5 BlueEdge HSA
•   RSH6 BlueEdge HSA
•   RSH7Y26 BlueEdge HSA
•   RSH8 BlueEdge HSA
•   RSH9 BlueEdge HSA
•   RSHE1Y26 BlueEdge HSA
•   SH1Y26 BlueEdge HSA
•   SH226 BlueEdge HSA
•   SH3 BlueEdge HSA
•   SH426 BlueEdge HSA
•   SH5 BlueEdge HSA
•   SH8 BlueEdge HSA
•   SH6 BlueEdge HSA