Texas Policy Documents

Pre-Affordable Care Act

Below is a list of actual policy documents for Pre-Affordable Care Act – individual grandfathered or grandmothered plan – market coverage. These policies describe how the plans generally work and include eligible expenses, claim filing and appeals procedures, and coverage limitations and exceptions, among other things.

While BCBSTX is posting every actual insurance policy as soon as it becomes available, including policies that contain customized benefit designs, your policy may not yet be available. If you are unable to locate your policy below, you may find it helpful to view one of the sample policies on the previous page, and you can also contact a customer service representative at 888-697-0683 for more information.

Policy Documents

• Blue Alliance (OST)
• Blue Alliance (TAA)
• BlueEdge 100/100 (SO 4/09)
• BlueEdge 100/100 (SO 7/08)
• BlueEdge 100/70 (SO)
• BlueEdge 100/70 (SO 1/07)
• BlueEdge 100/70 (SO 2006)
• BlueEdge 100/70 (SO 7/07)
• BlueEdge 75/60 (SO 1/07)
• BlueEdge 75/60 (SO 2006)
• BlueEdge 75/60 (SO 7/07)
• BlueEdge 75/60 (SO 7/08)
• BlueEdge 75/60 (SO 7/08)
• BlueEdge 75/60 (SO)
• BlueEdge 75/60 (SO 4/09)
• BlueEdge 90/70 (SO 1/07)
• BlueEdge 90/70 (SO 2006)
• BlueEdge 90/70 (SO 7/07)
• BlueEdge 90/70 (SO 7/08)
• BlueEdge 90/70 (SO)
• BlueEdge 90/70 (SO 4/09)
• BlueEdge HSA 100
• BlueEdge HSA 100/100
• BlueEdge HSA 75/60
• BlueEdge HSA 90/70
• Conversion PPO (C2)
• Foundation Hospital
• Select (MAT) 80/75
• Select 2000 (01/99)
• Select 2000 (03/95)
• Select 2000 (09/95)
• Select 2000 (09/95) MAT
• Select 80/75
• Select Advantage
• Select Basic
• Select Blue Advantage (SO 1/2007)
• Select Blue Advantage (SO 2005)
• Select Blue Advantage (SO 7/2007)
• Select Blue Advantage (S2)
• Select Blue Advantage 85/75
• Select Blue Advantage 2002
• Select Blue Advantage 2004
• Select Choice (ASO2)
• Select Choice (SO 1/2007)
• Select Choice (SO 2005)
• Select Choice (SO 2006)
• Select Choice (SO 7/2007)
• Select Choice (SO 7/2008)
• Select Choice (SO)
• Select Choice (SO 4/09)
• Select Choice 2002
• Select Choice 2004
• Select Choice 80/70
• Select Choice II
• Select Choice(SO 3)
• Select Saver (EO)
• Select Saver (SO 1/2007) 
• Select Saver (SO 2005)
• Select Saver (SO 2006)
• Select Saver (SO 7/2007)
• Select Saver (SO 7/2008)
• Select Saver (SO 4/09)
• Select Saver (S2)
• Select Saver 2002
• Select Saver 2004
• Select Saver 75/60
• Select Value Care
• SelectChoice 80/70

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