Health Care Coverage You Need. A Company You Know. - BCBSTX

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Health Care Coverage You Need.A Company You Know.Call 800-531-4456, visit bcbstx.com or contact anindependent, authorized agent to get a quote today.Note: The Consumer Choice Plan Disclosure Statement on the followingpage does not apply to the Blue Advantage Gold HMO SM 207 plan

Consumer Choice Plan Disclosure StatementThis health plan does not include the same level of benefits required in other plans.This HMO plan is a consumer choice plan. This plan doesn't include the same level of benefits that are inTexas health plans known as state-mandated plans. This plan does include all health benefits required by theAffordable Care Act.To see all benefits offered by this plan, go to the plan’s “Summary of Benefits and Coverage.”Benefit/coverage:This plan:DeductibleThe amount you pay for care before theplan begins to share the cost.Has a deductible.Out-of-Pocket CostsThe amount you pay when you receivecovered services, up to a calendar yearmaximum.Includes out-of-pocket costs thatmeet federal requirements butmay sometimes be more than in astate-mandated plan.A copay must be less than 50% ofthe total cost of the service. Annualout-of-pocket costs must be cappedat 200% of your annual premiumcost if you alert the plan.Habilitative and Rehabilitative CareCare that helps you improve skills fordaily living.Includes a limit on the number ofvisits per year for speech therapy,occupational therapy, physicaltherapy and chiropractic care.Has no limits on the amount of careif it is needed for medical reasons.A health plan with requiredbenefits (state-mandated plan):Has no deductibles for participatingprovider care.Limits do not apply for thetreatment of acquired brain injuryand autism spectrum disorder.Home Health ServicesIncludes a limit for home healthservices.Has no limits on home healthservices.If you want a plan with all required benefits:We also offer a state-mandated plan that includes all required benefits. This plan is not on Healthcare.govand does not allow you to get help with premiums and out-of-pocket costs. To learn more about this plan,call 1-800-531-4456 or visit https://www.bcbstx.com/shop-plans-and-products. By signing yourapplication to enroll in this plan, you acknowledge the following: I understand the consumer choice plan I am applying for does not provide the same level of coveragerequired in other Texas health plans (state-mandated plans). I understand if my health changes and this plan does not meet my needs, in most cases I won't beable to get a new plan until the next open enrollment period. I understand I can get more information about consumer choice plans from the Texas Departmentof Insurance's website, html, or by calling theConsumer Help Line at 1-800-252-3439.TX-I-H-CCD-22-EX-NEWA Division of Health Care Service Corporation, a Mutual Legal Reserve Company, anIndependent Licensee of the Blue Cross and Blue Shield Association

When It’s Time to Get Health Care Coverage,We’re Here for You.Choosing the right health care coverage to protect you and your family starts with a companyyou know. Blue Cross and Blue Shield of Texas (BCBSTX), a Division of Health Care ServiceCorporation, has been serving the people of Texas since 1929. As a customer-owned healthinsurer, our focus is on our members, not shareholders. We work hard to make sure you havechoices for your health care coverage.As health care in America changes, our dedication to our community will stay strong. BCBSTX willbe here serving the people of Texas, just as we have for more than 90 years.Your BCBSTX plan includes thefollowing: Choice of many doctors and hospitals rescription drug coverage, withPmail-order program1 Coveragefor many preventive care2services Mentalhealth and substance usedisorder benefits and services Choice of deductibles Health and wellness programs ember account with tools to help youMmanage your coverage1 Learn more about prescription drug coverage on page 4.2 Many in-network preventive services are covered at 100%. Refer to theSummary of Benefits and Coverage for benefit details.Visit us onlineat bcbstx.com.1Contact your independent,authorized Blue Cross andBlue Shield of Texas agent.Call us toll-freeat 800-531-4456.

Signing Up for Health Care CoverageGetting your health care coverage with BCBSTX is animportant decision. Here are a few things to consider.When do you sign up?You can enroll or change plans during the Open Enrollment period,from November 1 to December 15, 2020.What if you need to change outside that time period?If you have a major life event (got married or divorced, added toyour family, lost your group coverage, and so forth), you mayqualify for Special Enrollment. Visit bcbstx.com/sep tolearn more.Can you get help paying for your coverage?3Based on your income, family size and the type of plan youchoose, you may be able to get financial help when you buythrough the Texas Health Insurance Marketplace.3 I f you are Native American, the cost-sharing amounts and income levels may be different. Please call800-531-4456 or contact an independent, authorized BCBSTX agent for details.What are EssentialHealth Benefits?Our health care plans coverin-network, basic services thatare considered essential togood health. These include: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance usedisorder services, includingbehavioral health treatment Prescription drugs Rehabilitative and habilitativeservices and devicesHow can you sign up? Laboratory servicesStart at bcbstx.com. You can compare your options, see differentbenefit levels and get an online quote. You can even see if youqualify for help paying for your plan. Preventive services and chronicdisease managementYou may also learn more and sign up when you contact anindependent, authorized BCBSTX agent. Pediatric services, including oraland vision care2

How does an HMO work?An HMO, also known as a health maintenance organization, is a health plan that may provideindividuals with more affordable options to access care. An HMO may mean lower out-of-pocket costs than other types of health care coverage. ith an HMO, you choose a primary care provider (PCP) who will be your main contact for all your health care Wneeds. Whether you are making an appointment for an annual exam or need a referral, your PCP is the person to call. H MOs do not typically cover out-of-network expenses other than emergencies.4 It is important that you makesure your doctor, hospital or other health care provider is in the network so you can avoid unnecessary charges. Blue Advantage PlusSM plans may offer out-of-network benefits as well. Please see your benefit book formore information. If you need more details, you can visit bcbstx.com/insurance-basics.4 E mergency care benefits are available out of network for HMO plans. Medically Necessary covered services not available in network may be referred to an out-of-network provider and bereimbursed at the in-network rate. After you enroll, you will get a Benefit Book with more information about Medically Necessary covered services.Health Plans to Fit Every BudgetWe have three levels of health care plans available — bronze, silver and gold. Each plan hasdifferent benefits and costs, so be sure to choose the one that fits your needs best. All plansinclude the same essential health benefits.BRONZEPLANSSILVERPLANSGOLDPLANSLowest premium costsHigher premium coststhan Bronze plansHigher premium coststhan Silver plansLower out-of-pocket coststhan Bronze plansLower out-of-pocket coststhan Silver plansHigher out-of-pocket costswhen you receive carePlan pays60%You pay40%Plan pays70%You pay30%Plan pays80%You pay20%The percentages shown reflect the average total cost for members, including all deductibles, copays and coinsurance. Your actual costs and ratios may vary based on your specific plan and howyou use your benefits. Please refer to the Summary of Benefits and Coverage for more information.33

Our Security and Dental Plan OptionsVisit bcbstx.com or contact your independent, authorized agent to find out more aboutthese options.Blue Advantage Security HMOSMBlueCare DentalSMThis is a special catastrophic health care planfor certain people under age 30 and somepeople with low incomes. This plan has lowerpremiums than other health plans, but hashigher deductibles.BCBSTX has options to provide you and yourfamily with dental coverage. Our dental plansprovide coverage for cleanings, preventiveservices and much more.Prescription Drug Coverage is Included in All Our PlansTierDrugTypeYourCost Your health plan’s prescription druglist has many levels of coverage,called payment level tiers.6Non-Preferred Specialty5Preferred SpecialtyOur plans have six payment leveltiers. Most often, the lower the tier,the lower your out-of-pocket costswill be for the drug.4Non-Preferred Brand3Preferred Brand2Non-Preferred Generic1Preferred Generic BCBSTX also offers ways for you to save time and money on your prescriptions.Cost savings: You may pay less when you choose generic medicines from our drug list. You also may save when you getup to a 30-day supply of a covered prescription drug from an in-network pharmacy. Talk to your doctor about what isright for you.Time savings: Maintenance medications are those drugs you take on a regular basis. You can have up to a 90-daysupply of these medications delivered directly to you through the mail order program or at a retail preferred pharmacyparticipating in the Preferred Pharmacy Network.5Online resources: You can search the drug list, find a pharmacy, see your claims, order home delivery, and get anestimate of your costs for a medication 24/7 by logging in to Blue Access for MembersSM (BAMSM) at bcbstx.com.5 The Preferred Pharmacy Network does not apply to 100% cost sharing plans.The relationship between Blue Cross and Blue Shield of Texas and contracting pharmacies is that of independent contractors, contracted through a related company, Prime Therapeutics LLC.Prime Therapeutics LLC is a separate pharmacy benefit management company. Blue Cross and Blue Shield of Texas contracts with Prime Therapeutics to provide pharmacy benefit management andother related services. Blue Cross and Blue Shield of Texas, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.4

Get the Most From Your BCBSTX MembershipAt Blue Cross and Blue Shield of Texas, we want you to be well. Our goal is to help you live ahealthier life. We work hard to provide our members with choices to help manage their health.Member ConnectionVirtual Visits powered by MDLIVE Text BCBSTXAPP to 336336 to downloadthe BCBSTX App and register forBlue Access for Members7 righton your mobile device to: Many plans cover appointments with anMDLIVE doctor on your phone or computer.Available 24/7. See your claims coverage anddeductible information Get checked for certain health issues rightaway and even have an electronicprescription sent to your pharmacy. Find an in-network doctor, hospital orurgent care facilityTelehealth Access a temporary digital memberID card Chat live with a customer servicerepresentative Tell us how you want to get importanthealth and benefits information —by email, text or mailPrefer desktop or PC?Register for Blue Access for Members atbcbstx.com instead. Some primary care and other doctors mayoffer phone and online services which arecovered at the same member share as aregular office visit or in-person equivalent.Ask a Nurse Any Time 24/7 Nurseline is a service where nurseslisten to your health concerns, give youcommon health facts and tips, and help youknow where to go for care if you need it.Member Discount ProgramsFind Providers Use our online Provider Finder atbcbstx.com. Quickly find your nearest network doctor,hospital or clinic with this easy-to-useonline tool. Search by specialty, read reviews andresearch providers. With many plans youcan also look up costs for some healthvisits and procedures. Our member discount program, Blue365 ,lets you save on useful health and wellnessproducts and services. Save on exercise equipment, gymmemberships, weight loss programs, stopsmoking programs and more.Health and Wellness Tools BCBSTX provides tools and resources likeWell onTarget to help guide you toward yourhealth and wellness goals. You can alsoaccess the portal through the AlwaysOn app.6 Message and data rates may apply. Terms and conditions and privacy policy at bcbstx.com/mobile/text-messaging.7 B CBSTX makes no representation or warranty with respect to the accuracy or completeness of information on BAM. The information on BAM is based on information provided by you and claimsreceived by BCBSTX. This information has not been independently verified.Virtual Visits may not be available on all plans. Non-emergency medical service in Montana and New Mexico is limited to interactive online video. Non-emergency medical service in Arkansas andIdaho is limited to interactive online video for initial consultation.MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Texas. MDLIVE is solely responsible for its operations and for those of its contractedproviders. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without permission. Blue365 is a discount program only for BCBSTX members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. Please check your benefit bookletor call the Customer Service number on the back of your ID card for specific benefit facts. Use of Blue365 does not change your monthly payment, nor do costs of the services or products count toward anymaximums and/or plan deductibles. Discounts are only given through vendors who take part in this program. BCBSTX does not guarantee or make any claims or recommendations about the program’sservices or products. You may want to talk to your doctor before using these services and products. BCBSTX reserves the right to stop or change this program at any time without notice.AlwaysOn is owned and operated by Onlife Health Inc. an independent company that has contracted with BCBSTX to provide digital health management for members with coverage through BCBSTX.B CBSTX makes no endorsement, representations or warranties regarding third-party vendors. Members should contact the vendor directly with questions about the products or servicesoffered by third parties.5

Is a Health Savings Account (HSA) Right for You?8An HSA is a special savings account that you may use to cover a wide range of qualified medical expenses. An HSA helpsyou take charge of your health and be responsible for how you spend your health care dollars. For many people, usingan HSA is an effective way to help manage the costs of health care.Not all plans are HSA compatible. Visit bcbstx.com or speak with an independent, authorized agent to learn more.Notice: If you get cost-sharing reductions under your health plan that have the effect of reducing the deductible below the federal government’s minimum deductible,you may not be eligible to contribute to a Health Savings Account.8 A s a reminder, a Health Savings Account (HSA) has tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice and nothing herein should be construedas legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on for the purpose of avoiding taxpenalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You shouldseek advice based on your particular circumstances from an independent tax adviser regarding the tax consequences of specific health insurance plans or products.Health Care Services That Work for YouTo help our members get care in their communities when they need it, we provide case management and utilizationmanagement services. We can help you find a new doctor when your child turns 18 and moves from the care of apediatrician to an adult level of care with a non-pediatrician primary care doctor. We can also help members locate anOB-GYN for specialty care without referrals. You can find out about services that need preauthorization and how topreauthorize at bcbstx.com or by calling Customer Service at the number on the back of your member ID card.6

Depend on a company with more than90 years of experience in Texas.Enroll today.Visit us onlineat bcbstx.com.Contact your independent,authorized Blue Cross andBlue Shield of Texas agent.Call us toll-freeat 800-531-4456.Privacy PracticesPlease visit the website at bcbstx.com to viewa copy of our policies and proceduresregarding collection, use and disclosure ofProtected Health Information (PHI).Notice About Your BenefitsTo get information about covered andnon-covered benefits, go to bcbstx.com,contact your independent, authorizedBlue Cross and Blue Shield of Texas agent orcall our Sales Center toll-free at 800-531-4456. Blue Cross and Blue Shield of Texas is a Qualified Health Plan Issuer on the Texas Health Insurance Marketplace. lue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,Ban Independent Licensee of the Blue Cross and Blue Shield AssociationBlue Cross , Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association,an association of independent Blue Cross and Blue Shield Plans729761.1020

Health care coverage is important for everyone.We provide free communication aids and services for anyone with a disability or who needs languageassistance. We do not discriminate on the basis of race, color, national origin, sex, gender identity, age,sexual orientation, health status or disability.To receive language or communication assistance free of charge, please call us at 855-710-6984.If you believe we have failed to provide a service, or think we have discriminated in another way, contact us to file a grievance.Office of Civil Rights CoordinatorPhone/TTY/TDD: Call the customer service number1001 E Lookout Dron your member ID cardRichardson, TX 75802Fax:800-279-7419You may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at:U.S. Dept. of Health & Human ServicesPhone:800-368-1019200 Independence Ave SWTTY/TDD:800-537-7697Room 509F, HHH Building 1019Complaint Portal: ington, DC 20201Complaint Forms: x.com

If you, or someone you are helping, have questions, you have the right to get help and informationin your language at no cost. To talk to an interpreter, call 855-710-6984.bcbstx.com

through the Texas Health Insurance Marketplace. 3 If you are Native American, the cost-sharing amounts and income levels may be different. Please call 800-531-4456 or contact an independent, authorized BCBSTX agent for details. How can you sign up? Start at bcbstx.com. You can compare your options, see different benefit levels and get an online .

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