èßäÊÓƵapp

Administered by BCBS of Texas

BlueChoice® PPO Plan
(877) 768-2005

Know Where to Go

You have the opportunity to enroll yourself, your spouse, and eligible children. It is extremely important that you understand the eligibility criteria and enroll only those dependents that meet the following criteria.

• Eligible children until 26^th birthday (regardless of marital or student status). "Children" are defined as your natural children, stepchildren, legally adopted children, and children under your legal guardianship.

There are three medical options available, each with different deductibles and monthly/bi-weekly premiums. You do not need a referral to see a specialist. You have the option to receive care from in-network or out-of-network providers, or both, depending on your needs.

Summary Plan Descriptions (SPDs):

• $2,000 Deductible PPO 
• $3,200 Deductible PPO (High Deductible Health Plan with HSA)
• $5,000 Deductible PPO (High Deductible Health Plan with HSA)
• $3,200 Deductible PPO (High Deductible Health Plan without HSA)
• $5,000 Deductible PPO (High Deductible Health Plan without HSA)

Click on the links above for detailed information about how each option covers various health care services including physician office visits, hospital charges, x-rays, prescription drugs and much more. If you have additional questions about coverage for specific procedures or services, or about plan limitations and exclusions, please call BCBSTX at 877-768-2005.

Preventive Benefits - Routine Physicals & Screenings

The Medical plans cover 100% of the cost of annual in-network routine physicals, age-recommended screenings (including breast, bone density, prostate and colon screenings), and immunizations for you and your enrolled dependents. 

IMPORTANT: If your doctor submits a claim for a screening or a physical exam under a diagnostic code (vs. a routine preventive code), the claim will be applied to your deductible. The only exception will be for a colonoscopy, which will be paid at 100% for individuals enrolled in the $2,000 deductible Medical plan, regardless of whether the claim is coded as diagnostic or routine preventive. In accordance with IRS regulations, this colonoscopy exception does not apply to individuals enrolled in the $3,200 or $5,000 deductible Medical plans.

Alight Solution Health Services

Did you know that charges for medical services vary widely – by location and by provider? Medical charges for a specific service can vary by as much as 300%, even within the BCBSTX network.

èßäÊÓƵapp has partnered with Alight Solution Health Services to provide a service that will enable you to identify high-quality doctors, hospitals, imaging centers, etc., and make choices that can significantly reduce your expenses. In addition, your Alight Health Pro can help you better understand your medical insurance and provide assistance with billion/claim disputes.

For more information visit the Alight Solution Health Services page here.

Exchange Visitors on a J-1 Visa

If you are an Exchange Visitor on a J-1 Visa (visiting scholar, professor, or researcher), you and your dependents (J-2) are required by the Department of State to carry and maintain appropriate medical coverage while at èßäÊÓƵapp. Your medical coverage must include: medical benefits of at least $50,000 per accident or illness, repatriation of remains in the amount of $7,500, coverage for expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $10,000, and a deductible not to exceed $500 per accident or illness.

èßäÊÓƵapp has made special arrangements to provide a health plan that meets these requirements. You are required to enroll in this plan immediately upon your arrival. Please call the èßäÊÓƵapp Benefits Representative at 214-768-2072 for additional information and enrollment assistance.

Resources

Medical Plan Resources

• Blue365 Davis Vision Discount Program
• BCBS Medical Claim Form
• Alight Solution Health Services
• How èßäÊÓƵapp's Medical Plans Work With Medicare
• Required Health Plan Notices
• CHIP Notice
• Know Where To Go

Wellness Resources

• Adult Wellness Guidelines
• Children's Wellness Guidelines
• Perinatal Wellness Guidelines

Summary of Benefits and Coverage

• $2,000 Deductible PPO
• $3,200 Deductible HDHP With HSA
• $3,200 Deductible HDHP Without HSA
• $5,000 Deductible HDHP With HSA
• $5,000 Deductible HDHP Without HSA